Chairperson's File

Chairperson's File / en Sat, 09 Aug 2025 13:02:18 -0500 Mon, 28 Jul 25 10:16:20 -0500 Chair File: The OBBBA and What’s Next for Health Care /news/chairpersons-file/2025-07-28-chair-file-obbba-and-whats-next-health-care The recently enacted One Big Beautiful Bill Act will bring big changes to health care. AHA President and CEO Rick Pollack joined me for a Leadership Dialogue conversation earlier this month to talk about the key provisions that apply to health care. If you missed that episode, you can <a href="/news/chairpersons-file/2025-07-16-chair-file-leadership-dialogue-continuing-work-strengthen-health-america-aha-president-and">watch the video or listen to the podcast</a>.Our health care field, supported by patch after patch since 1965, is not sustainable for today’s world of 2025. Some of the patches that we needed to keep going are gone, and it’s unrealistic to think they’re coming back. This time doesn’t just feel different, it is different. So what should we be focused on as hospitals and health systems?First, we have to accept reality and make the smartest choices we can with the resources and constraints we have to maximize our delivery on our mission. The AHA has already begun some of this work and will be assisting hospitals to help individuals retain eligibility for coverage, as well as sharing best practices for improvements and operational efficiencies. We also are looking ahead at several hospital priorities that will need to be addressed before the end of the year — from waivers for telehealth and hospital at home, Medicaid disproportionate share hospital cuts, the Medicare rule making process, regulatory relief and more. Now more than ever, we are here to help you do what you do best: care for our communities.While the AHA is pulling all the levers in Washington, D.C., to advocate for priorities that advance health, all of us have an important role to play in engaging our legislators. There’s nothing more powerful than hearing from you, their constituents, about the impact certain policies will have on the people they represent. You can find resources and more information on how to best do this below.Our second, and most important, job is to actually reform and transform health care for the long term. We need to do the hard work and create a health care model that is sustainable for the world of 2065, not 1965. We have to start putting proposals on the table that challenge the status quo yet move us forward.At the AHA Leadership Summit in Nashville last week, I heard so many incredible stories of how you have started this work. As a field, we are using technology and innovation to transform care delivery, improve quality and patient safety, and meet people where they need care. And that is what makes me hopeful and optimistic.We’ve been dealt a difficult hand, but it’s our opportunity to open the door wide for transformation and innovation. We owe it to ourselves, our team members, our patients and our communities to make the very best choices we can today — and to transform our health care system for tomorrow.<h2>Helping You Help Communities — Key AHA Resources</h2><ul><li><a href="/resources-one-big-beautiful-bill-act-signed-law-july-4-2025">Advocacy Resources on OBBBA</a></li><li><a href="/advocacy/action-center">AHA Action Center</a></li><li><a href="/advocacy-issues">Key Advocacy Issues and Resources</a></li><li><a href="/advocacy/working-with-congress">Guide to Working with Congress</a></li></ul> Mon, 28 Jul 2025 10:16:20 -0500 Chairperson's File Chair File: Leadership Dialogue — Continuing the Work to Strengthen Health in America With AHA President and CEO Rick Pollack /news/chairpersons-file/2025-07-16-chair-file-leadership-dialogue-continuing-work-strengthen-health-america-aha-president-and This month Congress enacted the One Big Beautiful Bill Act — a sweeping package that contained many of President Trump’s legislative priorities on taxes, border security, energy and deficit reduction, as well as significant policy changes to Medicaid and the Health Insurance Marketplaces.This legislation will have a significant impact on hospitals and health systems as the changes are enacted. AHA President and CEO Rick Pollack joined me for a Leadership Dialogue conversation to help us understand the key provisions that apply to health care. We discuss how the AHA is helping the field prepare for some of the law’s changes, as well as our ongoing efforts to mitigate some of the policies. No matter what, we are here for you so you can continue to provide the care and services that our communities depend on.During the conversation, Rick and I also look ahead to the many key advocacy priorities that are still on the table for the remainder of the year, including several provisions that the AHA hopes to get enacted as part of a government funding bill at the end of September.Grassroots advocacy and sharing stories with your legislators about the real-world impact the policies they enact will have on patients and communities remain vital, and we close our conversation by exploring what this looks like for hospitals and health systems.I hope you find our conversation insightful and strategic. Look for future conversations with health care, business and community leaders on making health better as part of the Chair File in 2025.* Note that this conversation was recorded on July 11, 2025.&nbsp;<div></div>&nbsp; Wed, 16 Jul 2025 10:53:03 -0500 Chairperson's File Chair File: Leadership Dialogue — Legal Advocacy to Protect Hospitals With AHA General Counsel Chad Golder /news/chairpersons-file/2025-06-30-chair-file-leadership-dialogue-legal-advocacy-protect-hospitals-aha-general-counsel-chad Advocacy is a core part of the work of the AHA, protecting and sustaining what hospitals and health systems need to truly care for our communities. We often hear about legislative and regulatory advocacy, but legal advocacy is another important part of these efforts, both in and outside the courts.Chad Golder, general counsel at the AHA, recently joined me on the Leadership Dialogue for a conversation on our current legal environment, what the AHA is doing on behalf of members, and what hospital and health system leaders can do to help.&nbsp;We discuss a number of issues, including:<ul><li>The 340B Drug Pricing Program, a crucial lifeline for eligible hospitals to manage rising prescription drug costs and ensure our patients and communities have access to the health care services they need.</li><li>Regulatory relief to address regulations that foster anticompetitive conduct by insurers and limit the ability of hospitals and health systems to thrive in a competitive free market.</li><li>The many legal challenges to actions the Trump administration has undertaken.</li><li>Potential implications of a Supreme Court decision last year overturning the Chevron doctrine, which required courts to defer to federal agencies to interpret ambiguous laws.&nbsp;</li></ul>I hope you find our conversation insightful and strategic. Look for future conversations with health care, business and community leaders on making health better as part of the Chair File in 2025.* Note that this conversation was recorded on June 10, 2025. &nbsp;&nbsp;<div></div>&nbsp; Mon, 30 Jun 2025 09:55:49 -0500 Chairperson's File Chair File: The Importance of Legal Advocacy /news/chairpersons-file/2025-06-16-importance-legal-advocacy Advocacy is such an important part of what we do as hospitals and health systems — and what the AHA does on behalf of our field — to help ensure that we get the resources we need to care for our communities. When most people think of advocacy efforts, they might think first about legislation and regulatory efforts. But legal advocacy is another important component of this work that has an effect on all of us and the work that we do.One example is the 340B Drug Pricing Program. 340B is a vital lifeline for over 2,100 of AHA’s member hospitals, particularly those who serve rural or low-income communities. There is currently an effort led by drug companies to move to a&nbsp;“rebate model,” rather than the long-standing “upfront discount” model. Many 340B hospitals do not have the infrastructure to comply with rebate policies, meaning that critical resources would have to be shifted from patient care to meet the new demands.The AHA is engaged in many court cases on this issue, and it continues to urge the Department of Health and Human Services to reject the drug companies’&nbsp;unlawful requests that would result in negative consequences for patients and communities. The AHA&nbsp;— working with many state hospital associations&nbsp;— also is engaged in many cases defending state laws prohibiting drug companies from denying hospitals the same 340B discounts for drugs delivered to community pharmacies.Sometimes legal advocacy occurs outside the courts. One example of this is the AHA’s efforts with the Department of Justice and the Federal Trade Commission related to unnecessary or burdensome anticompetitive regulation. The AHA recently sent letters to DOJ and FTC with recommendations for addressing regulations that foster anticompetitive conduct by insurers and limit the ability of hospitals and health systems to thrive in a competitive free market, among other recommendations.Of course, there are many overlapping efforts with legislative and regulatory advocacy as well, including tariff implications and trade in critical supply chains, community benefit, and response to executive orders, just to name a few. The AHA is listening to our members and the challenges you face and is dedicated to engaging on all advocacy fronts to help protect the resources and provisions you need to focus on what you do best: making health better for the people we serve.I will be speaking with Chad Golder, AHA’s general counsel, for our next Leadership Dialogue episode. Tune in later this month to learn more about the current legal environment, the work the AHA is doing on behalf of our members, and what you can do to help.<h2>Helping You Help Communities — Key AHA Resources</h2><ul><li><a href="/type/amicus-brief" title="AHA Amicus Briefs">AHA Amicus Briefs</a></li><li><a href="/lettercomment/2025-05-09-aha-urges-hhs-reject-effort-several-large-drug-companies-undermine-340b-drug-pricing-program" title="AHA Comment Letter to HHS">AHA Urges HHS to Reject the Effort by Several Large Drug Companies to Undermine the 340B Drug Pricing Program</a></li><li><a href="/lettercomment/2025-05-23-aha-comments-doj-anticompetitive-deregulations-rfi" title="AHA Comment letter to DOJ">AHA Comments on DOJ Anticompetitive Deregulations RFI</a></li><li><a href="/lettercomment/2025-05-23-aha-comments-ftc-anticompetitive-deregulations-rfi" title="AHA Comment letter to FTC">AHA Comments on FTC Anticompetitive Deregulations RFI</a></li><li><a href="/testimony/2025-05-14-aha-senate-statement-trade-critical-supply-chains" title="AHA Statement for Senate Hearing on Trade and Critical Supply Chains">AHA Statement for Senate Hearing on Trade in Critical Supply Chains</a></li></ul> Mon, 16 Jun 2025 09:50:51 -0500 Chairperson's File Chair File: Leadership Dialogue — Tariffs and Health Care with Brian Pomper and Akin Demehin /news/chairpersons-file/2025-05-27-chair-file-leadership-dialogue-tariffs-and-health-care-brian-pomper-and-akin-demehin We are all closely watching changing tariff policy as it raises serious considerations for the medical products, devices and pharmaceuticals supply chain. Our ability to deliver safe, effective care to our patients relies on having essential supplies available.In this Leadership Dialogue, I am joined by Brian Pomper, a partner specializing in international trade policy at Akin Gump Strauss Hauer &amp; Feld, and Akin Demehin, vice president of quality and safety policy at the AHA. We discuss tariffs and their potential implications on the health care supply chain.You’ll hear Brian talk about current tariff agreements*, a brief history of U.S. tariffs and what could prompt a change in some current tariffs. Akin dives into how the AHA is working to secure tariff exemptions for medical devices and pharmaceutical products. He encourages all of us to share stories about the steps our teams go through to access supplies and deliver care, what that means to patients and how it impacts our hospitals and health systems.I hope you find our conversation insightful and strategic. Look for future conversations with health care, business and community leaders on making health better as part of the Chair File in 2025.* Note that this conversation was recorded on May 15, 2025.<a href="https://www.youtube.com/watch?v=TGXdfXOSJlA"><img src="/sites/default/files/inline-images/leadership-dialogue-freese-decker-pomper-demehin-watch-900x400-5-27-2025.jpg" data-entity-uuid="696806eb-1aaf-4869-a12b-71ad0b1e428b" data-entity-type="file" alt="May 27th Leadership Dialogue Watch video banner" width="900" height="400"></a><hr>&nbsp;<div></div><div class="raw-html-embed"> <details class="transcript"> <summary> <h2 title="Click here to open/close the transcript."> View Transcript &nbsp; </h2> </summary> 00:00:01:04 - 00:00:32:24 Tom Haederle Welcome to Advancing Health. Most experts agree that less reliance on foreign made medical and pharmaceutical products would be a good thing for U.S. health care. But experts also agree it's going to take some time to increase control over our supply chain. In today's podcast hosted by Tina Freese Decker, president and CEO of Corewell Health and the 2025 Board Chair of the �� Association, we hear from two experts about the potential impact of the Trump administration's trade tariffs on our supply chain and what they could mean for patients and providers. 00:00:32:27 - 00:00:39:28 Tom Haederle This podcast was recorded on May 15th. 00:00:40:00 - 00:01:04:17 Tina Freese Decker Hello, and thank you so much for joining us today. I'm Tina Freese Decker, president and CEO of Corewell Health and board chair for the �� Association. This month, we are diving into a topic that is top of mind for all of our leaders, not just in health care. It's tariffs. As our nation watches the changing tariff policy play out for those in the hospital field, there are serious considerations as it relates to our supply chain. 00:01:04:19 - 00:01:31:00 Tina Freese Decker Every day at Corewell Health and I'm sure at every hospital health system across our country, we use a wide array of products, devices and pharmaceuticals to deliver safe and effective care to our communities. The lives of the people we serve often depend on these items being readily available, making a robust health care supply chain critical. While the field shares the administration's long term goal of strengthening the domestic supply chain for essential medical and pharmaceutical products, 00:01:31:03 - 00:01:57:00 Tina Freese Decker we know that achieving this goal will require significant time. In the short term, there is concern that tariffs could inadvertently disrupt that availability of these essential care delivery products, increase the complexity of delivering patient care, and significantly raise hospital costs. So today, I'm joined by two guests who will help us better understand the current environment as it relates to tariffs and the potential implications to health care supply chain. 00:01:57:02 - 00:02:06:12 Tina Freese Decker Brian Pomper is a partner at Akin Gump Strauss Hauer and Feld, a D.C. based law firm, and he specializes in international trade policy. Welcome, Brian. 00:02:06:19 - 00:02:07:05 Brian Pomper, JD Thanks for having me. 00:02:07:20 - 00:02:24:28 Tina Freese Decker Before joining Akin Gump, Brian formerly served as the chief international trade counsel to the Senate Finance Committee, where he advised of all aspects of the committee's international trade and economic agenda. So we'll get into some of your expertise today. And we are also joined by Akin Demehin. Welcome, Akin. 00:02:25:05 - 00:02:26:03 Akin Demehin Thank you Tina. 00:02:26:05 - 00:02:54:05 Tina Freese Decker Akin is AHA's vice president for quality and safety policy. He leads public policy analysis, development and advocacy efforts related to quality, patient safety and workforce on behalf of the �� Association. He also leads a regulatory policy development efforts related to the health care workforce. So thank you so much for joining us today. There's so many ups and downs, so many negotiations about what's happening with tariffs. 00:02:54:08 - 00:03:00:20 Tina Freese Decker So Brian, I'm going to start with you. Can you tell us where we are today about what's happening for tariffs. 00:03:00:22 - 00:03:29:23 Brian Pomper, JD Sure thing. Well there's a couple different avenues that the administration has taken on its trade and tariff plan, I'd say. The first I'd just talk about the giant reciprocal tariff regime that the president announced on Liberation Day, as he calls it, on April 2nd. On April 2nd, he announced that he would be imposing 10% tariffs on every country in the world and higher tariffs on 57 of those countries on April 9th. 00:03:29:23 - 00:03:53:27 Brian Pomper, JD And so the 10% tariffs went into effect April 5th and then April 9th - for about a few hours - you had much higher tariffs on those 57 countries. The bond market and the stock market reacted quite negatively at the time. And so he decided he would pause those higher tariffs on the 57 countries for 90 days to allow for negotiations. 00:03:53:27 - 00:04:18:21 Brian Pomper, JD He said at the time it was because the bond market had gotten, in his words, yippy. So they were watching what was happening in the broader market. Concerned about where the market was trending, decided to pause this enterprise to allow for these kind of bilateral negotiations over the course of 90 days. And so that's where we are now. Where there are, really, one hears 18 to 20 countries that are in active negotiations with the administration. 00:04:18:21 - 00:04:38:22 Brian Pomper, JD There are many more that have proposed some degree of, measures they could take for their own economy. So there are really are dozens of countries that are engaged in negotiations with the United States during this 90 day period. There's been one announced agreement with the United Kingdom that was late last week or earlier this week. 00:04:38:24 - 00:04:58:07 Brian Pomper, JD I would just note that that agreement with the U.K., it's much less of an operational agreement and much more really of a kind of a scoping exercise in agreement to agree sometime in the future on certain matters. And so it's really just a little bit of an appetizer for what maybe these agreements might look like in the future. 00:04:58:07 - 00:05:22:03 Brian Pomper, JD And the hard part in even negotiating with the U.K. has yet to be done. There's a rumor that there's another agreement that should be announced here fairly soon, but I expect there will be a whole series of these kinds of announcements over the course of the next 90 days, until July 9th. I wouldn't expect the very high reciprocal tariffs on those 57 countries to snap back immediately into place on July 9th. 00:05:22:06 - 00:05:39:01 Brian Pomper, JD My expectation is that countries that are able to negotiate, as the U.K. did, will end up with a 10% tariff. They won't get their higher tariff. But even for those countries that have expressed a willingness to negotiate with the United States, I don't think that the higher tariffs will go into place. I think the president will extend the pause there. 00:05:39:08 - 00:06:05:14 Brian Pomper, JD So that's reciprocal tariffs. And then there are section 232 investigations. This is a mechanism whereby the president can ask the Department of Commerce to do an investigation into the national security impact of certain imports. And there has been, a variety of investigations that this president has, has undertaken and actually imposed tariffs on steel and aluminum and autos. All those tariffs are in place under the section 232 authority. 00:06:05:16 - 00:06:30:16 Brian Pomper, JD But there's also investigations into pharmaceuticals, into semiconductors, trucks, timber, lumber, copper, aerospace, potentially more coming down the pike. And so we're expecting those investigations to be announced here in the coming months. But we don't know exactly where the president will land yet. The premise of those investigations is supposed to be the national security impacts of those imports. 00:06:30:18 - 00:06:52:20 Brian Pomper, JD But really, the president seems to be using them as a cudgel to try to force companies to restore their manufacturing from overseas to the United States by tariffing the imports. He seems to like a tariff of 25%. That's the tariff that applies on steel, aluminum and autos. I think that's where we see him landing on some of these others. 00:06:52:23 - 00:07:26:13 Brian Pomper, JD And unlike the reciprocal tariffs where there's a lot of negotiation that's ongoing, the section 232 tariffs feel a lot stickier. They'll be a lot harder to get out from underneath them. And then of course there are the China tariffs. When the president announced the 34% reciprocal tariff for China. China retaliated and we ended up in a tit for tat retaliation that ended up really with, 145% base tariff on imports into the United States from China and 125% tariff from US exports to China. 00:07:26:15 - 00:07:46:12 Brian Pomper, JD That really was like an economic blockade. And both economies really needed to lower those and in fact, they did agree. The United States and China agreed to lower those tariffs. And so now the tariffs on products coming into China, the base tariff is 30% plus whatever additional tariffs might apply. And from the US side into China, it's 10%. 00:07:46:15 - 00:08:02:28 Tina Freese Decker I was just recently reading a book, history book and talked about tariffs. So can you share how tariffs have been handled differently compared in the past, how they are different today than they were used in past administrations or past years and strategies? 00:08:03:00 - 00:08:26:03 Brian Pomper, JD Yeah. Thank you. I love this question. Allows me to bring out my inner professor. So I would say for the first 150 years of American history, there was no topic that was more often and more frequently debated in Congress than what should be the level of the tariff. You had the incipient industrial industries in the North that wanted higher tariffs to protect their growing power up there. 0:08:26:05 - 00:08:49:15 Brian Pomper, JD And then you had growers in the South who wanted open export markets, and so they wanted low tariffs so that other countries don't go there. So there was this just constant negotiation. We ended in 1930 with something called the Smoot-Hawley tariff, which people may remember from their high school history class, as blamed for having deepened the Great Depression, I think widely perceived as a negative economic outcome. 00:08:49:17 - 00:09:10:10 Brian Pomper, JD And since 1930, what the Congress has really done is to delegate to the president quite a bit of authority over trade policy. This is why we have things like the section 232 investigation, where Congress has understood that well, you know, maybe it's not the best use of congressional time to negotiate on what the tariff on salmon imports should be. 00:09:10:13 - 00:09:33:18 Brian Pomper, JD You know, we're going to let the president kind of deal with that stuff. So we have for the last almost 100 years, had this kind of joint authority between Congress and the president where they would share this, this sort of responsibility. And I think there are those who will argue that that President Trump is using this authority in ways that hadn't been contemplated. 00:09:33:20 - 00:09:56:17 Brian Pomper, JD In particular, I would say, with a line of tariffs that I didn't talk about, which are these tariffs under the International Emergency Economic Powers Act that were imposed on Canada and Mexico, also on China. And actually, I should say IEEPA is the underlying authority the president used for this entire reciprocal tariff regime. It is a very aggressive use of this authority. 00:09:56:20 - 00:10:17:18 Brian Pomper, JD That that's unusual. The president is much more willing to push legal boundaries, of course, not just in tariffs, but we certainly see it in tariffs here. So much so it is currently being challenged in the courts. And it's really anybody's guess whether the courts are going to decide that he may have exceeded his authority under the IEEPA statute to him to impose these tariffs. 00:10:17:21 - 00:10:19:28 Tina Freese Decker And can you explain the IEEPA statute? 00:10:20:01 - 00:10:43:18 Brian Pomper, JD Sure. I'm happy to. So IEEPA stands for the International Emergency Economic Powers Act. It was passed in 1977 to allow the president to act quickly in cases of some sort of economic emergency. It's actually the basis for our entire export controls regime. It has never been used before to impose tariffs. President Trump is the first president to use it to impose tariffs. 00:10:43:21 - 00:11:08:13 Brian Pomper, JD There was a predecessor statute called the Trading With the Enemy Act, that President Nixon used to impose tariffs when we were in the process of going off of the gold standard, because there was a balance of payments crisis at the time. That was challenged in the courts, and the court at the time decided that was okay because the court decided, well, those tariffs that the president imposed were really in response to a true economic crisis. 00:11:08:13 - 00:11:32:19 Brian Pomper, JD There wasn't enough gold in Fort Knox to cover the number of dollars that were in circulation at the time. And those tariffs were imposed for a relatively short period. It was only four months. And it wasn't every country and every product. If you fast forward now to the successor statute, the IEEPA statute, which was written largely because the Trading With the Enemy Act...it was an awkward fit for some of these actions that President Nixon took. 0:11:32:21 - 00:11:59:07 Brian Pomper, JD Here you now have a president who has used IEEPA to impose tariffs on every country, every product, effectively forever. And so the question that the court in Yoshida, which is the case I'm talking about, the court in Yoshida decided the president in that case was not seeking to usurp the role of Congress, which is clearly given to Congress in the Constitution to control international economic relations, trade with foreign nations. 00:11:59:10 - 00:12:30:11 Brian Pomper, JD The president wasn't seeking to stand in the role of Congress in resetting tariffs, because it was only time limited and, you know, limited in coverage. Here it's a much different circumstance where you really do have the entirety of the harmonized tariff code that covers all of our trade with every country being reset through executive order. I do think that there are very strong legal arguments that will be made and are being made in court, literally right now as we speak, that the president exceeded his authority under 00:12:30:14 - 00:12:40:06 Brian Pomper, JD IEEPA. So it's not inconceivable in the next few weeks, you could see a court order that would invalidate the president's actions and really get rid of this entire reciprocal tariff regime. 00:12:40:08 - 00:13:04:03 Tina Freese Decker Thank you very much. That was an excellent summary, we really appreciate that. I'm going to switch to Akin. Akin, can you share an overview of concerns specific to hospitals as how it relates to the tariffs may impact access to pharmaceuticals, medical supplies, other needed devices, and do you think that there is going to be a concern about exasperate some of the shortages that we have experienced to date? 00:13:04:06 - 00:13:27:02 Akin Demehin Absolutely. I think the complexity that Brian was talking about in terms of how these tariffs are being rolled out is really needing the complexity of the health care supply chain. And the concern that we hear from members and that we really put front and center in our own advocacy efforts is what does this mean for the delivery of patient care? 00:13:27:04 - 00:13:54:21 Akin Demehin What does it mean for our caregivers in health care facilities? Hospitals and health systems are constantly weaving together both domestic and international sources for their drugs, for their medical devices, and for other critical supplies. And we know that even temporary disruptions to the flows of those goods can have significant impacts to how hospitals deliver care. Great example are cancer drugs. 00:13:54:24 - 00:14:20:02 Akin Demehin Many of those are manufactured in China or rely on a significant number of key starting materials that are manufactured in China or in other locations across the globe. The disruption from tariffs could potentially lead to disruptions in those carefully planned cancer treatments that really rely on careful scheduling. The same thing is true of things like cardiovascular medicines. 00:14:20:04 - 00:14:57:21 Akin Demehin As you raised at the outset, Tina, we certainly support ongoing efforts to onshore production and really strengthen the domestic supply chain. At the same time, even those medical goods and devices that are manufactured here in the U.S. often draw in content from abroad. Great example is an infusion pump, where even those infusion pumps are manufactured here in the US might have parts from 20 or more different countries, ranging from the aluminum that goes into manufacturing the pole to the computer chips to the plastics. 00:14:57:24 - 00:15:12:17 Akin Demehin All of that involves a considerable amount of complexity. And switching sourcing and offshoring production really is a long term effort. So we've really tried to elevate those concerns in our work around tariffs. 00:15:12:19 - 00:15:19:09 Tina Freese Decker So can you tell us what the �� Association is doing to secure exemptions for medical devices and pharmaceuticals? 00:15:19:11 - 00:15:56:23 Akin Demehin Sure. So early in the rollout of the tariffs from the administration - going back to early February - we actually sent a letter to the president outlining our concerns about the potential impacts of tariffs to the delivery of patient care, to our ability to provide things like personal protective equipment to frontline providers. And we've continued to follow that up with ongoing proactive dialogue with the administration to really focus on advocating for exemptions for pharmaceutical products and for medical devices. 00:15:56:25 - 00:16:27:12 Akin Demehin Bryan talked about the section 232 investigations. The administration has one ongoing for pharmaceutical products, and had an opportunity for the field to share feedback. And we share our concerns with the administration and continue to ask for exemptions. The other thing that we are trying to do is to really provide the hospital and health system perspective to policymakers, to the media, to the administration. 00:16:27:14 - 00:16:51:22 Akin Demehin We're in a bit of a unique position versus other kinds of fields where we are large consumers of the goods within the supply chain. Our ability to stockpile any of these supplies is often constrained by just the sheer availability of the supplies. The shelf life for things like pharmaceuticals is finite, so it's not necessarily something that you can just have hanging out on a shelf. 00:16:51:25 - 00:17:20:12 Akin Demehin There's space that you have to have in order to warehouse some of these materials. And the way that hospitals and health systems are reimbursed means that it's really our members that bear the costs of tariffs. Because our rates are set by government and by contracts in the private sector, the potential cost impacts of tariffs are ones that we really feel quite directly for our members. 00:17:20:14 - 00:17:33:17 Tina Freese Decker Akin, you answered all of my questions coming through there. That was fantastic, because those are all of the concerns that we have as members and what's going on. Brian, do you think that exemptions are likely knowing this administration? 00:17:33:19 - 00:17:54:18 Brian Pomper, JD An excellent question I get from many, many clients. And I would go back to what I mentioned earlier. My expectation is that the American economy is going to struggle a bit under the weight of all of the tariffs that the president has imposed in all these ways. And there are more tariffs coming under these section 232 investigations that are currently ongoing. 00:17:54:20 - 00:18:27:09 Brian Pomper, JD I think that many in Congress, especially on the Republican side, have expressed privately but not publicly concern about the president's strategy with respect to tariffs and how it might impact their constituents. But I think over time, the political and economic pressure is going to force some kind of adjustment in the administration. And I think the most logical pressure valve to be released for the administration is for them to reimpose some type of exclusion process, as we did have in the first administration. 00:18:27:09 - 00:18:33:15 Brian Pomper, JD So if I'm a betting person, yes, I think we will have some kind of exclusion process. 00:18:33:18 - 00:18:54:27 Tina Freese Decker We'll come back to see if you're right. And so to close out our conversation today, this has been really helpful, a great history lesson and understanding of what's going on. Brian and Akin, can you share with us what your advice would be for our members? What should we be thinking about doing, planning for, as we think about these tariffs and the impact that they have? 00:18:54:29 - 00:19:13:08 Brian Pomper, JD Yeah, I always tell clients if something is important to you, important to your bottom line, you need to be vocal about it, and you need to be telling people how these measures are going to impact you. It's hard to argue with the goal, or at least one of the goals the president has of increasing manufacturing employment in the United States. 00:19:13:08 - 00:19:34:21 Brian Pomper, JD Who doesn't want that? I think where there's debate is how best to achieve that. But I do think it's important for organizations like AHA to go talk to your members, talk to the people who focus on the policy issues, the policy areas that you deal with. Let them know how these tariffs are going to impact you, and ask them to weigh in on your behalf. 00:19:34:21 - 00:19:46:01 Brian Pomper, JD And just make sure that whatever the administration does, they try to maximize benefit while minimizing harm. So I would just say where there's an opportunity to engage, I encourage the AHA to do so. 00:19:46:04 - 00:19:50:13 Tina Freese Decker Maximize benefit and minimize harm. Great statement. Akin? 00:19:50:15 - 00:20:20:02 Akin Demehin You know, Brian's counsel here is extremely wise. I'll just build on it in a couple of ways. One of the things that I know hospitals and health systems are so good at doing is bridging that gap between data and story. And often it is those stories of what's happening on the ground, how the steps that you go through to access supplies to deliver care, how those are affected, and playing that out for what it means for patients. 00:20:20:04 - 00:20:49:15 Akin Demehin Those are the kinds of stories that I know policymakers respond to. It really makes the issue even more real for them. And as Brian alluded to, raising some of those concerns with policymakers and certainly reaching out to us here at AHA, we can always be strong advocates on your behalf when we have intel and stories, and other information from all of you to help make the case as best we can. 00:20:49:16 - 00:20:58:17 Akin Demehin So we want to stay connected as we possibly can with all of you going forward so that we can push for those exemptions for pharmaceuticals and medical devices. 00:20:58:19 - 00:21:23:02 Tina Freese Decker That's wonderful. And your example about the cancer drugs or the smart pump or MRI and how all of those pieces come together is one of those stories that we can talk about and how it impacts us. So Brian and Akin, thank you so much for your time today and sharing in your expertise. I know this is an evolving issue and the AHA will continue to monitor closely and advocate on behalf of our field. 00:21:23:04 - 00:21:29:13 Tina Freese Decker And thank you to everyone tuning in today. We'll be back next month for another Leadership Dialogue conversation. 00:21:29:15 - 00:21:37:26 Tom Haederle Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts. </details> </div> Tue, 27 May 2025 10:11:08 -0500 Chairperson's File Tariff Implications for American Health Care /news/chairpersons-file/2025-05-19-tariff-implications-american-health-care Most hospitals and health systems are the largest organizations in our communities, providing critical services needed by every one of our neighbors. We take care of our communities as best as possible — which means advocating for the support and resources we need.A series of tariffs recently implemented could have significant implications for health care. A large proportion of medical goods currently comes from international sources, including pharmaceuticals, medical devices and personal protective equipment, as well as other low-margin, high-use essentials like syringes, needles and blood pressure cuffs.Tariffs on these items could impact patient care by jeopardizing the availability of vital medications and essential health care devices. They also could raise costs for hospitals and heighten shortages and supply chain disruptions.We’ve already seen the impact of supply chain disruptions in the aftermath of Hurricane Helene. To continue providing the care our communities rely on, hospitals and health systems need exemptions to ensure access to essential imports.AHA President and CEO Rick Pollack has&nbsp;<a href="/lettercomment/2025-02-05-aha-urges-administration-grant-exceptions-tariffs-medications-and-medical-supplies" title="AHA comment letter">urged the administration</a> to provide tariff exemptions for medications and medical supplies.The AHA also&nbsp;<a href="/lettercomment/2025-05-06-aha-comments-commerce-department-investigation-pharmaceutical-imports" title="AHA response to a request for public comment">recently responded</a> to a request for public comment on the Department of Commerce’s Section 232 national security investigation on pharmaceuticals and pharmaceutical ingredient imports, urging the administration to maintain tariff exemptions to minimize inadvertent disruptions to patient care.We’ve seen the creativity, innovation and resiliency of our hospitals to deliver patient care during the pandemic and other challenging circumstances. Health care leaders can work toward evaluating their supply chains to look for alternate sources, even as we advocate on behalf of our patients.There also is an important opportunity to make the supply chain more resilient. AHA has <a href="/testimony/2025-05-14-aha-senate-statement-trade-critical-supply-chains" title="AHA Senate testimony">been working with Congress</a> to urge consideration of legislation that would support efforts to proactively map and assess the pharmaceutical, medical device and equipment supply chains.I will be talking with Brian Pomper, partner with Akin Gump Strauss Hauer &amp; Feld, and Akin Demehin, AHA’s vice president of quality and patient safety policy, for an upcoming Leadership Dialogue on tariffs. Join us to learn about the potential impact on health care and how leaders can prepare.Helping You Help Communities: Key AHA Resources<ul><li><a href="/lettercomment/2025-02-05-aha-urges-administration-grant-exceptions-tariffs-medications-and-medical-supplies">AHA Urges Administration to Grant Exceptions for Tariffs for Medications and Medical Supplies</a></li><li><a href="https://www.modernhealthcare.com/providers/aha-akin-demehin-tariffs-medical-devices" target="_blank">The steps the AHA is taking to exempt medical devices from tariffs — Modern Healthcare</a></li><li><a href="/system/files/media/file/2025/04/The-Cost-of-Caring-April-2025.pdf">The Cost of Caring: Challenges Facing America’s Hospitals in 2025</a></li><li><a href="/lettercomment/2025-05-06-aha-comments-commerce-department-investigation-pharmaceutical-imports">AHA Comments on Commerce Department Investigation of Pharmaceutical Imports</a></li></ul><hr><div></div> Mon, 19 May 2025 10:16:36 -0500 Chairperson's File Chair File: Leadership Dialogue — Cybersecurity in Health Care with John Riggi, AHA’s National Advisor for Cybersecurity and Risk /news/chairpersons-file/2025-04-28-chair-file-leadership-dialogue-cybersecurity-health-care-john-riggi-ahas-national-advisor Cybersecurity and physical threats are unfortunately significant enterprise risks for health care, regardless of size or location. Every hospital, physician group and medical center is at risk — and this risk puts the people we serve at risk, which is why we must take these threats seriously.I welcomed John Riggi, AHA’s National Advisor for Cybersecurity and Risk, to our Leadership Dialogue to have a conversation about planning for and navigating cyber and physical threats. John spent nearly 30 years with the FBI before joining the AHA in 2018.John shared three major themes we all must lean into regarding cyber and physical threats. The first is leadership. We must recognize that cyber and physical threats are an enterprise risk issue and put the necessary resources in place to be proactive and prevent these threats from occurring. Second, third parties pose a major risk. It is important to evaluate our third-party risk and put plans in place to minimize the risk as much as possible. Third, prepare, prepare, prepare! Part of preparation is educating leaders and staff and creating partnerships within the organization and in the community to be able to respond and act if and when something happens.I hope you find our conversation insightful and strategic. Look for future conversations with health care, business and community leaders on making health better as part of the Chair File in 2025.<hr><a href="https://www.youtube.com/watch?v=fHgCZJFQa60" target="_blank" title="Leadership Dialogue Tina Freese Decker with John Riggi">Watch on Youtube.</a><hr><div><a href="https://www.youtube.com/watch?v=fHgCZJFQa60" target="_blank" title="Leadership Dialogue Tina Freese Decker with John Riggi"></a></div><div class="raw-html-embed"> <details class="transcript"> <summary> <h2 title="Click here to open/close the transcript."> View Transcript </h2> </summary> 00:00:01:01 - 00:00:26:02 Tom Haederle Welcome to Advancing Health. Cybersecurity is a risk. And because of that, a priority for all hospitals and health systems. In this Leadership Dialogue, Tina Freese Decker, chair of the �� Association, and John Riggi, AHA’s national advisor for Cybersecurity and Risk, discuss planning for cyber attacks, putting protections in place, navigating cyber threats, and rebuilding trust and confidence in the system 00:00:26:04 - 00:00:31:01 Tom Haederle when cyber attacks do occur. 00:00:31:04 - 00:01:00:23 Tina Freese Decker Hello, and thank you so much for joining us today. I'm Tina Freese Decker, president CEO of Corewell Health and the board chair for the �� Association. From data breaches to ransomware attacks to outages, cybersecurity affects patient safety and enterprise risk and is increasingly a strategic priority for hospitals and health systems. Planning for cyber attacks and putting the proper protections in place is key to ensuring sustainability, patient privacy and clinical outcomes. 00:01:00:26 - 00:01:34:22 Tina Freese Decker So I am so pleased to have the �� Association's John Riggi joining me for today's conversation. John is an expert in this field, and he serves as the AHA's first national advisor for cybersecurity and risk. He joined AHA in 2018 after a long, distinguished 30-year career with the FBI. He brings with him tremendous experience in the investigation and disruption of cyber threats, as well as the unique ability to provide informed risk advisory services to hospitals and health systems. 00:01:34:24 - 00:01:41:26 Tina Freese Decker So before we jump into the conversation, John, can you just tell me a bit about yourself so that our audience can get to know you a little bit better? 00:01:41:29 - 00:02:08:13 John Riggi Thank you, Tina, so much for inviting me here today to discuss these topics, which unfortunately, as you said, top of mind for everyone. So when I ended my 30-year career at the FBI, I still wanted to be in a position to serve. I spent a lifetime doing that, and in my last role at the FBI, my job was to establish mission critical relationships with private sector, with critical infrastructure in the health care sector in particular. 00:02:08:15 - 00:02:29:22 John Riggi That's when I had the privilege and honor to be introduced to AHA and Rick Pollack in talking about cyber threats. And that's when I really learned how critical a role that the �� Association served for the entire health care sector. I could send over, you know, an immediate urgent alert to the and with a single press of a button 00:02:29:29 - 00:02:56:16 John Riggi 5000 plus hospitals received that alert. 50,000 executives received it. So I understood at that point we needed to engage in that continuing relationship. And when I retired, fortunately for me, Rick Pollack in the team said, John, you know, we've been listening to you and we think cyber will be an emerging threat, going forward. Unfortunately, none of us realized how significant a threat it would be. 00:02:56:19 - 00:03:00:12 John Riggi And so, again, my privilege and honor to be here with you today. 00:03:00:14 - 00:03:22:21 Tina Freese Decker Well, we are privileged and blessed that you are part of the �� Association team, and you're helping us navigate so many of these issues that come forward. Let's start with kind of one of the underlying questions that I have. We've seen all these cyber and physical threats that have targeted hospitals and health systems. How have they evolved over the last, let's say, 7 to 8 years? 00:03:22:24 - 00:03:58:21 John Riggi Yeah, unfortunately they've increased pretty dramatically. So not only are they increased in frequency, but also in complexity and severity of impact. So on the cyber front, we have seen a, for instance, in hacking of patient health information. In 2020, it was about 450 hacks impacting 27 million individuals, not inconsequential. Last year, last year with the Change Healthcare attack, we had 259 million Americans had their health care records stolen or compromised by foreign bad guys, by foreign bad guys. 00:03:58:27 - 00:04:24:17 John Riggi If we add up the numbers, just since 2020, over 500 million Americans have had their health care records compromised or stolen. So, John, wait a minute. There's only 330 million Americans. That's the population. Meaning that every American in this country has had their health care records compromised more than once. But what really concerns us are the dramatic increase in ransomware attacks, which are often accompanied by data theft attacks. 00:04:24:19 - 00:04:51:12 John Riggi So these bad guys, primarily Russian speaking, believed to be provided safe harbor by the Russian government primarily but not exclusively Russian, have increased these attacks so that the impact really is not only disablement of technology, internal networks get shut down, data gets encrypted, organizations are forced to disconnect from the internet has a very, very dramatic impact on care delivery. 00:04:51:15 - 00:05:18:21 John Riggi So this resulting disruption, delay to care delivery and ultimately posing a serious risk to patient care and safety, not only for the patients in the hospital, but for the entire communities that depend on the availability of their nearest emergency department for life saving care, radiation oncology, so forth. So we've seen that evolve again very significantly, and one of the reasons I think it's evolved so dramatically. 00:05:18:23 - 00:05:30:21 John Riggi Geopolitics is part of that. But I think on a very base level, we as a sector depend more and more on network and internet connected technology and data. 00:05:30:24 - 00:05:56:13 Tina Freese Decker Very true. You know, I did a podcast earlier this year about trust and rebuilding confidence and trust and having that public trust in health care systems and hospitals. And when you have a cyber attack or an act of violence that targets hospitals, health systems, it impacts patients, like you said, it impacts staff and our communities. How can we go about building that trust and regaining that confidence when we have these instances occur? 00:05:56:15 - 00:06:06:23 Tina Freese Decker And do you have some examples of stories or insights organizations have used that have helped them navigate those cyber threats and build that public trust? 00:06:06:26 - 00:06:32:07 John Riggi Great question, Tina. And also on the on the violence side, unfortunately, as I wanted to mention as well, that's increased pretty dramatically to set the stage there. I was shocked, as a former law enforcement officer, to find out nurses are the second most assaulted profession outside of law enforcement. And, you know, we expect it as law enforcement officers to be engaged, confrontational engagements. 00:06:32:07 - 00:06:37:09 John Riggi You're making arrests, but nurses who just want to deliver care to help people? Shocking. 00:06:37:09 - 00:06:38:19 Tina Freese Decker It's sad and unacceptable. 00:06:38:23 - 00:06:58:27 John Riggi Agree, totally. So I think how do we how do we get that trust in the community? I think one - and I think we've done a fantastic job with your leadership and the AHA - acknowledge the risk, acknowledge the threat. Let's not hide it. Let's not pretend it's not there. But then to take real steps to prepare and help mitigate the impact of these threats. 00:06:59:00 - 00:07:25:01 John Riggi So now we see, on the cyber side, hospitals are actively working to develop better downtime procedures, better backup systems to help shorten the length of the impact and help recover more quickly. And work with the federal government. Exchange threat information across the sector with our partners in other sectors. And really understand if we're attacked, this isn't a stigma. 00:07:25:02 - 00:07:51:18 John Riggi This isn't something that an organization failed to do. We're all in this together. And on the physical side, we're working very closely with the FBI to help develop resources to help identify and mitigate targeted acts of violence directed toward health care organizations. But most importantly, our frontline health care heroes, our frontline health care workers. And again, working with the community, this is all partnership with the community as well. 00:07:51:20 - 00:08:08:05 Tina Freese Decker So I'm sure you have a top ten list of things that we could do to prevent these attacks. But if you could share the top three things that we should do to prevent these attacks and how we can be resilient. And when I say attacks, I'm talking cyber and physical. We have limited time, we have limited resources. 00:08:08:05 - 00:08:10:19 Tina Freese Decker But what is the most important things that we should be doing? 00:08:10:22 - 00:08:36:21 John Riggi I think the overarching umbrella that all the others follow under is leadership. And really looking at these risks, acknowledging them and ensuring that both cyber and physical risks are treated as an enterprise risk issue. And then within that, on the cyber side, making sure on the defensive side that you're following well known, well-established, recognized cyber frameworks, making sure you start there. 00:08:36:24 - 00:09:03:08 John Riggi Second, really thinking about third party risk. What we have seen is that a majority, the vast majority of cyber risk, cyber attacks we face come to us through insecure third party service providers. Insecure third party technology and insecure supply chain. Doesn't negate us from our responsibility to do what we can, but we have to understand that. And then the third thing is ultimately prepare. 00:09:03:10 - 00:09:24:08 John Riggi We must prepare for the attack. There's an often, I would say, overused expression in the cyber security world. It's not a matter of if, but when. It's true. But I would also change that a little bit about it's not a matter of if you will be attacked. The question is are you prepared? So focusing on resiliency and so forth. 00:09:24:10 - 00:09:55:13 John Riggi And then with on the physical side, education of staff, leadership priority, and working with the FBI and local law enforcement to potentially identify ahead of an incident acts of targeted violence directed towards the hospital. And then working together as a community help mitigate and prevent that act. The police always want to respond, can respond after the FBI. But I can tell you from personal experience, we'd rather prevent a crime, prevent an act of violence than respond after the fact. 00:09:55:15 - 00:10:19:15 Tina Freese Decker Agree. And I think that developing those relationships with local FBI, with local law enforcement is critical because you to your point, it's not if, but when. But we'd like to be able to prevent all of it. Having those relationships is key. So I know that the AHA has been working very closely with the FBI and some health care systems to exchange that threat intelligence and enhance collaboration across our sector 00:10:19:15 - 00:10:28:21 Tina Freese Decker and with federal agencies. Can you share more about that partnership and how it has helped us in identifying and mitigating both physical and cyber threats? 00:10:28:24 - 00:10:51:26 John Riggi Great question again, Tina, and thank you for highlighting what we're doing with the FBI. So on the cyber front, we've been actively engaged in cyber threat, information threat intelligence exchange. Both on a very technical level, exchanging what - without getting too technical - threat indicators, malware signatures and so forth, but also identifying big strategic threats that we may face as a sector. 00:10:51:28 - 00:11:19:23 John Riggi So, for instance, working with the FBI, we helped identify last year a threat to the blood supply before it was on the government's radar. We helped the government understand that cyber attacks on hospitals are not just data theft crimes. These are truly threat to life crimes. So the federal government actually previously raised the investigative priority level of ransomware attacks on hospitals to equal that of a terrorist attack once they understood what the impact was. 00:11:19:24 - 00:12:00:17 John Riggi We are working very closely with the famed Behavioral Analysis Unit of the FBI, the profilers that many books and TV shows and movies have been written about to develop resources to help hospitals identify targeted acts of violence, threats that are pending against hospitals, and again, help intercede, intervene and help prevent those attacks. We have a whole series of resources available on the first ever joint FBI and Joint Health Care Sector webpage. We're about to issue a manual coming out here within the next month or so, based upon, joint work with the FBI in the field on best practices and lessons learned to prevent these acts of violence. 00:12:00:17 - 00:12:06:08 John Riggi So we have a robust, almost daily interaction with the FBI and other federal agencies. 00:12:06:10 - 00:12:25:15 Tina Freese Decker It's so helpful to know that we have those robust partnerships at the national level, and then we can create it at the local level, and to make sure that we're all in this together to, help protect our patients and the people that we care for in our community. So that's wonderful. My last question for you is just one about how we look forward. 00:12:25:17 - 00:12:38:26 Tina Freese Decker Can you tell us what you think about is going to happen in the threat environment for 2025 and maybe into 2026? What are those things we should be watching, looking out for? And is there anything positive that you can see? 00:12:38:29 - 00:13:11:18 John Riggi I will let you know there is some hope. Talk about the realistic environment. Then we'll talk about where I see the hope. So first of all, I do believe that the frequency of the attacks may decrease, but I think the bad guys are looking to make a greater impact. We have seen them go after systemically important organizations that serves health care. Change Healthcare, for example. Last year, attacks against the blood supply. The year before they attacked - found vulnerabilities in a commonly used technology and software known as Move It. 00:13:11:21 - 00:13:41:03 John Riggi By attacking that software, it gave the bad guys, a Russian ransomware group, were able to gain access to millions and millions of patient records. I do believe geopolitics will have a very significant influence, for better or worse, on the level of cyber threat we face. Depending on how we deal in the outcomes of our negotiations, of our diplomatic efforts with Russia, China, North Korea and Iran has the potential to mitigate or increase the cyber threats that we face. 00:13:41:05 - 00:14:08:19 John Riggi And ultimately, again, third party risk, major, major issue. Where do I see the signs of hope? And there are signs of hope, folks. Honestly, I have never seen the sector come together to share threat information to prepare for attacks, best practices, lessons learned not only amongst the sector. We see channels of threat information sharing and best practice across with other critical and sectors, with the federal government. 00:14:08:21 - 00:14:45:26 John Riggi We've had victim organizations, CEOs come out publicly. Dr. Leffler from University of Vermont, Chris Van Gorder from Scripps. We've had Eduardo Conrado from the recent attack against Ascension not only come out publicly, but testify before the UN Security Council last November about the impact of this Russian ransomware attack against Ascension. So what I see is hope. The fact we are banding together and with the government and I hope, as we did in the great fight against terror, international terrorism, we will come together in a whole of nation approach to help mitigate that risk. 00:14:46:01 - 00:15:09:17 John Riggi Now, Tina, I know I've done a lot of speaking here, and if I may, and with all due respect, I'd like to ask you a question if I could. Tina, in your role, you have very unique dual role. You're CEO of a large health system, and you're also the chair of the �� Association board. So how do you think about cyber and physical threats for your own organization 00:15:09:19 - 00:15:11:20 John Riggi but on a national level? 00:15:11:22 - 00:15:33:26 Tina Freese Decker Well, I believe that cyber and physical threats must be prioritized. It's a strategic risk. We have to understand how we focus on it, and we have to significantly prioritize it and emphasize what we're doing there. Previously, maybe 5 or 10 years ago, it was just thought of as a technical issue. It's not that. It's how we operate. Because like you said, we're so connected, 00:15:33:26 - 00:16:01:07 Tina Freese Decker it's critical infrastructure and we must make sure that we are coming together. So for us as an organization, we prioritize our efforts, our investments, our work on it, but also prioritize business assurance. So how do we operate and make sure that everyone understands all the key components and the lessons that you shared on this discussion today, but also when we've had conversations before, how are we making sure that we know those and our teams know those? 00:16:01:09 - 00:16:25:19 Tina Freese Decker I think the importance of safeguarding sensitive patient data and ensuring the integrity of our systems cannot be overstated. And that applies for my organization, and that applies for all of our members throughout the �� Association. And so I think those are some critical points. As we think about this it is making sure that we are safeguarding sensitive patient data and ensuring the integrity of our systems, as we go forward. 00:16:25:19 - 00:16:59:14 Tina Freese Decker That cannot be overstated. And as we do that, I think we all uphold that level of commitment to excellence that our patients and the people in our community want. So, John, thank you so much for your time today, for sharing your expertise. While we may not be able to prevent or mitigate everything, you have given us such great advice and we should make sure we take that down, but also listen to many of your podcasts that you put out or the Action Alerts that you sent through because they are helpful and direct and provide that great advice to move forward. 00:16:59:16 - 00:17:17:11 Tina Freese Decker And I know that you are available to connect with all of our members if there is a specific situation, or they just want to learn more to make sure that we're better. So thank you, John, for being here. And thank you to all of those that have tuned in to this conversation. We will be back next month for another Leadership Dialogue. 00:17:17:13 - 00:17:25:24 Tom Haederle Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts. </details> </div> Mon, 28 Apr 2025 11:46:47 -0500 Chairperson's File Chair File: Resources for Navigating Transformation and Change /news/chairpersons-file/2025-04-14-resources-navigating-transformation-and-change This is an incredibly dynamic and transformative time for health care. One resource I have found incredibly helpful in speaking with many of you and engaging in strategic discussions are the <a href="/type/fact-sheets" target="_blank" title="Key Issues Fact Sheets">fact sheets</a> provided by the AHA. These concise, simple documents offer a wealth of information around key issues, what the AHA is doing and why, and how you can engage with these efforts.There are likely to be substantial changes in health care policy during the new administration, and these fact sheets are great tools for advocating with your legislators and understanding the implications on the financial sustainability of our hospitals and health systems. Topics include enhanced premium tax credits, Medicaid, site-neutral payments, 340B drug pricing and more.The AHA is focused on addressing these challenges head on with Congress, the administration, regulatory bodies and the courts to shape policy that advances our long-term viability and efforts to provide quality patient care. Our&nbsp;<a href="/advocacy-agenda" target="_blank" title="2025 Advocacy Agenda">2025 Advocacy Agenda</a> is focused on:<ul><li>Ensuring access to care.</li><li>Strengthening the health care workforce.</li><li>Advancing quality and health care system resiliency.</li><li>Leading innovation in care delivery.</li><li>Reducing health care system costs for patient care.</li></ul>We will be talking about these key advocacy priorities and pressing issues facing our field at the&nbsp;<a href="https://annualmeeting.aha.org/" target="_blank" title="AHA Annual Membership Meeting">AHA Annual Membership Meeting</a> May 4-6 in Washington, D.C. I hope to connect with many of you there as we engage in insightful conversations with policymakers, legislators and thought leaders.Each of us has influence to use on behalf of our patients, caregivers and communities, and every vote matters. Together as a field, we have the power to make a difference. When we work together, we speak with a voice that is loud, clear and effective. Because we are here to care for the neighbors in our communities no matter what headwinds we face.Helping You Help Communities: Key AHA Resources<ul><li><a href="/type/fact-sheets" target="_blank" title="AHA Fact Sheets">AHA Fact Sheets</a></li><li><a href="/advocacy-agenda" target="_blank" title="2025 Advocacy Agenda">2025 Advocacy Agenda</a></li><li><a href="/advocacy-issues" target="_blank" title="Advocacy Issues and Resources">Advocacy Issues and Resources</a>&nbsp;</li><li><a href="https://annualmeeting.aha.org/" target="_blank" title="AHA Annual Membership Meeting Webpage">2025 AHA Annual Membership Meeting</a></li></ul> Mon, 14 Apr 2025 11:14:43 -0500 Chairperson's File Chair File: Leadership Dialogue — Importance of Advocacy and Storytelling in Rural Health with Lori Wightman, R.N., CEO of Bothwell Regional Health Center /news/chairpersons-file/2025-03-31-chair-file-leadership-dialogue-importance-advocacy-and-storytelling-rural-health-lori Rural hospitals and health systems face big challenges, but together — with a unified voice — we can work to ensure people living in rural communities get the safe, quality health care they need.In this Leadership Dialogue, I’m joined by Lori Wightman, R.N., CEO of Bothwell Regional Health Center, in Sedalia, Mo. Lori and I discuss working in a “family atmosphere” unique to a rural hospital and navigating the same pressures that face urban hospitals, including workforce shortages and the high costs of labor, supplies and drugs. Rural hospitals also experience severe underpayments by Medicare and Medicaid, and most have “razor-thin” operating margins.Lori describes leading annual advocacy days — where Bothwell board members meet with state legislators (and candidates in election years) — and emphasizes the importance of all team members telling the hospital story.I hope you find our conversation insightful and strategic. Look for future conversations with health care, business and community leaders on making health better as part of the Chair File in 2025. &nbsp;<a href="https://www.youtube.com/watch?v=P0QCVh9HyZ4&amp;embeds_referring_euri=https%3A%2F%2Fwww.aha.org%2F&amp;source_ve_path=OTY3MTQ" target="_blank" title="YouTube: Leadership Dialogue Series: Importance of Advocacy and Storytelling in Rural Health">Watch the Leadership Dialogue on YouTube.</a><hr><div></div><a href="https://player.captivate.fm/episode/934a92c6-6fc0-4245-b43b-0c44a2bc9ea4" target="_blank" title="Captivate: Leadership Dialogue Series: The Importance of Advocacy and Storytelling in Rural Health">Listen to the Leadership Dialogue on Captivate.</a>&nbsp;<div class="raw-html-embed"> <details class="transcript"> <summary> <h2 title="Click here to open/close the transcript."> View Transcript </h2> </summary> 00:00:01:05 - 00:00:23:09 Tom Haederle Welcome to Advancing Health. In the face of today's multiple challenges, every hospital needs support and buy in for its mission of great care. Storytelling - sharing the right kinds of stories with the right audience at the right time - is a great way to build and maintain that support. This is particularly important for rural hospitals and health systems, most of which have razor-thin operating margins. 00:00:23:12 - 00:00:40:10 Tom Haederle In this month's Leadership Dialogue, hosted by the �� Association's 2025 Board Chair Tina Freese Decker, we hear more about the importance of advocacy and of all team members participating in telling the hospital story. 00:00:40:13 - 00:01:07:25 Tina Freese Decker Thank you so much for joining us today. I'm Tina Freese Decker, president CEO for Corewell Health, and I'm also the board chair for the �� Association. Last month we talked about trust and how our hospitals and our health systems can strengthen that trust with our communities and the people that we serve. Our rural hospitals are uniquely positioned to do this, as they are often the largest employers in their towns and communities, and frequently the only local source of care. 00:01:07:27 - 00:01:28:07 Tina Freese Decker Rural health care is about being a family. We take care of each other in our communities as best as possible, and we're here to provide that care close to home, no matter what headwinds that we all face. I recently had the opportunity to attend the �� Association's Rural Conference and you could really feel that sense of family and community in the room. 00:01:28:09 - 00:01:59:15 Tina Freese Decker We work in hospitals in red states and blue states all across the country, but we are all focused on the same thing: helping our neighbors in our communities to be healthier. There are some big challenges that are facing real health care, but together with a unified voice, we can get what we need. As I have traveled around our country meeting with the �� Association's regional policy boards and visiting the rural hospitals and my health system and others, the number one concern that I have heard from our hospitals, our communities, is access. 00:01:59:18 - 00:02:22:28 Tina Freese Decker And that is why it is so integral to the �� Association strategy and it is why it is so important that we come together as a field and that we're united as a field, because these challenges that we are facing are real. So today, I am pleased to have a distinguished leader in rural health care with us to talk about how we can all work together to advocate for the needs of our hospitals. 00:02:23:01 - 00:02:45:09 Tina Freese Decker I'd like to welcome Lori Wightman. She is the CEO of Bothwell Regional Health Center, a 108 bed acute care hospital in Sedalia, Missouri. Laura has served in this role since 2019, but even prior to Bothwell, she worked in real health care as the president of Mercy Hospital Ada in Ada, Oklahoma. So, Lori, welcome. Glad you were able to join us today. 00:02:45:15 - 00:02:46:17 Lori Wightman, R.N. Thank you, Tina. 00:02:46:19 - 00:03:03:20 Tina Freese Decker And I wanted to start out with just telling us a little bit about yourself. I know you started your health care career as a nurse and then you made the shift to administration. Can you tell us about yourself and how you see that family aspect in the hospital and the community in our rural areas? 00:03:03:22 - 00:03:30:01 Lori Wightman, R.N. Sure. Well, my father was a hospital administrator and my mother was a nurse, so I did both. And so it was a natural progression. And I think the foundation that nursing lays gives you all kinds of transferable skills that have been very helpful as I went into hospital administration. My career and dating advice has always been, you can't go wrong with a nurse. 00:03:30:03 - 00:03:57:14 Lori Wightman, R.N. And there's certainly served me well. And you talk about that family atmosphere. That is why I continue to choose rural health care. I've done the CEO position in a suburban hospital, and I sat at our senior leadership team meeting and thinking I was the only one on our senior leadership team that even lived in the area that we served. 00:03:57:17 - 00:04:23:24 Lori Wightman, R.N. Everyone else lived in a different suburb, and I just thought that was strange and disconnected. And, so I returned again then to rural health care because it is like a family. And it's ironic because we just finished revisiting our mission, vision and values. And our new mission statement talks about together we work to provide compassionate and safe care to family, friends, and neighbors. 00:04:23:27 - 00:04:37:07 Lori Wightman, R.N. Invariably, when I met new employee orientation, a significant number of people were born at the hospital. That's why I love rural. It's like that "Cheers" phenomenon where everyone knows your name. 00:04:37:09 - 00:05:01:02 Tina Freese Decker Very true. I used to lead a couple of rural hospitals as well. And like you said, even just walking into a rural hospital it feels like family where everyone there knows your name and of course, protect things from a confidentiality and a privacy perspective, but that feeling that we're all in this together. So I love that your mission statement is about together, that you can make an impact on people's health. 00:05:01:05 - 00:05:13:28 Tina Freese Decker I described a little bit about what it's like to walk into a rural hospital. Can you share a little bit about what is like to be a rural hospital, what it means in today's environment and why it's such a great place to work? 00:05:14:01 - 00:05:47:06 Lori Wightman, R.N. Well, in many ways, rural hospitals are uniquely the same as our suburban or urban counterparts. Forty six million people depend on a rural hospital for their care. So we struggle with the same labor shortages, the cost of labor supplies and drugs is rising faster than our reimbursement. We have all of those same struggles. Unique is that family atmosphere, I think. 00:05:47:06 - 00:06:13:26 Lori Wightman, R.N. And we have multiple generations working at the hospital. Now, you can't say anything bad about anyone because invariably they're somehow related. Or they were best friends in high school, or they used to be married to each other. So I mean, it's unique in that way. We have the same types of struggles that &nbsp;our counterparts do. 00:06:13:28 - 00:06:18:03 Tina Freese Decker What pressures are you feeling the most acutely right now? 00:06:18:06 - 00:06:47:09 Lori Wightman, R.N. Well, you take all of those common challenges that I talked about, and you turn up the volume a little bit. Because for us, 78% of our patients and our volume is governmental payers, so 78% of our business, we're getting reimbursed below cost. You can't make that up in volume. So we rely on all of the governmental programs, you know, disproportionate share all of those things. 00:06:47:09 - 00:06:54:22 Lori Wightman, R.N. And, 340B is doing exactly for us what it was designed to do, save rural hospitals. 00:06:54:25 - 00:07:11:22 Tina Freese Decker Those areas are critical that they remain. And so that we can continue to provide that sustainable, high quality care in our communities and all of our communities. 78% being governmental. It's a huge portion of what we do and what we rely on for access and caring for people. 00:07:11:29 - 00:07:23:15 Lori Wightman, R.N. Right. We are the typical rural hospital. We have razor-thin margins and aging plant of 18 years. 00:07:23:18 - 00:07:31:10 Tina Freese Decker So those are challenges that you're trying to navigate right now with all of the other things that happen. And how is your staffing levels going? Are those going okay? 00:07:31:13 - 00:07:55:12 Lori Wightman, R.N. Have the same labor shortage issues. We still have 22 traveling nurses here, but we have started being very aggressive in a grow your own program. And so as soon as the next month we're going to cut that number in half and then, within six months, we're hoping to have all of contract staff out. 00:07:55:15 - 00:08:02:04 Tina Freese Decker Is that something that you're most proud of, or is there something else that you want to share that you're most proud of from a rural hospital perspective? 00:08:02:06 - 00:08:29:24 Lori Wightman, R.N. I think what I'm most proud of is you get to personally view the impact of your decisions on people. I'm very proud of our all the talented people that we have here, from clinicians to community health workers. All of our physicians get to use all of the things they learned in medical school and residency, because there isn't a lot of subspecialists, so they are working at the top of their license. 00:08:29:26 - 00:08:50:21 Lori Wightman, R.N. Just several months ago, one of our critical care physicians diagnosed a case of botulism. Now as an old infection control nurse I get very excited about that because I never thought in my career I would see botulism. But it was diagnosed and treated here and the person's doing well. 00:08:50:23 - 00:09:25:27 Tina Freese Decker Oh, that's wonderful to hear. When you talk about all the different people that are part of health care in rural settings, or also another settings, it's quite amazing to see how many different areas we need to come together to take care of our community. When you think about an even larger scale, from rural hospitals to urban and teaching hospitals and others, how do you think about the whole ecosystem of our field and how we, you know, do we need all of us or and is there a way to form that greater fabric and social connection, or is there something else that we should be doing? 00:09:25:29 - 00:09:50:21 Lori Wightman, R.N. We are all very interconnected and I believe we are all needed. And I especially feel that as an independent hospital, not part of a health system, this is my first independent hospital. I rely on my hospital association more than I ever did when I was working for a health system, because it all comes down to relationships. 00:09:50:21 - 00:10:18:13 Lori Wightman, R.N. And so how do you develop, how do you get yourself in situations where you are meeting and now working with your partners around the state or the region? Because it comes down to relationships, you really need to know who your neighbors are in terms of other hospitals, who you're referring your patients to and develop that working relationship because it is all interconnected. 00:10:18:13 - 00:10:25:06 Lori Wightman, R.N. And we rely on our partners that we refer to, and they rely on us, too. 00:10:25:08 - 00:10:43:23 Tina Freese Decker One of the things I heard you say about the Rural Health Conference that the �� Association just put on, and the value of the �� Association is that we're not alone. And those values of relationships are really critical. So I appreciate that. The �� Association also talks a lot about how do we tell the hospital story. 00:10:43:25 - 00:10:55:15 Tina Freese Decker So how do you engage in advocacy to make sure we're telling that hospital story so that our legislative leaders and others know the value that we're bringing to the community? 00:10:55:17 - 00:11:22:11 Lori Wightman, R.N. Well, we are surrounded by stories. And so the first thing is to always be picking up on what is the story that is surrounding us, and how can we capture that? Because the most effective way is to bring that patient or nurse or physician to the legislator to testify, because they are the most effective way of communicating a message. 00:11:22:18 - 00:11:49:07 Lori Wightman, R.N. You know, the suits can go and talk about data, but nothing is more effective than what I call a real person telling their story and how a decision or a potential decision is going to impact them and how it feels. The other thing we do is every October, it's become tradition. We have Advocacy Day with our board, at our board meeting. 00:11:49:09 - 00:12:21:12 Lori Wightman, R.N. We invite our state elected officials &nbsp;- so people representing us at the state capitol - to come to our board meetings. On election years their challengers also come and I invite the hospital association and they all answer two questions: What do you hope to accomplish in the next legislative session, and what do you think might get in the way? That sets the scene for my board to understand that part of their role in governance is advocacy. 00:12:21:14 - 00:12:29:19 Lori Wightman, R.N. And so I've had two of my board members...almost every legislative session I go and testify on on some bill. 00:12:29:21 - 00:12:50:01 Tina Freese Decker That is really a good idea. Thank you so much for sharing that. Do you have any other final suggestions for us as AHA members, as other hospitals, whether it's rural or urban, that we should think about or do as we think about advocacy and access or also field unity? 00:12:50:03 - 00:13:22:11 Lori Wightman, R.N. You know, having been on the board of two different state hospital associations, I get it. You know, sometimes members can be at odds with each other on a given issue. And my advice to AHA would be to play the role of convener, facilitating conversations between members to better understand each other's position. And if a middle ground can't be reached, then that might be an issue that AHA remains neutral on. 00:13:22:14 - 00:13:34:07 Lori Wightman, R.N. But there are so many issues where we can agree on and that is very much the role and what all of us depend on AHA to play in advocating. 00:13:34:09 - 00:14:02:15 Tina Freese Decker There's a lot that binds us together. Like you said, we're all caring for our neighbors and our communities, and that's the most critical piece of it. And we have to keep that front and center with every decision that we make and every action that we do. Well, Lori, thank you so much for being with us today on this AHA podcast, for sharing your expertise in rural health care and for talking about some new ideas that all of us can take forward to ensure that we're telling the hospital story in the best way possible. 00:14:02:18 - 00:14:21:09 Tina Freese Decker So while I know that we have our work ahead of us, I know that I continue to be energized every time I speak with committed and passionate hospital leaders like Lori. Again, appreciate your work that you do every single day for the neighbors and for the people in your community that you serve. We'll be back next month for another Leadership Dialogue conversation. 00:14:21:13 - 00:14:23:01 Tina Freese Decker Have a great day. 00:14:23:03 - 00:14:31:13 Tom Haederle Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts. </details> </div> Mon, 31 Mar 2025 10:49:30 -0500 Chairperson's File Chair File: Rural Health — Caring for Our Neighbors /news/chairpersons-file/2025-03-11-rural-health-caring-our-neighbors I’ve often said that rural health care is about family. We take care of each other and our communities as best as possible. Rural hospitals and health systems are often the largest employers in our cities and towns and care for our neighbors despite the challenges we face.I recently attended the <a href="/topics/aha-rural-health-care-leadership-conference">AHA’s Rural Health Care Leadership Conference</a>, and the passion in the room and family connections formed were electrifying. We were from all over the country, red states and blue states, coastal areas and inland, but every single person there was fully committed to helping the communities they serve be and stay healthy. And that is what unites us.Leading a rural hospital can feel like you are battling alone, but together with a unified voice we can advocate for what our rural patients need.As I’ve traveled across the country, meeting with the AHA’s Regional Policy Boards and visiting the rural hospitals in my own health system, the number one concern I heard from our hospitals and our communities is access.All of our neighbors deserve to have access to the care they need. That’s why we must be united, together as a field, to create the best health care system possible.Everyone should be able to access high-quality care. We need Congress to renew Medicare flexibilities past April 1 and help make telehealth options more available to patients. And we need continued investment and public-private partnership to bring broadband to more remote communities.We also have to help our rural hospitals maintain funding so they can continue to be that essential anchor in communities. Congress needs to protect 340B as well as address barriers that may make it difficult for rural hospitals to qualify for 340B eligibility. Additionally, Medicare and Medicaid are foundational for rural health. Although these programs are so important, on average, they do not cover the costs of providing care to patients. Proposals to cut Medicare and Medicaid reimbursement will only make it more difficult for hospitals to provide care now and prepare for the future.The AHA has done an incredible job voicing the needs of our hospitals and health systems, and we will continue to engage with Congress, the White House, regulators and the courts to advocate for your needs. But we need your support and engagement as well. <a href="/tellingthehospitalstory">Share your stories</a> of how you innovate and adapt to provide local, high-quality care to your neighbors, even during challenges.And this doesn’t just apply to our rural hospitals: We all need to work together and advocate to be recognized for the unique capabilities we provide. It’s so important because our neighbors are counting on us to be there for them well into the future.<h2>Helping You Help Communities: Key AHA Resources</h2><ul><li><a href="/advocacy/rural-health-services">AHA Rural Health Services and Resources</a></li><li><a href="/rural-advocacy-agenda#:~:text=The%20AHA%20urges%20Congress%20to,Clinic%20(RHC)%20Payment%20Cuts">2025 Rural Advocacy Agenda</a></li><li><a href="/advocacy/action-center">AHA Advocacy Action Center</a></li><li><a href="/tellingthehospitalstory">Telling the Hospital Story Webpage and Share Your Stories with the AHA</a></li></ul> Tue, 11 Mar 2025 10:15:52 -0500 Chairperson's File