Medicare money get to share in a portion of the savings. The Trump
administration will examine whether ACOs are saving healthcare dol-
lars before setting its policy, says Michael Strazzella, co-head of feder-
al government relations at Buchanan Ingersoll & Rooney, a
Washington, D.C.-based law firm. Practicality might make it impossi-
ble to eliminate or cut back on ACOs. "They're already in place across
the country," says Dr. McDonough. "Eliminating them now would
throw the healthcare system into turmoil."
Ms. Madhani would be surprised if ACOs were shuttered. "They've
been in place for a while and a lot of resources have already been
invested in making them work," she says. "Dismantling them would
be difficult and there'd be an outcry among some healthcare leaders."
Dr. Shapiro hopes the new administration discourages healthcare
consolidation that creates monolithic health systems and instead
favors decentralized health care, which benefits independent surgery
centers. "Has that been the effect of the ACA up until this point?" he
asks. "That's up for debate, but it certainly seems to be."
The marketplace created by the ACA has discouraged the entrepre-
neurial spirit in the ASC space, says Dr. Shapiro. He also points out
that increasing numbers of physicians are seeking employment within
large health systems instead of striking out on their own in private
practice since Obamacare was passed. "That trend has contributed to
the flattening of growth of new ASCs," says Dr. Shapiro.
Price transparency
At his core, Mr. Trump is a businessman who wants to see individuals
move into insurance markets and make coverage choices for them-
selves, says Mr. Strazzella. To that end, Mr. Trump believes in expand-
ing the use of health savings accounts (HSAs). The accounts are cur-
rently available under Obamacare for individuals enrolled in high-
4 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • D E C E M B E R 2 0 1 6
