In this episode:

• What is prior authorization and how does the process work in the real-world.
• Startling results of a recent American Medical Association physician survey highlighting the negative impact of prior authorization on patient care:
  • 94% of physicians report that prior authorization delayed access to necessary care for patients;
  • 89% report prior authorization had a negative impact on patient outcomes – sometimes even leading to death. 
• Effects of additional administrative burden prior authorization places on caregivers and hospitals.
• Efforts to pushback against insurers and stop the harmful overuse of the prior authorization process.
•  Impact of new CMS rules aimed at reforming prior authorization and what it could mean for patients.

Guest:
Todd Askew, Senior Vice President of the Advocacy Group for the American Medical Association

In this episode:

• Why non-compete clauses are important in health care setting.
• How proposed rule from Federal Trade Commission (FTC) banning employers from using non-compete clauses on employees could impact patients’ access to care.
• The additional burden new non-compete rule could have on tax-paying systems.
• Effect of FTC’s increased scrutiny on health systems integration.
• Repercussions of slowing integration on access to hospital care in rural areas.

Guest:

Dr. Subbu Ramanarayanan chairs NERA’s Health care Antitrust practice and is an adjunct Associate Professor of Competitive Strategy at UCLA Anderson School of management. Dr. Ramanarayanan has extensive experience advising clients on antitrust reviews of proposed mergers and acquisitions before the Federal (FTC and DOJ) and state antitrust agencies across a variety of settings in health care including hospital services, health insurance, physician services, medical devices, and Healthcare IT services.    

The Federal Trade Commission’s recent activity to end noncompete clauses has potential to cause severe ramifications for health care systems. At the same time, the FTC is taking a dim view of important hospital system integration.

Each of these things can have an immediate and powerful impact on the health care landscape. 

The latest controversial proposed rule – which would ban employers from imposing noncompete clauses on their employees - would make it more difficult for health care systems to staff up while also increasing already high workforce costs --- all potentially effecting access to patient care and available services. 

In this episode:

• What are the prospects of McCarthy Speakership? Functionality of Washington with divided government?   
• Comparing similarities/differences between the House in the late 1990s and now.  
• Discuss Speaker Gingrich’s experience leading a Republican House and how he dealt with health care while balancing the budget and attempting to reform entitlements.  
• Speaker Gingrich’s outlines his vision for the future of American health care.  
• How hospitals can prioritize preventative care and aging. 
• The role hospitals play for the future of health.  
• What policymakers can do to support and elevate health care innovation. 

There are very few people who know more about the House, navigating divided government or developing major budget legislation than former Speaker Newt Gingrich. Chip has known Gingrich for more than 50 years and in this episode, the Speaker shares his perspective and provides deep insight into the current  House majority and looming policy debates – especially when it comes to health care.

In this episode: 

• What is Medicare Advantage (MA)? We examine the roots of this supplementary private health insurance coverage for seniors and its explosive growth, which now includes almost half of all Medicare beneficiaries (more than 28 million people). 
• There are increasing cases of abuse by insurance companies in charge of MA plans. Reports show they are denying and delaying doctor’s requests for necessary – and in some cases lifesaving - care. We discuss how this harms patients and burdens the hospitals caring for them. 
• We dive into how COVID-19 compounded the issues with MA as insurers continued adding barriers to care for seniors during surges. 
• How can we address MA issues? We highlight bipartisan efforts in Congress to fix the problem, like the Improving Senior's Timely Access to care Act. 
• Important to note - not long after our recording - CMS released two separate proposed regulations that address some aspects of prior authorization in Medicare Advantage, as well as Medicaid and ACA private plans. The two rules address some of the challenges highlighted in this podcast and the proposals may help to ameliorate certain of the abuses directly affecting patients that you will hear outlined. The proposed regulations are open for public comment.    

Guest: Sunitha Reddy, MBA, MPH, FACHE Chief Revenue Officer & Vice President, Operations, Prime Healthcare  

Medicare Advantage (MA) is on a growth path to become the dominant part of Medicare in many states across the country. This means that many of our most vulnerable seniors will, on one hand, receive the added benefits and discounts that these plans offer up front, but may find pathways to receive care more difficult than they bargain for – as insurance companies delay or even deny necessary care. Chip speaks to Sunitha Reddy about how this can be more than an inconvenience for patients – it can be harmful. 

In this episode:

• We’ll discuss the major stresses and challenges facing rural hospitals, including geography, patient mix, a growing workforce crisis, and funding shortfalls.  
• Since 2010, 140 rural hospitals have closed, including 25 since the start of the pandemic. Congressional support helped keep that number from being even higher, but what happens now as COVID-19 relief runs out? What’s the impact on a small, rural community when a hospital closes?
• Congress needs to take actions to preserve funding for rural hospitals during Lame Duck session. What will be the impact on access to care if Medicare Dependent Hospital and Low-Volume Hospital programs aren’t extended and lawmakers don’t waive PAYGO?
• How will divided government affect rural hospital policy moving forward in 2023? Is there room for bipartisan compromise? 

Guest: Brock Slabach, Chief Operating Officer, National Rural Health Association.

In this episode:

• The Joint Commission’s role in working to reduce the health care workforce shortage.
• How TJC is addressing health equity moving forward.
• How hospital measurement is used to assure patients that their hospitals are safe and providing quality care. 

Guest: Dr. Jonathan Perlin, M.D., Ph.D., M.S.H.A., M.A.C.P., F.A.C.M.I., President and CEO, The Joint Commission

The Joint Commission is celebrating its 70th anniversary this year; at the helm is Dr. Jon Perlin, previously of HCA Healthcare. Chip talks to Dr. Perlin about his vision for the future of The Joint Commission and the ways the organization can confront issues like social determinants of health and providers impact on climate change.

In this episode: 

• How the Sarah Cannon Cancer Center’s integrated care model allows for high quality patient care close to home. 
• The research being done at Sarah Cannon, including finding the potential cure for sickle cell disease. 
• Hospitals are safe and patients should not put off cancer screenings – they save lives. 

Guest: Dr. Dax Kurbegov, Vice President and Physician-in-Chief of Clinical Programs of the Sarah Cannon Cancer Center 

The Sarah Cannon Cancer Center offers patients the unique opportunity to receive world class cancer care without traveling far from home. Dr. Dax Kurbegov joined Chip to discuss the benefits of the center’s integrated structure for patients, the research they are working on, and the importance of patients being regularly screened for cancer from their providers.  

The overturning of Roe V Wade has far reaching implications for hospitals and health care providers. Hospitals have a duty to care for every patient that walks through their emergency room, however that care may create a gray area that conflicts with new state laws on abortion.

Hospitals are in every community across the country and will continue to care for women with very real and dangerous conditions in need of care.

Tom Barker is a partner at Foley Hoag and focuses his practice on complex federal and state health care legal and regulatory. He was previously General Counsel for the Center for Medicare and Medicaid Services and Acting General Counsel for the Department of Health and Human Services. He joins the conversation today to highlight the critical questions that need to be addressed as the fallout from the SCOTUS decision continues.

Our country is facing a doctor shortage of nearly 124,000 physicians in just 2 years and the impact on patient access could be devastating. The problem is especially acute in economically disadvantaged areas, like California’s Inland Empire which is comprised of San Bernadino and Riverside Counties east of Los Angeles. The Inland Empire is also now the home of the California University of Science and Medicine, a unique institution built on a public private partnership. CUSM was created to promote health equity by training the next generation of caregivers in their own community by the Prime Healthcare Foundation. The school just graduated its very first class of doctors last month and Chip wanted to learn more about the school and the graduates. Joining Chip is Dr. Paul Lyons, President of CUSM and Dean of the school of Medicine.

Then at 18:51 hear our latest Making the Rounds from Paddi Juliano, the Nurse of the Year at Lakewood Ranch Medical Center – a Universal Health Services hospital in Florida. Paddi knew she wanted to be in a helping profession since a young age and dreamed of being a Buffalo, New York Firefighter! She achieved her dream and then transitioned into nursing after moving to Florida.

Tune into hear Paddi tell us her story of caregiving and what her profession means to her.

Hospitals have learned a lot about treating COVID-19 since the world first learned of the novel disease at the end of 2019. Integrated hospital systems worked together to share knowledge and best practices to treat this disease at unprecedented speeds and the advancements continue to come. Out of these advancements is a new normal for our hospitals. Chip spoke with Dr. Michael Cuffe and Prof. Martin McKee about what hospitals are experiencing now and how governments in both the UK and US can support them moving into the future.

Martin McKee is a Professor of European Public Health at the London School of Hygiene and Tropical Medicine and soon-to-be president of the British Medical Association.

Dr. Michael Cuffe is the Executive Vice President and Chief Clinical Officer for HCA Healthcare, the largest integrated health system in the US.