CLEVELAND — Dr. Cliff Megerian got an unexpected phone call this week.
The nation’s new Health and Human Services Secretary, Robert F. Kennedy Jr., was inviting him to a meeting in Washington, D.C. It would be a small group discussion, with just four top executives from a diverse group of hospitals and health care systems.
Megerian, the chief executive of University Hospitals, said he still isn’t completely sure why he got picked. But he jumped at the chance to talk about what’s working, what’s not, and what possible cuts to Medicaid and Medicare would do to patients’ access to health care and hospitals’ bottom lines.
“When you are asked to give your opinion on behalf of our 33,000 employees, our millions of patients and the Northeast Ohio community, you take that opportunity,” he said. “You get there, and you get a seat at the table, and you do your best to create a relationship where … when there is something that is tangible, that’s potentially harmful to your patients in your community, you have a vehicle to have a good-faith discussion.”
During an interview at UH’s main campus in University Circle on Friday, he wouldn’t discuss Kennedy’s controversial views on vaccines.
Megerian described the meeting, which took place Thursday, as an introductory conversation about health care policy, from cutting red tape to using digital tools, including artificial intelligence.
He advocated for more health care systems to be financially rewarded by Medicare for keeping patients healthier and holding costs down – and penalized when they don’t.
UH participates in a voluntary initiative called the Medicare Shared Savings Program that does just that. And Megerian believes that model, if it’s expanded, could be a way for the government to save money without making drastic cuts to health insurance programs that millions of people rely on.
Forty-eight percent of University Hospitals’ patients use Medicare, the federal insurance program for people ages 65 and older. And 18% of the UH system’s clients are on Medicaid, which serves low-income families. Medicaid patients make up roughly 70% of the clientele at UH Rainbow Babies & Children’s Hospital, Megerian said.
“We made it abundantly clear,” he said of the group of health care CEOs, “that … those folks cannot afford to have their services cut. And that we have to provide solutions to (Kennedy) to allow the financial flexibility so that there are no cuts.”
The following interview has been edited for brevity and clarity.
Michelle Jarboe: Who were the other health care executives in the room?
Dr. Cliff Megerian: There was a large academic health system, which is University Hospitals. There was a very large, non-academic Catholic hospital system that is in a multi-state arena – that’s Bon Secours Mercy. There was a gentleman who runs a critical access hospital in western Kansas. And then a small rural hospital leader. Each person was representing a different constituency of the hospital industry.
Jarboe: What did the secretary's office tell you they wanted to get out of it?
Megerian: First was the goal of understanding how Medicare and Medicaid can do a better job of responding to the needs of patients.
Goal number two was him asking our opinions about how AI can improve the care and throughput and efficiency of hospital delivery systems.
And then number three was a very – I was impressed – frank question. What are we doing wrong? What is Medicare and Medicaid doing wrong as it relates to administrative burdens?
Jarboe: What did you want to talk about going in?
Megerian: If I had to have one overarching goal, it was to really explain to him … that there's already an existing mechanism within his portfolio (the Medicare Shared Savings Program). If it were expanded, it could lead to better health for our patients, our communities all over the United States of America, because the data from those who have participated in Medicare Shared Savings is really unbelievable. If that shift were to happen, it saves Medicare nearly $200 billion a year. And then we're not worried about the future of the Medicare trust fund as much as we are today. So that was my major goal.
Jarboe: What impressions did you get from the Secretary about his commitment to maintaining Medicare and Medicaid?
Megerian: This was an introductory meeting, and certainly I wanted to glean more. And there's going to be more meetings.
I reminded him that we are the public health system of this nation. Many nations have a separate public health system that is separate from the health care system. The American health care system is the backbone of America's public health system. And during COVID, we saw it play out in real time. We did the testing. We did the hospitalizations. And when it came time for vaccines to be delivered, it was the hospitals who delivered those. We have multiple reasons why we cannot injure the hospital systems at a time where many of them are under stress.
Jarboe: You talked about this not being the only meeting. So what comes next?
Megerian: We really arrived at four major action items. Number one is further education of the secretary and his staff (about ways to build on the Medicare Shared Savings Program model).
Number two is an agreement that all of us would participate to at least have some common ideas about which AI mechanisms are ultimately going to be helpful and which should be avoided. Because there is danger if generative AI is used to make decisions about diagnosis and treatment without human eyes on it.
I think number three is further investigations about what can and should be done in the government's relationship and rules around Medicare Advantage (the program that lets Medicare participants access their benefits through private insurance companies) and how Medicare Advantage companies can do better about, for example, denying care. How they can do better about pre-authorizations. How they could be better about denying certain services that sometimes seem arbitrary and appear capricious.
Number four was that this group, either alone or an expanded version, would be available to help the secretary and his team to further their insights and help them with the decisions that they will make. We've already been communicating today, even with the secretary and some of his team. The (National Institutes of Health) leader and I spoke this morning.
My job is to make sure I curate that relationship so I can help and protect our patients.
Jarboe: How have the administration’s decisions around policy impacted you so far?
Megerian: There's really two buckets by which we can be affected. One is executive orders, and those that particularly affect medicine. The second are things that we hear about, we hear rumors of, but are gonna come into reconciliation of the 2026 budget.
The one that is actually tangibly hit, as it relates to health care in an executive order, has been the order to lower NIH indirect funding from 59% to 62% between us and Case (Western Reserve University) down to 15%. Obviously, that would be problematic. It would be injurious to our research mission, so we have been very vocal about our concerns. That is on a halt. There was a stay on the implementation of that.
We've heard cuts to Medicare, cuts to Medicaid. What we're doing, and I'm doing, is making it abundantly clear what would happen if all of these things were to happen, and to let them know that it's unpalatable. The totality of those potential cuts would be devastating, and it's my job to make it abundantly clear what would happen and then argue against some of them.
But you get the most latitude with government leaders when you don't spend your entire time with them with this litany of complaints. You come with potential solutions to obviate the need to do a drastic thing. And that's really what we've been working on.
Jarboe: It sounds like a lot about building on what's working and fixing systems, versus eliminating them.
Megerian: Yes. Exactly. There's a lot of opportunity to deal with inefficiencies, let’s just say, within the systems that exist today. If you were to start over, and you and I were to be building a Medicare system, we would probably not have some of the regulations, rules that have kind of come together almost like a cobweb that's grown over time.
Jarboe: Did you feel like you were heard?
Megerian: I was absolutely heard. It was a very small group. … (Kennedy) was intently interested and taking notes and then follow-up questions. He was basically in a listening mode. And I found that very, very helpful.
Jarboe: How did you feel when you left that conversation?
Megerian: I felt optimistic that there were no preconceived notions. That they are in a fact-gathering mode. And then we'll see how things transpire, and whether this is going to be perpetuated and address change.
Jarboe: What do you want the community here in Northeast Ohio to know? Obviously, you went there as a representative of UH, but you're also a representative of this community.
Megerian: There's nothing wrong with having a feather in our cap from Northeast Ohio, that University Hospitals was asked to this group.
I’d like the community to know that I emphasized the absolute, unalienable right and need for proper health care in this community – and was able to give some advice as to how to make sure not only that that continues, the health care that we enjoy, but it actually could potentially be better, less burdensome.
Jarboe: What haven’t I asked you about that you think is important for me to know?
Megerian: Much of this is, frankly, not going to be decided by the agency. It is going to be decided in Congress.
And there is an opportunity for our citizens to be very vocal to their congressmen and women and their senators about what they don't want to see happen. They have to hear it from their constituents that they want to protect Medicare. They want to protect their hospitals. They want to protect Medicaid. They want to protect food programs. They want to protect the work being done to lower the infant and maternal morbidity and mortality rates.
Not only do patients suffer if there are significant cuts to those agencies, both Medicare and Medicaid, but the hospitals they've grown accustomed to relying on become injured. Almost 10 hospitals in Ohio have gone bankrupt because these pressures are already coming to bear. This has to be avoided. And the most powerful voice is the citizenry, working with their elected officials.
