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Laura Dyrda on Policy Shifts and Workforce Pressures in Healthcare · Becker’s Healthcare Podcast

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  This is Scott Becker with the Beckers HealthCare
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  podcast.
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  I'm thrilled today to be joined by Laura
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  Dierda, editor in chief at Beckers HealthCare.
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  She joins us regularly to talk about
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  what she's watching in health care, the big
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  stories, and more. Laura, can I ask I'll
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  tee it up and ask you to take
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  it away? What are some of the big
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  stories that you're watching currently?
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  Hi, Scott. Well, thank you so much again
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  for me. I think right now, one of
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  the big stories that we're looking at and
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  have been following for the last several months
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  is just,
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  what's happening currently with three forty b program
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  and some of the ins and outs and
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  ups and downs of that program. But the
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  biggest news in recent days is the American
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  Hospital Association alongside the Maine Hospital Association of
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  four safety net hospitals
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  filed a federal lawsuit to halt some of
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  the upcoming changes, what they've described as unlawful
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  changes to the three forty b pricing program,
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  which they warn, could shift some of the
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  major financial
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  challenges and burden onto hospitals and health systems,
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  especially the rural and underserved communities nationwide.
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  The lawsuit was filed December 1 and challenges
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  HHS's plan to move the three forty b
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  program to a new rebate
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  based model beginning January 1. Under these changes,
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  the safety net hospitals and clinics would be
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  required to pay full market price for the
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  drugs upfront and then seek reimbursement
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  after,
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  administration,
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  which would be a complete reversal for some
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  of the longstanding up front discount model programs
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  that have supported three forty b providers for
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  more than thirty years. The is arguing that
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  the new structure would settle hospitals with hundreds
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  of millions in added annual costs, extensive
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  administrative burdens, and not really benefit patients at
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  all.
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  The president and CEO, Rick Pollack, said giving
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  hospitals only a few months to comply with
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  these new requirements
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  or risk losing millions of dollars in discounts,
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  which they are entitled to, actually harms patients
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  and communities across the country.
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  According to the three forty b,
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  hospitals provide nearly a $100,000,000,000 in community benefit
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  in 2022
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  alone, including free and discounted medications, behavioral health
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  services, opioid treatment, and food pantry support.
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  This new model the federal government announced on
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  July 31,
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  and since, the CEOs and CFOs across the
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  country have really been thinking in strategically contingency
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  planning for what would happen if these changes
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  actually go through.
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  Some have mentioned pivoting to tap into potential
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  new revenue
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  streams or philanthropic
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  sources
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  amid this transition,
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  which they're hoping doesn't occur, but as of
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  now, it's still slated to to change, next
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  year. And they're also looking at things like
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  uncertain Medicaid coverage, ACA subsidies,
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  and additional uninsured patients and charity care in
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  the next year because of all of this
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  change. And so hospital leaders are really gearing
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  up for a challenging 2026,
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  but they're also finding spaces,
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  for true innovation and transformation within some of
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  these,
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  tight spots they're in. And so they're trying
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  to continue to positively impact their communities and
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  and workforce amid these uncertain times.
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  Thank you very, very much. And these lawsuits
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  by the agent and others,
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  what do those look like? Is there a
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  chance of success for those? What what is
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  it just
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  negotiation,
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  or can those really be effective?
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  Yeah. Yeah. You know, I think,
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  there is always a possibility of potential for
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  success and for changes. I think we've seen
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  back and forth, especially if legislators
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  see in their districts, their hospitals are,
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  something that their communities are proud of and
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  and really wanna keep sustained.
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  You know, no,
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  congressperson
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  or legislator really wants to be the one
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  that, puts programs in place that are going
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  to make health care,
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  more challenging within their districts. And so,
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  you know, really framing it in that way,
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  it could be helpful and beneficial if they
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  actually get backing from,
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  people in DC and there's a a real
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  movement towards,
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  not allowing this to happen. However, it is
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  just
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  uncertain as to how much momentum it actually
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  has, the influence that'll have. Obviously, there's not
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  much time and then through the beginning of
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  next year, and so it would have to
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  be a very quick,
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  you know, temporary suspension or something along those
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  lines. Well, their details are continued to be
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  re reviewed, I think. But, you
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  know, I I know that, American Hospital Association
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  as well as others have really been on
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  this for a while. And so filing this
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  lawsuit certainly, you know, is, a next step
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  and another effort to really try to prevent,
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  the changes for to three forty b happening.
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  So, you know, it it's tough to say
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  exactly
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  the chances of success us, but I do
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  think, you know, we have seen positive momentum
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  in, being able to shift some of the
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  the policies and priorities of the Trump administration
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  if there's enough energy behind,
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  making those changes or or slowing down the
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  process,
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  because hospital health systems would be too negatively
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  impacted.
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  No. I I think that's right on. So
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  watching the three forty b, watching the the
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  federation, others look at this, what other stories
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  are you watching currently? Is there anything else
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  that's top of mind?
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  Absolutely. So,
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  another thing that has been top of mind
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  for us too is just really continuing to
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  think about how hospitals and health systems are
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  are,
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  dealing with the labor crisis. I think staffing
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  both from staffing shortages on the clinical and
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  administrative side, then continuing to see,
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  their costs increase.
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  It's just a challenge for hospitals and health
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  systems, and and some, you know, would think
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  that maybe increasing labor costs is a good
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  thing because they're investing in the workforce. But,
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  you know, especially if you're looking at,
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  a tighter margin and, the labor typically being
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  a a large portion of,
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  any hospital or health systems budget and expenses.
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  It's, you know, something that hospitals and health
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  systems are really thinking about. So it's been
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  interesting to see in Kaufman Hall's last
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  flash report,
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  you know, we're really seeing more and more
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  of the persistent climb in labor expenses even
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  as hospitals have gotten away from more contract
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  labor as they've implemented
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  AI to try to become more efficient with
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  less people.
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  We've seen the month over month cost for
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  hospitals and health systems continue to rise. I
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  think nationally, labor expenses were up 2%
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  in, September from month over month and 5%
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  year over year.
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  And, just in looking at year to date,
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  we're still about 5% up from 2023. And
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  so,
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  that continues to build some of the workforce
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  inflation,
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  settling in and additional
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  additionally becoming more of a permanent part of
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  the operating environment for hospitals and systems. And
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  then regionally,
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  you know, we saw in the West labor
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  costs are rising because competition for staff is
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  intense and, the wage floors are increasing. In
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  the Midwest, we saw a bigger month to
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  month jump around 3% in just one month,
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  signaling some, you know, shifting workforce dynamics.
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  In the South, we see a steadier but
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  stable,
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  workforce take shape. We're seeing more retention. We're
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  seeing additional culture and leadership development because, you
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  know, things have plateaued one bit.
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  But then in the Great Plains region, we
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  saw a bigger year over year increase about
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  7%
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  in labor expenses, which suggests, some delayed market
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  corrections maybe hitting that space all in once.
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  And so,
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  you know, I think in terms of hospital
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  size too, we see some fluctuation.
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  Mid sized hospitals are feeling the squeeze from
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  labor
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  expenses, but as well as, like, the labor
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  shortages. And so we're seeing higher
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  costs rising there. And it's just been, a
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  challenge for those, but we do see, you
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  know, a little bit of a light at
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  the end of the tunnel. We're hearing from
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  a lot of hospital health system executives how
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  they're thinking about the future. They're building more
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  pipeline programs, investing in the,
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  community colleges and universities in their area to,
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  bring in not only nurses, but also,
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  additional technical staff,
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  you know, IT cybersecurity
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  partnering with their local,
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  schools
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  to train even at the high school and
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  middle school level. And so it's just been
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  interesting to see more of those programs take
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  shape and additional efforts,
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  to reskill and upskill their teams and build
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  more middle management,
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  as they incorporate artificial intelligence to try to,
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  right size how they're thinking about their workforce,
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  their resources. So,
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  it's been just a very interesting year for
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  the workforce, and I think it'll continue to
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  be that way in 2026
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  and beyond.
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  Thank you very, very much.
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  Laura, what a pleasure to visit with you
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  today on the Becker's Healthcare podcast. Again, Laura
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  Dirda, tremendous leader at Becker's Healthcare. Thank you
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  for joining us today. Thanks so much, Scott.
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  I appreciate it.