Health Care Policy In 2023: Five Areas To Watch

 The results in 2022 demonstrated once again that the United States is a divided nation. In light of the new Congress's razor-thin margins of victory, a divided government is the norm.

One might imagine that little will be accomplished without a strong majority, but there are numerous health care problems with bipartisan support. 

We believe the following five health care policy areas should be addressed, given that both parties will need to demonstrate success prior to the 2024 presidential election.

From Shortages To Stability: Caring For The Health Care Workforce

Long before the epidemic, the United States suffered a lack of health care providers across the continuum of care, a problem that persists beyond the end of the pandemic. 

One-third of all clinical personnel resigned their employment during the pandemic, significantly double the 2019 percentage. 

However, the December report from the Department of Labor and Statistics suggests that there are 2.7 vacant vacancies for every filled post.

To keep valuable employees, providers have increased pay for competent staff by approximately 17 percent, resulting in an additional $24 billion in wage expenses.

To fulfil the needs of an ageing population and to replace the void left by retiring nurses, experts estimate a shortfall of up to 124,000 physicians by 2033 and the need to hire at least 200,000 nurses every year.

Congress and the administration must adopt a three-pronged strategy to develop a long-term solution.

First, to address the new economic status quo of increased compensation for clinical professionals, the Centers for Medicare and Medicaid Services (CMS) want improved and more real-time data to determine labour expenses, 

including actual wages paid directly by hospitals to employed and contracted clinicians. 

With more precise reimbursement, health organisations will be able to attract and retain talent by paying market rates.

Second, the country must develop additional educational options for health care professionals. 

For example, funding programmes could promote the expansion of vocational training programmes for clinical jobs that do not require a four-year degree.

such as home health aides, nursing assistants, and pharmacy, radiology, and laboratory technicians. 

Moreover, loan forgiveness schemes should be considered as a means of attracting new talent to the sector.

Lastly, in tight labour markets, talented individuals will avoid unfavourable employment opportunities. 

In a 2018 survey, approximately 89 percent of nurses reported episodes of workplace violence, ranging from verbal abuse to physical assaults and even deaths, and there is evidence that workplace violence against nurses rose during the epidemic. 

This tendency, along with the ageing of the clinical workforce and the epidemic of burnout, explains why approximately five million nurses are projected to abandon the field by 2030. 

The previous Congress presented bipartisan legislation giving federal protections for health care workers who encounter violence and intimidation in the workplace, as well as grants to minimise incidents of violence; we are confident that this will become law in 2023.

From Talk To Action: Closing Gaps In Care

The pandemic shed light on the disparate health care outcomes of various communities. 

When the problem is getting more known, it's time to move beyond the research phase and into implementing solutions to close them. 

Yet, few organisations do standard social needs screenings, and fewer still capture these needs in the electronic medical record.

As a first step, CMS must convene a dedicated task force of public and private stakeholders in 2023 to advance standards that would lead to the consistent collection of sociodemographic and socioeconomic factors that have been demonstrated to matter, i.e., moving beyond process measures to those that influence outcomes. 

Structured data collection is essential for determining where needs exist and which evidence-based treatments are most effective at bridging care gaps. 

Standardized data will also help to move the needle by providing national benchmarks against which health care facilities can measure their success over time and in comparison to their peers.

Also, CMS must eliminate geographically disparate care gaps. Almost one-quarter of Medicare recipients reside in rural areas, however many value-based care initiatives do not apply to these providers. 

Similarly, alternative payment model (APM) financial techniques are untenable for many rural suppliers since they operate on slim margins and are unable to assume financial risk. 

The result is a two-tiered system in which urban and suburban health systems are accountable and producing continuous cost and quality improvements, but rural providers lag behind in the old era of volume-based, fee-for-service payment.

Modifying the APM benchmark technique to account for historical underutilization of services in order to avoid penalising rural providers when patients take better advantage of enhanced access and care coordination services could substantially close these gaps. 

Rather than focusing solely on Medicare savings, rural models should prioritise enhancing the sustainability and accessibility of treatment in rural communities. 

To this aim, APM financial approaches for rural providers should feature measures, such as a decreased minimum savings rate or reduced APM rebates, that increase the number of providers eligible to participate in these programmes.

From Just In Time To Just In Case: Supply Chain Reforms

In 2022, the supply chain was characterised by empty shop shelves, longer lead times, and higher prices, as large-scale interruptions for medical gadgets and medications, as well as record-breaking inflation, disrupted practically every facet of commerce. 

Today, the nation is still confronted with a variety of global, macro-level concerns that, when stacked, create bottlenecks in an unprepared system.

For 2023, public policies should be established to facilitate the modernization and adaptation of supply networks in order to increase their resilience.

To assist reduce drug shortages, Congress should allow the Food and Drug Administration (FDA) broader ability to proactively identify and address supply-threatening bottlenecks. 

For example, the agency should compel manufacturers, including those that make active pharmaceutical ingredients, to report the volume of product manufactured in each FDA-registered facility so that it may better comprehend sources of overconcentration and vulnerability. 

Similarly, the FDA must establish an equivalent mechanism to track device shortages, which are now only reported for the period of a public health emergency and subsequently on a voluntary basis.

While these reforms will surely be beneficial, the government must also begin the process of repatriating manufacturing to the United States and de-risking the overconcentration of key health care supplies originating from China and India.

To encourage manufacturers to invest in domestic facilities and automation technologies that level the playing field in terms of labour costs, Congress should consider tax incentives for producers of essential medical goods. 

Concurrently, policies must strengthen the market for domestic purchases. One such solution would be to enhance the requirements for government purchasers (e.g., Department of Defense, Department of Veteran's Affairs, CMS, etc.) 

To purchase and/or reimburse essential medical supplies and medications made in the United States.

With the correct incentives and a receptive buyer market, the US could significantly reduce its reliance on foreign suppliers and make significant strides to create new, sustainable jobs for American workers.

The United States must ultimately update its supply chain data infrastructure. The Government Accountability Office identified the lack of visibility into the actual quantity of key medical supplies and pharmaceuticals on US soil at any given moment as a serious failing during the pandemic. 

As part of the reauthorization of the Pandemic and All-Hazards Preparedness Reauthorization Act, bipartisan legislation was introduced in the previous Congress that would enable, for the first time, real-time data on the entire supply chain for critical medical supplies needed to treat patients during emergencies; we believe this could become law in 2023.

From Scarcity To Sustainability: Ensuring Predictable Health Care Funding

The pandemic demonstrated that the US health care system is an integral component of our nation's first response and national security infrastructure. 

There are invariably health care demands that must be met and handled across the continuum in the case of any domestic incident, from terrorism to natural disasters.

 Yet, we approach health care as a piggy bank far too often, starving public health and slashing provider funding to balance other federal budgets.

According to the American Hospital Association, hospital margins were anticipated to decrease by about 130 percent in 2022, with more than two-thirds of all systems in the red. 

The American Health Care Association estimates that 32 to 40 percent of all senior residents in postacute care dwell in an institution that is financially "at risk."

This poor financial picture, coupled with restricted expansion opportunities, is a contributing factor to bond-rating agencies' frequent downgrades of providers. 

Yet these downgrades create a difficult-to-break negative financial cycle; with a downgrade, costs to borrow money are higher than before, forcing systems to deplete their reserves. 

As cash reserves deplete, rating agencies further penalise institutions for a lack of cash on hand, reiterating the cycle of downgrades and putting providers on precarious ground.

To reverse this negative trend, frontline clinicians require reliable funding sources. Throughout the past many years, including before the COVID-19 pandemic, providers have been in a perpetual state of crisis, having to defend themselves against at least annual and usually more frequent payment reductions. 

As they strive to keep their doors open, providers are unable to focus on longer-term strategic planning and care transformation due to this ongoing struggle.

As providers prepare to effectively transition to a post-epidemic environment and unwind the waivers and flexibilities offered during the pandemic, a substantial runway of relief is essential as they adapt to the new norm. 

As a result, full respite from Medicare provider cuts should be extended for a least of two extra years in order to alleviate the current financial constraints that are squeezing so many systems and to allow sufficient time for reconstruction and recovery. 

In addition, before establishing payment rates, CMS needs access to more timely data that reflects current expenses and budgetary challenges.

As is typical for other first responders such as law enforcement and the military, policymakers should regard health care funding as an investment in national security.

Looking Ahead To 2023

Overall, 2023 will not usher in huge health care reforms, but gradual action could go a long way towards ensuring that providers are able to recover and tackle future difficulties. 

The goal is that these policies would usher in long-overdue improvements that will modernise the sector for improved efficacy, reliability, equity, and efficiency, despite the impossibility of foreseeing their precise outcomes.