What hospitals hope to see from Washington in 2023

Hospitals secured some key wins in the $1.7 trillion federal spending package President Biden signed just after Christmas, but they didn’t quite get all that they were seeking.

Now, healthcare leaders are dealing with a new Congress.

While Democrats maintained control of the Senate, Republicans regained a majority in the House of Representatives, albeit by a much smaller measure than some political analysts predicted.

Kevin McCarthy’s turbulent, tortured process to eventually become House Speaker highlighted tensions among House Republicans. House Republicans have talked about curbing spending on domestic programs, and Biden’s battle with House Republicans over raising the debt limit underscores the bitter partisan divide in Washington.

In this environment, hospitals and health systems will be pushing Congress and the Biden administration for funding and some legislative priorities.

Lisa Kidder Hrobsky, the American Hospital Association’s senior vice president of advocacy and political affairs, spoke Thursday with Chief Healthcare Executive about what hospitals hope to see, and what they hope to avoid.

Medicare cuts

Some House Republicans are pushing for reductions in federal spending, and healthcare leaders are concerned about cuts to entitlement programs, including Medicare.

“For the provider community, we do worry about that,” Kidder Hrobsky said.

While McCarthy has said Republicans will protect Medicare and Social Security, some conservative House members are pushing to reduce spending, and some are worried Medicare would be a target for cuts.

Health leaders are also concerned about cuts in Medicare payments to doctors. Healthcare groups managed to avoid steeper Medicare reductions in physician payments in the omnibus spending package approved in December, but the package still included cuts in payments for doctors.

The Medicare Payment Advisory Commission has proposed a modest increase in Medicare payments to doctors and hospitals, but health systems and physicians said they would like a bigger bump.

Still, the bigger concern remains broader cuts to Medicare or Medicaid, which would have far-reaching consequences. “We’re hoping they don’t look at entitlements,” Kidder Hrobsky said.

COVID-19 relief

The federal government provided federal aid to hospitals to help offset their added expenses in the COVID-19 pandemic, but that funding has dried up. While grateful for the help earlier in the pandemic, hospital leaders have said they are disappointed that the government didn’t provide additional relief to help with the waves of patients during the Delta and Omicron variants.

The outlook for additional COVID-19 relief funding isn’t promising, Kidder Hrobsky said.

“I think it’s a tall ask,” she said.

The association will look to pursue other levers to give hospitals some assistance.

Helping urban hospitals

Some hospitals were disappointed that the omnibus package didn’t include any money directed to safety-net hospitals. But Kidder Hrobsky said the hospital association is working with Congress to get some help.

The AHA has called for a special federal designation for “Metropolitan Anchor Hospitals,” which serve a large number of patients with lower incomes who rely on Medicaid. The group has proposed the designation for about 465 hospitals, or about one in eight urban hospitals. It could also be extended to other hospitals that states deem as necessary providers.

The AHA is developing legislative language and has been talking to key players on Capitol Hill about developing such a program to help hospitals that provide such a critical role in their communities. She said she’s been encouraged by the response among members of Congress.

“We were quite pleased to see there was a lot of receptivity,” she said.

Boarding assistance

Hospital leaders said they have been keeping some patients that are ready to be discharged because nursing homes and other post-acute care facilities have had a lack of beds, due to staffing shortages. Hospitals are also running into similar hassles in transferring patients to behavioral health facilities.

Health systems said housing those patients is adding to their considerable financial headaches.

“We’re trying to figure out if there’s a way to pay these hospitals appropriately. That definitely is something we are looking at,” Kidder Hrobsky said.

Hospitals discussed the problem with lawmakers in recent months, and they have expressed some interest in providing relief, she said.

Protecting healthcare workers

Doctors, nurses, and other healthcare workers have been facing more and more violence in hospitals, and they have been pushing lawmakers for action.

Health advocates have said healthcare workers should get federal protections similar to those for airline employees. U.S. Reps. Madeleine Dean, a Pennsylvania Democrat and Larry Bucshon, an Indiana Republican, sponsored a bill last year that would have imposed tougher penalties on those who attack healthcare workers, but it didn’t get through Congress.

“That’s one that befuddled me, that it didn’t gain more action,” Kidder Hrobsky said.

Hospitals will push lawmakers to offer greater protections for workers and for grants to reduce violence, she said.

Given the attacks many doctors and nurses have suffered, she said, “It’s an issue that really is front and center.”

Prior authorization

Doctors and hospitals have long assailed prior authorization as a roadblock to healthcare. In the prior authorization process, doctors must get insurers to sign off on treatments and procedures, and providers say the process is onerous and hurts patients by delaying care. Conversely, payers say the process curbs excessive costs and unnecessary treatments.

Hospitals are hoping that some reform could be coming.

“We have our fingers crossed,” Kidder Hrobsky said.

“There is a lot of enthusiasm on this issue, on the Republican and Democratic side, which is helpful.”

The House of Representatives passed a bill that would have streamlined prior authorization in Medicare Advantage programs. The measure had some Senate support, but it was not included in the final omnibus spending package.

The Centers for Medicare and Medicaid Services proposed a new rule in December that is aimed at revamping prior authorization, and providers have said it would make some much-needed improvements. But hospitals would also welcome some legislative fixes.

340B Program

With a new Congress, there’s speculation that some Republican lawmakers may be interested in looking at changes to the 340B drug pricing program.

Under the program, hospitals can purchase some medications at a discounted rate if they serve a high number of patients from vulnerable communities. Hospitals say the program is critical in providing services in urban and rural areas, but critics say the program has grown far beyond its intended purpose. Some drug companies have also reduced their discounts in the program.

The 340B program has plenty of supporters, and hospitals will be ready to fight for it, Kidder Hrobsky said.

“The program is an important safety net for hospitals,” she said, adding, “We’re happy to talk about the program and what it means for hospitals and health systems.”

Hospitals won a Supreme Court case last year over reductions in Medicare payments under the program, but they are still waiting for the Biden administration to devise a remedy.