Opinion / Editorial

Opinion / Editorial / en Sat, 26 Apr 2025 18:58:26 -0500 Fri, 07 Jul 23 15:13:31 -0500 Proposed Medicare Cuts Jeopardize Access to Care for Patients and Communities /news/opinion-editorial/2023-07-07-proposed-medicare-cuts-jeopardize-access-care-patients-and-communities This Op-Ed originally appeared in <a href="https://thehill.com/opinion/congress-blog/4078385-proposed-medicare-cuts-jeopardize-access-to-care-for-patients-and-communities/" target="_blank" title="The Hill: Proposed Medicare cuts jeopardize access to care for patients and communities">The Hill</a>. Will the care be there? A confluence of unprecedented challenges over the last three years, including workforce shortages, skyrocketing costs of providing care and supply chain disruptions, poses a serious risk to America’s hospitals’ and health systems’ ability to do what communities across the country rely on them for — providing quality and accessible care 24/7 to all who need it. These headwinds also include an aging population in need of medical care and the necessity to invest in newer facilities and technological upgrades, such as those to fight against growing cybersecurity threats and to ensure patients have access to the latest cutting-edge scientific breakthroughs. With all that is at stake, now is not the time to expand flawed policies that undermine the unique services hospitals provide for their patients and the critical roles they play in their communities. Congress is considering <a href="/news/headline/2023-05-24-committee-advances-bills-expand-site-neutral-payment-cuts-delay-medicaid-dsh-cuts-add-reporting">several pieces of legislation</a> that would impose billions of dollars in additional Medicare payment cuts for services provided by hospital outpatient departments (HOPDs). If enacted, these misguided so-called “site-neutral” policies would reduce patient access to vital health care services, particularly in rural and other medically underserved communities. Here are five reasons these proposals are flawed and should be rejected. Site-neutral payment policies are based on an erroneous assumption that hospitals are overpaid for outpatient services provided to Medicare patients. The reality is Medicare severely underpays hospitals for the cost of caring for patients. In fact, <a href="/news/blog/2023-03-24-out-touch-reality-pushing-back-editorial-washington-post-calling-medicare-cuts-hospitals-and-health#:~:text=AHA%20survey%20data%20finds%20that,from%20the%20patient%20or%20insurer.">AHA survey data shows</a> hospitals received payment of only 84 cents for every dollar spent caring for Medicare patients in 2020. Even without these newly proposed cuts, Medicare outpatient margins are <a href="https://www.beckershospitalreview.com/finance/hospitals-battling-17-5-medicare-outpatient-margin-urge-congress-against-site-neutral-pay.html" target="_blank">already a staggering negative 17.5 percent</a>. Meanwhile, <a href="/press-releases/2023-04-20-new-aha-report-finds-financial-challenges-mount-hospitals-health-systems-putting-access-care-risk#:~:text=The%20report%20found%3A,20.8%25%20between%202019%20and%202022.">hospitals’ expenses increased by 17.5 percent</a> between 2019 and 2022, while Medicare rates for outpatient care increased by only 7.5 percent during this period. Patients, particularly those in rural and medically underserved communities, could lose access to local hospital care. Most rural hospital funding comes from government payers, and Medicare comprises nearly half of their revenue. Medicare’s chronic underpayments have contributed to <a href="https://www.ncsl.org/state-legislatures-news/details/new-medicare-designation-could-prevent-closure-of-struggling-rural-hospitals" target="_blank">at least 149 rural hospitals closing or converting to another type of provider</a> since 2010. Additionally, other types of sites of care often do not locate at all in rural or urban areas where the commercial insurer patient mix is lower. Further site-neutral cuts would lead to devastating financial hardship, reduced access to essential services and programs, and additional hospital closures. HOPDs treat sicker, lower-income patients with more complex and chronic conditions than those treated in independent physician offices or ambulatory surgery centers. This is in part because hospitals are better equipped to handle complications and emergencies, which often require the use of additional resources that other care settings do not typically provide, such as access to ICUs and other critical hospital services. Site-neutral proposals do not account for key differences between HOPDs and other sites of care. The cost of care delivered in hospitals and health systems takes into account the unique benefits only they provide to their communities. This includes maintaining standby capacity for natural and man-made disasters, public health emergencies and other unexpected traumatic events. In addition, hospital facilities must comply with a much more comprehensive scope of licensing, accreditation and other regulatory requirements compared to other sites of care. Hospitals also deliver around-the-clock emergency care to everyone who walks through their doors, regardless of their ability to pay or insurance coverage. <a href="/system/files/media/file/2023/06/Private-Equity-and-Health-Insurers-Acquire-More-Physicians-than-Hospitals-Infographic.pdf">Health insurers and private equity firms</a> — not hospitals — are responsible for most of the acquisition of physicians during the last five years. At the same time, as physician polling data has shown, most physicians are choosing to become employed rather than operate their own practice due to increased costs and burden from policies like commercial insurer prior authorizations. Clinicians consistently tell us they would rather focus on the practice of medicine and their patients and not have to be responsible for creating their own infrastructure, for example, with electronic medical records or paying liability premiums. In deals where health insurers acquire physician practices, the average number of acquired physicians per deal was <a href="/system/files/media/file/2023/06/Private-Equity-and-Health-Insurers-Acquire-More-Physicians-than-Hospitals-Infographic.pdf">more than ten times higher</a> for health insurers than for any other acquirer type, including hospitals and health systems, according to an AHA analysis of data from Levin Associates. When people see the blue and white “H” symbol, they think of healing, hope and health. They feel comforted knowing help is here. Hospitals and health systems provide care to all who need it, 24 hours a day, seven days a week, 365 days a year. People must realize what is at stake. Congress should reject these harmful proposals, and instead work to strengthen access to essential care for patients and communities across the nation. Rick Pollack is the president and CEO of the �� Association. Fri, 07 Jul 2023 15:13:31 -0500 Opinion / Editorial Washington Post Letter to Editor: Hospitals do more to support those in need /news/opinion-editorial/2023-03-29-washington-post-letter-editor-hospitals-do-more-support-those-need This OpEd was posted in the Washington Post on March 28, 2023. <a href="https://www.washingtonpost.com/opinions/2023/03/28/hospitals-support-those-need/" target="_blank" title="The Washington Post: Opinion Hospitals do more to support those in need">View the Washington Post page.</a> The March 21 Health &amp; Science article <a href="https://www.washingtonpost.com/health/2023/03/18/medical-debt-hits-poor-hardest/?itid=lk_inline_manual_2" target="_blank" title="The Washington Post: Americans are knee-deep in medical debt. Most owe hospitals.">“Many Americans — especially those below U.S. poverty level — are buried in hospital bills”</a> missed a major reason that medical debt has increased in our country: the rise of high-deductible and skinny insurance plans that result in larger out-of-pocket expenses for consumers. The last thing that hospitals want is for their patients to face financial barriers. That’s why hospitals go to great lengths to help patients understand their health coverage and financial obligations for care, which is based, in large part, on their insurance. The �� Association has been identifying and promoting best practices in patient billing for decades. We updated our voluntary <a href="/system/files/media/file/2020/10/Patient-Billing-Guidelines.pdf">patient billing guidance</a> in 2020 to better reflect a changing health-care system in which patients are increasingly being asked to shoulder more of the cost of their care through insurance co-payments and deductibles. Our guidelines include assisting patients who cannot pay for the care they receive and protecting patients from certain debt collection practices. Most hospitals provide free care for patients with the most limited means. In the past three years, hospitals and health systems have cared for more than 6 million <a href="https://www.washingtonpost.com/coronavirus/" target="_blank" title="The Washington Post: Coronavirus">coronavirus</a> patients. As the pandemic reinforced, we are often the front line in a crisis because our doors are always open to anyone who needs care, regardless of ability to pay. Hospitals of all types have provided almost <a href="/fact-sheets/2020-01-06-fact-sheet-uncompensated-hospital-care-cost#:~:text=Since%202000%2C%20hospitals%20of%20all,uncompensated%20care%20to%20their%20patients.&amp;text=Each%20year%2C%20the%20American%20Hospital,all%20types%20of%20U.S.%20hospitals.">$745 billion in care since 2000 for which they received no payment</a>. Hospitals do more than any other part of the health-care field to support patients and communities in need. Rick Pollack, Chicago The writer is president and chief executive of the �� Association. Wed, 29 Mar 2023 08:55:17 -0500 Opinion / Editorial Working with Congress to Keep our Hospitals Strong and Communities Healthy /opinion-editorial/2023-02-24-working-congress-keep-our-hospitals-strong-and-communities-healthy As the 118th Congress begins its work for 2023, hospitals and health systems continue to face significant challenges that are jeopardizing access to care for patients and communities. At the top of the list are workforce pressures and financial challenges. The health care workforce is exhausted – physically and mentally – as we persevere through a third pandemic winter. More than <a href="https://www.healthaffairs.org/do/10.1377/forefront.20220412.311784/" target="_blank">100,000 nurses left the profession in 2021</a>, and nearly <a href="/fact-sheets/2022-06-07-fact-sheet-workplace-violence-and-intimidation-and-need-federal-legislative" target="_blank">70% say they experience verbal abuse on the job</a>. Physicians also are struggling, with <a href="https://www.ama-assn.org/practice-management/physician-health/what-physician-burnout" target="_blank">nearly 63% reporting feeling burned out</a>. While hospitals and health systems have made many efforts to “care for the caregivers” and reward, retain and recruit staff, the bottom line is we don’t have enough clinicians to care for patients today and not enough are in the pipeline to care for an aging population, more complex diseases and increased behavioral health conditions. At the same time, inflation and cost increases for essential medical supplies, drugs and labor have been at historic highs. More than <a href="/system/files/media/file/2022/09/The-Current-State-of-Hospital-Finances-Fall-2022-Update-KaufmanHall.pdf" target="_blank">half of all hospitals were projected to operate at a financial loss in 2022</a>. And experts expect the <a href="https://www.modernhealthcare.com/finance/hospitals-financial-2023-contract-labor-staffing-payer-reimbursements?utm_source=modern-healthcare-am-thursday&amp;utm_medium=email&amp;utm_campaign=20221228&amp;utm_content=article1-headline" target="_blank">financial outlook</a> to be extremely difficult for many hospitals in 2023 as well. Our mission to advance health for all patients and communities has never been more critical. We cannot accomplish this alone. We need to involve all stakeholders, including consumers, higher education institutions, front-line caregivers and health care administrators, commercial insurance companies, drug manufacturers and technology companies, just to name a few. Similarly, all stakeholders at every level of government have a role. Preserving the ability of hospitals and health systems to continue to advance health for individuals and communities is not a partisan issue. At the end of 2022, Congress passed and <a href="/special-bulletin/2022-12-20-appropriations-committees-release-omnibus-spending-bill-health-provisions">President Biden signed legislation that provided some support</a>, including preventing Medicare cuts, extending vital rural health programs, mitigating physician payment reductions, and extending critical regulatory flexibilities for telehealth and the Acute Hospital Care at Home program, among other provisions. But more must be done. The AHA this year will work with leaders on both ends of Pennsylvania Avenue and both sides of the political aisle to enact legislation and policies in four areas: <ul> <li>Ensure Access to Care and Provide Financial Relief</li> <li>Strengthen the Health Care Workforce</li> <li>Advance Quality, Equity and Transformation</li> <li>Enact Regulatory and Administrative Relief</li> </ul> <h2>Ensure Access to Care and Provide Financial Relief</h2> We must protect funding for Medicare, Medicaid and other federal programs that support hospitals’ ability to provide a wide range of essential services to patients. In addition, we must continue to support the 340B drug pricing program and acknowledge the special role that “metropolitan anchor hospitals” and rural hospitals play in their communities. And we must hold commercial insurance companies accountable for their harmful practices that deny or delay patient care. <h2>Strengthen the Health Care Workforce</h2> The lifeblood of our health care system are its caregivers and workers. We must do more to support and protect them, as well as build a stronger and deeper talent pipeline. Among other actions, we should enact federal protections for health care workers against violence and intimidation; increase the number of residency slots for eligible Medicare funding to address physician and behavioral health shortages; and work to address nursing shortages. <h2>Advance Quality, Equity and Transformation</h2> High quality care should never be determined by insurance status, age, race, gender, sexual orientation, or geography. We need to enact policies that advance hospitals’ efforts to deliver higher quality and safe care to all patients, including improving maternal and child health outcomes with a particular focus on eliminating longstanding racial and ethnic disparities. We also must protect health care organizations and patients from the growing threat of cyberattacks. <h2>Enact Regulatory and Administrative Relief</h2> Every day, hospitals and health systems confront the daunting task of complying with a growing number of regulations and commercial insurer requirements. This burden contributes to clinician burnout and drives up the cost of delivering care, or in some cases, delays necessary care. We can’t improve care without addressing regulatory burden. We also must streamline commercial insurer prior authorization practices because clinicians — not insurance companies — should determine what care patients receive. For many people, health care careers are a calling. The more than 6 million people who work at our nation’s hospitals and health systems were there for our families, friends, and neighbors during the darkest days of the pandemic. They are still there, 24/7. We must support them. Rick Pollack is the president and CEO of the �� Association. Fri, 24 Feb 2023 09:26:42 -0600 Opinion / Editorial Rising Costs, Inflation Threaten America's Hospitals & Health Systems /opinion-editorial/2022-07-15-rising-costs-inflation-threaten-americas-hospitals-health-systems <div class="container"> <div class="row"> <div class="col-md-8"> For the past two and a half years, America’s hospitals and health systems — and the courageous nurses, physicians and caregivers that treat patients — have gone above and beyond in the fight against COVID-19, taking extraordinary action to care and save lives. They have worked around the clock, pioneered innovative treatment protocols, partnered with community organizations to address health disparities and inequities, and greatly expanded their capacity to provide care. This heroic response to COVID-19 has taken a significant toll on the financial health of organizations that care for millions of people. While we are grateful for the lifelines provided to our field, additional support is crucial to ensure our caregivers can continue doing what they do best – taking care of patients and advancing the health of their communities. Indeed, America’s hospitals and health systems are facing a crisis: a tsunami of financial challenges that are exerting tremendous pressure on their ability to deliver care. A recent AHA report highlights the significant increase in costs of labor, drugs, equipment and supplies (including food and energy costs) — all of which are being exacerbated by surging inflation. These expense increases have been severely detrimental to hospital finances, threatening their stability and ability to provide access to high-quality health care services. In fact, one-third of hospitals routinely operate in the red and another one-third barely break even. Some key findings of the report show: <ul> <li>Labor expenses, which generally account for more than 50% of hospitals’ total expenses, increased 19% per patient in 2021 compared to 2019.</li> <li>Average hospital drug expenses in 2021 were 37% higher per patient compared to 2019.</li> <li>Medical supply expenses jumped by 21% per patient through the end of 2021 compared to prepandemic levels.</li> </ul> Meanwhile, Medicare and Medicaid, which account for more than 60% of all care provided by hospitals and their caregivers, reimburse less than the cost of providing care. And, their reimbursement rates are virtually non-negotiable. The Medicare Payment Advisory Commission, an independent agency that advises Congress on the Medicare program, found that hospitals experienced a -8.5% margin on Medicare services in 2020, and projects that will fall to -9% in 2022. Combined underpayments from Medicare and Medicaid to hospitals were $100 billion in 2020, up from $76 billion in 2019. Taken together, these financial challenges pose an immediate threat to hospitals’ ability to deliver the care their communities depend on each day. To address these pressing needs and ensure access to care, it is imperative that Congress provide additional support to hospitals and their caregivers. Among other actions, we are urging Congress to: <ul> <li>Halt cuts to Medicare payments to hospitals, health systems and other providers.</li> <li>Prevent the Centers for Medicare &amp; Medicaid Services from moving forward with additional, unnecessary payment cuts that do not reflect the cost of providing care.</li> <li>Extend or make permanent critical waivers that have improved patient care.</li> <li>Extend health coverage subsidies that if not renewed could lead to millions of people losing coverage at the end of the year.</li> <li>Hold commercial health insurers accountable for improper business practices —especially those that take caregivers away from the bedside to deal with burdensome administrative hurdles.</li> </ul> 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. We must make sure hospitals and their caregivers have the resources — today, tomorrow and in the future — as we work to advance health in America. To read more, visit www.aha.org. </div> <div class="col-md-4"> <a href="/system/files/media/file/2022/07/Rising-Costs-Inflation-Threaten-Americas-Hospitals-Pollack-WSJ-Advertorial.pdf" target="_blank" title="Click here to download the wSJ Advertorial Rising Costs, Inflation Threaten America's Hospitals &amp; Health Systems PDF."><img alt="WSJ Advertorial: Rising Costs, Inflation Threaten America's Hospitals &amp; Health Systems" data-entity-type="file" data-entity-uuid="4ce7ab15-7965-46d2-99fd-76801df84e15" src="/sites/default/files/inline-images/Rising-Costs-Inflation-Threaten-Americas-Hospitals-Pollack-WSJ-Advertorial_0.png" width="695" height="900"></a> </div> </div> </div> Fri, 15 Jul 2022 14:15:14 -0500 Opinion / Editorial How to Elevate Diversity, Equity, and Inclusion Work in Your Organization -The Wharton School, University of Pennsylvania /node/681454 This article looks at DEI and how it is valued or unvalued in organizations. It is more common for employees who are attempting to do DEI work to be penalized or disregarded. The article offers a the "MERIT" framework to guide leaders in making their employees feel valued to do the work for DEI. Thu, 06 Jan 2022 15:46:34 -0600 Opinion / Editorial AHA Advertorial: Doing Our Part to Control Costs and Improve Value for Patients /opinion-editorial/2018-07-25-aha-advertorial-doing-our-part-control-costs-and-improve-value The affordability of health care services is one of the biggest concerns facing families, as well as employers and government. However, it is a challenge that hospitals and health systems are tackling head on. Hospitals are making care more affordable in four key ways. Wed, 25 Jul 2018 15:56:41 -0500 Opinion / Editorial