Our priorities
Reflect beyond the ledger
What’s spent and what’s saved
The Rundown
- Work on government funding inches forward
- Senate HELP subcommittee examines AI in healthcare
- Senate Finance Committee advances package of health bills
- Healthcare Workforce Resilience Act re-introduced
- NIH now has a permanent director
- The latest from our desks
- Virtual office hours – come see us on November 28!
- Join the Duke Health Advocacy Network!
Federal Updates
Lights check: still on, but clock ticks once again
We are currently one week away from a potential government shutdown, and it remains unclear whether a last-minute deal can come together to avert it.
Yes, we know you’ve heard this before. We don’t enjoy writing or thinking about it, either – but here we are.
Yesterday, Senate Majority Leader Chuck Schumer (D-NY) filed a short-term continuing resolution (CR) designed to keep the federal government open until mid-December. The Senate is expected to start the procedural votes for this measure early next week.
On the House side, there is still no consensus on what House Republicans are planning to do. One option that has been floated is a “laddered” CR, with several spending bills expiring in December and the remainder in January. The idea is to provide a short amount of time to finalize the (supposedly) less controversial appropriations bills, and a longer deadline for the more controversial bills. How this would work in practice remains to be seen, and the idea seems to be a non-starter in the Senate.
Separately, the House Rules Committee is scheduled to consider the fiscal year (FY) 2024 spending bill for the Departments of Health and Human Services (HHS), Education, and Labor on Monday, November 13. The Committee will decide which of the dozens of filed amendments, many of them partisan in nature, can be considered on the floor, which will ultimately determine whether the bill be able to garner enough votes to pass. If it’s close or uncertain, the bill may be pulled from the scheduled altogether.
The honeymoon appears to be over for Speaker Mike Johnson (R-LA), and the process of governing will only get more difficult from here.
Our team continues to advocate for Duke Health funding priorities and sharing with our delegation the harmful impact of proposed cuts and the uncertainty caused by constant CRs.
Senate HELP subcommittee probes AI and healthcare
This week, the Senate Health, Education, Labor, and Pensions (HELP) Subcommittee on Primary Health and Retirement Security Committee held a hearing entitled, “Avoiding a Cautionary Tale: Policy Considerations for Artificial Intelligence in Healthcare.”
Witnesses included representatives from academic medicine, the patient advocacy community, and clinical experts who testified to the efficacy and potential of emerging technologies to advance healthcare delivery. Much of the discussion was directed toward data privacy, biosecurity, and safety. The panel largely agreed that algorithm developers should maintain some degree of control and autonomy at the point of design and implementation, albeit under the umbrella of broader federal guidelines. Committee members and witnesses also agreed that any established regulations or guidance must address inherent bias and that AI is a tool that can be used to augment the clinical experience but would not replace the human elements of medicine.
Senator Ted Budd (R-NC) is a member of the subcommittee, and our team worked with his staff ahead of the hearing to share resources from our experts at Duke AI Health.
Several other congressional committees held hearings on AI this week, including the Senate Homeland Security and Governmental Affairs Committee, the Senate Judiciary Subcommittee, and the House Oversight and Government Reform Committee specifically on issues related to national security, elections, and intellectual property.
These types of conversations will pick up for the remainder of the year as Congress works to put its legislative and regulatory stamp on artificial intelligence policy. An emerging underlying thread among these debates is data privacy, which may spur activity by early next year to tackle a comprehensive data privacy law ahead of more meaningful AI legislative activity. Data privacy efforts could have a sizeable impact on healthcare policy, particularly as some members are interested in revisiting and expanding HIPAA in the future to better capture technological advances with health data.
Our team will continue to position Duke Health and our leadership and experts as partners for the federal government as healthcare AI moves more to the forefront of the AI policy revolution.
Senate Finance Committee advances package of health bills, setting the stage for year-end activity
This week, the Senate Finance Committee advanced the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act out of committee by a vote of 26-0. The bill addresses several issues the Committee has been examining throughout the year, as well as pending and timely health policy issues.
Senate Finance Committee Chairman Ron Wyden (D-OR) said that the package of health proposals represents key bipartisan initiatives undertaken by the Committee and achieves several goals: expanding access to mental health care and mental health parity for Americans with Medicare and Medicaid coverage; extending essential Medicaid and Medicare provisions that expire this year; and shoring up Medicare payments to physicians.
The bill also includes several policies that have been a priority for Duke Health and part of our advocacy strategy, including increasing Medicare payments under the Physician Fee Schedule (PFS) and extending the Medicare Advanced Payment Model incentive payments. Below is just a snapshot of the provisions in the legislation, and we encourage you to view the summary here.
-
Extending HPSA bonuses to certain non-physician providers including NPs, and clinical social workers (among others).
-
Increase the payment under PFS for certain behavioral health integration services for a certain period of time.
-
Requiring Medicare Advantage (MA) plans to maintain accurate provider directories on a public website.
-
Delaying cuts to Medicaid Disproportionate Share Hospital payments.
-
Extending Medicare Advanced Payment Model (APM) Payment Incentives by providing 1.75% APM Incentive Payment for Qualifying APM Participants.
-
Replacing the statutory increase of 1.25% for Medicare physician fee schedule services furnished in 2024 with 2.50% for that year.
-
Requiring CMS to regularly update information on licensure requirements for furnishing telehealth services under Medicare and Medicaid, including regular updates on guidance to clarify interstate licensure compacts.
-
Limiting payment reductions of up to 15% in the Medicare Clinical Laboratory Fee Schedule until January 1, 2025 by delaying the reporting and collecting of private insurance payments for clinical laboratory services through December 31, 2024 and by extending the zero-percent cap on payment reductions through 2024.
Our team reached out to the office of Senator Thom Tillis (R-NC), a member of the Finance Committee, ahead of the markup to offer connections with Duke Health experts.
Healthcare Workforce Resilience Act reintroduced
Legislation has been reintroduced in the Senate to help support international healthcare worker recruitment and visa processes.
The Healthcare Workforce Resilience Act (S.3211) would recapture up to 40,000 unused employment visas, designating 25,000 for nurses and 15,000 for physicians. It would also require expedited processing for those qualified to secure these types of visas without the assessment of additional processing fees, recognizing their critical role and contributions to addressing the health of the nation.
The legislation was originally introduced during the height of the public health emergency in an effort to address critical healthcare workforce shortages tied to the impact of COVID. Senator Thom Tillis (R-NC) has joined as an original cosponsor of the bill.
Our team continues to work with our delegation and key committee staff in Congress in support of policies to ease visa processes and wait-times for international healthcare workers being recruited to Duke Health and around the county.
Senate confirms NIH director; NIH says she is now at the helm
This week, the Senate voted 62-36 to confirm Dr. Monica Bertagnolli as director of the National Institutes of Health (NIH). Senator Thom Tillis (R-NC) voted to support her nomination, while Senator Ted Budd (R-NC) voted no.
Director Betagnolli wasted no time getting to work, and NIH issued a press release on Thursday confirming her installation as the 17th director of NIH. The press release noted that “chief among her key priorities is ensuring clinical trials yield the best results by increasing the diversity of participants; embracing the rapid expansion of new learning-based analytical tools and ensuring their use improves care for all people; and restoring trust in science by making it accessible to all communities and inspiring the next generation of doctors and scientists. Dr. Bertagnolli also is committed to leveraging commonalities across all diseases — from biology to accessing care — to strengthen collaboration across the 27 NIH institutes and centers.”
From our desk(s): Duke Health GR this week
This week our office reached out to congressional offices in support of including an APM incentive extension in the November 15th Energy and Commerce Committee markup.
We met with coalition colleagues to discuss long-term policy and advocacy strategies to support AI in healthcare.
Members of our team also participated in and led government relations strategy conversations on trauma care and policy, 340B, data privacy, telehealth, and support for cancer centers.
See You Soon – Virtual “Office Hours” on November 28th
Duke Health (federal) Government Relations is once again partnering with our Duke State Relations colleagues to hold virtual "office hours.” Open to members of the Duke Health Advocacy Network, these “office hours” are not formal presentations but instead an opportunity to talk about health-related issues before Congress and for us to learn more about the issues that are at the forefront for you and your work.
Date: Tuesday, November 28, 2023
Time: 12:00pm
A meeting invite will be distributed soon. If you would like to be added to meeting invite, click here.
Not yet a member of the Duke Health Advocacy Network? No problem! Learn more about how to join below.
Join the Duke Health Advocacy Network!
Looking for more opportunities to connect with fellow advocates and professionals interested in public policy across the health system? Join the Duke Health Advocacy Teams Channel!
Managed and moderated by Duke Health Government Relations and Duke State Relations, the purpose of the platform is for you to connect with your colleagues throughout the health system who are engaged and/or interested in public policy advocacy. We hope the channel will be used as a space for sharing ideas, collaboration, and engaging with the government relations teams on the issues most important to your work.
We encourage you to explore the channel, as we will post relevant news items, policy updates, questions, advocacy resources, and opportunities for engagement. As importantly, this is your space to do the same and to help grow the community.
Click to Join
(Note: This is only open to Duke Health employees. By joining this teams channel, you acknowledge that the platform and your participation are intended for information sharing and connections/relationship building and is not an inducement by Duke Health Government Relations and Duke State Relations, or the channel’s participants, to act as an unauthorized advocacy and/or lobbying representative of Duke Health or Duke University).