CEO Power Panel: Pressure builds on Congress to act as COVID-19 spikes again

Facing a potentially divided government, Congress and the incoming Biden administration will have to table any ambitious and disruptive plans for health reform in exchange for more moderate approaches. And that may not be a bad thing, according to respondents to Modern Healthcare’s most recent Power Panel survey.

CEOs responding to the survey—conducted the week following the Nov. 3 election—were split roughly 60%-40% as to whether a potentially divided government would help or hurt their organizations. Congress’ final makeup won’t be known until after results are tallied for the Jan. 5 runoff election for both of Georgia’s Senate seats. As things stand now, Republicans have 50 seats in the upper chamber and the Democratic caucus—this includes two independents—has 48.

“If you have a divided Congress once again, it leads to more moderate policy, with no extreme policy to the left or to the right,” said Warner Thomas, CEO of Ochsner Health. “Hopefully in a situation with a Republican Senate and a Democratic House we can have healthcare policy results that are favorable and moderate.”

One area where healthcare executives are united though, is in wanting Congress to do more to address the COVID-19 pandemic. Randy Oostra, CEO of Toledo, Ohio-based ProMedica, said he’s optimistic that a rise in coronavirus cases will prompt lawmakers to act even with a divided legislative branch.

“Out of what has happened, maybe they can put partisanship aside to find a path forward. It’s time for Congress to lead on this issue,” Oostra said.

Congress has floundered for months trying to pass another major COVID-19 stimulus bill, but healthcare executives overwhelmingly want lawmakers to move forward with more relief. The last major COVID-19 bill passed in April.

Out of all the priorities healthcare providers have asked Congress to address, the Power Panel’s top four issues were funding for COVID-19 testing and tracing; money for vaccine development and distribution; liability protections for healthcare providers; and an extended suspension of the Medicare sequester.

COVID-19 cases across the country are spiking again, and executives said healthcare workforces are burned out. They are hoping that an investment in public health priorities can mitigate the pandemic and demands on their workforce.

Cathy Jacobson, CEO of Milwaukee-based Froedtert Health, said Wisconsin’s coronavirus spike has decimated staff numbers while simultaneously increasing the need to man community testing sites. Froedtert had more than 200 COVID-19 inpatients as of mid-November, and Jacobson said they had “hundreds” of staff out on any given day.

“We think testing and tracing have not been managed well,” Jacobson said. “We have to alleviate what is hitting our hospitals from the back end.”

Oostra said repeated waves of COVID-19 have caused attrition among experienced staff across the industry, while the constant pressure has led to burnout.

The American Hospital Association doesn’t collect data on how many workers are leaving the field—and doesn’t plan to add that burden on providers during a pandemic, but the association has heard anecdotal reports from health systems across the country that people are retiring early or looking for healthcare jobs that don’t involve caring for hospitalized patients, Nancy Foster, AHA’s vice president of quality and patient safety policy, told Modern Healthcare in late November.

Louisiana was an early COVID-19 hot spot, but Thomas said he is seeing similar trends of burnout among staff. “If you’re a front-line clinical worker supporting clinical operations it has been a challenging year, and there is no immediate end in sight,” Thomas said.

Thomas praised the Trump administration’s Operation Warp Speed investments in developing vaccines and building a distribution infrastructure, but said a new stimulus package is “crucial” to supporting a broader vaccination process.

As state budgets are squeezed next year due to the prolonged economic downturn, nearly all the Power Panel executives were somewhat or very worried that their state could cut provider pay rates to balance the budget.

Medicaid is usually a large line item in state budgets, and some states have already moved forward with cuts. For hospitals and health systems, that could mean another financial hit after having to cut back on elective procedures throughout 2020.

Jacobson said Wisconsin hospitals have already been working with state lawmakers to head off cuts.

“Medicaid payments are wholly inadequate as a baseline, so if you’re starting with that, any less is fully inadequate,” Jacobson said.

Oostra said beyond hospitals and health systems, senior care would be particularly hard-hit by provider pay cuts, which would create a convergence of increased regulations and lower reimbursement rates.

“There have been a lot more costs and a reduction in revenue because of COVID, and a loss of surgeries and spending. If you add in another funding cut, we are very, very concerned about it,” Oostra said.

A new COVID-19 stimulus package that includes aid to state and local governments or increased federal Medicaid matching funding could also mitigate future cuts. More state and local aid has been a priority for Democrats, but Republicans have balked.

One policy that will affect hospitals and health systems before Inauguration Day is the implementation of new hospital price transparency requirements. The policy is set to be implemented on Jan. 1, and the Trump administration has said it’s not planning a delay.

Respondents largely indicated they have begun preparing to disclose the required information, though a third said they would likely be ready to comply after Jan. 1.

However, nearly all Power Panel participants said the transparency rule is the top issue they are watching as it makes its way through the court system. The U.S. Court of Appeals for the District of Columbia Circuit heard oral arguments in the case in October, and the three-judge panel appeared skeptical of hospitals’ arguments against the rule.