Becker's Hospital Review

82 THOUGHT LEADERSHIP America's Essential Hospitals CEO Dr. Bruce Siegel on Healthcare Reform, Proposed Medicaid DSH Payment Cuts and the Safety Net By Kelly Gooch A s Ameri- cans con- tinue to debate healthcare, many issues come into play, such as potential changes to the ACA and proposed cuts to Medicaid Dispro- portionate Share Hospital allot- ments under the current health law. In recent months, federal Republican lawmak- ers have made continued healthcare reform ef- forts. e House passed the American Health Care Act to repeal and replace the ACA in May. en the Senate took up repeal and re- place legislation, called the Better Care Recon- ciliation Act. However, those efforts failed in July. Senate attempts at a straight repeal of ma- jor portions of the ACA without a replacement also failed, as did efforts for a "skinny" repeal bill. Moving forward, the future of healthcare reform is uncertain. In addition to healthcare reform efforts, CMS issued a proposed rule that includes a meth- odology for implementing Medicaid DSH payment cuts. e payments, which help compensate hospitals that provide care to a large number of poor and uninsured patients, would be cut by $43 billion by fiscal year 2025. America's Essential Hospitals President and CEO Bruce Siegel, MD, recently spoke to Becker's Hospital Review about these issues and other issues facing safety-net hospitals. Question: How will healthcare reform affect safety-net hospitals, regardless of what Congress does? Dr. Bruce Siegel: Nothing good is going to come with everything we've seen so far. Ev- ery bill has been an assault on the safety net. We have seen proposed policies that included per capita caps that gut Medicaid, rolling back expansion, undermining the exchanges. All of that is going to rip apart the safety net, and lawmakers have done little to address other is- sues like the looming Medicaid DSH cuts. One of the problems is lawmakers have gone far be- yond simply going to roll back the ACA. Per capita caps have nothing to do with the ACA. Per capita caps are simply a long-term objec- tive of some folks in Congress, and they're us- ing this opportunity to try to jam it through. Additionally, looking at what happened last week, for instance, we're watching 100 sen- ators throw spaghetti at the wall and try- ing to see what sticks. We're talking about revamping one-sixth of the U.S. economy and possibly taking away health insurance from 16 million to 32 million people, and it was done in utter chaos. We literally did not know from hour to hour what is going to be voted on in Congress. I've been in health policy for 30 years and I have never seen anything like this. Q: How would Medicaid DSH cuts af- fect safety-net hospitals? BS: Medicaid DSH cuts would have impli- cations for most Americans. It's not sim- ply about the safety net. So when we look at Medicaid DSH, it's supporting hospitals that do things no one else does — that's what we mean by essential hospitals. So the payments support hospitals that pro- vide the only Level I trauma center, they support hospitals that provide the only burn unit in the community, they support hospitals that are the first line of response to emergencies like Ebola or Zika virus or a mass-casualty event. We need to realize that entire communities depend on the spe- cial services that Medicaid DSH helps sup- port. Those services are not covered in reg- ular insurance payments or Medicaid. DSH allows that higher level. It's about more than just poor people. It's about the health and well-being of hundreds of millions of Americans. Q: What are the equity and disparity issues affecting safety-net hospitals? BS: e ACA has been the biggest tool we've had to close disparities. e ACA had a big impact on equity by covering millions of Americans who are poor, Latino, black or other minorities. e ACA had a huge im- pact on economic equity and on equity be- tween races and ethnic groups. It really tries to level the playing field, and rolling that back will reopen disparities in this country. So they're linked issues. We saw for people who make less than $25,000 a year a huge increase in coverage. e good news is hospitals and health sys- tems are really confronting disparities in their communities. ey are asking hard questions about the care they provide. Hos- pitals are trying to make sure they're part of the solution to the disparities and not part of the problem. at's really good news. I think the challenge we've had is: How do we go beyond the four walls of the hospi- tal? What is the hospital's role more broadly in the community? We know most of what drives disparities and health outcomes is rooted in where people live, their housing, the availability of healthy food. ose are some of the demographic drivers of dispar- ities. We're now at the very early stages of defining the hospital's role in painting the picture. Around the country I see health leaders grappling with this conundrum, and nobody has the magic formula. One of the things I hear a lot of leaders talking about is the anchor hospital in their community. ese institutions are the biggest caregivers, but they're also the biggest economic en- gines. ey're the major employer. ey're the major purchaser. ey have the biggest footprint. ey affect the fabric of the com- munity profoundly. One of the reasons I'm so worried about repeal and replace and the Medicaid DSH cuts is those things will make it impossible for hospitals to fulfill these things. We'll be fighting fires rather than promoting health. We're at the early stages. We don't really know what works yet. We have a grant from the Robert Wood Johnson Foundation that is helping us create a learning community of essential hospitals to address social de- terminants of health and address population health. So this is a top priority for us as an association. Our hospitals are oen the an- chor in the community. ey have a mission of service, so we are taking this on as a top priority, but with that said, I think many hospitals are thinking about this, and I think every hospital in the country has a role to play here. n

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