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2020 is now officially half over, and looking back, we can certainly say that thus far the year has been full of regulatory changes. From shutdown orders to regulatory waivers, trillion-dollar federal aid laws, public health guidelines and reopening orders, the COVID-19 emergency has produced thousands of pages of new regulations. 

With the healthcare industry at the center of many of these changes, tracking new regulations has never been more important for physician practices. As we look ahead to the second half of the year with CMS’s annual rulemaking cycle and the 2020 elections still to come, there are no signs of the pace of change slowing down.  

For those looking for a preview of what to expect next, here are the top regulatory issues for physician practices to watch the rest of the year:

2021 Medicare Physician Payment Rules

Every year, the Centers for Medicare and Medicaid Services (CMS) updates its payment rules, polices, and rates for everything from inpatient hospital stays, to physician services, to hospice care. As in previous years, the proposed 2021 Medicare physician payment regulation is expected to be released this summer (any day now). Following this release, it will be open for public comment for 60 days. CMS will then issue a final rule in late October or early November prior to a January 1, 2021 implementation date for most of the rule’s policies. This year’s Physician Fee Schedule proposed rule is expected to include critically important updates for the Quality Payment Program, Merit-based Incentive Payment System (MIPS), telehealth services program, Accountable Care Organization program, and other quality and value-based payment programs.  

“Phase 4” COVID-19 Aid Legislation

Next week, Congress is set to return from recess with the intention of passing another major coronavirus aid bill before departing for their next recess in early August. Currently, leaders of both political parties in both the House and the Senate are working through the details of what that bill will include. As with the other recent pandemic aid bills, this bill is likely to include direct financial support for healthcare providers and small businesses, in addition to other provisions. One major point of disagreement between the two political parties that still needs to be resolved before any bill can pass into law is the price tag. Senate Republicans have said that the $3 trillion bill passed by the House in May is “dead on arrival” in the Senate, while House Democrats have signaled their opposition to Republican attempts to limit the bill’s cost to under $1 trillion overall. 

Permanent Telehealth Reimbursement Policies

During the COVID-19 emergency, Medicare, Medicaid, and commercial insurers have expanded their telehealth reimbursement policies and as a result, the utilization of telehealth services has skyrocketed. However, most of these polices are tied to the duration of the national emergency declaration or time limited in some manner. Over the next few months, payers across the country will be focused on establishing permanent telehealth policy changes extending beyond COVID-19. For Medicare, this will require an act of Congress, which is already under discussion in the key healthcare committees in the House and Senate. The outcome of these policy changes from each of these different payers will have a big impact on the future of telehealth and the delivery of healthcare services more broadly.

2020 Election and Healthcare Policy Implications  

Although the pandemic has limited pubic campaigning and disrupted several aspects of the 2020 election process to date, we are quickly approaching the general election campaign season for the 2020 Presidential election. With the pandemic dominating the national news headlines and impacting life across the country, healthcare policy will be a central- if not the central- issue in this year’s election. Depending on the results of the November 3rd election, we could see very different healthcare policy changes implemented in 2021. As such, most of the industry’s attention will naturally shift towards the election this fall and its likely implications next year.

Beyond these issues, we are likely to see further changes to value-based alternative payment models and key policy decisions being made at the state level. Ultimately, the biggest factor to watch will continue to be the COVID-19 pandemic since most of the healthcare policy changes enacted by our federal, state, and local governments will be in anticipation of or reaction to the ongoing and changing health crisis.

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Chris Emper

Government Affairs Advisor, NextGen Healthcare

Chris Emper, JD, MBA, is government affairs advisor at NextGen Healthcare and president of Emper Healthcare Advisors—a health IT industry advisory and consulting services firm in Washington, D.C. that specializes in helping healthcare providers and technology companies successfully navigate and comply with complex regulations and value-based reimbursement models. Prior to forming Emper Healthcare Advisors in 2016, Chris was vice president of Government Affairs at NextGen Healthcare (NASDAQ: NXGN) and Chair of the Electronic Health Record Association (EHRA) Public Policy committee.

An expert in The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), The Patient Protection and Affordable Care Act (ACA), and The 21st Century Cures Act, Chris is a frequent speaker at industry conferences and has written or appeared in articles in publications such as Politico, Health Data Management, Accountable Care News, and Medical Economics. From 2016-2019, Chris served as Chair of the HIMSS Government Relations Roundtable, a leading coalition of health IT government affairs professionals.

Prior to joining NextGen Healthcare in 2013, Chris served as a Domestic Policy Advisor for former Massachusetts Governor Mitt Romney’s 2012 Presidential Campaign, where he advised the campaign on policy issues including healthcare, technology, and innovation. He holds a law degree and an MBA from Villanova University and a BA from Boston College.