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Blog / en Thu, 31 Jul 2025 16:37:06 -0500 Fri, 27 Jun 25 14:52:04 -0500 More Than a Safety Net: A Social Worker and Mom of a Disabled Child Talks the Human Cost of Medicaid Cuts /news/blog/2025-06-27-more-safety-net-social-worker-and-special-needs-mom-talks-human-cost-medicaid-cuts <div><h2>A Q&amp;A with Becky Pletzer, social worker and parent to a son with disabilities&nbsp;</h2><hr></div>Q: Can you tell me about yourself and your family?A: I’m Dr. Becky Pletzer. I'm a licensed clinical social worker in Alaska and the mother to two boys, Sloan and Sawyer. Sawyer, my 11-year-old son, has a very rare chromosome syndrome and moderate autism. As both a social worker and the mother of a child with special needs,&nbsp;<a href="https://www.youtube.com/watch?v=9H5txI6ewoI">Medicaid has been imperative</a>, forming the foundation of my son's life trajectory and outlook.Our [Medicaid] journey started over eight years ago when we knew, right before Sawyer turned 3 years old, that something wasn't right. We had genetic testing done and learned Sawyer has a very rare chromosome syndrome called 22q11.2 duplication. And most of the people who have this syndrome are on the autism spectrum with other co-occurring diagnoses, which is the case with Sawyer.Q: How has Medicaid been essential to you and your family?A: Having Sawyer be diagnosed at an early stage and having access to Medicaid&nbsp;— to help supplement the thousands of dollars of services his care requires each month — has been imperative to his growth. It means he can build the skills he needs to participate in everyday activities, like being able to take care of himself and converse with his peers, his therapists and his teachers.It has meant the gift of language, communication and meaningful relationships, which we all need and desire as humans. I wouldn't know what to do without the services and the people — the professionals who saw him every day, sometimes 25 hours a week — who make sure he has the foundation to be an independent guy and become a contributor to our community.Q: There are some false narratives about how many Medicaid beneficiaries don’t work or don’t want to work. But the majority do work or can’t work because they serve as primary caregivers, are in school or have a disability. Can you talk about those narratives?A: In my clinical experience, there's often this assumption that Medicaid is like food assistance. But that’s really not the case. Medicaid pays for lots of things, including long-term care. It is the only insurance, sans a few rare ones out there, that actually pays for long-term care.And long-term care can look like a lot of things. It may mean a nursing home, community services or teaching life skills to people who profoundly need assistance but want to live at home. I've worked with people like this, who wanted to live independently and have their own apartment. And I was able to help them live independently through Medicaid, saving the state millions of dollars it would have otherwise spent on a 24-hour, long-term care facility.Sawyer’s care falls into this long-term care window. We have private health insurance, but like most of our insurances as Americans, it only covers so much or a certain amount of time. And he needed Medicaid to supplement the thousands of dollars it cost to get him the right therapies: occupational therapy, speech therapy and applied behavioral analysis. It costs upwards of $30,000 a month.Some people ask me, “Why does your kid have to have Medicaid? You're a professional.” My private insurance paid what they could, but it was still short of thousands of dollars.&nbsp;<blockquote><a>And the services that Sawyer received through Medicaid are the reason that he can speak, have a conversation and joke around with you today.&nbsp;</a></blockquote>He is now able to communicate and express his needs. He went from eloping or having temper tantrums to being a human who can voice his autonomy, which is all that we want.[Medicaid being cut] affects us all. This isn't just my story, this could be your story. This could be your neighbor’s story. And it's going to be ours eventually. If we all live long enough, we're all going to need that type of care. As a social worker, my story is two-fold; but this shouldn't just be about my son Sawyer and his needs. This is about our neighbors and our community. This affects all of us.Q: If you had the chance to speak to a lawmaker who is considering cutting Medicaid, what would you say?A: “I really wish you would spend some time with your constituents who are doing this every day, with professionals like me, who help your constituents try to figure out how they're going to live life.”It is so difficult to understand why we would cut something that could propel people to invest their lives in Alaska, to hopefully create generations that want to stay here and do the same. I don't know why we would want to push more people away from participating in our community and in the future that Alaska could offer people.These are people who are working hard — trying to raise families, be good neighbors, be good clinicians. I don't understand why we would intentionally harm people who just want to live their American dream.&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;The views expressed here are those of the individual author and do not necessarily reflect the views of the AHA<div><div><div id="_com_1" language="JavaScript">&nbsp;</div></div></div> Fri, 27 Jun 2025 14:52:04 -0500 Blog Current Employee Experience Trends in Health Care /news/blog/2025-06-09-current-employee-experience-trends-health-care Recent data from Press Ganey, reflecting input from over 1.4 million health care employees, reveals that after an initial post-pandemic rebound, employee engagement declined slightly in 2024 — a decrease of 0.02 on a 5-point scale. This downward trend cut across nearly all roles. Most notably, the steepest declines were observed among physicians and advanced practice providers, with scores falling by 0.06 and 0.08, respectively.So, what’s driving this downturn after last year’s positive momentum?To explore this question, the �� Association (AHA) and Press Ganey partnered with leaders from seven diverse health care systems — including chief human resource officers, chief nursing officers and chief medical officers — to gain insight into their employee and physician experience strategies. Our aim was to better understand the challenges they are facing today and <a href="/news/blog/2025-04-29-7-tactics-successfully-driving-health-care-team-engagement">the tactics they’re using to overcome them</a>.Challenges to driving employee and physician experienceFrom a series of group discussions and workshops with the group of executives, four key challenges emerged in advancing employee and physician experience.<ol><li>Competing priorities.&nbsp;Health care organizations face the constant challenge of balancing multiple critical domains of performance — patient experience, employee experience, physician experience, safety and quality. Each of these areas is vital and deserves careful attention and planning. Yet, addressing them in isolation can dilute impact. The most <a href="/workforce-strategies">successful organizations</a> integrate these priorities into a unified, strategic approach.</li><li>Prioritizing and managing change.&nbsp;Health care is steeped in deep-rooted traditions. But a mindset of "we've always done it this way" creates barriers to progress. Resistance to adopting new processes, technologies or strategies is common but will prevent an organization from keeping up with key advancements. Overcoming this inertia requires strong leadership, clear communication and a sound case for how change benefits both employees and patients.</li><li>Psychological safety.&nbsp;Creating an environment where team members feel safe to share feedback is essential. <a href="https://info.pressganey.com/press-ganey-blog-healthcare-experience-insights/6-questions-to-ask-about-your-team-s-psychological-safety">Psychological safety</a> must be integrated into organizational values and reinforced at every opportunity; respect should be akin to hand hygiene. When individuals believe their voices are heard and that their input leads to meaningful change, trust deepens, engagement rises and innovation thrives.</li><li>Making the case for employee and physician experience.&nbsp;Perhaps the most persistent challenge is securing full senior management buy-in for making the investment in workforce experience. Building the case for investment in the current resource-constrained environment starts with data showing how employee and physician experience is directly linked to patient and financial outcomes. It also calls for compelling and relatable real-world examples. Seeing how other organizations reap benefits from investing in the caregiver experience demonstrates what’s possible and creates a compelling call to action.</li></ol>Chris DeRienzo, M.D., is the AHA’s senior vice president and chief physician executive, and president of AHA’s Health Research and Educational Trust. Nell Buhlman is chief administrative officer and head of strategy at Press Ganey.Upcoming Event: The AHA and Press Ganey at the 2025 AHA Leadership Summit&nbsp;in Nashville, Tenn., will host a pre-summit workshop,&nbsp;<a href="https://web.cvent.com/event/05ffbe14-fab7-4ddf-89d9-93f63942d9ca/websitePage:44c2cfcd-a0ea-4f01-bbe4-16d10551d7bb?session=3b0e30b4-8c73-4f5e-bca4-9a7b28edc574&amp;shareLink=true">The Path to Sustained Excellence in Engagement</a>,&nbsp;on Sunday, July 20, from 8:30 a.m. to 12:30 p.m. This interactive workshop will explore how employee engagement drives safety, quality and the patient experience — and how aligning these efforts leads to meaningful, sustained improvement. Learn how top-performing organizations gather feedback, integrate data and take targeted action.&nbsp;Attendees will also have the opportunity to share challenges, successes and strategies for advancing performance.&nbsp;<a href="https://web.cvent.com/event/05ffbe14-fab7-4ddf-89d9-93f63942d9ca/regPage:3f8b931f-b9d6-4518-a292-bb4f25e2fba6">Registration is open</a>. Mon, 09 Jun 2025 10:27:24 -0500 Blog Innovative Solutions and Strategic Insights Take Center Stage at the 2025 AHA Leadership Summit /news/blog/2025-06-03-innovative-solutions-and-strategic-insights-take-center-stage-2025-aha-leadership-summit The 2025 AHA <a href="https://leadershipsummit.aha.org/" title="AHA Leadership Summit">Leadership Summit</a> will take place July 20-22 at the Music City Center in Nashville, Tenn. Renowned speakers from across health care will provide in-depth guidance and actionable strategies to enhance care quality and financial stability, overcome workforce challenges and improve the health care user experience.The summit offers insights and ideas for senior executives, clinical leaders, and emerging and next-generation health care professionals. Attendees can expect:<ul><li>Expert-Led Sessions: Find inspiration to transform your organization, system and community with <a href="https://cvent.me/d5nzvD" title="educational sessions">educational sessions</a> in these critical focus areas:<ul><li>Transforming Care Delivery</li><li>Patient Engagement and Education</li><li>Workforce</li><li>Financial Sustainability</li><li>Strategy and Innovation</li><li>Behavioral Health</li></ul></li><li>Inspiring Plenaries: Prepare for future challenges with forward-thinking insights from a lineup of powerful speakers featured in inspirational <a href="https://leadershipsummit.aha.org/program/keynote-speakers-ls" title="plenary sessions">plenary sessions</a>:<ul><li>Leading Through Change: Strategies for Inspired Leadership and Resilient Teams Cassandra Worthy,&nbsp;chief executive officer and founder,&nbsp;Change Enthusiasm Global</li><li>Designing the Future of Care Delivery Moderator:&nbsp;Elizabeth Cohen,&nbsp;senior medical correspondent,&nbsp;CNN Panelists:&nbsp;Marty Bonick,&nbsp;president and chief executive officer,&nbsp;Ardent Health, Brentwood, Tenn. Tina Freese Decker, MHA, MSIE, FACHE,&nbsp;president and chief executive officer,&nbsp;Corewell Health, Grand Rapids, Mich.;&nbsp;chair,&nbsp;Board of Trustees,&nbsp;�� Association Wright Lassiter, III,&nbsp;chief executive officer,&nbsp;CommonSpirit Health, Chicago Eugene A. Woods, FACHE,&nbsp;chief executive officer,&nbsp;Advocate Health, Charlotte, N.C.</li><li>Addressing Health Care's Most Complex Challenges: A New Leadership Role Moderator:&nbsp;Elizabeth Cohen,&nbsp;senior medical correspondent,&nbsp;CNN Panelist: Laura S. Kaiser, FACHE,&nbsp;president and chief executive officer,&nbsp;SSM Health, St. Louis</li><li>AHA Town Hall: Navigating the 2025 Political Landscape Chad Golder,&nbsp;general counsel and secretary,&nbsp;�� Association Stacey Hughes,&nbsp;executive vice president, Government Relations and Public Policy,&nbsp;�� Association Ashley Thompson,&nbsp;senior vice president, Public Policy Analysis and Development,&nbsp;�� Association</li><li>The Caring in Health Care: Challenges and Opportunities in a Technological Era Abraham Verghese, MD,&nbsp;New York Times&nbsp;bestselling author;&nbsp;practicing physician; professor,&nbsp;Stanford University</li></ul></li><li>Tailored Learning: Engage in sessions designed specifically for various leadership roles, ensuring that content is relevant and applicable to your position and organization.</li><li>Networking Opportunities:&nbsp;Engage in Summit <a href="https://leadershipsummit.aha.org/program/networking-connections-ls" title="Summit Networking Connections">Networking Connections</a> to reconnect with peers, establish new connections and network with business partners who offer innovative solutions. Sponsors will be categorized based on critical interest issues to help attendees better find solutions to their challenges.</li></ul>Early-bird registration ends June 6.For more information on the AHA Leadership Summit, please visit <a href="https://leadershipsummit.aha.org/" title="Leadership Summit Webpage">leadershipsummit.aha.org</a>.&nbsp; Michelle Hood is AHA’s executive vice president and chief operating officer.&nbsp; Tue, 03 Jun 2025 11:20:39 -0500 Blog From Infancy to Adolescence: Hospitals Step Up to Support Youth Mental Health /news/blog/2025-05-30-infancy-adolescence-hospitals-step-support-youth-mental-health Even before the COVID pandemic, the mental health and wellness of our young people was failing. The pandemic <a href="https://www.cdc.gov/healthy-youth/mental-health/mental-health-numbers.html" target="_blank">exacerbated the crisis</a> and made it difficult for them to access needed care; many health care systems are still struggling to meet the challenge. Though Mental Health Awareness Month is coming to an end, AHA will continue to track and share how behavioral health care specialists are working hard to improve access to timely, high quality behavioral health treatment for children and adolescents.Today we released a <a href="/advancing-health-podcast/2025-05-30-bringing-virtual-behavioral-health-care-access-rural-youth-west-virginia" target="_blank">podcast</a> from a child and adolescent psychiatrist at West Virginia University about improving access to care for young people with mental health diagnoses who live in rural areas; we also have a new video about how Corewell Health is <a href="https://www.youtube.com/watch?v=iLorDolgwSM" target="_blank">improving access to behavioral health care in schools</a>. This year, we’ll be digging deeper and telling the stories of how <a href="https://www.1011now.com/2024/08/20/nebraska-hospital-association-shares-benefits-report-new-initiatives-combat-mental-health/" target="_blank">Children’s Nebraska</a> has trained nearly 100 providers across the state to help treat mild to moderate mental health conditions in young people and how a <a href="https://www.urmc.rochester.edu/childrens-hospital/behavioral-health-wellness/pediatric-mental-health-urgent-care" target="_blank">new facility at Golisano Children’s Hospital</a> in New York addresses urgent behavioral health matters for the area’s youth. Behavioral Health Care for Life Just as physical needs change as people age, so do behavioral health care needs. We speak often about the need to “treat the whole person, mind and body;” now the conversation is evolving to treat the whole person for their whole life. The AHA is committed to highlighting how our member hospitals and health systems provide high quality, innovative behavioral health care, often through our <a href="/tellingthehospitalstory" target="_blank">Telling the Hospital Story project</a>; we encourage you to submit how your organization is meeting the needs of your community. We also will continue to develop resources that help hospitals meet the needs of their communities. Our new <a href="/infographic-realities-behavioral-health-older-adults" target="_blank">infographic on behavioral health care in older adults</a> and our <a href="/advancing-health-podcast/2025-05-07-postpartum-mental-health-breaking-stigma-women-infants-hospital" target="_blank">recent podcast</a> on breaking the stigma surrounding postpartum mental health show that we understand that behavioral health must be tailored to the patient. Nothing — not age, not location, not circumstance — should stop someone from becoming the healthiest version of themselves.&nbsp; Fri, 30 May 2025 12:56:38 -0500 Blog Filling the Gaps in Maternal Mental Health Care /news/blog/2025-05-12-filling-gaps-maternal-mental-health-care One of our best strategies to address the unique behavioral health challenges and demands of pregnant women and new mothers is recognizing that mental health is a central element to physical health, meaning we need to continually treat the whole person in our settings to the best of our abilities.Identification and early intervention for maternal mental health not only impacts the mother’s overall welfare but also ensures the healthy development of her child. Early detection is important to prevent or identify pre/postpartum depression, anxiety, PTSD, and addiction. Early identification can impact the baby’s well-being related to secure attachment, low birth weight and long-term health outcomes.Woman’s Hospital in Baton Rouge, La., is the largest single hospital birthing facility in the state, with over 8,000 deliveries annually. Before the pandemic, Woman’s Hospital began offering outpatient mental health services in response to both community and medical staff requests. Louisiana has one of the highest rates of Medicaid coverage for births in the nation, but many patients using Medicaid face significant barriers to accessing mental health care. According to the Louisiana Pregnancy-Associated Mortality Review, mental health was a contributing factor in 20% of pregnancy-related deaths in 2020.As the medical staff at Woman’s Hospital identified patients in crisis, the need for a specialized facility became urgent. Unfortunately, many existing facilities were not equipped to meet the unique needs of pregnant and postpartum women, especially those in their third trimester.To address this gap in care, Woman’s Hospital repurposed space within the hospital and opened Woman’s Perinatal Mental Health Unit in 2024. The 10-bed inpatient unit provides specialized care for women during pregnancy and up to one year postpartum. Each patient works with a comprehensive team of psychiatrists, obstetricians, maternal-fetal medicine specialists, social workers, psychologists, nurses and recreational therapists.Halfway across the country, at Yale New Haven Children’s Hospital, Matthew Grossman, M.D., has developed one of the first new treatments for babies born to mothers addicted to opiates. The treatment reduced babies’ withdrawal time by replacing drug therapy with increased contact with their mothers — a simple yet novel approached termed “more love, less drugs.” One of the key highlights Grossman found was that babies who spent more time with their mothers left the hospital after an average of 22 days instead of the average of 29 days for babies who spent less time with their mothers. Early recognition that a baby has been exposed to substances prenatally improves a team’s ability to immediately engage a high-quality care plan for the best results.Our maternal health patients are experiencing important life changes, some of which significantly impact mental health, and they benefit from supportive therapeutic interventions to best support overall wellness. Early identification and treatment remain key in quality of care and outcomes. Taking the time to truly connect with patients when they present with behavioral health or substance use disorders provides a safe environment to help patients receive the help they need to become the mothers they have always wanted to become. Mon, 12 May 2025 13:58:49 -0500 Blog 7 Tactics for Successfully Driving Health Care Team Engagement /news/blog/2025-04-29-7-tactics-successfully-driving-health-care-team-engagement In today’s rapidly evolving health care landscape — where patient outcomes and safety are non-negotiable top priorities — health systems and their staff are under constant pressure to balance competing demands. On one side is the growing expectations for personalized, high-quality care, and on the other, the urgent need to support a stretched and often overwhelmed workforce. And, of course, the former depends on addressing the latter.&nbsp;The �� Association (AHA) and Press Ganey convened leaders from seven health care systems — including chief human resource officers, chief nursing officers and chief medical officers — to discuss their experiences and successes with a range of tactics to build team engagement. Seven key tactics emerged from the conversation:<ol><li>Articulate a clear focus and defined roadmap. The first step in creating a positive employee and physician experience is defining clear, measurable objectives — and prioritizing what’s truly core and critical. Develop a roadmap to achieve those goals, and ensure leaders understand not only the plan but also their specific role in driving it forward. When leadership is aligned and invested, the work is elevated to a strategic priority and more easily reinforced by middle management and embedded across the organization.&nbsp;</li><li>Connect work to purpose. Health care employees are more engaged when leadership places mission, vision and values at the heart of their strategy. Aligning performance goals to a purpose reinforces the connection between the day-to-day work and the “why” behind it. When employees see how their actions contribute to fulfilling the mission, they experience greater job satisfaction, deeper commitment and a more purpose-driven culture.</li><li>Establish clear behavioral standards. Accountability starts by setting clear expectations — not only around performance outcomes but also around the behavior standards that define how people interact. These standards should be tied directly to organizational values, with concrete examples of what they look like in practice. Just as important, behavior that falls short of those expectations should be addressed immediately. Tolerating behavior outside the standards gives people permission to ignore them.&nbsp;</li><li>Visible leadership builds trust. Trust is the bedrock of effective health care — vital to the relationships between staff and patients and equally essential among colleagues and leaders to support strong, collaborative teams. Building that trust starts with leadership. Leaders who are visible, transparent and approachable and who consistently model the behaviors that align with organizational values set the tone for the entire culture. Their example fosters openness, accountability and psychological safety that cascades throughout the organization.&nbsp;</li><li>Establish two-way communication. Clear, consistent communication is vital for any organization — but in health care where the environment is fast-paced, and the work is high-stakes, it’s essential. Messages need to be timely, relevant and aligned with organizational priorities. But truly effective communication is two-way. &nbsp;Listening to your employees and inviting their input on improvement efforts fosters trust, strengthens engagement and leads to smarter, more sustainable solutions.</li><li>Create “FOMO.” In health care, strong communication and teamwork are essential — but keeping employees engaged can be a challenge. One effective tactic? Create a sense of FOMO (fear of missing out). When team meetings, communication channels and collaborative projects feel valuable, inclusive and energizing, people want to show up. Building a culture of excitement and engagement drives greater participation and fosters stronger team connections.&nbsp;</li><li>Recognize that leadership is a skill. Effective leadership is the cornerstone of every successful organization. While some may view leadership as an innate trait, the reality is that it can be cultivated, taught and honed through intentional development. Managers at all levels need access to the right tools, training and support to grow their skills so they can lead with confidence, mentor effectively and foster collaboration. Leadership development is a strategic investment in organizational success.</li></ol>Health care is fundamentally a human experience — people interacting with people. That is why investing in employee experience isn’t just a nice-to-have; it’s a strategic imperative. A highly engaged workforce collaborates more effectively, drives better patient outcomes and strengthens performance across the board. When employees thrive, the entire system functions at its best.Chris DeRienzo, M.D., is AHA’s senior vice president and chief physician executive, and president of AHA’s Health Research and Educational Trust. Nell Buhlman is chief administrative officer, head of strategy at Press Ganey.&nbsp;Upcoming Event: The AHA and Press Ganey at the 2025 AHA Leadership Summit in Nashville will host a pre-Summit workshop, <a href="https://web.cvent.com/event/05ffbe14-fab7-4ddf-89d9-93f63942d9ca/websitePage:44c2cfcd-a0ea-4f01-bbe4-16d10551d7bb?session=3b0e30b4-8c73-4f5e-bca4-9a7b28edc574&amp;shareLink=true" target="_blank" title="The Path to Sustained Excellence in Engagement">The Path to Sustained Excellence in Engagement</a>, on Sunday, July 20, from 8:30 a.m. to 12:30 p.m. This interactive workshop will explore how employee engagement drives safety, quality and the patient experience — and how aligning these efforts leads to meaningful, sustained improvement. Learn how top-performing organizations gather feedback, integrate data and take targeted action. Attendees will also have the opportunity to share challenges, successes and strategies for advancing performance. Registration is open.&nbsp; &nbsp; Tue, 29 Apr 2025 14:17:33 -0500 Blog Cuts to State Medicaid Finance Methods Would Limit Access to Care for Everyone /news/blog/2025-04-03-cuts-state-medicaid-finance-methods-would-limit-access-care-everyone Paragon Health Institute continues their series of misguided and harmful characterizations of Medicaid financing and provider payment, including through two reports “Addressing Medicaid Money Laundering: The Lack of Integrity with Medicaid Financing and the Need for Reform” and “California’s Insurance-Tax Shuffle: How Federal Money Ends Up Paying for Medicaid for Illegal Immigrants.” The timing of this series of reports aligns with the efforts of some policymakers in Congress to further limit states’ ability to finance their Medicaid programs to fund tax cuts for the wealthy.In their reports, Paragon recommends that Congress pursue several policies that are ultimately harmful to patients and providers, targeting specific state Medicaid programs, such as those in California, North Carolina, Arizona, and Tennessee, without adequate justification. The policies Paragon recommends include:Eliminating or Reducing Provider Taxes. Provider taxes are a legitimate financing method used by 49 states and the District of Columbia to fund a portion of the non-federal share of their Medicaid programs. There are federal limits, overseen by the Centers for Medicare &amp; Medicaid Services (CMS), including a 6% tax safe harbor threshold. Eliminating provider taxes or reducing the safe harbor threshold likely would result in shifting the tax burden to state residents through higher income taxes, property taxes, sales tax or other state tax structures. Specifically:<ul><li>California’s Managed Care Organization (MCO) tax generates general fund revenue, which the state uses to increase already low provider rates and to pay for care to its Medicaid beneficiaries. California’s MCO tax operates under strict federal requirements and oversight of the integrity of its financing arrangement. Even with funds contributed by the federal government, California continues to make state investments in its Medicaid program — at a faster pace than federal spending. California can hardly be accused of taking advantage of the federal government. California pays billions (approximately $83 billion) more in federal taxes than it receives back in federal spending. It’s important to note that a state cannot use federal dollars to pay for undocumented immigrants, and Paragon’s report provides no evidence that federal dollars were used to pay for coverage of undocumented immigrants in the state.</li><li>North Carolina’s provider tax is a financing method the state initiated in 2011 to increase low provider base payments and fund critical Medicaid services, including behavioral health services and postpartum care. Like many states, Medicaid reimbursement without provider taxes and supplemental payments factored in makes it difficult for North Carolina hospitals to continue to serve their communities.</li></ul>Eliminating or Capping State-Directed Payments (SDPs). Medicaid MCOs’ low provider payments have created the need for additional provider support through state-directed payments, particularly for hospitals that serve disproportionately high rates of Medicaid and other public-payer patients and routinely operate with negative margins. Today, as many SDP programs await approval, some hospitals are already making difficult decisions to cut their workforce, struggling to make payroll and fighting to maintain service lines or stay open entirely amid further financial instability. For example:<ul><li>Arizona’s hospital-directed payment program, known as HEALTHII payments, is used to support hospital services, recruit and retain providers in rural communities and keep hospitals open. In Arizona, these payments are a particularly vital source of funding as the state continues to cut inpatient and outpatient Medicaid rates and a significant portion of hospitals face operating losses. Funded in part through provider taxes, if directed payments or finance mechanisms were cut, 69% of hospitals in the state would have a negative operating margin.</li><li>Tennessee’s directed payment program, which is currently awaiting CMS approval, will help sustain the hospital network in a state that has not expanded Medicaid. The directed payment program provides needed funding to improve Medicaid base rates, which cover only half of the cost to provide care to low-income or uninsured residents. Critically, Tennessee has the second highest number of hospital closures in the nation, and without directed payments, that number will only increase.</li></ul>What most people don’t realize is that cutting provider taxes and directed payments wouldn’t just impact Medicaid patients and providers; it would limit access to care for everyone.Cutting provider taxes and supplemental payments would worsen the already significant gap between Medicaid reimbursement and the actual cost of providing care to Medicaid patients. In Florida, for example, with directed payments factored in, which are in part financed through provider taxes, Medicaid pays $0.68 for every dollar spent on care. Without these additional payments, reimbursement would drop to $0.48 for each dollar spent on Medicaid beneficiaries. In California, Medicaid pays $0.80 for every dollar spent on care. Without the additional payments financed by California’s provider tax arrangement, payment would decrease to just $0.70 for each dollar spent on Medicaid patients. In the context of specific services, hospitals experienced a -42% Medicaid margin for inpatient obstetrics care and a -44.9% Medicaid margin for outpatient obstetrics care in 2023. The Medicaid shortfall faced by providers is directly linked to the services and sites of care that they can offer to all patients.Cutting off the financing for a program that is the single largest source of health care coverage in the U.S., while harming providers and patients, is hardly reform. We discourage anyone from trusting attacks on state Medicaid programs that call for unjustifiable federal funding cuts to Medicaid at the expense of Medicaid patients and our communities as a way to finance tax cuts for the wealthy.We urge Congress to reject cuts to vital Medicaid financing methods, including provider taxes and state-directed payments. Thu, 03 Apr 2025 09:27:58 -0500 Blog Can Collaborative Efforts to Improve Device Design Improve Safety? /news/blog/2025-03-28-can-collaborative-efforts-improve-device-design-improve-safety During World War II, the U.S. Army Air Corps depended on its B-17 bombers to inflict incredible damage against the Axis powers in Europe. These “Flying Fortresses” were deemed essential to winning the war in the European theater, but they had one big problem. Despite the plane’s technically advanced design and the provision of effective training for the young pilots responsible for steering them through war zones, too many crashed on landing, destroying the machines and often killing the pilots and crew.Initial investigations into B-17 crashes concluded that the accidents resulted from pilot error, and the Army invested in training and retraining pilots. Yet, the crashes continued. Then Alphonse Chapanis, a young psychologist who joined the Army Air Corps’ aeromedical lab in 1942, noticed that the switches for the plane’s flaps and the landing gear were adjacent on the dash and identical in appearance — but radically different in function.It was far too easy for pilots — stressed and weary after hours of combat flying — to flip the wrong switch when trying to land the B-17. The plane’s design had failed to account for the likelihood of normal human error. Chapanis suggested changing the knobs so that one was triangular and the other was spherical, making it easy for pilots to differentiate. This small change in design led to an immediate and substantial decrease in the number of B-17 crashes. (<a href="https://uxmag.com/articles/pilot-error-chapanis-and-the-shape-of-things-to-come" target="_blank">Read more about Chapanis</a> and his influence on device design).While most health care isn’t delivered in war zones, health care and device company leaders recognize that care is often delivered in high-stress, high-risk situations. Despite elegant efforts to design for safe use, rigorous standards and regulatory requirements from the Food and Drug Administration and standards bodies, and lots of training of health care professionals, many acknowledge that there is still room to ensure clinicians are “flipping the right switch” when using medical devices.<h2>AHA and AAMI Meeting</h2>Earlier this year, the �� Association (AHA) and the Association for Advancement of Medical Instrumentation (AAMI) brought together a small group composed of hospital and health system leaders, device manufacturers and policy leaders to explore how to make devices safer by design. Their energy and commitment were palpable. Participants were invigorated and challenged by the shared goal of creating devices that could be used more easily, effectively and safely.The meeting began with table-setting presentations to make sure all attendees understood each other’s perspectives. Clinical leaders described the stresses and distractions of the busy hospital environment that make it difficult for staff to use devices as the designers had envisioned, including their personal experiences of devices being implicated in near misses or safety events. Manufacturers discussed their rigorous processes for designing, testing and providing instructions to ensure safe use. An AAMI leader described the role of standards in promoting safety, and a former FDA official spoke about the role of regulation, oversight and post-market surveillance in promoting safety. The group then broke into multidisciplinary groups with direction to identify practical, actionable pathways that augment or replace current activities and lead to better safety by design.<h2>3 Key Takeaways from the Conversations</h2><ul><li>Users and manufacturers need better information. Engineers and users need to be able to exchange the right information to make design improvements that address usability issues. Right now, they are not connecting well. Health care providers often discover a design challenge with a piece of equipment when conducting a root cause analysis and then report that information to their patient safety organization, but that information is not readily available to manufacturers. Manufacturers get information from FDA databases, but these may not have sufficient information to understand exactly how the device design may have contributed to the occurrence of patient harm or inform design alterations that could prevent it in the future. Finally, post market surveillance reporting is often slow to reach the manufacturer, limiting their ability to alter design in a timely fashion.</li><li>Work as imagined differs from work as done. In designing each particular product, engineers imagine the clinical environment in which it will be placed, plan for a rigorous training of the health care professionals who will be operating it and create comprehensive instruction manuals. Health care professionals use an expanding and rotating panoply of devices every day, and their ability to be trained on each and every one of those, remember that training and use it in a moment of emergent patient need is radically different from what the designer imagined. Better communication between users and designers is the only way to help designers anticipate how their devices will actually be used.</li><li>There is a natural tension between innovation and the experience that promotes safe use of a device. In a busy clinical environment, it is challenging for clinicians to keep up with all they must learn, but device makers may want to make routine improvements to the software or user interface of their devices to refresh perceptions of the device. Honest discussions about the kind of innovation device manufacturers intend and how the alteration will work in a busy clinical environment are needed to ensure innovation better contributes to safety and ideally decreases the draw on clinicians’ already-stretched mental capacity. Further, the regulatory framework needs to support this balance between innovation and safety by recognizing and creating safe tables and sandboxes within which to drive progress.</li></ul>One actionable item that drew keen interest was creating an opportunity for the manufacturers’ engineers to participate in a hospital’s response to a patient safety event. Stakeholders across the spectrum agreed that open sharing of how design may have contributed to an event is vital to generating changes needed to promote safer use and reduce patient harm. AHA and AAMI are committed to working to make these conversations a reality as part of our ongoing efforts to make care safer.Nancy Foster is the AHA’s vice president of quality and safety policy. Fri, 28 Mar 2025 11:56:05 -0500 Blog Setting the Record Straight: Beware of Opinions Masquerading as Facts /news/blog/2025-03-27-setting-record-straight-beware-opinions-masquerading-facts For health care organizations that care for the 70 million Medicaid patients in the U.S., provider taxes are a life vest that keep state Medicaid programs afloat and allow them to continue providing critical health care services for their communities. While policymakers in Congress look to finance an extension of the 2017 tax cuts, some are advocating for further limits on states’ ability to use provider taxes to help finance their Medicaid programs.Some new reports have displayed a gross misunderstanding of both the legitimacy of various Medicaid financing arrangements and the consequences of stripping those resources from states trying to provide health care access to their most vulnerable residents. For example, a recent report from the Paragon Health Institute, “Addressing Medicaid Money Laundering: The Lack of Integrity with Medicaid Financing and the Need for Reform” recycles misguided opinions.Medicaid is not a money laundering scheme. Medicaid is a complex program that takes into account state and federal priorities to provide coverage for children, older adults, people with disabilities, and low-income adults. Let’s be clear: Any suggestion that provider taxes are anything but longstanding, legally vetted, state and federally approved tax arrangements, is dishonest and a distraction from what these proposals truly are — a way to cut the Medicaid program.The primary way states generate revenue to pay for state programs, including Medicaid, is through taxes — this includes income tax, sales tax or, in the case of Medicaid, provider taxes. All are legally permissible ways for states to raise money to pay for their portion of the Medicaid program.Provider taxes are a longstanding, legitimate and heavily regulated tax arrangement which states can levy on health care organizations, including hospitals and health systems, nursing facilities, and managed care organizations to pay for their portion of the Medicaid program. Nearly every state (49 states and the District of Columbia) uses some form of provider taxes, and many have done so for decades. In most cases, for a state to implement a provider tax, state legislators are required to first vote on provider tax arrangements. They then must be reviewed and approved by the federal government. Once established, the taxes are then overseen by both state and federal regulators. As an example of the federal oversight, Congress limits these taxes to no more than 6% of net patient revenue. &nbsp;Nearly every state Medicaid program would be hurt by lowering the limit on provider taxes, and state residents would be put in the crosshairs of these cuts. States with strained budgets will need to shore up funding from elsewhere, either by raising taxes on their residents or cutting health care coverage and benefits for some of our most vulnerable people. For many states, a budget gap of this magnitude simply could not be backfilled through other funding sources.For providers, this also could mean steep reimbursement cuts and increased uncompensated care. Even with provider tax financing, state Medicaid programs do not cover the cost of caring for Medicaid patients. Nationally, the Medicaid shortfall — the difference between the hospital's cost of serving Medicaid patients and the payments it receives for services — was $27.5 billion in 2023. These numbers underscore that further strain on hospital revenue would likely require them to reduce or eliminate service offerings, reduce staffing, or — to an entire community’s loss — close altogether.&nbsp; Provider taxes are fundamental to the Medicaid financing structure in nearly every state. The accusation by some that these carefully reviewed, legitimate tax mechanisms are fraudulent is false and a distraction. Just because someone does not like a law, it does not mean that those adhering to the law are committing “money laundering.” Attacks on provider taxes are an attempt to disguise unjustifiable federal funding cuts to Medicaid, which will be devastating to Medicaid patients and our communities. Medicaid provider taxes protect access to care for everyone. We urge Congress to protect Medicaid and reject efforts to mislead and distort the facts about the legitimate use of provider taxes to care for patients.Ashley Thompson is AHA’s Senior Vice President, Public Policy Analysis and Development. Thu, 27 Mar 2025 12:33:27 -0500 Blog Blog: 3 Ways Not Extending the Enhanced Premium Tax Credits Would Hurt Patients in Rural Communities /news/blog/2025-02-27-blog-3-ways-not-extending-enhanced-premium-tax-credits-would-hurt-patients-rural-communities Congress passed into law legislation in 2021 that allowed additional eligibility for enhanced premium tax credits to help certain individuals and families purchase insurance on the health insurance marketplaces. This change has been especially impactful for those in rural areas, who tend to face higher premiums and fewer coverage options, in allowing them to access needed health care coverage.These EPTCs are scheduled to expire at the end of 2025. If they are not extended, millions of Americans will lose coverage or incur significantly higher costs. The largest disruptions will be felt by those who can face some of the highest challenges: the individuals and families living in rural communities.Below are three takeaways about the potential impacts of ending EPTCs on rural patients and communities:Increases in Coverage Disruptions and Uninsured Populations. Analysis by KNG Consulting for the AHA shows the most rural states in America would experience, on average, a 30% decrease in marketplace coverage and a 37% increase in their uninsured populations.Higher Taxes Via Premium Increases. The EPTCs helped millions of rural Americans purchase affordable commercial health care coverage and access necessary health care. The expiration of this policy would both harm the health of entire rural communities and raise individuals’ taxes via premium increases.Exacerbated Health Care Access Challenges. Rural populations have more complex health needs, face longer travel distances to providers and have fewer health care options. The EPTCs are a fundamental support for keeping critical health care access in rural communities and their expiration would exacerbate these existing access challenges.&nbsp;The AHA urges Congress to continue the EPTCs as they remain an important part of increased access to health care coverage and high-quality care for patients and communities served by hospitals, health systems and other providers. See the <a href="/2025-02-27-fact-sheet-expiration-enhanced-premium-tax-credits" target="_blank" title="AHA Fact Sheet">AHA fact sheet</a> for more details. Thu, 27 Feb 2025 22:58:48 -0600 Blog