The American Hospital Association (AHA) laid out some specific policy priorities for hospitals in a letter to President-elect Donald Trump, offering clues to where their lobbying efforts will focused once Trump takes office.

The AHA’s post-election statement didn’t include advocating particular policies, but it expressed hope it can work with the new administration. Since then, the association has supported Trump’s pick to run HHS, U.S. Rep. Tom Price, MD, R-Georgia.

“In today’s transformative and challenging environment, we are proud of the contributions of America’s hospitals and health systems, and are encouraged by the opportunities to lead our health care system into the future,” wrote AHA President and CEO Rick Pollack. “To help advance health in America, we ask that your administration – in collaboration with Congress and the courts, and in partnership with health care providers – help modernize the public policy environment to enhance providers’ ability to improve care and make it more affordable for patients.”

Included in Pollack’s policy wish list:

1. Reducing regulations

Pollack called the current regulatory burden on hospitals “unsustainable,” arguing removing some rules would save money and allow physicians to spend more time on patients. In particular, he asked for Trump to cancel Stage 3 of the Meaningful Use program “so that hospitals will not be forced to spend large sums on money” upgrading electronic health record systems to meet regulatory requirments.

He also asked for new waivers and exceptions within self-referral and anti-kickback laws, changes to how the Federal Trade Commission and Department of Justice address hospital mergers, and elimination of regulations on post-acute care, like the home health agency pre-claim review demonstration.

2. Fighting insurance mergers and reducing medical liability

While the AHA wants a “standardized” process for challenges to hospital mergers, when it comes to deals combining insurance companies, it hopes Trump will continue to challenge them to “prevent harmful repercussions for consumers and providers.”

Pollack asked for support for more hospital-specific reforms to keep costs down, like a cap on non-economic damages in medical malpractice cases.

3. Raising the age for Medicare eligibility

Tucked into the section on cost concerns was Pollack’s call for Trump to consider “structural reforms” for Medicare, including changing when Americans become eligible for Medicare benefits.

That age has been set at 65 years since Medicare was first enacted. A 2012 report from the Congressional Budget Office said raising the eligibility age to 67 could save the federal government $113  billion over a decade, but that estimate was contingent on the Affordable Care Act insurance marketplace and subsidies being available to would-be beneficiaries.

4. Don’t abandon value-based care

Pollack wrote it’s “critically important” that healthcare continue its transformation towards value-based payment and care delivery models, noting the potential cost savings and the significant investments hospitals have already made.

Besides preserving what’s already been put in place for value-based care, the AHA asked Trump to help the industry’s transition by “expanding the definition of advanced alternative payment models” within CMS’ Quality Payment Program and remove restrictions on the use of telemedicine.

5. Get rid of star ratings for hospitals

In the section of the letter on promoting quality and safety, Pollack asked Trump to “suspend” CMS’s hospital star rating system, saying it’s “inaccurate and provides misleading information to consumers.”

As noted in other critiques of the ratings, socioeconomic factors may account for lower scores for hospitals. Pollack asked Trump to consider what patient population a facility serves in other areas as well, like CMS’s readmissions penalties.  

6. Don’t just repeal the ACA, replace it

The letter doesn’t advocate for a specific plan on amending, repealing, or replacing the ACA, but given Trump’s own promises and the Republican control of Congress, the discussion of those plans has created “much uncertainty.”

What the letter seemed to argue against was the current strategy for repealing the ACA almost immediately after Trump takes office, while delaying the effects for years while a replacement plan can be crafted.

“We urge you to ensure that any repeal of portions of the ACA simultaneously include a replacement plan that continues to provide a mechanism for individuals to obtain affordable insurance coverage,” Pollack wrote.

He added that he would expect provider reimbursement reduced by the ACA to fund coverage expansion to be reconsidered if the law were scrapped.