Volume 36

Who Is House Speaker Michael Johnson?

U.S. Rep. Michael Johnson (R-La.), the newly elected speaker of the House, now holds the third-highest position in the U.S. government. (If the president and vice president both perish or are incapacitated, the House speaker becomes commander in chief.) Who is Rep. Johnson, and what are his stances on healthcare policy? Perhaps unsurprisingly, since he was elected with the support of Republicans, Rep. Johnson is reliably anti-abortion and anti-LGBTQ rights. He has co-sponsored legislation like the Pain-Capable Unborn Child Protection Act and the Heartbeat Protection Act of 2021 and has voted against bills supporting same-sex marriage. As chair of the conservative Republican Study Commission, Rep. Johnson shaped legislation that would cap federal Medicaid funds, expand health savings accounts, and create high-risk pools instead of ensuring coverage for those with pre-existing conditions.

So What’s The Big Deal? While Speaker Johnson's policy preferences are concerning, it is important to remember that, in a divided Congress, it will be difficult to enact his agenda. He will set the floor schedule for the House, but with the Senate still in Democratic hands, he will have to compromise to get anything done. After the 2024 elections, however? Well, we will just have to wait to see how those shake out. (Speaking of the election: remember that voting can be good for your health!)

Your BIG Thoughts: Be hopeful. What are some places where Speaker Johnson and Democrats could compromise?

New Advocacy Group For Independent Practices

Last week marked the launch of an important new national advocacy organization: the American Independent Medical Practice Association (AIMPA), which will champion the cause of independent medical practices. Representing the care of nearly 10 million patients across the United States, the nonprofit eventually could have significant sway with lawmakers and regulators and within the healthcare industry. What is particularly noteworthy is the diverse range of specialties within AIMPA’s membership. Cardiology, gastroenterology, medical oncology, and obstetrics and gynecology are among the providers supporting the startup advocacy organization.

So What’s the Big Deal? The medical community has been significantly fragmented over the past few decades, diluting its policy effectiveness. (It seems like every specialty, after all, has its own society.) With a unified platform, this initiative addresses a critical need, especially since independent practices often confront unique financial, regulatory, and operational challenges that can impact their ability to provide quality patient care.

Your BIG Thoughts: Obviously there are advantages to each speciality having its own voice, but what do you see as the primary benefits of an organization like AIMPA?

Workers STRIKE Again…And Again!

Healthcare workers increasingly resort to strikes to voice their concerns about pay, staffing shortages, and recruitment challenges. These strikes have involved employees from major health systems, including the notable walkout at Kaiser Permanente in Oakland, Calif., which represented the largest healthcare worker strike in the country. Cornell University recorded 109 strikes involving healthcare and social assistance workers since January 2021, with 39 occurring in 2022, an increase from the 33 strikes in the previous year. As of October 24, 37 strikes have transpired in the sector this year.

So What’s The Big Deal? We do not see this trend subsiding and believe addressing the underlying concerns voiced by healthcare workers, such as understaffing and compensation, will be crucial to ensuring the stability of healthcare delivery.

Your BIG Thoughts: Do you think strikes will continue to grow in force? What can health systems, other employers, and investors do to address the unrest?

Rural Health Designation Not As Popular As Lawmakers Anticipated

In 2020, federal policymakers approved a rural emergency hospital designation to aid struggling rural hospitals by offering increased federal payments if they transition to emergency-only. Only 16 rural hospitals have opted to make this change, however. For these organizations, the money provides a vital lifeline, potentially providing their only means of staying open at all. Other hospitals are skeptical of the designation since it would represent a substantial shift in their services and business model. Far more hospitals remain undecided, monitoring their financial stability and observing how the transition pans out for those that have embraced it. Advocates within the hospital community also have offered legislative adjustments that could make the program more appealing to a broader range of hospitals.

So What’s The Big Deal? The limited uptake of the rural emergency hospital designation underscores the challenges rural healthcare facilities face. While this option may offer a lifeline for some hospitals, there is significant uncertainty and risks associated with such a fundamental shift in operations. The situation highlights the delicate balance between preserving access to healthcare in rural areas and financial viability. Healthcare executives should closely watch developments in this area because the future of rural hospitals is paramount for addressing healthcare disparities and ensuring access to care for underserved populations. Legislative adjustments may hold the key to making this program more attractive and viable for a broader spectrum of rural healthcare providers.

Your BIG Thoughts: This conversation is not closed. Hospitals still have time to take up Congress on its offer. Do you think they will?

United Healthcare Board Chair Has Questionable Financial Arrangement

Stephen Hemsley, the former CEO of UnitedHealth Group and the organization’s current board chair, may have found himself in the middle of a hot ethics debate. That is because Hemsley also owns an investment firm that is responsible for managing his UnitedHealth stock portfolio and for overseeing accounts for affluent individuals with holdings in companies connected to UnitedHealth. This arrangement has raised eyebrows among securities and corporate law experts who view it as a conflict of interest.

So What’s The Big Deal? Hemsley’s dual role raises legitimate concerns about conflicts of interest and corporate governance. Such arrangements can blur the lines between personal interest and corporate responsibilities and raise questions about the need for robust disclosure requirements and transparency in corporate leadership roles, particularly in the healthcare industry.

Your BIG Thoughts: Should Hemsley be forced to choose between his competing interests or can adequate controls be put into place to ensure no conflict of interest?

A Month In AI Developments

MedPage Today recently posted a deep dive article about this month’s big announcements and advancements in artificial intelligence (AI). It is a great read, but here is a summary.

Is AI Regulation Becoming More Clear?

Government regulation of healthcare-related AI is still nascent, but developers and end users want clear guidelines. The Food and Drug Administration (FDA) and the Office of the National Coordinator for Health IT (ONC), at least, are starting to address this demand. Members of Congress also are showing interest in enacting legislation that would provide oversight. These federal government-led initiatives are fragmented and new, however, and since Washington moves slowly, some states have proactively taken the lead in crafting their own rules. Notably, six states, including California, Illinois, and Texas, have introduced legislative measures to regulate healthcare AI.

So What’s The Big Deal? While the healthcare industry recognizes the transformative potential of AI in improving patient care and clinical processes, the need for regulatory clarity and oversight is urgent. Investors also recognize the need for regulatory clarity. Without it, an investment in what seemed to be a promising product may be regulated out of existence. The regulation also allows investors and developers to mitigate potential problems earlier in the development stage.

Your BIG Thoughts: Regulation has the potential to impact the adoption and implementation of AI in healthcare and will have implications for patient care, data security, and innovation. What would you like to see the federal government tackle first?

WHO: Regulation Considerations In AI

Speaking of regulation, the World Health Organization (WHO) recently published a comprehensive guide addressing critical regulatory considerations for AI in healthcare. This publication addresses the importance of ensuring the safety and efficacy of AI systems, expediting their availability to those in need, and fostering open dialogues among various stakeholders, including developers, regulators, manufacturers, healthcare professionals, and patients.

So What’s The Big Deal? The WHO recognizes AI's far-reaching potential, from strengthening clinical trials and improving diagnostics to enhancing personalized care and supporting healthcare providers. Particularly in regions with limited access to specialists, AI can play a crucial role, aiding in tasks like interpreting retinal scans and radiology images. However, the rapid deployment of AI, including large language models, sometimes occurs without a full grasp of their benefits and risks. This absence of knowledge raises important questions about the impact on end-users, including healthcare professionals and patients. Additionally, when dealing with healthcare data, AI systems can access sensitive personal information, necessitating robust legal and regulatory frameworks to protect privacy, security, and data integrity.

Your BIG Thoughts: What impact will the WHO report have? Will it entice the United States and other countries to move more quickly to regulate AI in healthcare?

A Game Changer For Clinical Documentation?

Atrium Health of North Carolina believes AI is a game changer for documentation. More than 85% of doctors reported an improved documentation experience by using AI-enabled Nuance® Dragon® Ambient, which empowers clinicians to effortlessly generate draft clinical summaries during in-person patient examinations and telehealth consultations. Notably, early reports from Atrium Health physicians indicate substantial time savings, too, with some professionals reclaiming up to 40 minutes of their day. Atrium now plans for a widespread rollout across its healthcare network.

So What’s The Big Deal? Atrium Health's adoption of Nuance's DAX Copilot marks a significant stride toward harnessing AI to ease the administrative burdens that have long plagued healthcare professionals. The overwhelmingly positive feedback from clinicians, particularly the reported time savings and improved user experience, underscores the potential of AI-driven solutions in transforming healthcare operations. As the adoption of such technologies becomes more widespread, the focus on delivering personalized and high-quality care can take center stage, potentially mitigating burnout and enhancing overall clinical efficiency.

Your BIG Thoughts: We talked about staff walkouts above. Burnout also contributes to frustration. Will providers that adopt AI see fewer strikes?

Microsoft's Azure AI Aims To Simplify Clinical Decision Making

Microsoft's Azure cloud division is unveiling a series of capabilities designed to empower healthcare professionals with more accessible and comprehensible patient information. One such innovation is the introduction of patient timelines, a feature harnessing the power of generative AI to extract pertinent details from unstructured data like medication histories listed within electronic health records. These details are then organized chronologically. Azure also employs generative AI to simplify complex clinical terminology for patients, bridging the gap between technical jargon and patient comprehension.

So What’s The Big Deal? Microsoft's Azure technology represents a significant step forward in improving patient care and enhancing clinical decision-making. The utilization of generative AI to extract and organize patient data chronologically not only streamlines clinical workflows but also ensures healthcare providers have a comprehensive view of a patient's medical journey, which can lead to more informed decisions and ultimately better patient outcomes.

Your BIG Thoughts: As with any technology, careful consideration of privacy, security, and ethical implications is paramount to ensure innovations benefit both clinicians and patients while safeguarding sensitive health information. What rules and regulations are specifically needed to protect privacy?

Concerns That AI May Perpetuate Racial Biases

The advent of large language models in medicine has raised concerns about perpetuating racial biases in medicine, especially since humans are vulnerable to integrating AI-generated biased information into their clinical decision-making processes.

So What’s The Big Deal? While large language models offer valuable tools for processing vast amounts of medical data, they must be developed and deployed with utmost care to avoid reinforcing existing biases. The risk lies not only in the technology but also in how healthcare professionals interact with AI-generated information. As AI technologies accelerate, we must prioritize strategies that mitigate bias and ensure AI is a tool for equitable and evidence-based care.

Your BIG Thoughts: It will be up to developers and practitioners to eliminate bias. Government cannot do that for us. How can the industry proceed responsibly?

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Adam Brown