Latest / Becker’s Healthcare Podcast / Capital Hill, Payers, & the Future of Reimbursement in Healthcare

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Capital Hill, Payers, & the Future of Reimbursement in Healthcare · Becker’s Healthcare Podcast

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Hello everyone. This is Erica Spicer Mason with
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Becker's Healthcare. Thank you so much for tuning
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into the Becker's Healthcare Podcast Series.
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So today we're going to talk about Capitol
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Hill, Payers and the Future of Reimbursement
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in Healthcare.
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And I'm excited to welcome for this discussion,
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Patrick Veliki to the podcast.
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Patrick is the Chief External Affairs Officer at
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Halo MD and has spent more than a
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decade in the healthcare advocacy space with a
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deep understanding of healthcare policy.
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He's also spent time in Washington DC supporting
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congressional representatives and their offices.
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Patrick, it's so great to have you with
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us at Becker's today. Thank you so much
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for being here. Hey, Erica. Nice to be
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here. Patrick, it's we're so happy to have
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you with us today, and I'm glad that
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we have you to help us break down
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some of the policies and really the broader
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discussions that we're seeing in the payer and
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reimbursement space right now.
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So to kind of set the stage,
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what stood out to you most in recent
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testimonies on Capitol Hill, and what do those
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statements tell us about how payers are thinking
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about reimbursement at the moment?
1:03
Yeah. Thanks, Erica.
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Yeah, you know, there's a whole lot of
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attention right now on the health insurance industry
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and affordability.
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To your to your point, there were two
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hearings, very high profile,
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within the last couple of weeks,
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on on the house side of the capital,
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both energy and commerce and and ways means
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had, several health plan CEOs,
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in front of them to talk about issues
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facing health insurance industry and and affordability
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for, you know, for Americans.
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I think chairman Smith really did a a
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great job on the ways and means committee,
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teeing up some concerns that really resonate with,
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I think, a lot of Americans.
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He really opened by
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identifying
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the degree of of consolidation,
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both vertically and horizontally,
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that has been occurring
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within the insurance space,
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and, really called out the fact that the
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vast majority of,
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the large insurers that were there,
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are not just insurance companies anymore. They are
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also
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pharmacies and pharmacy benefit managers and and even,
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physician practices.
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And I think it's fair,
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to ask whether,
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the increasing,
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role that that insurance plays in the delivery
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process
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is what we really want within our health
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care system.
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So I I thought that was really helpful
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framing,
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for the broader sort of,
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analysis of of the insurance market and where
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congress is is heading in that space.
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And then even more specifically,
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some of the the plan,
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testimony and and,
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prioritization around their message.
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Frankly, I I think we're still seeing a
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lot of deflection
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in that space. And one thing that really
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stood out to me,
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at least as it relates to the No
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Surprises Act, which happens to be my my
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forte,
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was,
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the kind of return to
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claims on the payer side related to,
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the volume of disputes in the NSA's IDR
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process.
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There's this debunked notion
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that,
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the the
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IDR process was only ever designed for 17,000
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annual disputes
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and that the volume we've seen,
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is,
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indicative of of a need for reform.
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To hear insurers
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kinda tout out that,
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very
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outdated and and, like I said, debunked
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talking point around volume
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is, I think, indicative of,
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some of that deflection that I I don't
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think resonates
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with policymakers,
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or with the American people.
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And and and hopeful there's some further opportunity
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to
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instead get to accountability and and improvements
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in in the system.
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Yeah.
3:53
Patrick, such a helpful overview. I appreciate it.
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And when we, you know, you mentioned some
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of these talking points around,
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affordability,
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also consolidation,
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volume of disputes, really this need for reform.
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As you think about all of those areas
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that were addressed in Capitol Hill, how should
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health care organizations really interpret this? In other
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words, what does it mean for health care
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leaders right now?
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Yeah. I I think it it actually signifies
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an opportunity for education,
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among health care leaders.
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What is
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so great about
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health care, especially, you know, physician and and
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and hospital leaders
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when they do
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become motivated to to get involved in advocacy
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and and policy improvement
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is the significant amount of credibility that they
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bring with them to those conversations.
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I think there's often a reluctance among health
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care leaders to, you know, bother getting involved
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in,
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in policy conversations
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because it feels like such an insurmountable task
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to actually influence outcomes.
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But I I think
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if folks understand,
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how valuable their opinions actually are and,
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again, the inherent credibility that comes with the
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fact that they are actually
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directly providing care for the constituents of of
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policymakers,
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I I think
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yeah. Exactly to your question. What this what
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this should demonstrate
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to health care leaders
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is,
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that there is a real opportunity
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to engage
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and start working to improve the policy landscape.
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Yeah.
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Thank you so much, Patrick. And it's interesting
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to hear,
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you know, from where you sit, you're you're
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hearing perspectives from the provider side,
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testimonies of the payer side,
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policymakers and kind of this general sentiment of
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the American people as well.
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But when we when payers speak publicly about
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things like rising costs and utilization,
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from where you sit, how closely does that
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align with what providers are experiencing on the
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ground?
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Yeah. I think that's
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that's maybe the the
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primary question here. Right? It it it demonstrates,
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in my mind,
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the real disconnect between
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rhetoric and reality.
6:09
The reality on the ground for physicians and
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and facilities
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is that
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most of them continue to face an erosion
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of
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rate and reimbursement and sustainable,
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financial situations.
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Every year, more and more hospitals
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are placed on on the distressed list,
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operating on razor thin margins.
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When you know, to hear the the payers
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tell it,
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they're framing themselves as defenders of FISC. But
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for providers, they're
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seeing challenges
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in keeping facilities staffed
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and a growing,
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crush of administrative
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burden
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that forces them to spend even less time
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actually delivering care,
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and instead
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turn physicians into, you know, bureaucrats.
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I I've never met a physician who got
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into medicine
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because they were excited about filling out paperwork
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or sitting on the phone trying to get
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prior auth approved, but more and more, that's
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that's where they're spending their time.
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So
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there's a real disconnect there in what plans
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claim to be attempting to accomplish
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and what
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physicians are are actually feeling on the ground.
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And we've gotta we've gotta cut through that
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and
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figure out how to ensure
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physicians can can do what they got into
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medicine to do, actually provide care
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without
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having to,
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worry about keeping the lights on.
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Yeah. Yeah. Absolutely.
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It's so important, this disconnect between rhetoric and
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reality as as you've highlighted and as you've
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stated.
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And equally important, I know, are
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helping providers
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and health care organizations understand opportunities ahead at
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the same time to address that disconnect. So
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from a legislative perspective,
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what are some of the ideas or proposals
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that you think have really big potential to
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reshape
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reimbursement models and challenges over the next few
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years?
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So staying within the NSA for for some
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minute because, again, it it's just it's
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what I, you know, really know well. There
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is opportunity
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from both legislative and regulatory perspective,
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to improve,
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the NSA's ability and and the IDR processes'
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ability to
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really ensure
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physicians are are getting those sustainable
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rates of of reimbursement.
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I think congress has already demonstrated a willingness
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to to look at this issue.
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You know, you had, congresswoman Houchin on the
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Energy and Commerce Committee,
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raise an issue that E and C and
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Waze and Means have both looked at,
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when she asked a question of of Gail
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Boudreaux, CEO of of Elevance,
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about concerns being raised by physicians and hospitals
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about timely payment of arbitration awards.
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That's something that,
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the committees have have really spent significant amount
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of of hearing time on examining, hey.
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Why is the rate of timely payment
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after the No Surprises Act's arbitration process
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so abysmal?
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Why can't insurers
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seem to figure out how to pay in
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a timely manner,
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after, you know, an independent third party,
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says that they they need to?
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There's legislation that's pending
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related to to that as well as shoring
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up the patient protections,
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bicameral, bipartisan,
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introduced in the house by, congressmen Murphy and
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and Panetta in the senate by Marshall and
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and Bennett, the No Surprises Act Enforcement Act.
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And it it would create,
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penalties and and interest for failure to pay
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timely on arbitration awards. But even more importantly,
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would create parity in the penalty structure,
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for,
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violations of the actual patient protections.
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You know, one thing that, I I know
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congressman Murphy congressman Murphy has talked about in
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the past
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is there's lots of evidence around payer noncompliance
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with
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the actual
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sort of core of the No Surprise Act.
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You know, it was it was passed in
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order to ensure patients
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were only held accountable to their in network
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cost sharing.
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And there's a
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a long, long list of examples where payers
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have not provided that protection, where they've,
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treated
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protected claims as as though they were, you
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know, subject to the the rules that existed
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prior to No Surprises Act.
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So I think it's it's
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worth noting that that is the only piece
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of legislation related to No Surprises Act that's
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pending.
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So, you know, the real legislative opportunity here
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is when it comes to those prize act,
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if congress is interested in doing anything at
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all, it's in ensuring that what they passed
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in the first place
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actually goes into effect.
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Right? Actually enforcing
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those patient protections and the expectation that payment
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is made and made timely
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once the RDR our process is is utilized.
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So I I think there's good reason for
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optimism on the legislative side,
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and I think that proposal really has
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a a huge potential
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to get the NSA working and the IDR
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process working in the way that was was
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always intended.
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Yeah. Patrick, it's great to hear,
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some of these comments around optimism, around legislation,
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especially the no surprises act. And,
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you know, I know the policy landscape also
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changes frequently, and it's, of course, challenging for
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health care organizations
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of any kind to keep up. So as
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you look ahead, I'd love to know a
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little bit more about the role that organizations
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like HaloMD
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can play in helping providers navigate this reimbursement
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uncertainty,
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especially as legislative pressures and payer scrutiny are
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continuing to intensify?
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Yeah. I think, look, at at the end
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of the day, the the real
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hope here is that,
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organizations like the KLMD,
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can allow physicians
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to focus a whole lot less on some
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of those administrative
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burdens
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and,
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get back to actually delivering care.
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Most, especially independent medical groups,
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don't have the administrative back end to deal
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with the very complicated process of the IDR
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system.
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And,
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you know, back to to how I kinda
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started
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this conversation,
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the concern around consolidation, both vertical and and
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horizontal,
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being able to focus on that care delivery
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and
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not face
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ongoing
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cash flow pressure and reimbursement pressure
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is the difference for a lot of independent
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groups between remaining independent
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or having to consolidate, whether,
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by becoming part of a larger group, becoming
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part of a hospital, or, you know, by
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being part of an insurer.
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So
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I I think what,
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HalMD
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offers here is that ability to remain independent
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and let someone else handle administrative burdens while
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you handle health care delivery.
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Yeah. So well said, Patrick. And I think,
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sentiment that will resonate with a lot of
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leaders listening in, especially on the clinical side.
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So
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appreciate you synthesizing
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so much of this information for our listeners.
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I know that it does not come without
13:45
complexity, especially when we're talking health care policy.
13:48
So, again, I I wanna thank you for
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the time you spent helping to break down
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the latest in terms of what we're seeing
13:54
with payers and reimbursement.
13:56
But is there anything else that you would
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like to share, maybe something we glossed over
13:59
too quickly, or even any final thoughts?
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No. You know, I I think, more than
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anything else, I I wanna reiterate
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my optimism for the future of the the
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practice of of medicine. I think
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there are a whole lot more reasons to
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be optimistic
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about
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improvements to the system writ large than than
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reasons to be pessimistic.
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We've gotta stick the landing on on some
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of these things and really make sure that
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outcomes and and implementation
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match intention.
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But
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I think we've got the ability to do
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that, and I'm excited to see
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the further evolution and stability of the practice
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of medicine.
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Well, thank you, Patrick, and we hope to
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have you back again for the next time.
14:46
We need a a bit of a policy
14:47
debrief and kind of what's next for health
14:49
care leaders. It's been great having you with
14:51
Becker's today. So thank you again for your
14:53
time. Thanks, Erica. Really appreciate it. We'd also
14:56
like to thank our sponsor for today's podcast,
14:59
Halo MD.
15:00
Listeners, be sure to tune into more podcasts
15:02
from Becker's Healthcare by visiting our podcast page
15:05
at beckershospitalreview.com.