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Chip Kahn on the outlook for hospitals

Federation of American Hospitals Chip Kahn

Chip Kahn. Photo: Federation of American Hospitals

We caught up with Chip Kahn, the longtime CEO of the Federation of American Hospitals, to get his outlook on the rest of the year, including the lobbying around site-neutral payment reforms.

  • Kahn's the point person for for-profit operators that own nearly 20% of all U.S. hospital beds. The conversation has been edited for length and clarity.

What are your top priorities now that the spending deal is finished?

[Extensions of inpatient payment adjustments for] the Medicare-dependent and Medicare low-volume [hospitals] and the Medicaid disproportionate share cut delay will be our primary concerns. We need as long a time frame as we can get particularly on the rural side.

Are you still on guard for site-neutral — and what do you make of it not happening so far?

I think hospitals raised legitimate concerns that were important to many members of Congress regarding the effect this could have on access to care for patients.
I think it didn't get as much adjudication as would be required for action on it ... issues in health care brew for a while and there's discussion about them and then then you ultimately see whether or not they're going to happen.

House Energy and Commerce has a proposal for requiring unique identifier numbers at off-campus, outpatient facilities. Backers say it's to ensure payments are accurate. What's the argument against that?

Frankly, just because you want to do something doesn't mean it comes at no cost. And do you want us spending a lot of time and energy more on coding than we do now? And they're saying, Oh, well just go ahead and do it. Like there's no cost to it. Well, there is a cost to it.

What was the most successful argument you made to the Hill on site-neutral changes?

Whether it's off-campus or on campus, it all has to do with the campus. So whether or not a particular office is 24/7 across the street, the resources that are made available to cover the costs there and the cost in the hospital itself, are integrally tied.
We provide charity care. And we're generally in the hospital side treating sicker patients. And then frankly, there's a whole separate issue. And that is that right now on average, Medicare underpays.

With enhanced ACA subsidies due to expire next year, are you going to be pushing for an extension — and if so, how hard?

I know that that's going to be on the docket. And that could either be our highest priority and if it's not our highest priority, it could be our second priority.
Many of those people that fall in the categories that get the high subsidies would not be insured if it wasn't for those subsidies.
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