NASHVILLE, Tenn. (March 1, 2022) – This week the Nashville Health Care Council and a panel of experts from major health care industry trade groups examined the current state of health policy, the impact of the Biden administration and COVID-19, and the future of health care.
The conversation was moderated by Melinda Buntin, PhD, Mike Curb professor and chair of the Department of Health Policy at Vanderbilt University School of Medicine, and included Matt Eyles, president and CEO, AHIP; Chip Kahn, president and CEO, Federation of American Hospitals; and Tom Leary, senior vice president and head of government relations, HIMSS.
Reflecting on the last two years of COVID-19, Buntin asked the panel to consider how the perspective of health care consumers has changed regarding technology and digital care delivery, and the impact on policy. Leary said consumer expectations are “sky high right now” and patients want technology to support their care.
“At the height of the pandemic, we saw a dramatic increase in telehealth. In 2021 and 2022, we’re realizing access to care, remote patient monitoring and being able to see their own data are consumer expectations,” he explained. “We want to help providers continue offering that service.”
Eyles added that despite consumers’ continued requests for telehealth, there is not enough Medicare patient data available to say telehealth is budget neutral or a viable long-term offering. “We now have millions of Medicare patients who utilize telehealth and in-person care, but the first draft of CMS regulation is going back to pre-pandemic approaches in which you need 20 of 30 days of monitoring by a provider to be reimbursed,” he said. “Our biggest concern is that providers will have to relearn unnecessary approaches when they know access to care is available with this technology. We think it’s just absurd.”
While on the topic of care access and expectations, Buntin segued to extremely acute health care workforce challenges. Kahn believes there is unfortunately no “magic bullet” to relieve the staffing strain.
“At the end of the day, health care is a people business,” he said. “COVID-19 hit and caused hero fatigue, early retirement and an overall exhausted workforce. The cost of keeping staff has increased significantly and we’re also seeing pressure from unions. At the same time, it takes a while to train new nurses. Right now I don’t have a good answer to get out of this – I can’t visualize how the government or any entity could make magic happen.”
As the conversation steered toward the No Surprises Act, the panelists disagreed about the impact on health care consumers. “The administration misinterpreted the law and the language they chose is weighted toward insurers,” Kahn stated. “The dilemma is this makes surprise billing an existential issue for providers. The entire negotiation system for hospitals could be affected and this is tremendous leverage for insurers. Ultimately it could undermine us having funds for patient care.”
Eyles believes the regulation is a benefit for patients. “California implemented a surprise billing law that is administered much like the federal law with a benchmark payment, and we’ve seen network participation has increased over time. There is no decline in networks or participation,” he said. “We hope [the regulation] is implemented and finalized in May.”
Looking to the future beyond the pandemic, the panelists predicted the most significant policy issues affecting their sectors. Leary prioritized health equity and how technology can advance access to available and affordable care, specifically considering two subcomponents: modernizing the “woefully inadequate” public health infrastructure and maintaining health care data security and privacy. According to Leary, the health care industry is the most cyber-attacked economic sector, per the Federal Bureau of Investigation.
Eyles echoed Leary’s sentiment about the critical importance of health equity, stating that achieving equitable care is a multifaceted process. He is paying close attention to the federal standards around data collection, demographics and social determinants of health. “There is no uniform way to collect this information. And whose responsibility is it to collect it? The provider or health plan?” Eyles said. “It’s also important to consider what states are doing. What we’ve tried to do is focus on vaccine equity and helping socially vulnerable populations get vaccinated. If health plans have data, they can perform targeted outreach to say ‘Because of your condition, you could really use a booster. Let us help you get an appointment.’ But because states control that information and don’t share it with health plans, there is a huge gap to address vaccine hesitancy.”
At the federal level, Leary reports the administration is reviewing existing regulations and proposing RFIs for technology to support health equity. “You can’t have quality data if you’re still collecting it with paper and fax machines. That’s the baseline.” He added that his current equity focus is on immunization and maternal health. “Fifty percent to 80% of pregnancy-associated deaths are preventable. That’s unacceptable, and we need to invest in the education, workforce and interoperable technology to support this. How do we refine maternal health data standards and technology designed by a bunch of men 10 years ago? There were few women’s voices in those conversations, and we’re changing that now.”
Following the pandemic, Kahn believes health care will once again face the “hydraulic issue of hospital finance.” He expects hospitals to face financial challenges stemming from the No Surprises Act; dramatic growth in Medicare; Medicare and Medicaid constraint; value-based purchasing; and changes in the inpatient and outpatient service mix.