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A talk with AHA’s top man



Richard J. (Rick) Pollack, president and CEO of the American Hospital Association (AHA), was the keynote speaker at the EMHS Governance Summit, held on May 15 at the Wells Conference Center at the University of Maine. Pollack spoke about the challenges and opportunities for rural hospitals, and the current political landscape and its implications for the future of healthcare. We sat down with Rick to talk about many issues important to EMHS. The following is an excerpt of our conversation.
 
Q: There’s no question rural hospitals are facing many challenges, but there are opportunities too. What opportunities do they need to pursue to stay viable? 
 
A: What is interesting about where the healthcare system is going is just the amount of money and resources that will be spent on managing people with chronic conditions. Eighty-six percent of all healthcare dollars are spent on people with more than one chronic condition. It means that a lot of that care, whether it’s managing hypertension, diabetes, obesity, a variety of those kinds of things, can be done in rural communities. People don’t need to go any place else for their care.
 
Q: Telehealth is an area where EMHS has made some investments to provide care to our patients close to home. What sort of work is AHA doing to create better federal policies to allow for the continued expanded use of this technology?
 
A: That’s certainly high on our agenda. When it comes to Medicare, they don’t allow [reimburse for] telehealth for a range of services. They ought to make it available. There are all sorts of regulatory hurdles related to the site of origin of the service and the practitioner that is providing the service. And then, in many rural communities they don’t have the technology, the broadband doesn’t exist, so we’re trying to move on all those fronts.
 
Q: On Friday, May 4, the district court in Washington DC heard oral arguments from attorneys representing AHA on a legal claim to prohibit The Center for Medicaid Services (CMS) from permanently implementing a reduction in Medicare B payments for certain drugs purchased through the 340B discount program. EMHS, along with two other health systems, is a claimant in this case. What’s at stake here for the people of Maine?
 
A: Well, I think there are two things: one that for our hospitals, the largest component of cost increases in our budgets have been paying for drugs. It has gone up at a rate of nearly 40 percent over the last few years, so the ability to be able to get discounts in purchasing drugs from the manufacturers helps make care more affordable when it comes to drugs and costs. The second thing is that the 340B program was specifically designed to help certain hospitals, critical access hospitals, hospitals that serve a high number of poor people be able to fund outreach in terms of providing special services and drugs as well, that we might not be able to provide in the absence of that funding stream.
 
Q: The Trump administration recently touted a plan to reduce prescription drug prices in the U.S. by cracking down on Pharmacy Benefit Managers (PBMs) and raising prices abroad. Is this a sound approach to achieving lower prescription drug prices for consumers?
 
A: Well, we certainly applaud the administration for taking the initiative and providing leadership to address this issue but they need to go much further. The steps that they put out are good first steps, but they’re only first steps, and we need to push harder. We need to see the government be able to negotiate for lower drug prices in the Medicare program. We need to look at safe methods of reimportation. We need to look at eliminating direct to consumer advertising, where the U.S. and New Zealand are the only two countries in the world that allow that.
 
Q: The opioid epidemic is affecting Maine in much the same way it is affecting the nation. Lawmakers are aiming to pass some legislation to address this issue by Memorial Day. One measure is to improve the interoperability of state prescription drug monitoring programs. We have such a program here in Maine. Is that a meaningful solution? 
 
A: There’s no silver bullet that’s going to represent a cure for the problem overnight, but these monitoring systems need to be part of the effort, and they are a part of it. We think that is something that needs to be a tool to try and get at the opioid problem. The other thing that we also are advocating for is the ability to share information. Providers need to be able to share information about patients because, right now, the information in the medical records, with regards to certain types of behavioral health issues and substance abuse are walled off. Sometimes a provider won’t have the full panoply of information in the medical record. We’re trying to knock down those walls so that information can be shared as well as the monitoring systems.
 
To learn more about all the work the AHA is doing to support hospitals and healthcare systems nationwide, visit https://www.aha.org.