Adapting to Policy Changes in Healthcare: A Guide for Medical Practice Managers

You opened a medical practice to help people, not deal with bureaucracy and red tape. Still, if your practice wants to continue receiving Medicaid coverage from the federal government, it’s in your best interest to keep current with policy changes in healthcare.

Read on to discover more recent administrative actions from policymakers and how your practice and its providers can navigate these changes smoothly.

Overview of Recent Policy Changes in Healthcare

The Affordable Care Act (ACA), enacted by the Obama administration in 2010, has provided health insurance access to tens of millions of residents throughout the nation. For many years prior to the ACA’s enactment, people struggled to get coverage from insurers because of preexisting conditions.

Thanks to this legislation at the federal level, patients now have reliable access to healthcare services and prescription drugs. Per the White House, uninsured rates have dropped dramatically. Providers are now better able to keep their patients healthy while lowering costs.

The Affordable Care Act has undergone some major changes over the years. For example, the law originally included an individual mandate that required people to have “minimum essential coverage” through either Medicaid, Medicare, or a private health insurance plan. Proponents of the mandate believed it would spur personal responsibility and encourage more people to get health insurance. Opponents argued that people shouldn’t be forced to buy insurance they didn’t want. In 2017, a majority Republican-led Congress eliminated the mandate.

In addition to the ACA, some states have chosen to enact a Medicaid expansion. This significant health reform makes it easier for people below a certain income level to qualify for Medicaid services. Thanks to these expanded coverage efforts, millions can qualify for Medicaid, further reducing uninsured rates.

On top of this, in 2024, state-based marketplaces (SBMs) and federally facilitated marketplaces (FFMs) gained the ability to offer a new special enrollment period for Medicaid recipients. This change allows recipients to select a new plan either 90 days after or 60 days before losing coverage. Thanks to this health policy adjustment, fewer consumers now experience a gap in their healthcare.

The Department of Health and Human Services (DHHS) also issued a final ruling regarding Medicare payments on August 1, 2024. This health reform ruling projected a 2.9% increase in payment rates for hospitals that receive payments under the Inpatient Prospective Payment System (IPPS).

In 2022, the Centers for Disease Control and Prevention (CDC) launched the Moving Forward initiative to improve health outcomes and better prepare for future health risks. The CDC, which has a vested interest in managing our nation’s healthcare system, has begun committing to sharing scientific research findings faster and issuing timely public health communications about new research.

Changes to Medicare are likely to be the biggest focus in 2025. Congress may pass new legislation regarding supplemental benefit policies, prior authorization for Medicare beneficiaries, and telehealth reimbursements. Policymakers will also address concerns over price transparency regulations in the healthcare system.

Additionally, there’s growing interest in tackling exploitatively high prescription drug prices. Lawmakers are currently considering policies to fight high prices, and what’s more, the issue has bipartisan support.

Implications of Health Policy Changes on Medical Practices

Policy changes in healthcare can be extremely beneficial to both patients and healthcare providers, but they don’t come without challenges. For example, staff may struggle to adjust to new health policy changes from Congress or the Supreme Court. Frustrated providers may eventually leave the practice, affecting your turnover rates.

Government changes can also impact the satisfaction rates of your patients. The pharmaceutical industry, for instance, is notorious for raising the prices of drugs. Patients will be less than pleased if they have to pay more to get their drugs. They may also have to wait longer to get certain services, such as elective procedures.

And if you think politics don’t affect your bottom line, think again. Changes at the federal level from the presidential administration could impact your reimbursement rates and compliance costs. For example, you may receive more or less payment from Medicare for a certain procedure than you once did. In some cases, Medicare or an insurance company may decide to completely stop covering a service. Should this happen, your patients will be forced to pay out of pocket, possibly leading to a significant drop in appointments.

Strategies for Adapting to Health Policy Changes

How can hospitals and other health providers stay on top of changes made at the federal level? For starters, you should always assess and review any new law that could affect your practice or insurance coverage for patients. Be sure that you understand how these changes will affect healthcare costs. Most importantly, thoroughly explain any law changes to your employees.

You may also consider implementing a tracking system that keeps your practice up to date on health policy changes from the current administration. Without such a system, you would have to manually check for updates to health policy, taking up precious time and increasing the chance of human error. By using a tracking system, you’ll automatically get updates on issues that could affect your healthcare practice. This saves you a ton of time and stress.

For best results, demonstrate to providers how to access and use the system. Be aware that some providers may not have an interest in using the system, whether because of security concerns or wanting to do things the “old-fashioned way.” To improve adoption efforts, focus on how the system will help them better provide quality health services and make it easier to deal with insurers.

Managing Your Practice During Regulatory Changes in Healthcare

Providers may have fears about a new health reform law but realize that patients may similarly be anxious. They may wonder how health policy changes will impact the price of their drugs or whether they’ll still have the same access to quality care.

Just as it’s your job to keep them healthy, you must focus on clearly explaining any changes to your healthcare system. For instance, if a new change will affect a patient’s drug costs, be sure to communicate that to them promptly so they know what to expect and how to adapt if necessary.

Additionally, you’ll need a reliable communication platform to stay in touch with employees regarding health policy changes. A platform such as Weave can help you share research on changes and how new laws may affect patient outcomes.

Leveraging Technology To Navigate Health Policy Changes

Just as your healthcare practice uses technology to keep track of appointments and send reminders, you can also use it to stay abreast of health policy changes. Advanced systems designed for healthcare providers can significantly boost your practice’s efficiency when it comes to keeping patients healthy.

Does your practice offer telehealth? If so, you must pay attention to recent and upcoming health policy changes. For example, the Biden-Harris administration recently announced measures to preserve telehealth access to people who receive Medicare. One of these is a grant program that would allow providers to provide telehealth across state lines.

Due to health policy changes like this one, you’ll need a reliable phone system if your healthcare practice offers virtual services. Such a system ensures that your patients can stay healthy even if they can’t visit you in person.

Weave Helps Your Practice Stay on Top of Health Policy Challenges

Navigating policy changes in healthcare may feel like an uphill battle, but you’ll be a master at managing health policy adjustments with Weave at your side. Weave offers everything you need to help your healthcare practice make it through policy changes unscathed.

To support your healthcare practice in navigating these changes, consider Weave’s comprehensive communication solutions, including phones, reminders, online scheduling, and more. Get a demo today to see how Weave can enhance your practice’s adaptability and efficiency.