CEO Messages

When the COVID-19 pandemic first took hold of the nation, legislation quickly passed that has allowed most Medicaid enrollees to maintain coverage during the ongoing public health emergency. The federal Families First Coronavirus Response Act granted states an increase in federal Medicaid dollars as long as they paused disenrolling anyone from their Medicaid programs starting in March 2020. With the boost in Medicaid dollars Texas received, the state’s budget was stabilized, and Medicaid enrollees were granted uninterrupted coverage during the PHE.

Health care workers have dealt with endless challenges in recent years, especially after two years of COVID-19 patient care and the resulting burnout and fatigue. As hospitals and health systems face severe staffing shortages, the burden on those workers remaining grows more profound. Amid the mounting pressure and strain, health care workers must contend with, one concern is entirely preventable and must be addressed in a comprehensive and meaningful way. Workplace violence simply cannot be tolerated to any degree within a health care setting. With last month designated as Workplace Violence Awareness Month and June 3 called out by the American Hospital Association as Hospitals Against Violence day, now is the time to highlight what we as organizations and individuals must do to ensure safe, secure work environments for our dedicated health care workforce.

Hospitals around the state are breathing a collective sigh of relief following the Centers for Medicare & Medicaid Services’ approval of three directed payment programs in late March. These vital DPPs raise reimbursement rates closer to the cost of providing care to Medicaid enrollees and amount to $5.3 billion a year in payment enhancements to Texas providers. But for nearly seven months, the programs were left pending as CMS and the State of Texas remained in a deadlock over negotiations regarding the programs’ funding methods — leaving the state’s health care providers wondering if they were rapidly heading toward a financial cliff. The Texas Hospital Association is grateful CMS took a step in the right direction by issuing approval of the DPPs, but we also recognize that more work is needed to ensure the lasting viability of the Texas health care safety net.

Hospitals have grappled with health care workforce shortages long before the pandemic, but two years of providing COVID-19 care have strained provider resources and staff like never before. Health care workers serving on the frontlines of one COVID-19 variant surge after the next are profoundly burned out and exiting hospital employment in record numbers. Some are leaving the field altogether, while others are trading full-time work for more lucrative travel positions. Without policies designed to build and sustain a robust health care workforce, this exodus of skilled professionals from hospital employment could threaten providers’ ability to care for patients.

While much of our attention lately has been focused on the COVID-19 pandemic and related challenges, another crisis has been quietly brewing with the potential to drastically impede health care delivery across Texas. Since last fall, supplement payment programs that raise hospitals’ Medicaid reimbursements closer to the actual cost of care either expired or are still awaiting federal approval. Months have now passed without Medicaid providers receiving these desperately needed funds, as negotiations between the state and federal authorities remain at an impasse. Additionally, the 10-year Medicaid 1115 waiver extension was rescinded last April, and its future remains uncertain. The stress on hospitals responding to the ongoing pandemic is significantly compounded by this absence of funding and lack of clarity over the future of vital payment programs.

Hope was on the horizon as we inched closer to the end of 2021. Powerful tools like vaccines, masks, boosters and testing capabilities were ubiquitous, and the general public was deeply educated about how to protect themselves. A new year brought hope for a new health care environment that perhaps would largely leave COVID-19 in the rearview mirror. But, as the holidays unfolded, so did another serious wave of infections due to the omicron variant. And once again, health care workers and hospitals found themselves under siege as COVID-19 hospitalization trajectories went straight up in Texas and across the nation.