American Hospital Association CEO, Dartmouth Health CEO, discuss 2024 priorities

The head of the American Hospital Association says the group is pushing Washington to address the “fractures” in the healthcare system.

Rick Pollack, president and CEO of the association, says he hopes Congress and the Biden administration will agree to steps to heal those fractures.

Pollack talked about the AHA’s goals for the year ahead in a conversation last week with Dartmouth Health CEO Joanne Conroy, who is just beginning her term as the AHA’s board chairwoman. (You can watch the full conversation here.)

They discussed key federal spending priorities for the coming year. Just before the government was slated to run out of money, Congress sent President Biden legislation to maintain spending at current levels until early March. While delaying a government shutdown, it doesn’t leave much time before lawmakers must resolve spending issues, or at least come up with another stopgap.

Pollack said a top priority remains the prevention of billions of dollars in cuts to the Medicaid disproportionate share hospital (DSH) program, which supports providers with a high percentage of patients relying on Medicaid. The program is facing cuts of $8 billion annually over the next four years.

The funds are crucial for health systems, particularly safety net hospitals, healthcare leaders say. Hospitals have convinced Congress to delay those cuts in the past, and Pollack says he hopes to be successful again.

“We have got to make sure that that moratorium sticks for at least another year or two,” he said.

The AHA is also focused on deterring efforts on “site neutral” policies for Medicare payments, Pollack said. The association has said such policies could cost hospitals billions of dollars. Lawmakers have said the move could save the Medicare program billions.

Hospitals receive higher payments for outpatient departments than clinics and ambulatory surgical centers, and health systems have argued that is appropriate because they are more likely to treat patients who require more complex care. The AHA has said hospitals face different regulatory demands, including the need to have around-the-clock standby capacity for emergencies and greater emergency treatment requirements.

Pollack also pointed to cuts in Medicare payments for physicians, which took effect at the beginning of the year. The Centers for Medicare & Medicaid Services imposed a cut of 3.37% in physician payments. “That is something that's on our list that needs to be corrected in this package,” Pollack said.

Looking later in the year, Pollack noted that hospitals want to maintain certain flexibilities put in place during the COVID-19 pandemic that expanded telehealth and hospital-at-home programs. Those provisions are set to expire Dec. 31, and healthcare advocates are looking for permanent reforms, or at least extensions.

Hospitals also continue to press for reform in prior authorization, the process of obtaining approval from payers for many healthcare services. Hospitals, physicians and medical groups have long complained that the process is too onerous.

The CMS last week approved a final rule aimed at streamlining prior authorization, and while most healthcare groups praised it as a positive step, they say reforms are needed to reduce the volume of authorizations and plan to push Congress for more help. Pollack indicated prior authorization remains a top concern. He said insurers should be held “responsible for their behavior.”

“We see payment delays, we see payment denials, we see prior authorization obstacles being put in front of our caregivers, where they're taken away from the bedside to deal with asking for permission on the phone from insurers that are focused on denying care, as opposed to us that are trying to provide care. And they can exacerbate the workforce shortage, because it takes people away from the bedside,” Pollack said.

The hospital association will also continue pressing for more federal support for programs to train more healthcare workers, he said. He also pointed to greater support for cybersecurity, since many attacks are sponsored or supported by nation-states. Hundreds of hospitals have suffered cyberattacks in recent years.

Conroy noted New Hampshire is set to host the presidential primary this week, and she and Pollack discussed dealing with the highly partisan environment in Washington. Conroy noted the highly charged atmosphere, even though healthcare should be a high priority for Democrats and Republicans and “should be a shared interest and something that they could do together.”

Pollack noted that, so far, healthcare hasn’t emerged as a major issue in the presidential race.

“It's interesting that healthcare at the presidential level, now that you mentioned Iowa and New Hampshire, really has not gotten too much attention and that's unusual, because, for the last several presidential cycles, it got a lot of attention,” Pollack said.

The hospital association is bipartisan and doesn’t get involved in presidential elections, and works in a bipartisan way in the legislative agenda, Pollack noted.

Pollack expects Democrats to focus on abortion rights, while Donald Trump and Republicans are likely to push to repeal the Affordable Care Act, which he says isn’t realistic. Biden will likely aim to build upon the Affordable Care Act. Prescription drug prices should be an area of attention for both parties.

In answer to Conroy’s question about navigating the highly charged environment, Pollack said, “Very carefully.”

Conroy also said she looks forward to her role as chairwoman of the AHA board, saying she hopes to fill the big shoes of her predecessor, John Haupert, president and CEO of Grady Health System. She also noted the challenges many hospitals are facing.

“There are a number of things that are changed that are not going to go back to the way they were pre-pandemic,” Conroy said. “In some ways that creates challenges for us. In other ways, it creates opportunities.

“I know that staffing, and we talk about that a lot, is a huge issue,” she added. “Some hospitals and health systems are having a hard time financially staying afloat. Our supply chain is a challenge, and there are probably going to be more challenges as unrest around the world actually expands. And that’s just a small sample of the issues that we're facing.”