The American Hospital Association on 2024 priorities |

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Today’s edition: A Senate Committee is launching a probe into the assisted-living industry. The Supreme Court will review a case with major implications for federal administrative power. But first …

AHA president: Site-neutral reforms would jeopardize access to care, increase inequities

The new year is in full swing, and health-care advocates are working to get their agendas in front of Congress — with hospitals leading the push.

I spoke with Rick Pollack, president of the American Hospital Association, about legislation in Congress that would affect the nation’s hospitals and what the industry needs from Washington in 2024. This interview has been edited lightly for brevity and clarity.

H202: The AHA has pushed back hard against “site-neutral reforms” proposed in Congress, which would equalize Medicare payments for outpatient services regardless of where they were performed. What is at the core of that opposition?

Pollack: People are looking at this as an option because they want to simply be able to score savings to fund other programs. We have a real problem with that.

For hospital outpatient departments where they want to eliminate this differential, they are often the only access point to many communities. So when you reduce the payment for the services, you're jeopardizing access to vulnerable populations and you can increase inequities.

We’re there 24/7 for anybody that walks through the door. A lot of ambulatory surgery centers, physician offices and urgent care facilities, they only take people who are insured. There are a whole series of things that we do that these other sites don’t that are a part of providing essential public services, but also make us more expensive.

H202: The House approved some site-neutral reforms last year, and in the Senate, both the Democratic and Republican leaders on the Finance Committee have expressed an interest in exploring these policies. Are you in touch with them?

Pollack: Oh, absolutely. There have been cautionary notes sent by a whole bunch of folks. That’s what’s a little bit frustrating about this issue. On the surface when people say site neutral, it’s almost like a bumper-sticker slogan. But when you drill down into all of the substantive reasons that the differential exists, the more people begin to understand the dynamics here. I think there’s still a lot more discussion to come on this.

H202: The Lower Costs, More Transparency Act passed by the House in December also included a provision that would delay billions of dollars in funding cuts to the Medicaid disproportionate share hospital program. The industry is now pushing to get more permanent delays. Where do things stand?

Pollack: We’ve been delaying these payment cuts ever since they were put on the books in the Affordable Care Act. The thinking behind these reductions was that we were going to have much larger coverage as a result of the ACA, but there are still 10 states that haven’t expanded Medicaid, so the rationale doesn’t make any sense.

The other reason that the adjustments exist is the recognition that these safety-net hospitals are getting paid less than the cost of services to care for low-income and uninsured patients. It’s hard to make ends meet, keep your door open and do what we have to in terms of providing care to everybody.

H202: What are some of the AHA’s other priorities for 2024?

Pollack: Going back to Medicaid, the whole issue of the redeterminations process and making sure that folks who lose eligibility are still going to find coverage through other means is an important issue for us.

The issue of the workforce is another very big priority, and there are several dimensions to that. Something we’re working hard to do is push out all kinds of best practices about simply caring for the caregiver and making sure that we’re doing whatever we can to ensure that they are in an environment where their needs are being met. The second piece is the pipeline. Congress has paid some attention to this, but we have big shortages there. We have to not only ensure that training programs are being funded appropriately, but we also need techniques that attract young people to the health professions.

Violence is another concern for us. Unfortunately, patients being violent with hospital staff and other circumstances, like shootings, are a very significant problem. We have bipartisan legislation that has been introduced in the House and Senate that would make it a felony crime to assault a health-care worker, along with other provisions to help hospitals [with] violence prevention and de-escalation training.

[Another issue is] commercial insurance behavior and holding private payers accountable for it. Their pre-authorization requirements create all sorts of problems, and it’s not just about payments. It’s also about the workforce, because when caregivers are forced to call the insurance company to get their prior approval for something that they’ve done so many times, it takes them away from the bedside. It makes them frustrated, and it exacerbates the problems that contribute to burnout.

On the Hill

Senate to examine walkaway deaths in assisted-living facilities

The chairman of the Senate Special Committee on Aging is launching a review of safety lapses in the assisted-living industry, saying an investigation by The Washington Post into the deaths of dementia care residents who have wandered from facilities had revealed “horrific” neglect, my colleague Christopher Rowland reports.

The details: Sen. Bob Casey (D-Pa.) sent letters yesterday to the CEOs of the country’s largest assisted-living chain operators — Brookdale, Atria and Sunrise — asking for an account of how many walkway incidents have occurred in their facilities and how families are informed of “falls, injuries, elopements, violent interactions with other residents, etc.” He noted that The Post documented seven such deaths in his state.

The committee also inquired about how the companies set staffing levels and what percentage of their facilities meet those targets. Additionally, they asked how costs are communicated to residents and families, including add-on charges as people get older and sicker.

Next steps: A hearing set for Jan. 25 will be the committee’s most substantive review of the assisted-living industry in more than 20 years, according to Casey.

“You have a set of cascading crises: the staffing problem, the oversight problem, a lack of information the family members need and, at a fundamental level, you have the quality of care problem,” Casey said. At the hearing, committee members will discuss what steps the federal government needs to take to improve those conditions, he added.

Sen. Bob Casey (D-Pa.):

Assisted living facilities are supposed to ensure the safety of their residents. The cascading crises uncovered by the @WashingtonPost show that these facilities are violating the trust of seniors and their families. That’s why I’m seeking answers. https://t.co/mDRqKgoUmT

— Senator Bob Casey (@SenBobCasey) January 16, 2024

In other news from Capitol Hill …

Sen. Chuck Grassley (R-Iowa) has been hospitalized in Washington to receive treatment for an infection, The Post’s Azi Paybarah reports.

The eight-term senator, who is receiving antibiotic infusions, “is in good spirits and will return to work as soon as possible following doctors’ orders,” his office said in a statement. He is expected to make a full recovery.

Key context: At 90, Grassley is the oldest member of the Senate. Last year, he underwent surgery for a fractured hip and returned to the Senate a few weeks later using a wheelchair.

Sen. Katie Britt (R-Ala.):

Please join Wesley and me in praying for a speedy recovery for Senator @ChuckGrassley. I look forward to seeing him back on the Senate floor very soon.

— Senator Katie Boyd Britt (@SenKatieBritt) January 16, 2024

In the courts

Agency power at risk at the Supreme Court

On tap today: The Supreme Court will hear oral arguments in a pair of cases that could reel in the regulatory authority of federal agencies and make it harder to implement laws that Congress has passed.

The issue comes to the justices from a group of commercial fishing companies and could overturn the Chevron doctrine, a nearly 40-year-old legal framework that directs judges to defer to federal agencies when interpreting ambiguous federal laws.

Why it matters: Reversing Chevron could have vast implications for publicly funded health insurance programs such as Medicare and Medicaid and impact how agencies pay for drugs and regulate nursing homes, a coalition of public health organizations argued in a friend-of-the-court brief. The move would also probably reopen a flood of litigation that the statute previously resolved, they added.

Both lawsuits are backed by conservative legal groups who contend that Chevron handed unaccountable bureaucrats too much power. The lawsuits ask the justices to reconsider the framework, arguing it violates the Constitution’s due process clause by requiring courts to show deference to one of the parties in a case.

Reproductive wars

Becerra kick-starts reproductive health-care series

On tap today: Health and Human Services Secretary Xavier Becerra will join congressional Democrats on Capitol Hill to launch a reproductive health-care series ahead of the anniversary of Roe v. Wade next week, The Hill’s Joseph Choi reports.

Senate Majority Leader Charles E. Schumer (N.Y.) and Sen. Patty Murray (Wash.) are among the prominent Democrats slated to appear alongside Becerra at a briefing this morning on the state of abortion rights across the country.

On Thursday, the secretary will travel to Richmond to participate in a conversation with community members at the Planned Parenthood East End Clinic. Becerra will then head to Pennsylvania and Maryland on Friday to speak with students at Lincoln University and the University of Maryland at Baltimore.

HHS Secretary Xavier Becerra:

Ahead of next week's Roe v. Wade anniversary, I’m traveling through three states to hear directly from women, advocates, and health care professionals who have seen firsthand how access to reproductive and contraceptive care is impacted by where they live. https://t.co/eTmNSsrRPj

— Secretary Xavier Becerra (@SecBecerra) January 16, 2024

Meanwhile, Republicans are moving pregnancy-related bills …

House Republicans are planning votes on two measures tied to federal resources for pregnant people ahead of the annual March for Life on Saturday, Sandhya Raman reports for Roll Call.

The first measure the lower chamber will consider would prohibit HHS from limiting federal money for facilities that discourage people from having abortions. The second bill aims to increase protections and resources for college or university students who carry a pregnancy to term.

On our radar: The House is slated to vote on the funding bill tomorrow, and the education bill Friday. But don’t expect either piece of legislation to go anywhere in the Democratic-controlled Senate.