Q&A: Potential changes impacting case management

Q: While no one has a crystal ball, I am wondering what changes we might be expecting in the near future as the new administration makes its mark. How might case management be impacted?

A: Anytime a new presidential administration moves in, experts try to anticipate what changes it may bring.

“It is so risky to predict what incoming CMS officials will see as priorities,” says Ronald Hirsch, MD, FACP, CHCQM, CHRI, vice president with the regulations and education group at R1 Physician Advisory Services in Chicago. “But I expect removing the hurdles to signing up for [Affordable Care Act] policies along with removing work requirements for Medicaid will be near at the top of the list.”

There may be an overall shift away from some private-pay, market-based solutions toward more centralized, government-based solutions, predicts Alan Cudney, MBA, MHS, RN-BC, CPHQ, PMP, FACHE , of Healthcare Impact LLC in Concord, North Carolina.

“There will be a renewed push toward a single-payer system, with incentives for individual states to embrace single-payer models,” he says.

When it comes to regulatory actions, Hirsch says price transparency regulations may be a target.

“I suspect there will be a lot of pressure to ease or at least delay penalties for the price transparency regulations,” he says. “It is my hope that they will address the many abuses by Medicare Advantage [MA] plans that adversely affect beneficiaries and the many regulatory and payment issues that differ between the MA plans and Medicare.”

For more information, see January's issue of Case Management Monthly.