/ en Sat, 26 Apr 2025 01:22:33 -0500 Thu, 14 Sep 23 14:59:02 -0500 /talking-points/2023-09-14-patient-safety-talking-points-resources <div class="container"> <div class="row"> <div class="col-md-8"> <h2>Talking Points</h2> </div> <div class="col-md-4"> <div><a class="btn btn-wide btn-primary" href="/system/files/media/file/2023/09/Patient-Safety-Talking-Points-and-Resources.pdf" target="_blank" title="Click here to download the Patient Safety Talking Points & Resources PDF.">Download the Talking Points PDF</a></div> <p> </p> </div> </div> <div class="row"> <div class="col-md-8"> <p><strong>Hospitals and health systems are continuously dedicated to patient safety and delivering high-quality and equitable care to all their patients.</strong></p> <ul> <li>While even one incident of preventable harm or medical error is one too many, hospitals and health systems continuously seek to achieve the best possible outcomes for all.</li> <li>They build processes and implement policies to reduce safety issues and reliably deliver appropriate, high-quality care.</li> </ul> <p><strong>Health care workers' crucial life-saving roles have never been more evident, which is why their engagement, safety, protection, and well-being remain our top priority.</strong></p> <ul> <li>Hospitals have worked to foster cultures of safety that empower their workforces to identify and share potential patient and workforce safety issues so they can be addressed and prevented in the future. [SHARE EXAMPLES OF HOW STAFF INPUT LED TO SAFETY IMPROVEMENTS]</li> <li>In addition, hospitals and health care systems have long had robust protocols in place to detect and deter violence against their staff. Since the onset of the COVID-19 pandemic, however, violence against hospital employees has increased.</li> <li>This is why we have implemented [INCLUDE EXAMPLES FROM YOUR HOSPITAL] to protect our workers.</li> </ul> <p><strong>Hospitals and health systems have been transparent about sharing their progress in improving quality and safety.</strong> Over 15 years ago, they led the way in developing transparent reporting of quality and patient safety data and helped create <a href="https://www.medicare.gov/care-compare/?redirect=true&providerType=Hospital" target="_blank">Hospital Compare (now Care Compare)</a>, a website where consumers can find information about hospital quality.</p> <p>Over the past decade, our field has made <strong>bold changes to improve care quality and safety.</strong> Hospitals also have worked to ensure all patients benefit from these improvements by <strong>identifying and reducing disparities in care.</strong> [INCLUDE EXAMPLES FROM YOUR HOSPITAL]</p> <p>However, the <strong>once-in-a-century COVID-19 pandemic made it more challenging for hospitals and health systems to continue their quality improvement gains.</strong></p> <p><strong>The COVID-19 pandemic put unprecedented strain on our hospitals, health systems and caregivers</strong> in a variety of ways and made our health care delivery system look very different over the last three to four years. Hospitals and health systems had to:</p> <ul> <li>balance caring for an influx of COVID-19 patients while keeping the doors open to all others needing care;</li> <li>treat sicker patients (both with COVID-19 and without) who often had to spend longer periods of time in the hospital;</li> <li>operate with sometimes critical workforce shortages;</li> <li>contend with extraordinary worldwide shortages in supplies and personal protective equipment (PPE);</li> <li>temporarily expand capacity to meet critical treatment needs; and</li> <li>confront numerous challenges outside the control of hospitals and health systems.</li> </ul> <p>While the pandemic made our work more challenging, <strong>one thing remains constant for America’s hospitals and health systems: We are committed to providing patients with high-quality, safe, effective, equitable and person-centered care.</strong> That’s why, to give a few examples, hospitals and health systems are working hard to:</p> <ul> <li>further reduce healthcare-associated infections;</li> <li>improve communication among providers and between the patient and caregivers, especially during care transitions;</li> <li>include diverse patient voices in hospital processes and procedures;</li> <li>appropriately use opioids to protect patients from potential addiction;</li> <li>use antibiotics judiciously to preserve their effectiveness against deadly diseases;</li> <li>leverage data and analytics to predict trends in patient safety and care opportunities to prevent errors before they happen;</li> <li>engage clinicians even further in performance improvement and reducing inappropriate clinical variation;</li> <li>further help the field connect quality and safety efforts to equity of care; and</li> <li>ake sure women have safe pregnancies and childbirths, from the first days of pregnancy through the postpartum period.</li> </ul> <p><strong>The hospital field is united in re-doubling our efforts to improve quality and reduce health disparities.</strong> [INCLUDE EXAMPLES FROM YOUR HOSPITAL]</p> <h2>AHA Resources</h2> <p>The AHA has worked with hospitals and health systems to share tools that help build a culture of patient safety, adopt best practices around infection prevention and other critical safety topics, and share learnings so that hospitals can learn from each other’s experiences in improving safety. Examples include:</p> <p><strong><a href="/infection-control-and-prevention">AHA infection control and prevention resources</a></strong></p> <p><strong><a href="/center/projectfirstline">Project Firstline</a></strong>, which offers hospitals and health systems the tools and resources needed to engage all stakeholders on infection control – from bedside nurses to administrators to environmental staff – to identify areas of improvement, commit to an action plan, monitor practices, and adjust as needed.</p> <p><strong><a href="/center/team-training">Team Training</a>,</strong> which is designed to improve teamwork skills and practices that are essential to delivering safe, coordinated care.</p> <p><strong><a href="/center/living-learning-network">Living Learning Network</a>,</strong> is a 24/7 online community which provides an excellent opportunity for hospitals to share immediate needs and successful strategies in real-time in response to COVID-19 and overall patient safety to increase the quality of care.</p> <p><strong><a href="/center/age-friendly-health-systems">Age Friendly Health Systems</a>,</strong> which is a multidisciplinary project aimed at addressing the particular needs and concerns, including safety concerns, in caring for older patients.</p> <p><strong><a href="/center/palliative-care">Palliative Care strategies</a></strong> to help patients living with serious illnesses not only manage their symptoms and pain, but also set health goals, stay on track to meet those goals and live their best lives.</p> <p><strong><a href="/center/strive">STRIVE (States Targeting Reduction in Infections via Engagement)</a>,</strong> which was a national initiative funded by the CDC and aimed at improving infection control practices and strengthening health care-associated infection prevention stakeholder relationships at the local level.</p> <p><strong><a href="/about/awards/quest-for-quality">AHA Quest for Quality prize</a>,</strong> which honors hospitals and health systems that have made extraordinary improvements in the delivery of safe, high-quality care and seeks to share their strategies with other hospitals that seek to improve quality.</p> <p><strong><a href="/hospitals-against-violence/human-trafficking/workplace-violence">Hospitals Against Violence (HAV)</a>,</strong> an AHA initiative to share examples and best practices with the field, with a particular emphasis on workplace violence prevention.</p> <h2>Other Resources</h2> <p><strong><a href="https://www.ahrq.gov/hai/tools/clabsi-cauti-icu/index.html" target="_blank">AHRQ toolkits for preventing CLABSI and CAUTI</a></strong></p> <p><strong><a href="https://www.ahrq.gov/patient-safety/settings/hospital/candor/modules.html" target="_blank">AHRQ communication and optimal resolution (CANDOR) toolkit</a>,</strong> which provides strategies and training for clinicians to use in discussing safety events with patients and families.</p> <p><strong><a href="https://haitools.apic.org/" target="_blank">APIC HAI cost calculator tools</a></strong></p> <h2>Further Questions</h2> <p>If you have further questions about patient safety policy, please contact Nancy Foster, AHA’s vice president for quality and patient safety, at <a href="mailto:nfoster@aha.org">nfoster@aha.org</a> or Akin Demehin, AHA’s senior director for quality and patient safety, at <a href="mailto:ademehin@aha.org">ademehin@aha.org</a>.</p> <p>If you have communications or media-related questions, please contact Sharon Cohen, AHA’s senior associate director of media relations, at <a href="mailto:scohen@aha.org">scohen@aha.org</a>.</p> </div> <div class="col-md-4"> <p><a href="/system/files/media/file/2023/09/Patient-Safety-Talking-Points-and-Resources.pdf" target="_blank" title="Click here to download the Patient Safety Talking Points & Resources PDF."><img alt="Patient Safety Talking Points & Resources page 1." data-entity-type="file" data-entity-uuid="6f6afa11-3707-4b89-8695-494360155a40" src="/sites/default/files/inline-images/Page-1-Patient-Safety-Talking-Points-and-Resources.png" width="695" height="900"></a></p> </div> </div> </div> Thu, 14 Sep 2023 14:59:02 -0500 Talking Points <div class="container"> <div class="row"> <div class="col-md-8"> <ul> <li> <p>For over three decades, the 340B Drug Pricing Program has enabled eligible hospitals that serve large numbers of low-income patients and other underserved populations to stretch scarce federal resources and provide more comprehensive care to their patients and communities as Congress intended.</p> <p><strong>The program, which enjoys strong bipartisan support, requires drug companies to sell certain outpatient drugs at the same discount to eligible hospitals that they sell to the government.</strong> The program is funded by drug company discounts rather than federal dollars and it accounts for a small share of drug company revenues, but has tremendous impact on patients and communities across the country.</p> </li> <li><strong>The savings hospitals achieve from these discounts help provide their patients and communities with a range of critical programs and services, many of which may not be available without 340B.</strong> Examples include medication therapy management, free or discounted drugs for low income and uninsured patients, diabetes education and counseling, oncology services, food pantries, and mobile treatment clinics for underserved areas, among others. <span>[WE ENCOURAGE YOU TO INCLUDE SPECIFIC EXAMPLES FROM YOUR HOSPITAL]</span></li> <li>In 2019, the most recent year for which this information is available, <strong>tax-exempt hospitals participating in the 340B drug pricing program provided <a href="/system/files/media/file/2022/06/340b-community-benefits-analysis-6-3-22.pdf">$67.9 billion in total benefits</a> to the communities they serve.</strong></li> <li>However, many policymakers and other stakeholders have suggested that more can be done to communicate the vital work this program supports and why it is so important to patients and communities across the nation. <strong>This is why several policymakers have called for additional, onerous reporting requirements for 340B hospitals</strong> that would <em>not</em> provide a complete and accurate picture of the ways your hospital uses 340B savings to benefit patients.</li> <li>We believe it is important to proactively commit to being transparent about how hospitals use their 340B savings. <strong>340B hospitals should define what it means to be transparent within the 340B program rather than allow others, many of whom do not understand the program, to define it. For these reasons, the AHA developed the 340B Good Stewardship Principles (GSPs) in 2018 and is now revitalizing those principles.</strong> The GSPs call for: <ul> <li><strong>Communicating the value of the 340B program</strong> <ul> <li>Hospitals should publish a narrative on an annual basis that describes how they use 340B savings to benefit their community. This includes listing the services that the hospital could not continue to provide without 340B savings.</li> </ul> </li> <li><strong>Disclosing 340B estimated savings</strong> <ul> <li>Hospitals should publicly disclose on an annual basis their 340B estimated savings calculated in a standardized way.</li> </ul> </li> <li><strong>Continuing rigorous internal oversight</strong> <ul> <li>Hospitals should continue to conduct internal reviews to ensure that their 340B programs meet the Health Resources and Services Administration’s rules and guidance. Included in this effort is a commitment to regular training for hospitals’ 340B teams.</li> </ul> </li> </ul> </li> <li>In addition to the AHA, these principles have been endorsed by all of the major national hospital organizations: America’s Essential Hospitals, the Association of American Medical Colleges, the Catholic Health Association of the United States, the Children’s Hospital Association and 340B Health.</li> </ul> </div> <div class="col-md-4"> <p><a href="/system/files/media/file/2023/09/340B-Good-Stewardship-Principles-Talking-Points-20230912_0.pdf" target="_blank" title="Click here to download the 340B Good Stewardship Principles Talking Points PDF."><img alt="340B Good Stewardship Principles Talking Points page 1." data-entity-type="file" data-entity-uuid="3962e96d-bb75-459f-b648-81fc702a63cf" src="/sites/default/files/inline-images/Page-1-340B-Good-Stewardship-Principles-Talking-Points-20230912.png" width="695" height="900"></a></p> </div> </div> </div> Tue, 12 Sep 2023 14:45:00 -0500 Talking Points /talking-points/2023-04-04-talking-points-ensuring-protection-vital-340b-program-patients-and-providers <ol> <li><strong>340B is Already a “True” Safety-net Program</strong><br /> Attempts by PhRMA to redefine “true” safety net providers is dangerously disingenuous. All 340B hospitals provide meaningful care to underserved patients. More than half of hospitals participating in the 340B program care for inherently underserved populations, including children, cancer patients or patients living in rural areas. The other half of hospitals participating in the 340B program, called disproportionate share hospitals (DSH), qualify because they care for high numbers of Medicaid and low-income Medicare patients. In fact, data show that 340B DSH hospitals account for nearly 77% of the care provided to Medicaid patients.<sup>i </sup>Taken together, these two categories of hospitals provide a majority of their care to underserved patients in the nation.<br />  </li> <li><strong>Patients Already Directly Benefit from 340B Savings</strong><br /> Hospitals uses their 340B savings to furnish a variety of critical programs and services that directly benefit patients, such as free or discounted drugs to low income patients, medication therapy management programs, diabetes treatment programs and mobile treatment clinics targeted to serve rural communities. Hospitals also use 340B savings to offset the costs of care for patients covered by Medicaid and Medicare, both of which chronically underpay hospitals<sup>.ii </sup>The savings allow hospitals to care for more Medicaid and Medicare patients as a result. This is exactly the program’s intent. As Congress stated, the goal of the 340B program is to help providers “stretch scarce Federal resources as far as possible, reaching more eligible patients and providing more comprehensive services.” Notably, Congress preserved flexibility for how 340B savings were to be used. And for good reason. Congress recognized that every hospital and its patients are unique and have unique needs, and in order for the program’s savings to truly benefit those unique needs, hospitals need to have the ability to determine how those savings are best used for its patients. For example, a rural hospital may use their savings to ensure they are able to keep their doors open in the face of inadequate reimbursement, while an academic medical center may use its savings to support a novel medication therapy management program to treat patients suffering from opioid addiction.<br />  </li> <li><strong>340B Patient Eligibility is Well-defined and Audited. Drug Companies are not</strong><br /> The Health Resources and Services Administration (HRSA), which oversees the 340B program, has put forward clear guidance defining which patients are eligible to receive drugs that can be purchased by the 340B hospital at the discounted price.<sup>iii</sup> In addition, HRSA performs approximately 200 rigorous audits every year of 340B providers, a majority of which are hospitals, to ensure that 340B hospitals are not diverting discounted drugs to ineligible patients. In contrast, HRSA performs only five manufacturer audits every year.<br />  </li> <li><strong>Drug Companies have Taken the Law into their Own Hands to Undermine Contract Pharmacy Arrangements, which are a Critical Component of the 340B Program</strong><br /> This proposal would codify PhRMA’s unlawful actions restricting the use of contract pharmacies — something the Department of Health and Human Services has deemed unlawful. PhRMA objects to the use of these arrangements because they increase access to 340B medicines at the expense of PhRMA’s already-inflated profits. As a result, for the past three years, some of the largest drug companies have held the 340B provider community hostage, harming the needs of the very same underserved patients they now claim they want to “protect”. These actions have caused irreparable harm to all 340B covered entities, including federal grantees — like many community health centers — and hospitals, all of which rely on contract pharmacies to ensure access to lifesaving drugs for their patients. In fact, for many rural hospitals, the average impact of these actions is estimated to be over $500,000 annually, and for DSH hospitals, an average of nearly $3 million per year.<sup>iv</sup><br />  </li> <li><strong>Pharmacy Benefit Managers and Commercial Payers are Taking Advantage of 340B Savings</strong><br /> The savings 340B providers achieve through the 340B program have been a target of commercial payers and their pharmacy benefit managers for many years. Like many drug companies, the incentives for these middlemen in the pharmaceutical supply chain are to squeeze as much profit as possible from patients and providers, which is why 340B has been such an attractive target. Payers have instituted numerous policies, including those known as “whitebagging” and “brownbagging,” to steer patients away from hospital-based pharmacies or contracted community and specialty pharmacies; instead, they are pushed towards pharmacies that are owned and operated by the pharmacy benefit manager and/or the payer, at risk to patients.<br />  </li> <li><strong>Hospital Eligibility Requirements are Well-defined</strong><br /> PhRMA does not hide the ball here: it seeks to drastically shrink hospital participation in 340B so drug companies can protect their profits. Their proposal would have a direct and negative impact on patients’ access to quality care. Congress has recognized the value of the program to patients and providers and has expanded the program over the years. It did so for good reason: hospitals eligible to participate in the 340B program serve high numbers of underserved patients, whether they be underinsured patients, rural patients or patients of specific populations such as cancer patients or children. For certain hospitals whose eligibility is conditioned on providing a certain amount of care to low-income patients, they often provide a disproportionate level of care to underserved populations compared to other providers.<sup>v</sup> In addition, these hospitals often care for the sickest, most complex and resource-intensive patients that other providers, like community health centers, are not equipped to care for. Congress understood this fact in 1992 when it created the 340B program, and continues to appreciate this fact through its repeated efforts to protect 340B for all eligible hospitals and ensure greater oversight of the program through tools like the Alternative Dispute Resolution process.<br />  </li> <li><strong>340B Child Sites Promote Access to Care for all Patients</strong><br /> Outpatient clinics, referred to as child sites, are critical sites of care for hospitals to ensure they can reach patients closer to where they live. These sites allow the hospital to extend a range of critical services, from chemotherapy infusions to obstetrics care, to ensure patients can get the care they need without having to travel far distances. The benefits from 340B savings, achieved through outpatient sites of care, are felt, by all patients served by the hospital through the programs and services supported by those savings. These sites of care, like the primary hospital, are included in hospital audits performed by HRSA and are therefore subject to rigorous oversight.<br />  </li> <li><strong>340B Claims Reporting should Minimize Provider Burden</strong><br /> For the past three years, many drug companies have made contract pharmacy access conditional on whether providers meet a list of strict requirements and hand over certain data directly to drug companies. All the while, drug companies have kept hidden important data about their own pricing and other activities. Despite these strong-arm tactics, hospitals are amenable to a national, independent clearinghouse of claims data that safeguards patient and provider confidentiality, and allows both 340B providers and manufacturers the ability to hold each other accountable. The process must minimize burden on providers to report the claims data. Hospitals recognize that in order to have a strong 340B program, accountability needs to be a two-way street.<br />  </li> <li><strong>340B Hospitals Already Report a Wide Range of Information. Drug Companies do not</strong><br /> 340B hospitals report a variety of information to demonstrate their commitment to providing care to underserved populations. Hospitals report uncompensated care, charity care and other benefits provided to the communities they serve through both the Medicare cost reports and the IRS 990 form required for tax-exempt organizations. In fact, the most recently available IRS 990 data show that 340B hospitals alone provided nearly $68 billion in community benefits.<sup>vi</sup> At the same time, drug companies are not required to report information about how they set their prices or how much they decide to increase their prices. That type of information would be important in understanding drug companies’ pricing decisions and how we can mitigate arbitrary and egregious price increases for drugs that are critical and lifesaving for patients.<br />  </li> <li><strong>Drug Companies have Thwarted 340B Oversight at Every Turn</strong><br /> The 340B program is already subject to rigorous oversight by HRSA, which has sufficient authority to ensure compliance with program rules and requirements. Meanwhile, drug companies have consistently stood in the way of HRSA’s ability to exercise that authority, including by their collective refusal to participate in good faith in the Alternative Dispute Resolution process. Drug companies should support the agency’s existing authority to oversee the program before making insincere demands for additional authorities that the government does not need. In addition, PhRMA’s statement that the 340B statute supersedes state law is equally self-serving. PhRMA fears legislation, like the Arkansas law recently upheld in federal court that would prevent it from placing restrictions on contract pharmacy arrangements. Having lost in court, PhRMA offers this proposal for the same reason as all the others: to fill its swollen coffers at the expense of patients and communities.</li> </ol> <p>_________</p> <p><small><sup>i </sup><a href="https://www.healthaffairs.org/content/forefront/30-years-340b-preserving-health-care-safety-net" target="_blank">https://www.healthaffairs.org/content/forefront/30-years-340b-preserving-health-care-safety-net</a><br /> <sup>ii</sup> <a href="/fact-sheets/2020-01-07-fact-sheet-underpayment-medicare-and-medicaid" target="_blank">/fact-sheets/2020-01-07-fact-sheet-underpayment-medicare-and-medicaid</a><br /> <sup>iii </sup><a href="https://www.govinfo.gov/content/pkg/FR-1996-10-24/pdf/96-27344.pdf" target="_blank">https://www.govinfo.gov/content/pkg/FR-1996-10-24/pdf/96-27344.pdf</a><br /> iv </small><span><span><a href="/system/files/media/file/2022/11/survey-brief-drug-companies-reduce-patients-access-to-care-by-limiting-340b-community-pharmacies.pdf"><span><span>/system/files/media/file/2022/11/survey-brief-drug-companies-reduce-patients-access-to-</span></span></a></span></span> <span><span><a href="/system/files/media/file/2022/11/survey-brief-drug-companies-reduce-patients-access-to-care-by-limiting-340b-community-pharmacies.pdf"><span><span><span>care-by-limiting-340b-community-pharmacies.pdf</span></span></span></a></span></span><br /> <small><sup>v </sup><a href="https://www.healthaffairs.org/content/forefront/30-years-340b-preserving-health-care-safety-net" target="_blank">https://www.healthaffairs.org/content/forefront/30-years-340b-preserving-health-care-safety-net</a><br /> <sup>vi  </sup><a href="/2022-06-07-2022-340b-hospital-community-benefit-analysis" target="_blank">/2022-06-07-2022-340b-hospital-community-benefit-analysis</a></small></p> Wed, 05 Apr 2023 15:04:25 -0500 Talking Points <div class="container"> <div class="row"> <div class="col-md-8"> <ul> <li>The reality is that all of America’s hospitals and health systems, regardless of size, location and financial status stepped forward to provide essential care and keep communities safe during this historic pandemic. <ul> <li>The hospital field does far more than any other part of the health care sector to support our neighbors: Our doors are always open, 24/7, and we often act as a public safety net for the nation.</li> <li>Many hospitals came into the pandemic already in dire financial shape, with over two in three operating with negative margins or barely breaking even.</li> </ul> </li> <li>During the pandemic, many hospitals had to postpone or cancel non-emergent care due to government mandates, further threatening their financial stability. They were also paying much more for staffing and needed personal protective equipment, and to set up new care sites and vaccination clinics.</li> <li>Congress rightly recognized the indispensable role hospitals play as the backbone of our health care system and, on a bipartisan basis, swiftly took steps in the early days of the pandemic to provide needed support to ensure hospitals would remain resilient.</li> <li>These funds were for hospitals to use to prevent, prepare for, and respond to the novel COVID-19 virus, including by setting up alternative care sites, procuring testing, administering vaccines and supporting their workforce. They were also intended to compensate hospitals for lost revenue due to the pandemic. Under the law, the number of COVID-19 deaths in a community did not have anything to do with the distribution of funds, and would have been an unworkable metric at the beginning of the pandemic.</li> <li>The federal government appropriately worked to get this critical relief out quickly as our health care system was facing a historic crisis during this once-in-a-century pandemic. While we registered concerns at the time with the use of revenue as a proxy, we agreed that providing needed help in a timely manner was far more important. Subsequent distributions of federal dollars were adjusted to target hospitals in need.</li> <li>These funds, all of which providers are held accountable for under law, have allowed hospitals to continue to serve all who need care. If hospitals received more funds than their COVID-19-related expenses and lost revenue, there will be a reporting and auditing process and the excess funding will be returned to the government. The provider relief fund was a successful partnership between the federal government and the provider community to address our greatest health care threat in recent years.</li> <li>Financial reserves beyond the provider relief fund helped hospitals continue to provide care as the pandemic stretched into years, and through multiple variants, including the massive omicron wave at the end of 2021 and beginning of 2022. Reserves also help allow hospitals to pursue needed physical upgrades to their facilities, train the next generation of health care workers, and invest in cutting edge technology and research to better treat patients and find cures to chronic diseases.</li> <li>As highlighted in recent reports from the AHA and other organizations, hospitals and health systems are facing historic increases in costs to both operate and provide care. This includes expenses for workforce, drugs, supplies and equipment.</li> <li>These cost surges, along with ongoing challenges from the pandemic, Medicare sequester payment cuts phasing back in, inadequate Medicare payment updates that fail to account for inflation, workforce challenges and the downturn in the financial markets, have continued to strain the resources the hospital field needs to care for their patients and communities.</li> <li>We should now be looking for opportunities to ensure that we keep all hospitals and health systems strong and our patients and communities healthy.</li> </ul> </div> <div class="col-md-4"> <p><a href="/system/files/media/file/2022/12/Talking-Points-on-Provider-Relief-Fund.pdf" target="_blank" title="Click here to download the Talking Points on Provider Relief Fund PDF."><img alt="Talking Points on Provider Relief Fund page 1." data-entity-type="file" data-entity-uuid="8abc3340-6174-4453-ae6c-3a22b3454ac6" src="/sites/default/files/inline-images/Page-1-Talking-Points-on-Provider-Relief-Fund.png" width="695" height="900"></a></p> </div> </div> </div> Mon, 05 Dec 2022 15:47:00 -0600 Talking Points <div class="container"> <div class="row"> <div class="col-md-8"> <h2>Mandated Staffing Talking Points</h2> <h3>Patient safety is always the number one priority. Nurses need to be empowered with flexibility to determine appropriate staffing for the needs of their patients.</h3> <ul> <li>Hospitals and health systems are <strong>committed to safe nurse staffing</strong> to ensure quality care and optimal patient experience.</li> <li><strong>One size doesn’t fit all</strong> when it comes to safe staffing. The number of patients for whom a nurse can provide safe, competent and quality care is dependent upon multiple factors. <ul> <li>Patients in need of care in the unit;</li> <li>Type and degree of illness;</li> <li>The overall care team including caregivers who may not be nurses;</li> <li>Physical layout of the unit.</li> </ul> </li> <li><strong>We want to empower nurses</strong> so they can best tailor clinical care for the patient.</li> <li>Nurses, not legislators, should determine patient care. Mandatory nurse ratios do not allow for innovation and new team-based care models that we saw emerge during the pandemic.</li> </ul> <h2>Flexibility</h2> <ul> <li><strong>We agree that safe staffing is a critical component of good care.</strong> Mandated nurse staffing ratios remove needed flexibility from nurses for the care they provide.</li> <li><strong>Mandated nurse staffing ratios are a static and ineffective tool</strong> that cannot guarantee a safe health care environment or quality level to achieve optimal patient outcomes.</li> <li><strong>Care needs can change instantly.</strong> Nurses at the unit level need flexibility to adapt to the changing patient needs throughout the day.</li> <li><strong>Static ratios do not recognize</strong> the times when a nurse can safely care for a patient in times of <strong>low intensity like discharge.</strong></li> <li>Increasing the number of <strong>nurses on a shift does not necessarily translate to higher quality care.</strong> <ul> <li>Care is provided as a team with each member playing a key role based on their expertise and skills.</li> <li>Lack of flexibility and mandated ratios will lead to nurses handling aspects that take them away from bedside care such as housekeeping or transport, among other duties.</li> </ul> </li> </ul> <h2>Care Team</h2> <ul> <li><strong>Mandated approaches to nurse staffing require outdated care models</strong> that do not incorporate newer technologies or the interprofessional team-care model. What matters most for good care is the experience of the nurses in the unit, the composition of the care team and the needs of the patients.</li> <li><strong>In the interprofessional team-care model</strong>, the nurse, respiratory therapist, and case manager work together to ensure quality and optimal patient outcomes.</li> <li>Mandated approaches to nurse staffing <strong>limit innovation</strong> and increase stress on a health care system already facing an escalating shortage of nurses.</li> <li>Patient safety is the top priority for everyone in health care.</li> </ul> <h2>Workplace violence</h2> <h3>Our health care workers' crucial life-saving roles have never been more evident, which is why their safety, protection and well-being, remain our top priority.</h3> <ul> <li><strong>Hospitals and health care systems have long had robust protocols in place</strong> to detect and deter violence against their staff. Since the onset of the pandemic, however, violence against hospital employees has increased — and there is no sign it is receding.</li> <li>To support hospitals' efforts, <strong>the AHA created the Hospitals Against Violence member advisory group</strong>, and we have worked to address violence in hospitals and health systems and in the communities we serve. We have developed tools and resources to highlight and share with the field numerous programs and resources to combat violence.</li> <li><strong>The AHA has urged the U.S. Attorney General to support legislation that would increase protections for health care workers from assault and intimidation.</strong> While we may never reduce violence in our hospitals to zero – because we are there to serve in the most challenging settings and circumstances – we can insist on zero tolerance for abusive behavior.</li> <li>People who dedicate themselves to saving lives deserve a safe environment, free of violence and intimidation.</li> <li>Last year, we developed a focused <a href="/system/files/media/file/2021/10/building-a-safe-workplace-and-community-framework-for-hospitals-and-health-systems.pdf">framework</a> for hospital, health system and security leaders. We also collaborated with the International Association for Healthcare Security and Safety to create <a href="/system/files/media/file/2021/10/creating-safer-workplaces-guide-to-mitigating-violence-in-health-care-settings-f.pdf">a guide for hospital and health system leaders</a>.</li> <li>The AHA/IAHSS guide focuses on employee well-being, promotes data-driven approaches, embeds safety and security into existing workflows and electronic medical records, and helps facilities develop relationships to improve security. It also includes <a href="/system/files/media/file/2021/10/building-a-safe-workplace-and-community-framework-for-hospitals-and-health-systems.pdf">a framework for building safer workplaces</a>, actionable steps for mitigating violence in hospitals and health care settings, and links to resources including webinars and podcasts.</li> </ul> <h2>OSHA Emergency Temporary Standard</h2> <ul> <li>The health and safety of all health care workers remains a top priority for the AHA and our members.</li> <li>We are committed to following the science-based and quickly evolving guidance issued by the Centers for Disease Control and Prevention (CDC). Throughout the course of the pandemic, hospitals have followed these protocols to ensure the safety of front-line staff and patients.</li> <li>Hospitals and health systems already have protocols in place to protect their workforce.</li> <li>While we acknowledge and appreciate OSHA’s consideration of additional flexibility for employers and other potential changes to the ETS, hospitals diligent efforts have helped protect health care workers by ensuring that the latest evidence-based practices and policies are followed.</li> <li>With CDC guidance and recommendations, CMS’ vaccination requirement and strictly enforced OSHA general standards, we strongly believe that an inconsistent OSHA COVID-19 health care standard is not necessary, would cause confusion and will ultimately lower hospital employees’ morale and worsen unprecedented personnel shortages in hospitals.</li> <li>It is essential to a well-functioning health care system that only one set of science-based standards be applied to health care providers, and that these standards be aligned across federal agencies.</li> <li>CMS already enforces CDC infection prevention and control guidelines as well as its vaccination mandate via the Medicare Conditions of Participation. Together with this, OSHA has sufficient authority through its existing general standards to protect health care employees from the hazard of COVID-19, not to mention other hazards.</li> </ul> <h2>Protecting Workers</h2> <ul> <li>Maintaining front-line workers’ health and safety is central to a successful response to the pandemic, and no one has more of a stake in doing so than the nation’s hospitals.</li> <li>Through the efforts of their organizational leadership, infection control officers, hospital engineers and material managers, and other front-line staff, they have done everything in their power to ensure that health care workers and patients are protected and that the latest evidence-based practices and policies are followed.</li> <li>Even in the midst of incredible challenges, like unprecedented surges of patients, severe shortages of PPE and other critical supplies, these dedicated experts scrambled to do all they could to support patients and staff alike, seeking supplies of PPE and other necessary supplies when severe shortages were hitting the US. They showed dedication and ingenuity in the face of a sometimes overwhelming situation.</li> <li>And this is precisely why it is essential to a well-functioning health care system that only one set of science-based standards be applied to health care providers, and that these standards be aligned across federal agencies. Enforcement of unaligned rules would not help and could actually cause harm by focusing compliance efforts on contradictory or unnecessary tings.</li> </ul> <h2>Workers Infected on the Job</h2> <ul> <li>It is tragic that so many have died during COVID. What we have learned from talking to hospitals to understand how workers became infected is that the most common infections took place outside of the hospital setting.</li> <li>What you may not be aware of is a JAMA study that looked at this issue and found that health care workers were more likely to catch COVID-19 in the community than from the workplace.</li> </ul> <h2>Supply Chain Issues</h2> <ul> <li>From the beginning, the AHA worked with the federal agencies to sound the alarm to strengthen our current supply chain and we are actively engaged with all stakeholders to find solutions.</li> <li>This was a once in a lifetime pandemic that began in China and no one could have anticipated that the supply chain would shut down. Everyone has been affected by supply chain issues and hospitals are no different.</li> <li>Hospitals have served as a catalyst by launching innovative initiatives with the private sector, like the 100 Million Mask Challenge.</li> <li>We pushed all levers to increase supplies of PPE so that front line caregivers were protected to the best of our ability. This included calling on the Administration to fully implement the Defense Production Act, urging Congress to provide more resources to acquire PPE.</li> <li>We agree that strengthening the supply chain, including scaling up the capabilities for the stockpiling and rapid distribution of PPE must be a high priority of the federal and state governments going forward.</li> <li>We also support efforts to incentivize and strengthen the domestic production of essential medical products, such as PPE.</li> </ul> </div> <div class="col-md-4"> <p><a href="/system/files/media/file/2022/03/Workforce-messages-3-23-22.pdf" title="Click here to download the Workforce Messages PDF."><img alt="Page 1 of Workforce Messages." data-entity-type="file" data-entity-uuid="d6978a26-9a7d-4181-8f69-25597309df42" src="/sites/default/files/inline-images/Page-1-Workforce-Messages-May-2-2022.png" width="1700" height="2200"></a></p> <div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2022/03/Workforce-messages-3-23-22.pdf" target="_blank" title="Click here to download the Workforce Messages PDF.">Download the PDF</a></div> </div> </div> </div> Mon, 02 May 2022 08:00:00 -0500 Talking Points /talking-points/aha-advocacy-messages <hr /> <h2><span>1.   Support Continued Efforts to Conquer COVID-19 and Bolster Public Health <span> </span></span><span><span>      </span></span></h2> <p><span><strong>For more than two years, hospitals and health systems — along with our doctors, nurses and so many other team members — have been on the front lines of the COVID-19 pandemic, working tirelessly to provide the best care for patients, families and communities.</strong></span></p> <p>In your conversations on Capitol Hill, please thank your lawmakers for their support of hospitals, health systems and health care providers since the outset of the pandemic. Please share with them specifics of how that support has helped your organization save lives, heal families and protect communities.</p> <p>In addition, please share with them the many challenges your organization continues to face related to the effects of the COVID-19 pandemic and why additional support is needed.</p> <p><strong>Specifically, please urge Congress to:</strong></p> <p><span><strong>Provide Relief from Medicare Sequester Cut</strong></span><br /> <br /> Congress, as recently as December, halted harmful Medicare cuts to hospitals by eliminating a 2% Medicare reduction. However, on April 1, a 1% Medicare reduction went into effect. On July 1, that will increase to a 2% reduction. Congress should eliminate the Medicare cuts until the end of the COVID-19 public health emergency or Dec. 31, 2022, whichever is later.</p> <p><strong><span>Replenish the Provider Relief Fund</span></strong></p> <p>Congress should provide additional dollars to the Provider Relief Fund to support health care providers who faced lost revenues and increased expenses due to the tremendous financial strain caused by the delta and omicron variants, as well as continued COVID-19- related expenses and skyrocketing inflation. The government has not distributed any funds to providers to help with the exorbitant expenses related to the delta and omicron surges, and $17 billion that Congress secured for the PRF was diverted for other uses. In addition to replenishing the PRF, Congress should extend the deadline for providers to spend previously distributed funds.</p> <p><strong><span>Provide Flexibility on Accelerated and Advance Medicare Repayments</span></strong></p> <p>In March 2020, Congress and the Centers for Medicare & Medicaid Services made changes to the existing Accelerated and Advance Payments Programs to provide additional benefits and flexibilities due to the COVID-19 pandemic. Subsequently, Congress amended the repayment terms, but given the significant financial challenges facing the field, it is imperative to make additional changes. Specifically, Congress should suspend repayments for six months and allow for recoupment after the repayment suspension at 25% of Medicare claims payments for the following 12 months.</p> <p><strong><span>Provide Funding for Vaccines, Therapeutics and Supporting the Uninsured</span></strong></p> <p>Congress should provide additional federal support for vaccines and therapeutics, testing, research and funding that supports the uninsured.</p> <p><strong><span>Ensure COVID-19 Emergency Declarations Continue During the Crisis</span></strong></p> <p>Congress should urge the Administration to ensure the national emergency declaration and the COVID-19 public health emergency declaration continue to remain in effect through the duration of the crisis. These emergency declarations are necessary to ensure continuation of the critical 1135 waivers and Medicaid coverage flexibilities that have allowed health care providers to offer the most efficient and effective care possible during the continuing pandemic.</p> <p><strong><span>Extend or Make Permanent Certain COVID-19 Waivers</span></strong></p> <p>At the outset of the pandemic, CMS quickly moved to waive a number of regulatory requirements to provide hospitals and health systems with critical flexibilities to care for their patients and communities. This process acted as a catalyst for establishing new, innovative and safe ways for delivering patient-centered care. Congress, working with CMS, should make a number of these waivers permanent, including important telehealth flexibilities and changes in policies to reduce unnecessary burden, such as in discharge planning, and extend the waiver related to the critical access hospital 96-hour length of stay rule. In addition, Congress should pass legislation (<strong>S.3792/H.R.7053</strong>) to provide an extension of the acute care hospital at home program.</p> <p><strong><span>Bolster Public Health Efforts for Future Emergencies</span></strong></p> <p>During the pandemic, Americans instinctively did what they have done for generations in times of peril: They turned to hospitals for safety, security and healing. As Congress considers legislation to strengthen our nation’s ability to respond to future public health emergencies, we must establish a permanent fund that would quickly be activated to directly fund hospitals and health systems during emergencies so that health care services will be available regardless of the negative economic impact of any emergency. The lack of such a permanent fund is a major vulnerability in our nation’s health care system preparedness as COVID-19 has shown how hospitals fill significant gaps in the capabilities of our public health entities.</p> <h2><span>2.  Strengthen the Health Care Workforce</span></h2> <p><strong><span>The relentless battle to fight COVID-19 has</span> <span>strained our health care workforce like never before.</span></strong></p> <p>The incredible physical and emotional toll that hospital and health care workers have endured in caring for patients during the pandemic has, among other issues, exacerbated the shortage of hospital workers. Our nation simply does not have enough clinicians to care for patients today and not enough are in the training pipeline for the future.</p> <p>Because our workforce is our most precious resource, hospitals and health systems are committed to supporting them. Hospitals have created programs and developed resources to promote caregiver well-being and resiliency.</p> <p>However, the health care workforce crisis is a national emergency that needs immediate attention.</p> <p><strong>Specifically, please urge Congress to:</strong></p> <p><strong><span>Lift the Cap on Medicare-funded Physician Residencies</span></strong></p> <p>Congress should pass legislation (<strong>S.834/H.R.2256</strong>) that would add 14,000 Medicare-funded residency slots, which would expand training opportunities in rural settings and help address health professional shortages.</p> <p><strong><span>Fund Medical School Scholarships to Improve Diversity in the Physician Workforce</span></strong></p> <p>Congress should enact the Pathway to Practice Training Program, which would increase the number of Medicare-funded residency slots; increase physician diversity by providing scholarships to 1,000 underrepresented students a year; improve access in underserved and under-resourced communities; and promote cultural and structural competency training to help improve the overall quality of care.</p> <p><strong><span>Boost Support for Nursing Schools and Faculty</span></strong></p> <p>American nursing schools turned away over 80,000 qualified applicants from baccalaureate and graduate programs in nursing in 2019 alone due to an insufficient number of qualified faculty, clinical sites, classroom space and budget constraints. Congress should pass legislation (<strong>S.246/H.R.851</strong>) that would provide resources to boost student and faculty populations, as well as support educational programming, partnerships and research at nursing schools.</p> <h2><span>3.  Ensure Hospitals are Always There to Care</span></h2> <p><strong><span>Hospitals and health systems are the cornerstones of their communities, and patients depend on them for access to care 24 hours a day, seven days a week. Congress must help to ensure hospitals have adequate resources to care for their communities.</span></strong></p> <p><strong>Specifically, please urge Congress to:</strong></p> <p><strong><span>Ensure Access to Care in Rural Communities</span></strong></p> <p>Congress should pass a number of policies to support rural hospitals, including making permanent the Medicare-dependent Hospital program and low-volume adjustment; removing permanently the 96-hour physician certification requirement for critical access hospitals; repealing new payment caps on provider-based rural health clinics; and extending ambulance add-on payments.</p> <p><strong><span>Support Policies to Advance Health Equity</span></strong></p> <p>Advancing health equity requires a multi-faceted approach focusing on data collection, research, training and improving clinical outcomes. Congress should support initiatives to improve the collection of race, ethnicity and language data; increase funding for federal agencies that conduct and fund equity research; and address the social and structural factors that influence health.</p> <p><strong><span>Protect the 340B Drug Pricing Program</span></strong></p> <p>For nearly 30 years, the 340B program has been critical to expanding access to life-saving prescription drugs and comprehensive health care services. Since July 2020, several drug manufacturers have engaged in unlawful actions to limit the scope of the program by denying 340B pricing through contract pharmacies. As legal challenges persist, Congress must continue its bipartisan support for the program.</p> <p><strong><span>Remove Barriers to Behavioral Health Care</span></strong></p> <p>Congress should remove barriers for individuals to access behavioral health by increasing oversight authority and enforcement power of CMS to hold health insurance plans accountable for providing reasonable coverage for services. In addition, Congress should eliminate Medicare’s 190-day lifetime limit on inpatient psychiatric care in freestanding psychiatric facilities (<strong>S.3061/H.R.5674</strong>) and the Institutions for Mental Disease Exclusion under Medicaid.</p> <p><strong><span>Bolster Efforts to Improve Maternal Health</span></strong></p> <p>Congress should bolster hospitals’ efforts to improve maternal health by making permanent and requiring states to extend Medicaid and CHIP eligibility to pregnant individuals for 12 months postpartum. The AHA also supports provisions of legislation (<strong>S.346/H.R.959</strong>) that seeks to end preventable maternal mortality and severe maternal morbidity in the U.S. and reduce disparities in maternal health outcomes.</p> <p><strong><span>Increase Access to Affordable Health Care Coverage</span></strong></p> <p>While we have made substantial gains in coverage over the past decade, significant gaps remain and the wind down of the COVID-19 PHE puts coverage for millions at risk. Congress should prioritize maintaining health benefits for individuals and families and increase coverage options for those who are uninsured, including by making permanent expanded Marketplace subsidies, continuing to provide support for states to expand Medicaid, and assisting states with managing the eligibility redetermination process at the end of the PHE.</p> <p><strong><span>Reset the IMPACT Act</span></strong></p> <p>Congress should pass legislation (<strong>H.R.2455</strong>) to reset the Improving Medicare Post-Acute Care Transformation Act of 2014 to make it relevant to the current post-acute care landscape, align with recent transformations of the existing post-acute care payment systems and account for the pandemic.</p> <p><strong><span>Address Prior Authorization and Payment Denials</span></strong></p> <p>Congress should pass legislation (<strong>S.3018/H.R.3173</strong>) to streamline and improve Medicare Advantage prior authorization processes, which would help providers spend more time on patients instead of paperwork.</p> <p><strong><span>Strengthen Cybersecurity Efforts</span></strong></p> <p>Congress should pass legislation (<strong>S.3904</strong>) to improve collaboration and coordination between federal agencies to prevent and respond to cyberattacks, as well as authorize cybersecurity training and an analysis of cybersecurity risks for the health care and public health sectors.</p> Sun, 24 Apr 2022 12:02:25 -0500 Talking Points <h2>Background</h2> <p>An <a href="https://www.nytimes.com/2022/01/19/opinion/nurses-staffing-hospitals-covid-19.html" target="_blank" title="New York Times Opinion Video: We Know the Real Cause of the Crisis in Our Hospitals. It’s Greed.">opinion video published by The New York Times</a> Jan. 19 presents a distorted view about the workforce challenges facing hospitals and health systems as they continue to fight the COVID-19 pandemic. The following messages may be helpful in responding to questions you receive about the video or when talking about the issue with your teams or the public. Visit AHA’s <a href="/workforce-home" target="_blank" title="AHA Workforce landing page.">webpage on workforce</a> for more resources, including tools on workforce well-being.</p> <h2>Main Messages</h2> <ul> <li>Health care is, at its core, people caring for people. But the pandemic has strained our health care workforce like never before.</li> <li>Our health care workers’ crucial life-saving roles have never been more evident, which is why their safety, protection and well-being, including mental health, remain a top priority.</li> <li>The reality is that our front-line workforce has battled a novel, once-in-a-century virus that no one could have accurately predicted in advance.</li> <li>Stress, trauma, burnout and behavioral health disorders are at historic levels. It is clear the health and well-being of nurses and all health care workers is on an unsustainable path.</li> <li>The hospital field values nurses and is committed to compensating them fairly. Hospitals and health systems have also created programs and resources to promote well-being and resiliency for caregivers.</li> <li>At the same time, hospitals are facing serious financial pressures, including rapidly increasing costs. The cost of hiring and retaining nursing staff is a big part of this.</li> <li>Workforce pressures have also forced hospitals to increase their use of contract labor. Unfortunately, some nurse and other direct care staffing agencies are exploiting the severe workforce shortages during the pandemic by charging uniformly high prices.</li> <li>The behavior of some of these staffing agencies suggests widespread coordination and abuse.</li> </ul> <h2>Issue Messages</h2> <h3>Support for Nursing Staff</h3> <ul> <li>A recent survey found almost 60% of health care workers reported impacts on their mental health during the COVID-19 response. This is unsustainable.</li> <li>The AHA has pushed for enactment of the Dr. Lorna Breen Health Care Provider Protection Act to invest in behavioral health services for health care workers and prevent burnout.</li> </ul> <h3>Financial Pressures</h3> <ul> <li>Hospital employment data have indicated persistent critical shortages of workers. This has forced hospitals to incur increased costs during the ongoing pandemic.</li> <li>Through November 2021, labor expenses increased 12% compared to pre-pandemic levels according to the Kaufman Hall Monthly Flash Report.</li> <li>When looked at through the lens of labor expenses per adjusted discharges, meaning employee costs per patient, the increase was even greater: 19.5%.</li> <li>Sicker patients and supply chain shortages have led to higher expenses for drugs and supplies. Drug and supply expenses per adjusted discharge are up 37% and 20.5% respectively compared to 2019, according to Kaufman Hall data.</li> </ul> <h3>Role of Nurse Staffing Firms</h3> <ul> <li>Staffing agencies are exploiting this desperate situation for personnel by inflating prices beyond reasonably competitive levels – two or three times pre-pandemic rates – and retaining up to 40% or more of those amounts for themselves.</li> <li>The AHA has urged the government to investigate possible collusion and price gouging by these staffing agencies.</li> </ul> <h3>Mandated Staffing Ratios</h3> <ul> <li>While we can all agree that staffing is a critical component of good care, mandated nurse staffing ratios removes needed flexibility from nurses for the care they provide.</li> <li>Ratios are a static and ineffective tool that cannot guarantee a safe heath care environment. Patient care is team-based and a lack of flexibility to provide staffing based on the patient’s illness and individual needs jeopardizes safe patient care.</li> <li>We want to empower nurses so they can best tailor clinical care for the patient. <ul> <li><strong>Guidance from the American Nurses Association</strong> cites, “It is essential that nurses have a substantive and active role in staffing decisions, as they know best how to ensure they have the necessary time, resources and team members to meet patients’ care needs and their overall nursing responsibilities. When that happens, the outcomes are more favorable for everyone."</li> </ul> </li> </ul> Wed, 19 Jan 2022 16:32:18 -0600 Talking Points <div class="container"> <div class="row"> <div class="col-md-8"> <p>Hospitals and health systems oppose Section 30608 of the Build Back Better Act, (H.R. 5376), which would impose a 12.5% cut in Medicaid Disproportionate Share Hospital (DSH) to states that have not expanded Medicaid. Specifically, in the current version of the bill, the 12 states that failed to expand their Medicaid program face reductions in Medicaid DSH payments and federal funding for uncompensated care pools.</p> <ul> <li>Cutting hospitals is not the solution to expanding coverage. <ul> <li>The legislation includes provisions to expand coverage in non-expansion Medicaid states through permitting enrollment of eligible individuals in the federal marketplace. Unfortunately, the bill seeks to partially offset these costs by imposing harmful DSH cuts to hospitals and health systems.</li> <li>DSH payments are not limited to the uninsured. They are intended to address significant shortfalls for hospitals that disproportionately care for the Medicaid population, as well as preserve the financial stability of safety-net hospitals. The hospitals and health systems serving these historically-marginalized, medically-complex and low-income populations are inarguably under reimbursed.</li> <li>Reducing DSH allotments to either penalize states or offset coverage costs will financially undermine hospitals.</li> <li>Further constraining hospital and health system resources could gravely reduce their ability to continue serving their communities.</li> </ul> </li> <li>Now is not the time to cut hospitals given the COVID-19 pandemic, and most especially not in the states that have been particularly hard hit by the Delta variant. These facilities are already struggling with severe workforce and supply chain issues.</li> <li>Moreover, this provision cuts hospitals and health systems that are committed to treating uninsured patients and have been strong advocates within their states to expand Medicaid.</li> <li>The DSH reductions amount $4.7 billion over 10 years and are permanent for the non-expansion states. This will further unfairly disadvantage hospitals and health systems in these states.</li> <li>It is not at all clear that states will expand Medicaid even with the penalty, yet it will directly harm hospitals and the patients they serve; the payment cuts are certain, but the coverage gains are not. <ul> <li>States did not expand when coverage was fully federally funded (2014-2016).</li> <li>None of the non-expansion states have indicated interest in expanding since Congress added a 5% bump in the American Rescue Plan Act.</li> </ul> </li> </ul> </div> <div class="col-md-4"> <div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2021/11/DSHTalkingPoints.pdf" target="_blank">Download the Talking Points PDF</a></div> </div> </div> </div> Mon, 15 Nov 2021 11:09:42 -0600 Talking Points Wed, 18 Nov 2020 12:46:53 -0600 Talking Points <p>Talking Points: Hospitals and Health Systems – COVID-19 Response</p> Tue, 03 Mar 2020 11:50:25 -0600 Talking Points