Master Your Healthcare Career
Master Your Healthcare Career
Policy, Advocacy, and the Future of American Healthcare with Rick Pollack
In this episode, we sit down with Rick Pollack, President and CEO of the American Hospital Association, or AHA. Based in Washington, DC, the AHA represents nearly 5,000 hospitals, health care systems, and other providers of care. Rick shares insights on how policy is formed, and how the AHA works to ensure healthcare quality and access in the nation’s communities.
Tune in for an engaging conversation about the formation of healthcare policy, and on the critical issues impacting hospitals, health systems, and the communities they serve.
*The recording of this session took place prior to the Senate and House approving the Continuing Resolution (CR)*
Well, Melissa, thank you very much for that introduction and welcome today to the American Hospital Association's President and CEO, Rick Pollack. Rick, welcome to Master your Healthcare Career.
Speaker 2:Thank you so much, anthony, for having me, and let me just say I appreciate all the leadership that you've provided to our entire field and your contributions to advancing health in America. And let me just say I also appreciate the importance of the Council on Accreditation of Health Management Education. The Council plays a key role in training the healthcare leaders of our future, and it does that by ensuring that the nation has highly qualified academic programs in healthcare management that are providing the foundational and practical experience necessary for students to be successful. And I just want you to know we're proud to be a partner of yours in that effort.
Speaker 1:Rick, thank you very much for saying that. I think the AHA was one of the founding members of CAMI back in 1968, and neither you nor I were around back in 1968 when we were, when the AHA did commit to that. But you know it's been a very great process where we are producing, you know high, you know profile folks who are working in a variety of different hospitals and health systems in the US and in Canada. You know to make a difference. So, thanks, thanks for recognizing that.
Speaker 1:Rick, what I wanted to talk to you today and I think the interesting part for me, was health policy. And as I think about geez, you know the experts in health policy, I think about you. Policy, I think about you. You know I've watched you masterfully navigate the Affordable Care Act under the Obama administration when that went through, and we're in a you know, another difficult period where there's going to be some changes in healthcare. But first, before we get into that, I want to bring you back, because this podcast is really kind of focused toward people who are trying to understand where do they make their mark in their career? You started out as a legislative assistant to a congressman and if you kind of talk about that role and how you've kind of got involved in this process. It'd be great.
Speaker 2:Sure, well, I went to the State University of New York it's College of Cortland, and you know. For those of you that may not be familiar, with the.
Speaker 2:SUNY system. You know, it's got four major university centers and it's got law schools and it's got medical schools, but it's got eight arts and sciences four-year colleges, and that's what Cortland was. It's got eight arts and sciences four-year colleges and that's what Cortland was. But they had this SUNY-wide Washington semester program where they took political science majors from each of those four-year schools and university centers that came to Washington and then it was an internship program where you got a semester's credit and they only placed you in congressional offices that had a track record of providing a substantive experience as opposed to running errands and using the Xerox machine. So you couldn't just intern anywhere.
Speaker 2:I wanted to intern for a fairly young person who was in his 30s at the time, david Obey of Wisconsin. He ultimately served for over 40 years and became chairman of the House Appropriations Committee and I did appropriations work for him in education and in labor. I actually met my wife in his office. We only overlapped for two weeks, but she went on to work for him for several years. And then you know typical of the route that people take from the Hill, you become a lobbyist very often, or a policy analyst. I went the lobbyist way and I was a frontline lobbyist at first for two years for the American Nurses Association and then I came to the American Hospital Association, literally around 40 years ago, as a frontline lobbyist, then became vice president for legislation, then became executive vice president for a whole advocacy operation here in Washington for 24 years and then, I believe, in 126 years, I was the first internal candidate and well, first internal CEO to become CEO of AHA.
Speaker 1:And Rick. I remember when that happened because Rich Amdenstock, who preceded you, and Rick. I remember when that happened because Rich Amdenstock, who preceded you, was a really great CEO at the American Hospital Association and that was quite a change when you came in from internal and, I think, really represented everything you did at the AHA in the policy area and the way that you kind of mastered that element within the AHA was-.
Speaker 2:Now, maybe I shouldn't admit this to everyone, but I never took a healthcare course in my life. I went to graduate school in public administration. I learned it along the way, though.
Speaker 1:Well, you did. But let me kind of go back to your time at AHA, because I think you worked for some. You worked for Carol McCarthy, dick Davison and Rich Umdenstock, and you know three incredible leaders. What were some of the takeaways that you got from that experience working with those folks?
Speaker 2:Yeah, and I would add Alex McMahon as well, although I was relatively junior at that time, and you know, one of the big takeaways from Alex McMahon was his emphasis on having relationships with the state hospital association and building the alliance with the 50 state hospital associations. With Carol, I really wasn't a direct report, will you will, but she really focused on opportunities for member engagement to really make sure that members had a voice in what we did. Now, when it comes to Dick Davidson and Rich Umberstock, I work with them most closely, of course you know, for over 24 years as their executive vice president, over 24 years as their executive vice president. You know, and the way I'm so blessed of having been here for so many years because you know my bosses, but particularly Rich and Dick, who I work most closely with, were really mentors and you know I think of Dick as having been an uncle and Rich as a big brother, and different relationships there as one matures. You know, with Dick, what I really learned from him was asking the right questions is often more important than having the answers.
Speaker 2:I learned from him how sometimes in the world that you deal with in policy and in advocacy, you have to be comfortable in living with ambiguity and in advocacy, you have to be comfortable in living with ambiguity, and that was a little difficult for me, and he used to teach me how to do that, because I'm kind of like it's either black or white.
Speaker 2:And then the other thing that he taught me is you always have to have a vision of where you want to go, because, inevitably, policy is going to be done in an incremental way and you want to make sure that the increments add up to a vision, or or the pieces of a puzzle add up to a picture that makes sense at the end of the day. Um, which was a different relationship, because I say it's like a big brother. We were more partners, if you will. Um, he came from, uh, the field, he was a ceo of a health system, uh, and I was a political guy, so I handled one flank and he handled the other flank. What I learned from him is listening is as important as anything, and active listening is a skill in and of itself. His ability to synthesize complicated situations in order to reach a consensus was something that I really learned a lot from, and I also learned from him the importance of strategic planning, because strategic planning is a way really to align an entire organization along key priorities.
Speaker 1:And you know, rick, I think one of the things that you kind of took from Rich and kind of moved on was, I think you called it defining the H, because the question was are you really a hospital or health system? And under you you really kind of took that whole part to kind of say hey, let's talk a little bit about the defining the H kind of approach.
Speaker 2:Yeah, I had really two themes One was defining the H and the other was defining the A. Defining the H was really recognizing that the H that you see, that blue and white sign on the road is iconic and it really is a signal. It's a beacon for hope and healing and health. And you know that the people that work there are going to treat you with the highest levels of ethics and integrity and that building in and of itself is a foundation in a community. But it's more than a building and if we are to be successful as hospitals, we need to be reaching out beyond that building to make care more convenient. And that means, you know, providing care in the home, providing care in schools, providing care in workplaces, making care more accessible so that we meet the patient where they need the care. And that was the whole philosophy around redefining the H, and in some cases it meant that the H might even be a partner of, or their own health plan to try to provide care in a coordinated way across all the different settings. And that's the theme and that was the rationale behind it. Now, of course, we're always going to provide sophisticated surgeries and diagnostics and trauma care and deliver babies in the building, but when half of all surgeries today are done in an outpatient setting, there are more convenient ways to provide that care.
Speaker 2:And the redefining of the A was really to say that our association needed to be more focused and a recognition that advocacy and public policy needed to be the highest priority and to define the four functions of an association.
Speaker 2:Number one advocacy and public policy, but broad-based, not just on Capitol Hill but in the media, in the federal regulatory agencies and in the courts. And then the second part function of an association is to be thought leaders, to develop new ideas or, if you don't like something, coming up with alternatives. The third function of an association was knowledge exchange, being a place where our members can learn from each other to achieve best practices. And then the fourth, and this one I inherited from Davidson in particular, was being an agent for change. You know there are certain things that you want to push because they're simply the right thing to do, and whether it's dealing with, you know, quality improvement, whether it's dealing with community violence, because everything ends up on our ED doors, or whether it's dealing with things like eliminating health disparities, those are really important things that make us an agent for change. You can't boil the ocean, but those were the components of redefining the A.
Speaker 1:Yeah, you know it's funny. I can even feel some of those same things at Cami. How do we kind of make a difference, how do we inspire programs to get better, how do we share information, and those are kind of core parts to it. I think there's, you know, some amazing things at the American Hospital Association. I think of the Quest for Quality Prize and you know I had the good fortune during my career to be a Bon Secours as a board member when they won the award for that. Talk about the Quest for Quality and what the AHA's kind of purpose in creating that was.
Speaker 2:Yeah, you know, and, by the way you know, awards are important for organizations because they recognize important achievements. The Quest for Quality was really basically saying hey, quality is job one, and we have to make sure that we honor people that are performing at the highest level, that we shine a spotlight on them and they become a source of best practice for our members to learn from. We also have another important award called the Circle of Life Award, which really focuses on those that have really achieved really excellent care when it comes to care at the end of life, and that's something that we wanna honor and respect those people that are really providing that kind of compassionate care that is patient-centered and family-centered. Another important award we call the Dick Davidson Award, which really is to honor people that are reaching out into the community in non-traditional ways to provide care, Again, that's most accessible and convenient.
Speaker 1:Yeah, aha has done an amazing job in that area with the awards and I think also in the data area.
Speaker 1:You know, back in my days when I was in a hospital we used the AHA data set a lot to kind of help us understand how do we kind of plan and kind of approach the community. But it's certainly over the past 30 years or so it's certainly expanded and become far more robust. On what you've done in there too, one of the areas where I saw you very masterfully kind of work through the process was under the Affordable Care Act proposed by President Obama at the time, and I think it was a really and I want to say probably a challenging time for you because the hospitals were really kind of looked on as well. You know we need to kind of clamp down on them and kind of, you know, focus on some of that. But you've really kind of broadened out and created some great relationships within the government but also within other industries and healthcare pharmaceuticals to like an insurance company. Could I take a little peek under the cover? Tell me what was your secret sauce as you kind of navigated through that process?
Speaker 2:Well, you know it was controversial and in some respects I still have scars from it because it wasn't, as you may remember, at the beginning the most popular thing, and you know there were significant divisions. In fact, you know you look back in history and we're going through some extraordinary events right now. You know President Obama lost the House of Representatives after enacting it and yet now it's ingrained and it's a part of, you know, our whole health care system. But what we saw was a historic effort to really expand coverage. Was it going to be universal coverage? No, but we were going to add tens of millions of people and it was a moment of time to really finally get coverage expanded in a meaningful way. And certainly there was a public program aspect to it relative to Medicaid expansion, but also the creation of private insurance that would be more affordable in these marketplaces.
Speaker 2:Now the big controversy for us was they were going to make some significant reductions in Medicare hospital payments to help pay for this expanded access. And we navigated through it in two ways. One, we said we need to have really, really historic coverage expansions to make up for the loss of that financial support. But the other one is we extracted in in exchange for our support, several very important provisions that are in the law and remain in the law, you know, such as a prohibition on physician-owned hospitals, where doctors are able to refer to the hospitals in which they have an ownership interest, and they only would refer the good cases and the easy cases. That was undermining the infrastructure.
Speaker 2:One of the things we extracted was an expansion of something called the 340B program, which mandates that drug companies provide hospitals with discounts, and we expanded that program. We also had a very important seat at the table in creating something called value-based payment, which has a lot of different definitions but in essence moves away from our fee-for-service piecemeal system toward more integrated forms of care that provide better care at lower cost. I can go on, but it was a combination of the moment in time to expand coverage and being able to make these other changes. And I got to tell you, while it's almost 14 years since it passed, you know we've also been involved in defending it, and doing that both in Congress against repeal and replace, and also in the courts. There were three Supreme Court decisions that held it up and now you know I don't think we're going to see a repeal under President Trump and the Republican Congress, but you do see a disassembling of it, or an attempt to disassemble of certain pieces of it along the way.
Speaker 1:Well, I you know again, I remember that time I think I was with Aramark and we were involved with the American Hospital Association in a significant way, and I just remember that time how you kind of navigated those approaches and really, rick I want to use the term the art of the compromise. Did the American Hospital Association and the hospitals get everything they wanted? No, but did they get a significant part that really helped to ensure access to quality healthcare? I would say yes, and you were quite an inspirational kind of figure at that time as I watched and I still remember almost the way that you enacted one foot on the dock, one foot on the boat.
Speaker 2:And you know, the interesting thing about it is, you know, for students in this area. You know Medicare and Medicaid were born in the 1960s, aca was born in the 1990s and Medicare and Medicaid have been amended I don't know how many times since then, and I know that ACA is following that same course. But those are the things that meet the test of time and you know you want to continue to perfect it and improve it.
Speaker 1:Rick, let's kind of fast forward to today, because I think you're in a similar type of situation and you know you and I talked about this a little bit before and you said, anthony, we're really just in the second inning of the ballgame right now, so I know there's some challenges to hospitals. Could you give us a sense about what's going on in terms of public policy now and where the AHA is kind of approaching the policy management area in the government?
Speaker 2:Yeah, I would say that there are sort of several different pieces to that. To unpack, the first, of course and everybody's been reading about the different executive orders that are coming out, and you know we find ourselves in the middle of so many of these, whether it's immigration, whether it's restrictions on service, whether it's reductions in funding for research, whether it's you know how to deal with issues around diversity and equity. You know we are just right in the middle and what we're trying to do is really help our members understand what these executive orders mean, track the litigation that's out there on some of them, because a lot of them will be in flux and that's one area that obviously is taking up an awful lot of time. The second one has to do with funding the government. You know we are concerned with the capability of the agencies that we deal with to be fully staffed. I mean, we work very closely with the Centers for Medicare and Medicaid and you know we want to make sure that they're appropriately resourced. And by the time this airs, I don't know if it'll happen, but you know, this week the government runs out of money on Friday by midnight and there's a debate going on in Capitol Hill as we speak.
Speaker 2:But that is a platform that carries other health policy issues, and the continuing resolution on appropriations that has funded the government since its fiscal year started on October 1st, where they kicked the can down the road for a couple of months to December 20th and then they now kicked it down to March 14th, becomes a platform for dealing with other issues, because these other issues are must do and there are certain things that expire unless they are enacted on this government funding resolution. So, just as a, for instance, during COVID, we achieved very significant waivers that were reflective of innovation, hospital at home telehealth. Those expire at the end of this month unless this bill goes through. There were specific provisions we helped design that help rural hospitals. Those expire at the end of the month if this doesn't go through. There's a reduction in Medicaid dish payments of $8 billion. These are payments to hospitals that serve a high number of low-income people, poor people, disabled people. Those will kick in if this law doesn't go through to stop the kicking in of those cuts.
Speaker 2:So that's one aspect, that's one track, but the bigger funding bill that everybody is talking about is really the funding bill that is often referred to as the budget resolution and the reconciliation process and I won't go in the weeds here, but this is where you may hear the president referred to. I want one big, beautiful bill to advance my agenda, and the House has passed one version of that that calls for extraordinarily large cuts in the Medicaid program. The Senate is in a different place. That means we're in the top of the second in terms of them working it out. It's a long process, but the funding threats that are out there to provide the offsets to do the Trump tax cut extensions, which costs $4.5 billion, is where this comes into play, because the people that want to do the tax cuts are saying that we're going to lose government revenue. We've got to make it up, and they're saying let's do it by cutting significant health programs. So that's the big challenge that we're facing right now and it'll go on for the rest of the year.
Speaker 1:Yeah, it is really just an amazing time, particularly when you look at some of the proposals around Medicaid and the impact that that could have on hospitals and the impact that that could have on on hospitals. I I heard one CEO say uh, you imagine what the impact is going to be if Medicaid has some significant cuts, particularly on the rural hospital area where access is, you know, tenable? Uh, a lot.
Speaker 2:So yeah, and you know Medicaid is a lifeline for many rural hospitals, as you suggest. Uh, but what, what? What? People also don't realize and we're running a multimillion dollar campaign now on television ads and social media and grassroots lobbying grass tops and people don't understand the faces of Medicaid patients. They'll frame it as welfare reform and they'll frame it as something that only helps the urban poor. But the reality is it helps a lot of rural people, a lot of farmers, a lot of ranchers, a lot of single moms. 41% of babies are born on the Medicaid program. It helps a lot of seniors and disabled people and veterans. So the faces of Medicaid is a very important part of our message.
Speaker 1:Thanks, rick. So let me pivot another step right now, because we talked about policy and we got in the weeds a little bit there. But I want to go up to what your perspective is. You're kind of looking at people who are beginning their career why go in the hospitals, why go in the healthcare, and also where to go. So why? And if the answer is why, yes, where do you think are some of the opportunities for early careerists?
Speaker 2:Yeah, well, you know, I think, and what drew me to healthcare ultimately? You know it's foundational to every human being. I mean, without one's health you really can't be a contributing member of society and perform at your highest ability. And being in healthcare is really all about helping people and it's all about the opportunity to help organizations like hospitals provide what is essential public services. And there are so many areas in which one could contribute.
Speaker 2:Uh, we can go back to the policy area, but in general, um, whether it's in health care delivery itself, the delivery of an organization of services, whether it's in technology, um, you know, so much is reliant on technology, not only medical technology and medical equipment, but electronic medical records, the emergence of artificial intelligence. That has both opportunities and needs to have some guardrails as well. Research I mean research in healthcare, whether it's health services research or scientific research is a critical component of the whole healthcare system. And then again we can go back to public policy. You know, I think there are a lot of opportunities and you know, as someone that was an intern, you know internships and administrative residencies that are part of the CAMI programs are integral, and I think that that's one of the best ways to really progress in a career. It did me well and that's why I'm always a big proponent of those types of programs.
Speaker 1:I think, rick, for me, you know, when I began my career after graduating with my master's degree, that one year fellowship experience where I was at a hospital truly was one of the most important parts of my career to do. You know, the comment that I make is I got to sit on board meetings and kind of hear what was going on and it took me, you know, 20 or 30 years to get back into the boardroom. Hopefully people will get there sooner than myself, but that experience and that vision about you know how to care for the populations in need was really important in that part. Rick, this has been a fabulous conversation and I, you know, I really want to thank you for all of your support that you've given to CAMI over the years and your friendship. I mean, you've been such a great supporter of us but also, I really want to say, a great friend and supporter of myself as well too. So thank you very much for all of that, rick.
Speaker 2:Thank you for having me.