Be open to new
Things unseen; Step out, time’s now
Here’s to ‘24
Publication Note: Congress has departed for the end of year recess, and so will our newsletter! We will return to our regular publication in January.
The Rundown
- Thank you and see you next year!
- House and Senate make progress on SUPPORT Act reauthorization
- House moves forward on cuts to hospital outpatient departments
- Annual Defense policy bill moves forward
- Updates on our NC delegation
- Big moves on artificial intelligence in healthcare
- Duke Health signs White House healthcare AI pledge
- The latest from our desks
- Join the Duke Health Advocacy Network!
Federal Updates
Thank you – and see you next year
It’s been a week... I mean a month... I mean a year…ALL of those.
As we conclude 2023, there is a little unsettling calm on our end as we did not experience the usual December rush to finish a Continuing Resolution to keep the lights on for the federal government. That’s now a January and February issue. Instead, we faced the House and Senate’s rush to advance certain legislation before the end of the year, some good and some bad. You’ll read more about that below, so right now we want to take the opportunity to say that it is a privilege to represent Duke Health and its team members on federal policy issues. The best part of our job is getting to share the amazing work – your work – across Duke Health to support patients, our community, and our State. For those of you who engaged with us this year, thank you, and we value the opportunity to meet and hear from you on this work. For those of you who we have not yet met, we hope to in 2024 and will continue to share opportunities to engage with our team. Happiest of holidays. We’ll see you next year!
House and Senate make progress on SUPPORT Act reauthorization
This week the House voted 386-37 to reauthorize the Support for Patients and Community (SUPPORT) Act, advancing the bill to the Senate. The House passed its bill shortly after the Senate Health, Education, Labor & Pensions (HELP) Committee marked up its version of the bill out of Committee. The SUPPORT Act would reauthorize several substance use programs focused on opioid treatment and prevention.
Additionally, the SUPPORT Act would reauthorize the National Child Traumatic Stress Initiative/Network, which is coordinated by the Duke-UCLA National Center for Child Traumatic Stress. Our office has been working throughout the year to advance this reauthorization.
With little legislative time (maybe mere hours by the time you’re reading this) left this year, efforts to get to a negotiated final bill likely won’t happen until 2024.
House moves forward on cuts to HOPDs
On Monday, the House advanced the Lower Costs, More Transparency Act by a vote of 320-71 under suspension of the rules, which requires a two-thirds majority vote. While several aspects of the bill focused on reforms for pharmacy benefit managers (PBMs), solidified hospital price transparency rules, and other provisions that aim to strengthen transparency, which can be viewed here, the bill also included a concerning provision that would cut Medicare payments for physician-administered drugs provided in off campus hospital outpatient departments (HOPDs).
Our office has been working diligently to prevent these and other cuts to hospital outpatient departments. In anticipation of this vote, our office reached out to members of the NC Congressional Delegation urging opposition to this cut and stressing that HOPDs provide essential drug administration services, including for cancer patients, who may require a higher level of care than is available at other care settings. Furthermore, reduced payments would endanger the critical role hospitals and health systems play in their communities, including providing complex care to medically complex patients. Several offices expressed support and understanding of Duke Health's position on these cuts to HOPDs, but still voted in favor of the bill (some with reservations) because of other favorable provisions. These offices expressed hope that cuts to HOPDs can be removed in the Senate before the bill further advances.
The bill also extended Medicaid disproportionate share hospital payments and funding for Teaching Health Center Graduate Medical Education and the National Health Service Corps.
Annual NDAA bill moves forward
This week, Congress successfully passed the National Defense Authorization Act (NDAA), keeping its streak alive for passing the bill on time (before January 1) every year for the past sixty-plus years. The House passed the bill on Thursday by a wide margin, following a similarly bipartisan vote on Wednesday in the Senate. The bill now heads to President Biden’s desk to become law.
Why does it matter to Duke Health? The NDAA formally authorizes broad programmatic and spending initiatives at the Department of Defense (DOD), including the Defense Health Program, which supports and funds DOD medical research, as well as the Defense-supported medical workforce. Passing the policy bill also paves a much easier road – for Defense, at least – in broader discussions on final FY 2024 funding.
What’s up, NC Delegation?
This week, Rep. Valerie Foushee (D-NC-04) joined a Dear Colleague letter to House and Senate leadership urging quick legislative action to prevent the 3.37% cut to Medicare reimbursement scheduled for January 1, 2024. She joins Reps. Deborah Ross (D-NC-02), Don Davis (D-NC-01), Kathy Manning (D-NC-06), and Alma Adams (D-NC-12) in signing the letter.
Senator Thom Tillis (R-NC) and Senator Alex Padilla (D-CA) introduced the Local 9-8-8 Response Act of 2023, which would “expedite the process of connecting callers with their nearest call center so they can receive appropriate care from mental health professionals as quickly and as safely as possible, while still protecting user privacy.” Senators Tillis and Padilla are the co-founders of the recently formed Senate Mental Health Caucus. In his press release, Senator Tillis said, “From the creation of the 9-8-8 Suicide & Crisis Lifeline to historic mental health investments included in the Bipartisan Safer Communities Act, we have made substantial progress in recent years in expanding access to quality mental health care… This legislation furthers that goal by ensuring those experiencing a mental health crisis receive rapid and localized care when calling the Lifeline, and I’m proud to introduce this bipartisan legislation with my colleagues to make lifesaving mental health care more accessible.”
Senator Tillis also joined several of his colleagues to introduce the bipartisan Pregnant and Postpartum Women Treatment Reauthorization Act. The legislation would reauthorize residential treatment programs for pregnant and postpartum women and enhance comprehensive substance use disorder (SUD) treatments, prevention and recovery support, parenting training, mental health counseling, and harm reduction interventions.
We are also pleased to share that Senator Tillis joined several of his colleagues in introducing S. 3503, the Value in Health Care Act. This has been a priority for our office because of the support it provides to Accountable Care Organizations, including Duke Connected Care. Among the provisions in this bill is an extension of the Alternative Payment Model (APM) incentive payment, which has been important to the success of these type of models.
Artificial intelligence is taking over... really
It’s been a big week for artificial intelligence in healthcare – and it’s going to be a big 2024 for the federal government’s involvement in regulating it.
On Wednesday, the Department of Health and Human Services (HHS) released its final rule for Health Data, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing.
The regulations were crafted by the Office of the National Coordinator (ONC) for Health IT and will apply to clinicians using HHS-certified decision support software by the end of 2024. Health IT certification is technically voluntary but is required when the technology is used in many government and private health care settings. Certified software is used in 96 percent of hospitals and 78 percent of doctors' offices nationwide, according to ONC. AI tool developers will have to disclose information on how the software works and was created. That includes who funded the technology, what its intended decision-making role is, and when clinicians should be cautious about using it. Software developers will also have to tell their customers how representative the AI’s training data is, how they attempted to mitigate bias, and how the software was externally validated. Additionally, they’ll have to reveal performance measures, explain how they monitor performance over time, and describe how often they update algorithms.
The final rule also defines new data standards for interoperability, changes exceptions to an HHS rule barring health care providers from refusing to share patient data, and establishes reporting requirements related to interoperability.
While the final rule was in process before the White House announced its Executive Order on the usage of AI in the federal government in late October, the new algorithm rules meet the objectives of prioritizing patient safety and limiting bias in AI’s applications in clinical settings.
The House Energy and Commerce Committee also held a hearing with leadership in the Departments of Commerce, Energy, and Health and Human Services to talk about leveraging government expertise in AI regulation. Specifically, members of the Committee were interested in learning more about the administration’s plans to implement President Biden’s AI Executive Order and the departments’ associated regulatory agendas. ONC Director Dr. Micky Tripathi testified that more healthcare AI regulations will be coming in 2024 and that the agency and administration will be seeking public comment and feedback as part of the process.
Duke Health signs White House pledge on healthcare AI
This week, Duke Health joined a group of leading health systems and payers from across the country to sign a Biden administration pledge to advance ethical and responsible use of AI technology in healthcare.
The pledge was announced at an annual conference hosted by ONC Health IT and is a voluntary commitment to the principles of safety, security, and trust that are viewed as fundamental to the future of AI.
Duke Health is also a founding member of the Coalition for Health AI (CHAI) established to develop guidelines and guardrails for fair and credible applications of AI in healthcare.
More information about the pledge and support from Duke Health leadership can be found in Thursday’s press release.
From our desk(s): Duke Health GR this week
This week, a member of our team participated in a digital health policy roundtable in Washington, DC and met with key stakeholders to discuss FY 2024 appropriations, healthcare workforce issues, and healthcare tax-related policy.
Our office also attended a meeting for the Association of American Medical Colleges Government Relations Representatives Steering Committee, as well as a monthly virtual meeting of the North Carolina Healthcare Association and other hospital government relations representatives.
We joined year-end policy and strategy calls for priority issues, including telehealth and digital medicine, cancer research and care, trauma and trauma centers support, surprise medical billing, artificial intelligence in healthcare, mental and behavioral health, and immigration/supporting the international healthcare workforce.
Join the Duke Health Advocacy Network!
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