Policy wish list
QWhat tops your wish list on the regulatory and policy front?
Bonick: The Statutory Pay-As-You-Go Act reductions are a looming threat, given the state of the economy for many health systems across the country. We need to solve that once and for all. Sequestration is another cut. And the net impact of inflation is real. It’s baked into our wages, it’s baked into our supply costs, but the payments are not keeping up. If we don’t have legislative relief—and we know there are no additional bailouts coming as a result of the pandemic—we have structural ways the payment systems can be addressed to take some of those threats and pressures away from hospitals.
Surprise billing has been an issue that is continuing to challenge the industry. I don’t think anybody in the industry believes that patients should be put in the middle of these disputes between payers and providers. However, the legislation that was passed and the rules that were enacted are incongruent with each other and greatly favor the payers in these negotiations.
One, we can’t get disputes through the system because of the backlog. Two, we have payers that are actively finding ways to reduce the median rates by putting emergency room codes and anesthesia codes into primary care practices. We’ve got to get some tighter rules and regulations around the intent of this legislation and get away from the inadvertent consequences that it’s caused.
Pullin: Because of the demand on hospital beds, many of us have been flirting with the thought of hospital-at-home. And then when CMS made it easier for us to do, we really did accelerate and now have a thriving program. But we also still need those policymakers to make this a sustainable, long-term avenue to take care of patients.
From the graduate medical education perspective, how do we get our policymakers to expand residency slots? How do we make multistate licensure easier to do as we talk about telemedicine? Sometimes it can take four months for a clinician to get their license, so we have to become more assertive with our policymakers to help us do those types of things.
The pandemic also showed us that people are willing, interested and many prefer to have a healthcare experience remotely. We now see our physicians are more inclined to participate in a telemedicine experience.
The models and platforms that we embrace so dearly, we’ve been doing the same way for the last 50 or 60 years. It is time for us to be disrupted. Those of us responsible for taking care of our communities should drive that disruption. And I think if we have the support, from a policy perspective, it will allow that to happen faster.
Davidson: The first request based on our payer mix is increased reimbursement for Medicaid and Medicare beneficiaries. Again, I mentioned that we are trying to absorb the inflationary impact for what we’re seeing [with] our medical supplies, pharmacy supplies, labor, but we’re not able to based on the fixed reimbursement that we’re receiving today. It is unsustainable going forward. We need someone to listen to us and recognize that if the reimbursement levels are not adjusted, we will have to address closing some of our clinical programs. Today, we have patients driving an hour to two hours to [get to] a primary care clinic, or three hours to get to specialty care like cancer services or neurosurgery services. If we’re required to pull back or reduce the size of those programs because we can’t afford to operate them, it will create delays in care. Patients will have to wait longer to be seen by a doctor or that specific specialist. They’ll have to drive farther in a rural setting.
Asking our caregivers to do more with less is becoming problematic. They’re tired. The last thing we want them to do is leave healthcare
n entirely and work in another industry.