Analysis: Impact of the government shutdown on healthcare
On Dec. 21, the federal government began a partial shutdown that is by now the longest such episode in U.S. history, beating out a 21-day shutdown under President Bill Clinton in December 1995. What does it mean for physician practices and other healthcare organizations? The answer is nothing much – so far. But that could change if the shutdown continues for much longer.
Payments will still go out
Thus far, HHS and CMS are operating under a contingency plan that has involved the unpaid furlough of just under half its workforce – 40,845 furloughed while 41,070 are retained – but has managed to keep issuing Medicare payments. HHS estimates that the states currently have sufficient Medicaid funding to last through the second quarter of 2019, while CMS would allocate a portion of those retained employees to continue to assist in disbursing Medicaid funds under the Children’s Health Insurance Program (CHIP).
The Medicare program will continue “largely without interruption during a lapse in appropriations,” the HHS document states, with payments continuing to be made and CMS divisions involved in combating fraud and abuse continuing to operate.
However, other discretionary CMS activities have stopped as a result of the shutdown. First and foremost are the agency’s regulatory functions, and the anticipated release of electronic health record (EHR) interoperability rules from the Office of the National Coordinator for Health IT (ONC) are likely to be delayed.
Many industry experts had expected CMS to release the interoperability rule in December. Interoperability between various EHR and practice management software systems had been a policy priority under the Trump administration, with the proposed interoperability rule touted by CMS Administrator Seema Verma at various national conferences.
At this point, it’s unclear the extent to which CMS will have to scale back or stop distributing its regular series of regulatory guidance documents, such as policy transmittals revising its various manuals and the associated Medicare Learning Network (MLN) publications. CMS staff may also have to reduce their involvement in the various MACs’ physician and provider outreach education and feedback gathering programs, including webinars and public conference calls.
Other shutdown consequences
While claims processing functions at CMS – much of which is handled by the commercial organizations acting as Medicare Administrative Contractors or MACs – should continue without much of a hitch, Medicare patients will have trouble getting customer service, as many of the federal employees that handle beneficiary outreach and inquiries are among those furloughed.
Some of the other activities within HHS and CMS that will not continue as per the contingency plan include the following.
- While Indian Health Services (IHS) would continue to provide “direct clinical health care services as well as referrals for contracted services that cannot be provided through IHS clinics,” funding has stopped for national policy development and oversight functions within IHS.
- The ONC, as mentioned earlier, will cease work on “standards coordination, implementation, and testing” as required by HITECH and the more recent 21st Century Cures Act.
- The Agency for Healthcare Research and Quality (AHRQ), which had a major role in developing and curating many of the quality reporting measures used under CMS programs such as the Merit-based Incentive Payment System (MIPS), will be unable to fund new grants and contracts nor monitor existing projects.
- The CDC would continue operations that “protect life and property” including epidemiological surveillance and data collections. However, the CDC will not be able to support non-communicable disease prevention programs (e.g. cancer, diabetes, heart disease), or update its prevention recommendations including some of those that inform CMS coverage determinations.
- The FDA will stop many of its routine regulatory monitoring functions, including ceasing some medical product and drug activities.
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