Providers are key to effective advocacy + education. It's time to make your voice heard.

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As an unpredictable election cycle unfolds, healthcare remains surprisingly absent from the campaign spotlight, but significant policy shifts continue behind the scenes. Experts predict many of these changes will persist regardless of the election’s outcome.??

Here’s what to expect with the next administration.?

There will be more regulatory uncertainty and administrative burden across the industry.?

In addition to the recent Chevron decision, at least two other Supreme Court rulings stand to disrupt healthcare administrative law:??

• SEC v. Jarkesy mandates that the SEC must prosecute securities fraud cases in federal court, granting defendants the right to a jury trial. This could increase the administrative burden on hospitals, requiring more resources for legal compliance and defense.?

• Corner Post v. Board of Governors holds that the statute of limitations starts when an injured party first experiences that injury, rather than when the regulation is first published, which may put HHS in a retroactive defensive stance.? ??

Enforcement efforts will remain focused on antitrust, whistleblowing and fraud.?

Antitrust enforcement is intensifying and is likely to continue. CEOs should review payer contracts to avoid antitrust issues, especially if they hold significant market share. The DOJ’s new whistleblower program incentivizes reporting fraud in commercial insurance and Medicare Advantage plans, likely increasing criminal cases. Additionally, the DOJ is targeting Medicare Advantage fraud, urging hospitals to prepare for audits and ensure compliance through staff training.?

Both payers and providers will be fighting to extend ACA subsidies.?

Subsidies for ACA plans have driven record enrollment levels with the added benefit of bringing favorable reimbursement rates and contracting leverage to providers. However, these same subsidies are set to expire at the end of 2025. Providers must advocate for the extension of subsidies to protect tenuous financial margins.?

Rationalizing and right-sizing will guide policy efforts for the next decade.?

The first 100 days of the next administration, regardless of party, will likely be focused on finding ways to pay for government funding and tax cuts — these may include expanding site-neutral payments, scaling back 340B and continuing to evaluate ways to eliminate administrative waste and consumer friction from the healthcare system.?

Provider and patient voices amplify advocacy efforts.??

For providers concerned about these varying financial and legislative pressures, now is the time for action. Advocacy and education efforts now will help ensure policymakers are well-informed about providers’ critical perspectives for years to come.?

Here are three ways to make your perspective heard:

1. Amplify your voice through state and national associations?

Ensemble actively works with the American Hospital Association (AHA) and state hospital associations advocating on behalf of our clients, but the voice and experiences of providers are invaluable to this narrative.??

Get active in your state hospital association. Share data and stories with the AHA so they can advocate on your behalf. Collaborate with these advocacy groups, participate in policy discussions and provide data-driven insights that highlight both your wins and your ongoing challenges.?

2. Activate your community to lend support to your cause?

Encourage your employees to vote and provide them time off to do so. Leverage the power of social media to compel state and federal representatives to visit your facilities — hosting a tour or conversation enables you to show both tangible improvements that have been made and gaps where legislative support is still needed.??

You can also mobilize your networks and community to amplify the message about the precarious position of providers in today’s industry, ensuring that the voices of patients and providers are heard more broadly.?

3. Tell a compelling story?

It’s an unfortunate truth that many policymakers don’t comprehend the challenges many hospitals are currently facing. This is compounded by the forceful, proactive lobbying of payers, which shares a different narrative than the one providers would share. To tell your organization’s story effectively, you must make it personal.?

Educate your board about the issues your system is facing in an easy-to-digest way so they can educate policymakers. Combine compelling data with relatable anecdotes to convey concerns about the financial implications and community impact of disruptive payer behavior and inequitable policies.?

Your voice matters more than ever.?

Only when they can feel it will a critical mass of policymakers be willing to fight it. As a provider, staying alert and engaged with these issues can mean the difference between taking a successful stance advocating for your needs versus reactively responding to any legislative changes that come along.?

Regulatory Updates?

A new DOJ corporate whistleblower program incentivizes reporting of healthcare fraud involving private insurance plans. Learn more.?

CMS released the FY 2025 Inpatient Prospective Payment System (IPPS) and FY 2025 Long-Term Care Hospital Prospective Payment System (LTCH PPS) final rule. Updates include an increase in Medicare IPPS rates by a net 2.9% and LTCH payments by 2.2%. Learn more.??

The fiscal year 2025 final rules have been issued for skilled nursing facility, inpatient rehabilitation facility, inpatient psychiatric facility, and hospice. Links provide highlights of the changes.?

- FY 2025 Skilled Nursing Facility PPS Final Rule??

- FY 2025 Inpatient Rehabilitation Facility PPS Final Rule?

- FY 2025 IPF PPS Final Rule?

- FY 2025 Hospice Payment Rate Update Final Rule?

A national home health and hospice provider has agreed to pay $3.85 million to resolve allegations that it submitted false claims and knowingly retained overpayments for services provided to Medicare beneficiaries. Learn more.?

Two owners of three dentistry businesses in Connecticut are paying $1.7 million to resolve alleged violations of the federal and state False Claims Act. Connecticut Medical Assistance Program (“CTMAP”) provider agreements and the federal Anti-Kickback Statute were violated?for?visits referred by a third-party “patient recruiting” company. ?Learn more.?