April 16, 2025 • 22 mins
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)*
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Well, Melissa, thank you very much for that
introduction and welcome todayto the American Hospital
Association's President and CEO,Rick Pollack.
Rick, welcome to Master yourHealthcare Career.
Speaker 2 (00:13):
Thank you so much, anthony, for having me, and let
me just say I appreciate all theleadership that you've provided
to our entire field and yourcontributions to advancing
health in America.
And let me just say I alsoappreciate the importance of the
Council on Accreditation ofHealth Management Education.
The Council plays a key role intraining the healthcare leaders
(00:36):
of our future, and it does thatby ensuring that the nation has
highly qualified academicprograms in healthcare
management that are providingthe foundational and practical
experience necessary forstudents to be successful.
And I just want you to knowwe're proud to be a partner of
yours in that effort.
Speaker 1 (00:56):
Rick, thank you very much for saying that.
I think the AHA was one of thefounding members of CAMI back in
1968, and neither you nor Iwere around back in 1968 when we
were, when the AHA did committo that.
But you know it's been a verygreat process where we are
producing, you know high, youknow profile folks who are
(01:20):
working in a variety ofdifferent hospitals and health
systems in the US and in Canada.
You know to make a difference.
So, thanks, thanks forrecognizing that.
Rick, what I wanted to talk toyou today and I think the
interesting part for me, washealth policy.
And as I think about geez, youknow the experts in health
policy, I think about you.
(01:43):
Policy, I think about you.
You know I've watched youmasterfully navigate the
Affordable Care Act under theObama administration when that
went through, and we're in a youknow, another difficult period
where there's going to be somechanges in healthcare.
But first, before we get intothat, I want to bring you back,
(02:06):
because this podcast is reallykind of focused toward people
who are trying to understandwhere do they make their mark in
their career?
You started out as alegislative assistant to a
congressman and if you kind oftalk about that role and how
you've kind of got involved inthis process.
It'd be great.
Speaker 2 (02:23):
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 notbe familiar, with the.
SUNY system.
You know, it's got four majoruniversity centers and it's got
law schools and it's got medicalschools, but it's got eight
arts and sciences four-yearcolleges, and that's what
(02:44):
Cortland was.
It's got eight arts andsciences four-year colleges and
that's what Cortland was.
But they had this SUNY-wideWashington semester program
where they took politicalscience majors from each of
those four-year schools anduniversity centers that came to
Washington and then it was aninternship program where you got
a semester's credit and theyonly placed you in congressional
(03:11):
offices that had a track recordof providing a substantive
experience as opposed to runningerrands and using the Xerox
machine.
So you couldn't just internanywhere.
I wanted to intern for a fairlyyoung person who was in his 30s
at the time, david Obey ofWisconsin.
He ultimately served for over40 years and became chairman of
the House AppropriationsCommittee and I did
appropriations work for him ineducation and in labor.
I actually met my wife in hisoffice.
(03:32):
We only overlapped for twoweeks, but she went on to work
for him for several years.
And then you know typical ofthe route that people take from
the Hill, you become a lobbyistvery often, or a policy analyst.
I went the lobbyist way and Iwas a frontline lobbyist at
first for two years for theAmerican Nurses Association and
(03:53):
then I came to the AmericanHospital Association, literally
around 40 years ago, as afrontline lobbyist, then became
vice president for legislation,then became executive vice
president for a whole advocacyoperation 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
(04:18):
of AHA.
Speaker 1 (04:20):
And Rick.
I remember when that happenedbecause Rich Amdenstock, who
preceded you, and Rick.
I remember when that happenedbecause Rich Amdenstock, who
preceded you, was a really greatCEO at the American Hospital
Association and that was quite achange when you came in from
internal and, I think, reallyrepresented everything you did
at the AHA in the policy areaand the way that you kind of
(04:44):
mastered that element within theAHA was-.
Speaker 2 (04:47):
Now, maybe I shouldn't admit this to everyone
, but I never took a healthcarecourse in my life.
I went to graduate school inpublic administration.
I learned it along the way,though.
Speaker 1 (05:01):
Well, you did.
But let me kind of go back toyour time at AHA, because I
think you worked for some.
You worked for Carol McCarthy,dick Davison and Rich Umdenstock
, and you know three incredibleleaders.
What were some of the takeawaysthat you got from that
experience working with thosefolks?
Speaker 2 (05:21):
Yeah, and I would add Alex McMahon as well, although
I was relatively junior at thattime, and you know, one of the
big takeaways from Alex McMahonwas his emphasis on having
relationships with the statehospital association and
building the alliance with the50 state hospital associations.
With Carol, I really wasn't adirect report, will you will,
(05:43):
but she really focused onopportunities for member
engagement to really make surethat members had a voice in what
we did.
Now, when it comes to DickDavidson and Rich Umberstock, I
work with them most closely, ofcourse you know, for over 24
years as their executive vicepresident, over 24 years as
(06:08):
their executive vice president.
You know, and the way I'm soblessed of having been here for
so many years because you knowmy bosses, but particularly Rich
and Dick, who I work mostclosely with, were really
mentors and you know I think ofDick as having been an uncle and
Rich as a big brother, anddifferent relationships there as
one matures.
You know, with Dick, what Ireally learned from him was
(06:30):
asking the right questions isoften more important than having
the answers.
I learned from him how sometimesin the world that you deal with
in policy and in advocacy, youhave to be comfortable in living
with ambiguity and in advocacy,you have to be comfortable in
living with ambiguity, and thatwas a little difficult for me,
and he used to teach me how todo that, because I'm kind of
like it's either black or white.
(06:55):
And then the other thing that hetaught me is you always have to
have a vision of where you wantto go, because, inevitably,
policy is going to be done in anincremental way and you want to
make sure that the incrementsadd up to a vision, or or the
pieces of a puzzle add up to apicture that makes sense at the
end of the day.
Um, which was a differentrelationship, because I say it's
like a big brother.
We were more partners, if youwill.
(07:17):
Um, he came from, uh, the field, he was a ceo of a health
system, uh, and I was apolitical guy, so I handled one
flank and he handled the otherflank.
What I learned from him islistening is as important as
anything, and active listeningis a skill in and of itself.
(07:37):
His ability to synthesizecomplicated situations in order
to reach a consensus wassomething that I really learned
a lot from, and I also learnedfrom him the importance of
strategic planning, becausestrategic planning is a way
really to align an entireorganization along key
priorities.
Speaker 1 (07:58):
And you know, rick, I think one of the things that
you kind of took from Rich andkind of moved on was, I think
you called it defining the H,because the question was are you
really a hospital or healthsystem?
And under you you really kindof took that whole part to kind
of say hey, let's talk a littlebit about the defining the H
(08:18):
kind of approach.
Speaker 2 (08:19):
Yeah, I had really two themes One was defining the
H and the other was defining theA.
Defining the H was reallyrecognizing that the H that you
see, that blue and white sign onthe road is iconic and it
really is a signal.
It's a beacon for hope andhealing and health.
And you know that the peoplethat work there are going to
(08:40):
treat you with the highestlevels of ethics and integrity
and that building in and ofitself is a foundation in a
community.
But it's more than a buildingand if we are to be successful
as hospitals, we need to bereaching out beyond that
building to make care moreconvenient.
And that means, you know,providing care in the home,
(09:05):
providing care in schools,providing care in workplaces,
making care more accessible sothat we meet the patient where
they need the care.
And that was the wholephilosophy around redefining the
H, and in some cases it meantthat the H might even be a
partner of, or their own healthplan to try to provide care in a
(09:27):
coordinated way across all thedifferent settings.
And that's the theme and thatwas the rationale behind it.
Now, of course, we're alwaysgoing to provide sophisticated
surgeries and diagnostics andtrauma care and deliver babies
in the building, but when halfof all surgeries today are done
in an outpatient setting, thereare more convenient ways to
(09:49):
provide that care.
And the redefining of the A wasreally to say that our
association needed to be morefocused and a recognition that
advocacy and public policyneeded to be the highest
priority and to define the fourfunctions of an association.
Number one advocacy and publicpolicy, but broad-based, not
(10:11):
just on Capitol Hill but in themedia, in the federal regulatory
agencies and in the courts.
And then the second partfunction of an association is to
be thought leaders, to developnew ideas or, if you don't like
something, coming up withalternatives.
The third function of anassociation was knowledge
exchange, being a place whereour members can learn from each
(10:34):
other to achieve best practices.
And then the fourth, and thisone I inherited from Davidson in
particular, was being an agentfor change.
You know there are certainthings that you want to push
because they're simply the rightthing to do, and whether it's
dealing with, you know, qualityimprovement, whether it's
dealing with community violence,because everything ends up on
(10:56):
our ED doors, or whether it'sdealing with things like
eliminating health disparities,those are really important
things that make us an agent forchange.
You can't boil the ocean, butthose were the components of
redefining the A.
Speaker 1 (11:10):
Yeah, you know it's funny.
I can even feel some of thosesame things at Cami.
How do we kind of make adifference, how do we inspire
programs to get better, how dowe share information, and those
are kind of core parts to it.
I think there's, you know, someamazing things at the American
Hospital Association.
I think of the Quest forQuality Prize and you know I had
the good fortune during mycareer to be a Bon Secours as a
(11:32):
board member when they won theaward for that.
Talk about the Quest forQuality and what the AHA's kind
of purpose in creating that was.
Speaker 2 (11:42):
Yeah, you know, and, by the way you know, awards are
important for organizationsbecause they recognize important
achievements.
The Quest for Quality wasreally basically saying hey,
quality is job one, and we haveto make sure that we honor
people that are performing atthe highest level, that we shine
a spotlight on them and theybecome a source of best practice
(12:03):
for our members to learn from.
We also have another importantaward called the Circle of Life
Award, which really focuses onthose that have really achieved
really excellent care when itcomes to care at the end of life
, and that's something that wewanna honor and respect those
(12:25):
people that are really providingthat kind of compassionate care
that is patient-centered andfamily-centered.
Another important award we callthe Dick Davidson Award, which
really is to honor people thatare reaching out into the
community in non-traditionalways to provide care, Again,
that's most accessible andconvenient.
Speaker 1 (12:48):
Yeah, aha has done an amazing job in that area with
the awards and I think also inthe data area.
You know, back in my days when Iwas in a hospital we used the
AHA data set a lot to kind ofhelp us understand how do we
kind of plan and kind ofapproach the community.
But it's certainly over thepast 30 years or so it's
(13:10):
certainly expanded and becomefar more robust.
On what you've done in theretoo, one of the areas where I
saw you very masterfully kind ofwork through the process was
under the Affordable Care Actproposed by President Obama at
(13:30):
the time, and I think it was areally and I want to say
probably a challenging time foryou because the hospitals were
really kind of looked on as well.
You know we need to kind ofclamp down on them and kind of,
you know, focus on some of that.
But you've really kind ofbroadened out and created some
great relationships within thegovernment but also within other
(13:53):
industries and healthcarepharmaceuticals to like an
insurance company.
Could I take a little peekunder the cover?
Tell me what was your secretsauce as you kind of navigated
through that process?
Speaker 2 (14:06):
Well, you know it was controversial and in some
respects I still have scars fromit because it wasn't, as you
may remember, at the beginningthe most popular thing, and you
know there were significantdivisions.
In fact, you know you look backin history and we're going
through some extraordinaryevents right now.
You know President Obama lostthe House of Representatives
(14:29):
after enacting it and yet nowit's ingrained and it's a part
of, you know, our whole healthcare system.
But what we saw was a historiceffort to really expand coverage
.
Was it going to be universalcoverage?
No, but we were going to addtens of millions of people and
it was a moment of time toreally finally get coverage
(14:50):
expanded in a meaningful way.
And certainly there was apublic program aspect to it
relative to Medicaid expansion,but also the creation of private
insurance that would be moreaffordable in these marketplaces
.
(15:15):
Now the big controversy for uswas they were going to make some
significant reductions inMedicare hospital payments to
help pay for this expandedaccess.
And we navigated through it intwo ways.
One, we said we need to havereally, really historic coverage
expansions to make up for theloss of that financial support.
But the other one is weextracted in in exchange for our
support, several very importantprovisions that are in the law
(15:39):
and remain in the law, you know,such as a prohibition on
physician-owned hospitals, wheredoctors are able to refer to
the hospitals in which they havean ownership interest, and they
only would refer the good casesand the easy cases.
That was undermining theinfrastructure.
(16:00):
One of the things we extractedwas an expansion of something
called the 340B program, whichmandates that drug companies
provide hospitals with discounts, and we expanded that program.
We also had a very importantseat at the table in creating
something called value-basedpayment, which has a lot of
(16:23):
different definitions but inessence moves away from our
fee-for-service piecemeal systemtoward more integrated forms of
care that provide better careat lower cost.
I can go on, but it was acombination of the moment in
time to expand coverage andbeing able to make these other
(16:43):
changes.
And I got to tell you, whileit's almost 14 years since it
passed, you know we've also beeninvolved in defending it, and
doing that both in Congressagainst repeal and replace, and
also in the courts.
There were three Supreme Courtdecisions that held it up and
now you know I don't think we'regoing to see a repeal under
(17:06):
President Trump and theRepublican Congress, but you do
see a disassembling of it, or anattempt to disassemble of
certain pieces of it along theway.
Speaker 1 (17:17):
Well, I you know again, I remember that time I
think I was with Aramark and wewere involved with the American
Hospital Association in asignificant way, and I just
remember that time how you kindof navigated those approaches
and really, rick I want to usethe term the art of the
compromise.
Did the American HospitalAssociation and the hospitals
(17:38):
get everything they wanted?
No, but did they get asignificant part that really
helped to ensure access toquality healthcare?
I would say yes, and you werequite an inspirational kind of
figure at that time as I watchedand I still remember almost the
way that you enacted one footon the dock, one foot on the
(18:00):
boat.
Speaker 2 (18:02):
And you know, the interesting thing about it is,
you know, for students in thisarea.
You know Medicare and Medicaidwere born in the 1960s, aca was
born in the 1990s and Medicareand Medicaid have been amended I
don't know how many times sincethen, and I know that ACA is
(18:23):
following that same course.
But those are the things thatmeet the test of time and you
know you want to continue toperfect it and improve it.
Speaker 1 (18:32):
Rick, let's kind of fast forward to today, because I
think you're in a similar typeof situation and you know you
and I talked about this a littlebit before and you said,
anthony, we're really just inthe second inning of the
ballgame right now, so I knowthere's some challenges to
hospitals.
Could you give us a sense aboutwhat's going on in terms of
(18:53):
public policy now and where theAHA is kind of approaching the
policy management area in thegovernment?
Speaker 2 (19:02):
Yeah, I would say that there are sort of several
different pieces to that.
To unpack, the first, of courseand everybody's been reading
about the different executiveorders that are coming out, and
you know we find ourselves inthe middle of so many of these,
whether it's immigration,whether it's restrictions on
service, whether it's reductionsin funding for research,
(19:24):
whether it's you know how todeal with issues around
diversity and equity.
You know we are just right inthe middle and what we're trying
to do is really help ourmembers understand what these
executive orders mean, track thelitigation that's out there on
some of them, because a lot ofthem will be in flux and that's
(19:49):
one area that obviously istaking up an awful lot of time.
The second one has to do withfunding the government.
You know we are concerned withthe capability of the agencies
that we deal with to be fullystaffed.
I mean, we work very closelywith the Centers for Medicare
and Medicaid and you know wewant to make sure that they're
(20:10):
appropriately resourced.
And by the time this airs, Idon't know if it'll happen, but
you know, this week thegovernment runs out of money on
Friday by midnight and there's adebate going on in Capitol Hill
as we speak.
But that is a platform thatcarries other health policy
issues, and the continuingresolution on appropriations
(20:33):
that has funded the governmentsince its fiscal year started on
October 1st, where they kickedthe can down the road for a
couple of months to December20th and then they now kicked it
down to March 14th, becomes aplatform for dealing with other
issues, because these otherissues are must do and there are
certain things that expireunless they are enacted on this
(20:54):
government funding resolution.
So, just as a, for instance,during COVID, we achieved very
significant waivers that werereflective of innovation,
hospital at home telehealth.
Those expire at the end of thismonth unless this bill goes
through.
There were specific provisionswe helped design that help rural
(21:15):
hospitals.
Those expire at the end of themonth if this doesn't go through
.
There's a reduction in Medicaiddish payments of $8 billion.
These are payments to hospitalsthat serve a high number of
low-income people, poor people,disabled people.
Those will kick in if this lawdoesn't go through to stop the
(21:38):
kicking in of those cuts.
So that's one aspect, that's onetrack, but the bigger funding
bill that everybody is talkingabout is really the funding bill
that is often referred to asthe budget resolution and the
reconciliation process and Iwon't go in the weeds here, but
this is where you may hear thepresident referred to.
I want one big, beautiful billto advance my agenda, and the
(22:02):
House has passed one version ofthat that calls for
extraordinarily large cuts inthe Medicaid program.
The Senate is in a differentplace.
That means we're in the top ofthe second in terms of them
working it out.
It's a long process, but thefunding threats that are out
there to provide the offsets todo the Trump tax cut extensions,
(22:27):
which costs $4.5 billion, iswhere this comes into play,
because the people that want todo the tax cuts are saying that
we're going to lose governmentrevenue.
We've got to make it up, andthey're saying let's do it by
cutting significant healthprograms.
So that's the big challengethat we're facing right now and
(22:50):
it'll go on for the rest of theyear.
Speaker 1 (22:55):
Yeah, it is really just an amazing time,
particularly when you look atsome of the proposals around
Medicaid and the impact thatthat could have on hospitals and
the impact that that could haveon on hospitals.
I I heard one CEO say uh, youimagine what the impact is going
to be if Medicaid has somesignificant cuts, particularly
on the rural hospital area whereaccess is, you know, tenable?
(23:18):
Uh, a lot.
Speaker 2 (23:20):
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 andwe're running a multimillion
dollar campaign now ontelevision ads and social media
and grassroots lobbying grasstops and people don't understand
the faces of Medicaid patients.
(23:40):
They'll frame it as welfarereform and they'll frame it as
something that only helps theurban poor.
But the reality is it helps alot of rural people, a lot of
farmers, a lot of ranchers, alot of single moms.
41% of babies are born on theMedicaid program.
It helps a lot of seniors anddisabled people and veterans.
So the faces of Medicaid is avery important part of our
(24:03):
message.
Speaker 1 (24:05):
Thanks, rick.
So let me pivot another stepright now, because we talked
about policy and we got in theweeds a little bit there.
But I want to go up to whatyour perspective is.
You're kind of looking atpeople who are beginning their
career why go in the hospitals,why go in the healthcare, and
also where to go.
(24:28):
So why?
And if the answer is why, yes,where do you think are some of
the opportunities for earlycareerists?
Speaker 2 (24:35):
Yeah, well, you know, I think, and what drew me to
healthcare ultimately?
You know it's foundational toevery human being.
I mean, without one's healthyou really can't be a
contributing member of societyand perform at your highest
ability.
And being in healthcare isreally all about helping people
and it's all about theopportunity to help
(24:58):
organizations like hospitalsprovide what is essential public
services.
And there are so many areas inwhich one could contribute.
Uh, we can go back to the policyarea, but in general, um,
whether it's in health caredelivery itself, the delivery of
an organization of services,whether it's in technology, um,
(25:18):
you know, so much is reliant ontechnology, not only medical
technology and medical equipment, but electronic medical records
, the emergence of artificialintelligence.
That has both opportunities andneeds to have some guardrails
as well.
Research I mean research inhealthcare, whether it's health
(25:40):
services research or scientificresearch is a critical component
of the whole healthcare system.
And then again we can go backto public policy.
You know, I think there are alot of opportunities and you
know, as someone that was anintern, you know internships and
administrative residencies thatare part of the CAMI programs
(26:02):
are integral, and I think thatthat's one of the best ways to
really progress in a career.
It did me well and that's whyI'm always a big proponent of
those types of programs.
Speaker 1 (26:16):
I think, rick, for me , you know, when I began my
career after graduating with mymaster's degree, that one year
fellowship experience where Iwas at a hospital truly was one
of the most important parts ofmy career to do.
You know, the comment that Imake is I got to sit on board
meetings and kind of hear whatwas going on and it took me, you
(26:37):
know, 20 or 30 years to getback into the boardroom.
Hopefully people will get theresooner than myself, but that
experience and that vision aboutyou know how to care for the
populations in need was reallyimportant in that part.
Rick, this has been a fabulousconversation and I, you know, I
(26:59):
really want to thank you for allof your support that you've
given to CAMI over the years andyour friendship.
I mean, you've been such agreat supporter of us but also,
I really want to say, a greatfriend and supporter of myself
as well too.
So thank you very much for allof that, rick.
Speaker 2 (27:15):
Thank you for having me.
Well, Melissa, thank you very much for that
introduction and welcome todayto the American Hospital
Association's President and CEO,Rick Pollack.
Rick, welcome to Master yourHealthcare Career.
Speaker 2 (00:13):
Thank you so much, anthony, for having me, and let
me just say I appreciate all theleadership that you've provided
to our entire field and yourcontributions to advancing
health in America.
And let me just say I alsoappreciate the importance of the
Council on Accreditation ofHealth Management Education.
The Council plays a key role intraining the healthcare leaders
(00:36):
of our future, and it does thatby ensuring that the nation has
highly qualified academicprograms in healthcare
management that are providingthe foundational and practical
experience necessary forstudents to be successful.
And I just want you to knowwe're proud to be a partner of
yours in that effort.
Speaker 1 (00:56):
Rick, thank you very much for saying that.
I think the AHA was one of thefounding members of CAMI back in
1968, and neither you nor Iwere around back in 1968 when we
were, when the AHA did committo that.
But you know it's been a verygreat process where we are
producing, you know high, youknow profile folks who are
(01:20):
working in a variety ofdifferent hospitals and health
systems in the US and in Canada.
You know to make a difference.
So, thanks, thanks forrecognizing that.
Rick, what I wanted to talk toyou today and I think the
interesting part for me, washealth policy.
And as I think about geez, youknow the experts in health
policy, I think about you.
(01:43):
Policy, I think about you.
You know I've watched youmasterfully navigate the
Affordable Care Act under theObama administration when that
went through, and we're in a youknow, another difficult period
where there's going to be somechanges in healthcare.
But first, before we get intothat, I want to bring you back,
(02:06):
because this podcast is reallykind of focused toward people
who are trying to understandwhere do they make their mark in
their career?
You started out as alegislative assistant to a
congressman and if you kind oftalk about that role and how
you've kind of got involved inthis process.
It'd be great.
Speaker 2 (02:23):
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 notbe familiar, with the.
SUNY system.
You know, it's got four majoruniversity centers and it's got
law schools and it's got medicalschools, but it's got eight
arts and sciences four-yearcolleges, and that's what
(02:44):
Cortland was.
It's got eight arts andsciences four-year colleges and
that's what Cortland was.
But they had this SUNY-wideWashington semester program
where they took politicalscience majors from each of
those four-year schools anduniversity centers that came to
Washington and then it was aninternship program where you got
a semester's credit and theyonly placed you in congressional
(03:11):
offices that had a track recordof providing a substantive
experience as opposed to runningerrands and using the Xerox
machine.
So you couldn't just internanywhere.
I wanted to intern for a fairlyyoung person who was in his 30s
at the time, david Obey ofWisconsin.
He ultimately served for over40 years and became chairman of
the House AppropriationsCommittee and I did
appropriations work for him ineducation and in labor.
I actually met my wife in hisoffice.
(03:32):
We only overlapped for twoweeks, but she went on to work
for him for several years.
And then you know typical ofthe route that people take from
the Hill, you become a lobbyistvery often, or a policy analyst.
I went the lobbyist way and Iwas a frontline lobbyist at
first for two years for theAmerican Nurses Association and
(03:53):
then I came to the AmericanHospital Association, literally
around 40 years ago, as afrontline lobbyist, then became
vice president for legislation,then became executive vice
president for a whole advocacyoperation 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
(04:18):
of AHA.
Speaker 1 (04:20):
And Rick.
I remember when that happenedbecause Rich Amdenstock, who
preceded you, and Rick.
I remember when that happenedbecause Rich Amdenstock, who
preceded you, was a really greatCEO at the American Hospital
Association and that was quite achange when you came in from
internal and, I think, reallyrepresented everything you did
at the AHA in the policy areaand the way that you kind of
(04:44):
mastered that element within theAHA was-.
Speaker 2 (04:47):
Now, maybe I shouldn't admit this to everyone
, but I never took a healthcarecourse in my life.
I went to graduate school inpublic administration.
I learned it along the way,though.
Speaker 1 (05:01):
Well, you did.
But let me kind of go back toyour time at AHA, because I
think you worked for some.
You worked for Carol McCarthy,dick Davison and Rich Umdenstock
, and you know three incredibleleaders.
What were some of the takeawaysthat you got from that
experience working with thosefolks?
Speaker 2 (05:21):
Yeah, and I would add Alex McMahon as well, although
I was relatively junior at thattime, and you know, one of the
big takeaways from Alex McMahonwas his emphasis on having
relationships with the statehospital association and
building the alliance with the50 state hospital associations.
With Carol, I really wasn't adirect report, will you will,
(05:43):
but she really focused onopportunities for member
engagement to really make surethat members had a voice in what
we did.
Now, when it comes to DickDavidson and Rich Umberstock, I
work with them most closely, ofcourse you know, for over 24
years as their executive vicepresident, over 24 years as
(06:08):
their executive vice president.
You know, and the way I'm soblessed of having been here for
so many years because you knowmy bosses, but particularly Rich
and Dick, who I work mostclosely with, were really
mentors and you know I think ofDick as having been an uncle and
Rich as a big brother, anddifferent relationships there as
one matures.
You know, with Dick, what Ireally learned from him was
(06:30):
asking the right questions isoften more important than having
the answers.
I learned from him how sometimesin the world that you deal with
in policy and in advocacy, youhave to be comfortable in living
with ambiguity and in advocacy,you have to be comfortable in
living with ambiguity, and thatwas a little difficult for me,
and he used to teach me how todo that, because I'm kind of
like it's either black or white.
(06:55):
And then the other thing that hetaught me is you always have to
have a vision of where you wantto go, because, inevitably,
policy is going to be done in anincremental way and you want to
make sure that the incrementsadd up to a vision, or or the
pieces of a puzzle add up to apicture that makes sense at the
end of the day.
Um, which was a differentrelationship, because I say it's
like a big brother.
We were more partners, if youwill.
(07:17):
Um, he came from, uh, the field, he was a ceo of a health
system, uh, and I was apolitical guy, so I handled one
flank and he handled the otherflank.
What I learned from him islistening is as important as
anything, and active listeningis a skill in and of itself.
(07:37):
His ability to synthesizecomplicated situations in order
to reach a consensus wassomething that I really learned
a lot from, and I also learnedfrom him the importance of
strategic planning, becausestrategic planning is a way
really to align an entireorganization along key
priorities.
Speaker 1 (07:58):
And you know, rick, I think one of the things that
you kind of took from Rich andkind of moved on was, I think
you called it defining the H,because the question was are you
really a hospital or healthsystem?
And under you you really kindof took that whole part to kind
of say hey, let's talk a littlebit about the defining the H
(08:18):
kind of approach.
Speaker 2 (08:19):
Yeah, I had really two themes One was defining the
H and the other was defining theA.
Defining the H was reallyrecognizing that the H that you
see, that blue and white sign onthe road is iconic and it
really is a signal.
It's a beacon for hope andhealing and health.
And you know that the peoplethat work there are going to
(08:40):
treat you with the highestlevels of ethics and integrity
and that building in and ofitself is a foundation in a
community.
But it's more than a buildingand if we are to be successful
as hospitals, we need to bereaching out beyond that
building to make care moreconvenient.
And that means, you know,providing care in the home,
(09:05):
providing care in schools,providing care in workplaces,
making care more accessible sothat we meet the patient where
they need the care.
And that was the wholephilosophy around redefining the
H, and in some cases it meantthat the H might even be a
partner of, or their own healthplan to try to provide care in a
(09:27):
coordinated way across all thedifferent settings.
And that's the theme and thatwas the rationale behind it.
Now, of course, we're alwaysgoing to provide sophisticated
surgeries and diagnostics andtrauma care and deliver babies
in the building, but when halfof all surgeries today are done
in an outpatient setting, thereare more convenient ways to
(09:49):
provide that care.
And the redefining of the A wasreally to say that our
association needed to be morefocused and a recognition that
advocacy and public policyneeded to be the highest
priority and to define the fourfunctions of an association.
Number one advocacy and publicpolicy, but broad-based, not
(10:11):
just on Capitol Hill but in themedia, in the federal regulatory
agencies and in the courts.
And then the second partfunction of an association is to
be thought leaders, to developnew ideas or, if you don't like
something, coming up withalternatives.
The third function of anassociation was knowledge
exchange, being a place whereour members can learn from each
(10:34):
other to achieve best practices.
And then the fourth, and thisone I inherited from Davidson in
particular, was being an agentfor change.
You know there are certainthings that you want to push
because they're simply the rightthing to do, and whether it's
dealing with, you know, qualityimprovement, whether it's
dealing with community violence,because everything ends up on
(10:56):
our ED doors, or whether it'sdealing with things like
eliminating health disparities,those are really important
things that make us an agent forchange.
You can't boil the ocean, butthose were the components of
redefining the A.
Speaker 1 (11:10):
Yeah, you know it's funny.
I can even feel some of thosesame things at Cami.
How do we kind of make adifference, how do we inspire
programs to get better, how dowe share information, and those
are kind of core parts to it.
I think there's, you know, someamazing things at the American
Hospital Association.
I think of the Quest forQuality Prize and you know I had
the good fortune during mycareer to be a Bon Secours as a
(11:32):
board member when they won theaward for that.
Talk about the Quest forQuality and what the AHA's kind
of purpose in creating that was.
Speaker 2 (11:42):
Yeah, you know, and, by the way you know, awards are
important for organizationsbecause they recognize important
achievements.
The Quest for Quality wasreally basically saying hey,
quality is job one, and we haveto make sure that we honor
people that are performing atthe highest level, that we shine
a spotlight on them and theybecome a source of best practice
(12:03):
for our members to learn from.
We also have another importantaward called the Circle of Life
Award, which really focuses onthose that have really achieved
really excellent care when itcomes to care at the end of life
, and that's something that wewanna honor and respect those
(12:25):
people that are really providingthat kind of compassionate care
that is patient-centered andfamily-centered.
Another important award we callthe Dick Davidson Award, which
really is to honor people thatare reaching out into the
community in non-traditionalways to provide care, Again,
that's most accessible andconvenient.
Speaker 1 (12:48):
Yeah, aha has done an amazing job in that area with
the awards and I think also inthe data area.
You know, back in my days when Iwas in a hospital we used the
AHA data set a lot to kind ofhelp us understand how do we
kind of plan and kind ofapproach the community.
But it's certainly over thepast 30 years or so it's
(13:10):
certainly expanded and becomefar more robust.
On what you've done in theretoo, one of the areas where I
saw you very masterfully kind ofwork through the process was
under the Affordable Care Actproposed by President Obama at
(13:30):
the time, and I think it was areally and I want to say
probably a challenging time foryou because the hospitals were
really kind of looked on as well.
You know we need to kind ofclamp down on them and kind of,
you know, focus on some of that.
But you've really kind ofbroadened out and created some
great relationships within thegovernment but also within other
(13:53):
industries and healthcarepharmaceuticals to like an
insurance company.
Could I take a little peekunder the cover?
Tell me what was your secretsauce as you kind of navigated
through that process?
Speaker 2 (14:06):
Well, you know it was controversial and in some
respects I still have scars fromit because it wasn't, as you
may remember, at the beginningthe most popular thing, and you
know there were significantdivisions.
In fact, you know you look backin history and we're going
through some extraordinaryevents right now.
You know President Obama lostthe House of Representatives
(14:29):
after enacting it and yet nowit's ingrained and it's a part
of, you know, our whole healthcare system.
But what we saw was a historiceffort to really expand coverage
.
Was it going to be universalcoverage?
No, but we were going to addtens of millions of people and
it was a moment of time toreally finally get coverage
(14:50):
expanded in a meaningful way.
And certainly there was apublic program aspect to it
relative to Medicaid expansion,but also the creation of private
insurance that would be moreaffordable in these marketplaces
.
(15:15):
Now the big controversy for uswas they were going to make some
significant reductions inMedicare hospital payments to
help pay for this expandedaccess.
And we navigated through it intwo ways.
One, we said we need to havereally, really historic coverage
expansions to make up for theloss of that financial support.
But the other one is weextracted in in exchange for our
support, several very importantprovisions that are in the law
(15:39):
and remain in the law, you know,such as a prohibition on
physician-owned hospitals, wheredoctors are able to refer to
the hospitals in which they havean ownership interest, and they
only would refer the good casesand the easy cases.
That was undermining theinfrastructure.
(16:00):
One of the things we extractedwas an expansion of something
called the 340B program, whichmandates that drug companies
provide hospitals with discounts, and we expanded that program.
We also had a very importantseat at the table in creating
something called value-basedpayment, which has a lot of
(16:23):
different definitions but inessence moves away from our
fee-for-service piecemeal systemtoward more integrated forms of
care that provide better careat lower cost.
I can go on, but it was acombination of the moment in
time to expand coverage andbeing able to make these other
(16:43):
changes.
And I got to tell you, whileit's almost 14 years since it
passed, you know we've also beeninvolved in defending it, and
doing that both in Congressagainst repeal and replace, and
also in the courts.
There were three Supreme Courtdecisions that held it up and
now you know I don't think we'regoing to see a repeal under
(17:06):
President Trump and theRepublican Congress, but you do
see a disassembling of it, or anattempt to disassemble of
certain pieces of it along theway.
Speaker 1 (17:17):
Well, I you know again, I remember that time I
think I was with Aramark and wewere involved with the American
Hospital Association in asignificant way, and I just
remember that time how you kindof navigated those approaches
and really, rick I want to usethe term the art of the
compromise.
Did the American HospitalAssociation and the hospitals
(17:38):
get everything they wanted?
No, but did they get asignificant part that really
helped to ensure access toquality healthcare?
I would say yes, and you werequite an inspirational kind of
figure at that time as I watchedand I still remember almost the
way that you enacted one footon the dock, one foot on the
(18:00):
boat.
Speaker 2 (18:02):
And you know, the interesting thing about it is,
you know, for students in thisarea.
You know Medicare and Medicaidwere born in the 1960s, aca was
born in the 1990s and Medicareand Medicaid have been amended I
don't know how many times sincethen, and I know that ACA is
(18:23):
following that same course.
But those are the things thatmeet the test of time and you
know you want to continue toperfect it and improve it.
Speaker 1 (18:32):
Rick, let's kind of fast forward to today, because I
think you're in a similar typeof situation and you know you
and I talked about this a littlebit before and you said,
anthony, we're really just inthe second inning of the
ballgame right now, so I knowthere's some challenges to
hospitals.
Could you give us a sense aboutwhat's going on in terms of
(18:53):
public policy now and where theAHA is kind of approaching the
policy management area in thegovernment?
Speaker 2 (19:02):
Yeah, I would say that there are sort of several
different pieces to that.
To unpack, the first, of courseand everybody's been reading
about the different executiveorders that are coming out, and
you know we find ourselves inthe middle of so many of these,
whether it's immigration,whether it's restrictions on
service, whether it's reductionsin funding for research,
(19:24):
whether it's you know how todeal with issues around
diversity and equity.
You know we are just right inthe middle and what we're trying
to do is really help ourmembers understand what these
executive orders mean, track thelitigation that's out there on
some of them, because a lot ofthem will be in flux and that's
(19:49):
one area that obviously istaking up an awful lot of time.
The second one has to do withfunding the government.
You know we are concerned withthe capability of the agencies
that we deal with to be fullystaffed.
I mean, we work very closelywith the Centers for Medicare
and Medicaid and you know wewant to make sure that they're
(20:10):
appropriately resourced.
And by the time this airs, Idon't know if it'll happen, but
you know, this week thegovernment runs out of money on
Friday by midnight and there's adebate going on in Capitol Hill
as we speak.
But that is a platform thatcarries other health policy
issues, and the continuingresolution on appropriations
(20:33):
that has funded the governmentsince its fiscal year started on
October 1st, where they kickedthe can down the road for a
couple of months to December20th and then they now kicked it
down to March 14th, becomes aplatform for dealing with other
issues, because these otherissues are must do and there are
certain things that expireunless they are enacted on this
(20:54):
government funding resolution.
So, just as a, for instance,during COVID, we achieved very
significant waivers that werereflective of innovation,
hospital at home telehealth.
Those expire at the end of thismonth unless this bill goes
through.
There were specific provisionswe helped design that help rural
(21:15):
hospitals.
Those expire at the end of themonth if this doesn't go through
.
There's a reduction in Medicaiddish payments of $8 billion.
These are payments to hospitalsthat serve a high number of
low-income people, poor people,disabled people.
Those will kick in if this lawdoesn't go through to stop the
(21:38):
kicking in of those cuts.
So that's one aspect, that's onetrack, but the bigger funding
bill that everybody is talkingabout is really the funding bill
that is often referred to asthe budget resolution and the
reconciliation process and Iwon't go in the weeds here, but
this is where you may hear thepresident referred to.
I want one big, beautiful billto advance my agenda, and the
(22:02):
House has passed one version ofthat that calls for
extraordinarily large cuts inthe Medicaid program.
The Senate is in a differentplace.
That means we're in the top ofthe second in terms of them
working it out.
It's a long process, but thefunding threats that are out
there to provide the offsets todo the Trump tax cut extensions,
(22:27):
which costs $4.5 billion, iswhere this comes into play,
because the people that want todo the tax cuts are saying that
we're going to lose governmentrevenue.
We've got to make it up, andthey're saying let's do it by
cutting significant healthprograms.
So that's the big challengethat we're facing right now and
(22:50):
it'll go on for the rest of theyear.
Speaker 1 (22:55):
Yeah, it is really just an amazing time,
particularly when you look atsome of the proposals around
Medicaid and the impact thatthat could have on hospitals and
the impact that that could haveon on hospitals.
I I heard one CEO say uh, youimagine what the impact is going
to be if Medicaid has somesignificant cuts, particularly
on the rural hospital area whereaccess is, you know, tenable?
(23:18):
Uh, a lot.
Speaker 2 (23:20):
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 andwe're running a multimillion
dollar campaign now ontelevision ads and social media
and grassroots lobbying grasstops and people don't understand
the faces of Medicaid patients.
(23:40):
They'll frame it as welfarereform and they'll frame it as
something that only helps theurban poor.
But the reality is it helps alot of rural people, a lot of
farmers, a lot of ranchers, alot of single moms.
41% of babies are born on theMedicaid program.
It helps a lot of seniors anddisabled people and veterans.
So the faces of Medicaid is avery important part of our
(24:03):
message.
Speaker 1 (24:05):
Thanks, rick.
So let me pivot another stepright now, because we talked
about policy and we got in theweeds a little bit there.
But I want to go up to whatyour perspective is.
You're kind of looking atpeople who are beginning their
career why go in the hospitals,why go in the healthcare, and
also where to go.
(24:28):
So why?
And if the answer is why, yes,where do you think are some of
the opportunities for earlycareerists?
Speaker 2 (24:35):
Yeah, well, you know, I think, and what drew me to
healthcare ultimately?
You know it's foundational toevery human being.
I mean, without one's healthyou really can't be a
contributing member of societyand perform at your highest
ability.
And being in healthcare isreally all about helping people
and it's all about theopportunity to help
(24:58):
organizations like hospitalsprovide what is essential public
services.
And there are so many areas inwhich one could contribute.
Uh, we can go back to the policyarea, but in general, um,
whether it's in health caredelivery itself, the delivery of
an organization of services,whether it's in technology, um,
(25:18):
you know, so much is reliant ontechnology, not only medical
technology and medical equipment, but electronic medical records
, the emergence of artificialintelligence.
That has both opportunities andneeds to have some guardrails
as well.
Research I mean research inhealthcare, whether it's health
(25:40):
services research or scientificresearch is a critical component
of the whole healthcare system.
And then again we can go backto public policy.
You know, I think there are alot of opportunities and you
know, as someone that was anintern, you know internships and
administrative residencies thatare part of the CAMI programs
(26:02):
are integral, and I think thatthat's one of the best ways to
really progress in a career.
It did me well and that's whyI'm always a big proponent of
those types of programs.
Speaker 1 (26:16):
I think, rick, for me , you know, when I began my
career after graduating with mymaster's degree, that one year
fellowship experience where Iwas at a hospital truly was one
of the most important parts ofmy career to do.
You know, the comment that Imake is I got to sit on board
meetings and kind of hear whatwas going on and it took me, you
(26:37):
know, 20 or 30 years to getback into the boardroom.
Hopefully people will get theresooner than myself, but that
experience and that vision aboutyou know how to care for the
populations in need was reallyimportant in that part.
Rick, this has been a fabulousconversation and I, you know, I
(26:59):
really want to thank you for allof your support that you've
given to CAMI over the years andyour friendship.
I mean, you've been such agreat supporter of us but also,
I really want to say, a greatfriend and supporter of myself
as well too.
So thank you very much for allof that, rick.
Speaker 2 (27:15):
Thank you for having me.
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