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What hospitals want from Washington in 2024


Lisa Kidder Hrobsky of the American Hospital Association talks about Medicare and Medicaid funding, extending telehealth, protecting workers, and more.

Hospitals are hoping Washington can deliver on a host of priorities over the coming year.

Image credit: ©Andrea Izzotti - stock.adobe.com

Hospitals are pushing Congress to support key Medicare and Medicaid programs, among other top priorities this year. (Image credit: ©Andrea Izzotti - stock.adobe.com)

The American Hospital Association outlined its top goals with Congress and President Biden’s administration, and as one would probably expect, much of the focus is on federal funding for hospitals and healthcare. But the AHA is also pushing for policies on virtual care, hospital-at-home programs, and protecting healthcare workers.

Lisa Kidder Hrobsky, the AHA’s senior vice president for government relations, spoke with Chief Healthcare Executive® Thursday about the big issues for hospitals on Capitol Hill in 2024.

Kidder Hrobsky says she prefers not to speculate too much on what will and won’t get done, although she does suggest optimism for some priorities.

However, as she says, “I would never say anything with Congress is easy.”

Here is a rundown of major priorities for hospitals in Washington.

Medicare funding

Hospitals and health systems have long bristled at what they have called Medicare’s inadequate support.

“Hospitals are now receiving 82 cents on the dollar from Medicare,” Kidder Hrobsky says. Medicare’s underpayments to hospitals totaled nearly $100 billion in 2022, according to the AHA.

Hospitals are also going to be pushing against congressional efforts to enact “site-neutral” policies for Medicare payments of outpatient procedures.

Hospitals receive higher payments for outpatient services than physicians’ clinics and ambulatory surgical centers, and health systems say that is appropriate because hospitals face different regulatory demands, including the need to have around-the-clock standby capacity for emergencies.

“Hospitals have so many more requirements, and they provide so much more to the community, is the underlying reason that they do get paid more,” Kidder Hrobsky says.

However, some members of Congress have supported site-neutral policies, arguing they would save Medicare billions. The AHA is going to be pressing hospitals to talk to their members of Congress to dissuade them from backing site-neutral policies.

“This year, similar to last year, we know that site-neutral is on the mind of Congress,” Kidder Hrobsky says.

Telehealth and hospital-at-home

Congress and the Biden administration agreed to extend flexibilities for telehealth and hospital-at-home programs in 2022, but the clock is ticking.

Those flexibilities are slated to expire by the end of the year, unless Congress intervenes.

While it’s possible another extension could be given, Kidder Hrobsky says hospitals and other health advocates are hoping to see permanent reforms.

“You don't want extenders to go on forever, because there is some need to find some permanency and make certain that you're not going back to Congress every year or every two years,” she says. “It's not great policy. Frankly, it's not a great use of Congress's time to have to do that every year or two. So we'd love to come up with some permanent policies around both of them.”

Kidder Hrobsky sees support for both telehealth and home hospital programs, but she’s notably optimistic about support for telehealth. She notes telehealth has broad support.

“Particularly with telehealth, there's just no putting that genie back in the bottle,” she says.

Kidder Hrobsky says she is hopeful for extensions for both telehealth and hospital-at-home programs, but it’s unclear if there will be performance reforms, or another extension.

Medicaid payments

Hospitals are anxious to preserve a critical Medicaid program that supports safety-net hospitals.

The AHA and other advocates are hoping to prevent billions of dollars in cuts to the Medicaid disproportionate share hospital (DSH) program, which offers aid to hospitals with a high percentage of patients relying on Medicaid. The program is facing cuts of $8 billion annually over the next four years.

Congress included funding for the program as part of its temporary spending package (the continuing resolution), which is slated to end in early March.

“We are hopeful that they'll continue to see the priority that it is for some of these safety net hospitals, and that it will be included in whatever package they do next,” Kidder Hrobsky says.

Violence prevention

Hospital and healthcare advocates have been pushing for legislation aimed at preventing violence, which has become an all-too-common threat for clinicians. Lawmakers have introduced measures that would raise the penalties for assaulting healthcare workers, mirroring protections for airline workers.

While there has been bipartisan support for such measures, advocates are still waiting to see Congress pass legislation and send it to the president’s desk.

“This is one that frustrates me to no end,” Kidder Hrobsky says. “I would like to say this is the year that we get it done and I will say we really are going to make quite a big push on this.”

U.S. Reps. Larry Bucshon, an Indiana Republican and a doctor, and Madeleine Dean, a Pennsylvania Democrat, are sponsoring the Safety from Violence for Healthcare Employees (SAVE) Act. Both appeared at an AHA briefing on the Hill this week to talk about the measure. U.S. Sens. Joe Manchin, a Democrat from West Virginia, and Marco Rubio, a Republican from Florida, have sponsored a similar bill in the Senate.

Insurers and prior authorization

The AHA says it is also going to continue to push for Congress to take action against insurers for denying or delaying payments for services.

Kidder Hrobsky says she sees strong interest in Congress on the issue. Nearly three out of four hospital executives (73%) said they have seen an increase in claims denials, according to a survey by Kaufman Hall in November.

“I do think if you go to Capitol Hill and you talk to Republicans and Democrats, there is an acknowledgment that something needs to change, that there are care denials, that the care isn't happening as quickly as it should, as timely as it should for a lot of patients out there,” she says.

The Centers for Medicare & Medicaid Services released a new final rule in January to streamline the process of prior authorization from insurers for treatments and procedures. The AHA is hoping Congress will codify some of those measures.

Help for rural hospitals

Many rural hospitals are continuing to face serious financial struggles, and the AHA will be pushing to preserve programs that help support those facilities.

Hospitals are looking to secure continued support for the Medicare-dependent Hospital (MDH) program, which funds more than 170 hospitals. The program offers more aid to smaller hospitals with a large share of Medicare patients.

The AHA is also looking to sustain Medicare’s Low-Volume Hospital (LVH) program, which offers assistance to rural hospitals with a relatively small number of Medicare patients. That program supports more than 600 hospitals.

Both programs received a two-year extension in late 2022, and they are slated to expire at the end of September.

Kidder Hrobsky says the hope is that extensions can get done before the “lame duck” period in Congress, the time frame after the elections and before the end of the legislative session in December.

The 340B program

Health systems will push Congress for continued support of the 340B program, which offers discounts on some outpatient drugs for hospitals with a higher percentage of underserved patients and those with lower incomes. Hospitals have wrangled with the government over long-delayed payments following a legal battle that made it to the U.S. Supreme Court.

The program is often the source of heated debate in Congress. Critics say the program has grown far beyond its original purpose, and some drug companies have been reducing their discounts. Hospitals say the program helps provide essential services in urban and rural communities.

“It's just a perennial issue that gets a lot of attention,” Kidder Hrobsky says. But she says legislation to change the 340B program may take a back seat to other healthcare priorities.

A compressed calendar

It’s an election year, and not just to determine who sits in the White House for the next four years.

The members of the House of Representative are up for re-election, along with 34 members of the Senate. Some members are choosing not to run again, and depending on the election, next year’s Congress could be much different. Voters will decide which political party will control Congress.

Advocates for hospitals, and other interest groups, will likely have less time to advance key priorities. Congress typically begins a recess in August, and with most lawmakers running to keep their seats, they may not convene again, or do much legislation, until after the election.

“It's almost nice that they have this time here at the beginning of the year to front load some of these healthcare issues, so that maybe we can get some things done now, as opposed to …. waiting until they come back after the election,” Kidder Hrobsky says.

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