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Rick Pollack, CEO of the American Hospital Association, talks with Chief Healthcare Executive

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In an exclusive interview, he discusses financial and labor challenges, the need to make care more convenient, violence in hospitals, prior authorization, and improving health equity.

Seattle - Even amidst the challenges hospitals are facing, Rick Pollack remains hopeful.

Pollack is the president and CEO of the American Hospital Association, a title he has held since 2015.

During an address to kick off the American Hospital Association Leadership Summit earlier this week, Pollack stressed that hospitals need more federal aid from Washington, as well as more regulatory and legislative support. Hospitals have faced serious financial difficulties and labor shortages due to the COVID-19 pandemic, and they are facing more competition from big tech companies and retailers.

Pollack sat down for an interview with Chief Healthcare Executive® at the conference and talked about the difficulties ahead, including economic headwinds, prior authorization and violence in hospitals. He discussed the need to focus on health equity, and why hospitals must come up with ways to deliver care with more convenience. And he explained why he is, in fact, optimistic.

(Rick Pollack offers advice for hospital leaders in this video. The full interview continues below.)

Q: What feedback are you getting from other hospital and health system leaders, since 2022 was such a difficult year. Are hospital leaders saying that they’re seeing some relief, or are they still seeing a pretty difficult road?

A: “I think they’re seeing a little bit of light at the end of the tunnel. But they still have got to get through that tunnel, because they're still faced with the challenges.

“The financial pressures are still there. The workforce challenge has not gone away, even though the reliance on temporary labor, with astronomical costs, is beginning to tail off a little bit. Supply chain issues are still there. We're worried about the UPS strike, believe it or not. A lot of supplies come through that mechanism.

“So it's still a challenging time. And all the problems that we had before COVID were just exacerbated. And I would say that three big problems we had before COVID, one was behavioral health, the second one was the whole issue of healthcare disparities, and the third was the workforce. And all three of those not only still exist, but they got even worse.”

Q: Do you feel like after going through the nightmare that was COVID-19, that we’re a little bit more ready for the next pandemic? Do you think we are prepared?

A: “I think that it's fair to say that we learned some lessons. Whether they've been fully applied or not remains to be seen. On the supply shortage, the fact that we're still relying on one or two places for those supplies, I don't know that the lesson has been fully learned, although the flip side of that is I think that people have learned that stockpiles need to be refreshed constantly and maintained at a much higher level than we ever thought before.

“I think that people have learned that in terms of facilities, we need to be more adaptable, so that you can convert certain types of facilities to other uses very quickly. There has been a lot of learning.

“As a country, beyond what we do, we have to rely on the government, we have to rely on public health. We saw how inadequately funded the public health system was. And we became the de facto public health system in many communities, where those agencies and programs have been severely underfunded or neglected. I don't know that that's been fixed yet, although we have some grants from the government and are working with other people to come up with some recommendations to deal with it.

“So, I think we've learned, I think we will improve, but we have a long way to go. You know, you look at CDC, they're going through a major reorganization, and you know, they're still not where they need to be in collecting the data that's necessary when you get into these situations. So, learnings, yes. Do I feel confident to say that we fixed all of the issues? We have a little ways to go.

Q: I've been really struck by the number of health equity sessions at the conference this year. That obviously was a big topic during the pandemic. Do you feel like that's a really big priority for health system leaders across the country to close those disparities in underserved communities?

A: “Yeah, I do. And I'll tell you why. I think it really has two pieces. There's this moral imperative. It's the right thing to do. And I think people understand that. And our people in our field, are also pretty data-driven. And when you show them some of the numbers, particularly in maternal and child morbidity and mortality, you know, it speaks for itself, especially in the African-American community. We all have to do better on that.

“And two-thirds of the problem doesn't even occur within our walls. It's what goes on before and after, you know, as opposed to just the delivery side of it. So, there's a moral imperative that people understand when you see the data.

“But it's also the smart thing to do because it's a business issue, right? As people move toward value-based payment, if you're not doing the equity issues, you're going to get financially hurt, because your readmissions are going to be higher if you're not doing the right stuff for everyone. If you don't provide culturally competent care, your patient scorecard, in terms of the patient experience, is going to be low in terms of ratings, and you're going to get dinged financially.

“There’s a disparity side of needing to pay attention to this because if you don't pay attention to it, your infection rates are going to go up, and you’re going get to get dinged on those measures. And for those people that are taking care of people in accountable care organizations or provider-sponsored health plans, where you're taking responsibility for the total cost of caring for a life, it's only good business to be taking care of everyone in an equitable manner.

“And so that's why I say it's the right thing. And it's also a smart thing.”

Q: You talked about lessons from the pandemic. Hospitals had to be really nimble in developing telehealth programs, and then hospital-at-home programs. I'm just curious, from your perspective, what do you think the hospital is going to look like five years from now?

A: “Well, think about it this way. You know, I've been talking about the need to redefine the “H.” The “H” is iconic, and it means hope and healing, and it's an essential public service. But we often think about the “H” as a building. And it's more than a building. And I think what you're suggesting is, we're all redefining the “H.”

“We're always going to be providing sophisticated surgeries and diagnostics and therapies inside that building. But half of all surgery is done in an outpatient setting today already. And whether it's, as you said telehealth, home health, having clinics in the community to be closer to people and make care more convenient, I think that's what you're going to see.

“So you're going to see people redefining the “H” and it'll look different in different communities, based upon their needs. When you think about in the rural communities now, with the option to create rural emergency hospitals, or critical access hospitals, that's redefining the “H” from my perspective.

“So, they're going to look different. And I think we're going to see people really focused on making care more convenient. They've got to focus on that.”

Q: You talked about prior authorization reform, and getting approval from insurers has been the bane of the existence for a lot of doctors and hospitals for years. What's different now in terms of the momentum for change? Do you see more momentum to do something about it?

A: “Yeah, I do. There's a recognition that all of this contributes to burnout among doctors and nurses. It's exacerbated the workforce problem because people feel as if the insurance company is practicing medicine. And that's not their role. And when you see the number of denials that are overturned on appeal, it’s unexplainable.

“So two things have occurred. One is, I think, there’s a recognition from the insurance companies that they really need to clean this up. And some of them are thinking about gold card approaches, where if you have a really good track record of adhering to certain evidence-based standards, or if your appeals are always granted, there's something wrong there, so you ought to get some sort of safe zone, so you're not burdened with all of this.

“The second thing is politically, it's become a bipartisan issue. And there aren't that many bipartisan issues. And if Democrats or Republicans are now focused on this, I think that's changed some of the dynamics, and has probably put a little bit more pressure on the commercial insurance companies to change their behavior. Because they're going to be fearful that there's going to be legislation or regulation that will be passed to deal with it on terms that they may not feel are sympathetic as they might be to their perspective.”

Q: A Tennessee surgeon was shot and killed just last week, and other hospitals have had similar incidents recently. Are you hopeful that there's going to be some support for legislation to help, such as the legislation to give hospital workers the same protections airline workers?

A: We hope so. We hope so. So again, the good thing there is that it's bipartisan, the legislation that's been introduced in that regard, and there are many states that have already taken action. That doesn't mean that we don't think there ought to be a federal law, because the penalties are more severe. You have more uniform enforcement among the U.S. attorneys, and the FBI. So we still want to pursue that.

“We had a program here on hospitals against violence, and we have a committee on hospitals against violence. And you know, there are two pieces to it. One is internal. There's a lot that goes on within our buildings where, unfortunately, patients are the source of abuse of staff. And we're not talking about necessarily shootings all the time. We're talking about physical and verbal abuse. And some of it stems from insurance companies making people wait longer than necessary, because of prior authorization. Some of it stems from more waiting time because of staff shortages. Some of it is a carryover from frustrations with COVID, where there were visitor restrictions, and people had to wear masks and, and do all those kinds of things. So there's that aspect of it. And again, with the behavioral health issues exacerbated, that kind of abuse occurs.

“Now, there's the other community violence. And as much as it may be distasteful to people, we need to button down our security. And we're working to do that. And, you know, hospitals are pretty open places. There may not be as many doors of entry and people in certain areas are putting in metal detectors. And people are taking other measures that need to be taken.

“We’re part of the International Hospital Federation, and I chair a group of the association executives in the international group, and it's not as if we're the only country that experiences it. We probably have more guns going on here than in other places. But this notion of violence is one that's not just in the U.S. There's something that a lot of countries experience.”

Q: Despite all these challenges, do you have some optimism that things are getting better? Are you optimistic for the industry in the future?

A: “I'm optimistic because people need us, and we're an essential public service. And at the end of the day, people recognize that we have a very important role to play. And I think that when you look at the polls, and you look at everything we see, we're still one of the most trusted entities. And when they see that “H”, they know it’s a place that safe.

"So, I think when you're recognized as playing that role, you’ve got to be optimistic because you know that you're going to continue to be around and be of service to communities. We're not going anywhere.”

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