Timely Information From Around the Country that Impacts the Way You Work!

Senate Panel Launches Hearings on Health Reform - May 2008

The Senate Finance Committee today held the first in a series of hearings on health reform, at which former Health and Human Services Secretaries Donna Shalala and Tommy Thompson shared their views on reform strategies. According to Shalala, “80% of Americans like what they have, but they want lower cost.” She said any health reform plan will “have to make a very clear case about how they would be better off, particularly on the finance side.” She said reforms to Medicare would trigger similar reforms throughout the system, and should include electronic medical records and comparative effectiveness research to promote best practices. Thompson said reforms should promote wellness and prevent chronic disease, obesity and smoking, which drive up health care spending. He said companies should be encouraged through tax incentives to instill prevention and smoking cessation in the workforce. He also called for electronic prescribing to reduce medication errors.

Task Force Issues Guidelines for Mass Critical Care - May 2008

Every hospital with an intensive care unit should be prepared to provide emergency mass critical care in a disaster, according to recommendations from an expert panel published today in the journal Chest. This should be coordinated with regional hospital planning efforts, said the Task Force for Mass Critical Care, which issued the recommendations and framework for optimizing critical care surge capacity and allocating scarce resources during a mass critical care event. “Successful response to such overwhelming situations depends largely on having an effective conceptual and operational framework, such as EMCC,” the task force said. In circumstances where critical care cannot be provided to all those who are critically ill, the panel said “it will be necessary to target the resources available to those who are most likely to benefit in order to maximize overall survival.” It said this would exclude patients who have a very high risk of death and little likelihood of long-term survival.

AHA: DME Regulations Could Impede Care - May 2008

The AHA today urged Congress to allow hospitals to continue to provide equipment and supplies directly to their patients without participating in the Medicare durable medical equipment competitive bidding process. In a statement submitted to a House Ways and Means Health Subcommittee hearing on Medicare’s DMEPOS competitive bidding program, AHA said it supports the program’s goal to reduce Medicare costs for DME, prosthetics, orthotics and supplies. However, the association said it remains concerned that certain Centers for Medicare & Medicaid Services’ regulations will restrict hospitals’ ability to meet their patients’ DME needs in a clinically comprehensive and timely manner. “To avoid this problem, hospitals wish to continue participating in the DMEPOS program by accepting the price set through the competitive bidding process, without being required to submit a bid,” AHA said.

Report Examines Trends in Employer-Sponsored Coverage - May 2008

A new report from the Alliance for Health Reform examines recent proposals to strengthen or do away with employer-based health coverage. For example, a proposal by Sens. Ron Wyden (D-OR) and Bob Bennett (R-UT) would impose an individual mandate for the purchase of insurance in the non-group market, and require employers to convert their workers’ premiums to higher wages. Other proposals are modeled on Massachusetts’ reform initiative, which requires individuals to buy insurance and employers to provide coverage or pay a surcharge to offset costs for the uninsured. Still others, such as “Medicare for All,” call for a government-financed system of health coverage. “For the present, businesses and even some unions seem inclined to maintain the present employer-based system,” the authors said.

CA Providers Sue State Over Medicaid Payment Cuts - May 2008

The California Hospital Association and other health care provider groups today filed a lawsuit against the state of California to block a planned 10% cut in state Medicaid payments effective July 1. Filed in Los Angeles County Superior Court, the class-action lawsuit contends that the cuts violate state and federal laws that require that Medicaid payments “must be sufficient to enlist enough providers so that services under the (state’s Medicaid) plan are available to recipients at least to the extent that those services are available to the general public.” The governor and state legislature in February enacted $1.3 billion in Medicaid (Medi-Cal) cuts. In addition, June and August Medi-Cal payments to hospitals, pharmacists and adult day health care providers are slated to be delayed. In addition to CHA, groups filing the lawsuit include the California Medical Association, California Association of Public Hospitals and Health Systems, American College of Emergency Physicians, California Dental Association and California Pharmacists Association.

Hospital Leaders Urge Congress to Halt Medicaid Rules - May 2008

Regulatory cuts to Medicaid slated to take effect May 26 could close trauma centers, curtail emergency services and seriously erode hospitals’ ability to respond to a disaster, hospital witnesses said today during a House Oversight & Government Reform Committee hearing. The regulations would cut more than $5 billion from public safety-net and teaching hospitals unless Congress extends a moratorium blocking the rules. Roger Lewis, M.D., head of Torrance, CA-based Harbor-UCLA Medical Center’s emergency medicine department, told the committee, “The proposed Medicaid regulations will directly result in further reductions in hospitals’ emergency department capacity and specifically targets the trauma centers, the teaching hospitals and the public institutions whose surge capacity we must maintain if they are to function in a time of disaster.” Jay Wayne Meredith, M.D., chairman of the medical center’s department of general surgery, said the trauma center at Wake Forest University Baptist Medical Center in Winston-Salem, NC, “will go under” if the rules take effect. “We beg you to stop the Medicaid cuts and enact H.R. 5613,” said Meredith, referring to House-passed, AHA-backed legislation that would delay the rules until April 2009.

Hospital Employment Climbs 0.20% in April - May 2008

Employment at the nation's hospitals rose 0.20% in April to a seasonally adjusted 4,613,700 people, the Bureau of Labor Statistics reported today. That's 9,400 more than in March and 125,300 more than a year ago. Without the seasonal adjustment, which removes the effect of fluctuations due to seasonal events, hospitals employed 4,600,900 people in April, 6,200 more than in March and 125,800 more than a year ago. The nation's overall unemployment rate declined by one-tenth of a percentage point in April to 5.0%.

Uninsured Workers Cost Nation More Than $44 Billion a Year - May 2008

Uninsured workers and their dependents cost public health insurance programs $32.5 billion in 2004 and accounted for $12 billion in uncompensated care, according to a study released today by the Commonwealth Fund. That’s up from $21.2 billion and $9.4 billion, respectively, in 1999, the study found. About 10.8 million full-time workers and their family members were enrolled all year in public health insurance programs in 2004, up from 6.3 million in 1999, the authors note. The study used data from the Medical Expenditure Panel Survey to estimate the cost to the public when employers do not insure their workers.

CMS Announces RY 2009 Payment Update for Inpatient Psych Facilities - May 2008

The Centers for Medicare & Medicaid Services yesterday announced that inpatient psychiatric facilities would receive a 2.5% increase in payments - about $120 million- for rate year 2009, which begins July 1. RY 2009 is the first year these facilities will be completely reimbursed under a prospective payment system rather than a cost-based system. CMS said the increase is based on a full market basket update of 3.2% and a “stop-loss” provision designed to protect IPFs from significant losses as they transitioned to the new PPS, among other adjustments. CMS estimates a per-diem payment rate (per case) of $637.78 in RY 2009, compared to $614.99 in RY 2008. The agency phased in the IPFs’ transition to a PPS over the past three years.

CDC: Fewer Physicians Reporting Hospital Visits - April 2008

An estimated 308,900 office-based physicians were in practice in 2005-2006, according to data reported today from the National Ambulatory Medical Care Survey. About 56.8% of them reported making at least one hospital visit the week before the survey, a 26% decline from 2001, while 9% reported providing emergency department care. Use of clinical health information technology by office-based physicians was up 46% from 2003-2004, while use of computerized prescription order-entry was up 92%. Half of office-based physicians practiced in primary care specialties in 2005-2006, 28.6% in medical specialties and 21.5% in surgical specialties. For more on the survey, see the Centers for Disease Control and Prevention report.

AHIP: 6.1 Million People Covered by HSA-Eligible Plans - April 2008

More than 6.1 million Americans were covered by Health Savings Account-eligible insurance plans in January 2008, America’s Health Insurance Plans reported yesterday. That’s 1.6 million more people than in January 2007. The average annual deductible was $2,600 for single coverage and $4,846 for family coverage, while the average annual out-of-pocket limit was $3,661 for single coverage and $7,057 for family coverage. HSA products accounted for 31% of new coverage issued in the small-group market, and 27% of new purchases in the individual market, AHIP said.

LTCH Interim Final Rule Implements MMSEA Provisions - April 2008

The Centers for Medicare & Medicaid Services today issued an interim final rule with comment period on several changes to the long-term care hospital prospective payment system that were mandated by Congress in the 2007 Medicare, Medicaid and SCHIP Extension Act. The MMSEA authorized key LTCH provisions, including a three-year moratorium on new facilities and beds, and three years of regulatory relief on the so-called “25% Rule” and short-stay outliers. The MMSEA raised the 25% Rule thresholds to allow a larger percentage of LTCH referrals from host hospitals and prevents the rule from being applied to freestanding LTCHs. The interim final rule takes effect June 5; however, CMS will accept comments on the rule through July 7. CMS is expected to issue a separate rate year 2009 LTCH PPS final rule within days.

CMS Issues Proposed SNF Rule for FY 2009 - April 2008

The Centers for Medicare & Medicaid Services today proposed significant cuts to nursing homes as part of its fiscal year 2009 skilled nursing facility prospective payment system proposed rule. CMS asserts that these cuts are necessary to adjust for more-than-expected service utilization following the agency’s refinements to the case-mix indices in 2006. CMS also proposes to recalibrate payments for non-therapy ancillary services. It estimates that the fiscal impact of these two changes would cut SNF payments in FY 2009 by 3.3% ($770 million). This reduction largely would be offset by the proposed market basket update of 3.1%, however, resulting in a net reduction of 0.3% ($60 million) from this year’s payments. CMS is accepting comments on the proposed rule through June 30.

Coburn Stymies Attempt to Move Medicaid Bill - April 2008

Senate Majority Leader Harry Reid (D-NV) yesterday attempted to bring up the Protecting the Medicaid Safety Net Act (H.R. 5613) in the Senate by unanimous consent, but an objection was raised by Sen. Tom Coburn (R-OK). The AHA-backed legislation, which passed the House last week with a veto-proof margin of 349-62, would place a moratorium through March 2009 on seven Medicaid regulations. The administration has said it will veto any legislation blocking implementation of all seven rules, and opponents of the moratorium are trying to garner support through a letter from Republican senators. The letter advocates a delay until Aug. 1 of the expiration of the moratorium on the two Medicaid rules of particular interest to hospitals set to expire May 25. The AHA is working to dissuade senators from signing on to the letter.

CMS to Host NPI Conference Call - April 2008

The Centers for Medicare & Medicaid Services will host a 90-minute teleconference May 14 to address questions related to Medicare’s implementation of the National Provider Identifier standard. Participants can register and submit questions for the call online. For more information, see the conference call details. Providers cannot use legacy identifiers on Medicare claims submitted after May 23.

Cost of Family Coverage Rising Much Faster than Income - April 2008

The amount employees pay for family coverage increased an average 30% between 2001 and 2005, according to a study released today by the Robert Wood Johnson Foundation. That’s 10 times the average pay increase for family policyholders over the period, the study adds. “As costs continue to go up, fewer people can pay their portion of the premium, and fewer employers are able to offer insurance benefits,” said RWJF President and CEO Risa Lavizzo-Mourey, M.D. “This research shows that an ever-increasing number of people will join America’s uninsured unless our nation’s leaders act to reform our health care system.” The study was released in conjunction with Cover the Uninsured Week (April 27-May 3), an annual campaign led by RWJF to raise awareness about the 47 million Americans without health insurance. The AHA is a national partner in the campaign, which includes events to help those who are eligible enroll in low-cost or free health coverage programs.

CMS Issues Proposed Hospice Wage Index for 2009 - April 2008

The Centers for Medicare & Medicaid Services yesterday released proposed changes to the Medicare hospice wage index for fiscal year 2009. The proposed rule would phase out over three years a payment adjustment that was added in 1997 to minimize disruption in beneficiary access to hospice services. Yesterday’s proposed changes would phase-out this adjustment by 25% in FY 2009, 50% in FY 2010 and 25% in FY 2011, thus reducing projected hospice payments by $2.29 billion over five years. Combined with an estimated hospice market basket increase of 3%, the changes in the rule would result in an average net update of 1.9% in FY 2009. The agency also proposes changing the way multi-campus hospitals report their wage data, which affects the hospital wage index used to derive the hospice wage index. CMS will accept comments on the proposed rule through June 27. A final rule is expected by August.

Joint Commission Approves Grace Period for New Standard - April 2008

Failure to comply with The Joint Commission’s new emergency management standards will not affect its 2008 accreditation decisions, according to an April 17 decision by its accreditation committee. While non-compliance with these requirements will continue to be cited in an organization’s report and will be required to be addressed in an Evidence of Standards Compliance, they will not be included in the count of the Requirements for Improvement contributing towards a conditional accreditation or a preliminary denial of accreditation decision, according to Gail Weinberger, the Joint Commission’s director of accreditation and certification policy and administration. The AHA-affiliated American Society for Healthcare Engineering said it “encourages organizations to use this opportunity to continue to assess and develop their Emergency Management program, and build the relationships with community resources to assist with meeting the health care organization’s mission when responding to an emergency or unusual event.”

CMS Clarifies Message on NPI Sub-Parts - April 2008

Health care organizations with subparts should be able to process their Medicare fee-for-service claims using a single National Provider Identifier, the Centers for Medicare & Medicaid Services announced Friday. “We believe that your claims will be successfully processed using your NPI, regardless of whether you enumerate your subparts with NPIs,” CMS said in the email update. The email clarified an April 3 announcement that the agency had been unable to match an NPI with multiple legacy numbers. The National Uniform Billing Committee, whose members include the AHA, had expressed concern with the earlier announcement, given that providers cannot use legacy numbers on Medicare claims submitted after May 23.

Report Looks at Options for Covering Uninsured - April 2008

One in four people who lack health insurance in America are eligible for public insurance programs but do not enroll, including 64% of uninsured children, according to a report released today by the National Institute for Health Care Management Foundation. Possible solutions include increasing outreach and education activities, simplifying eligibility determination, and facilitating the enrollment and re-enrollment processes, the report states. Options for insuring those who are not eligible for current public programs include expanding public programs and strengthening private market options, the authors add. “Key policy decisions around expanding public coverage include which additional categories of people should qualify and what income level should be used to determine eligibility,” the report states. “Selecting an appropriate income threshold requires making judgments regarding the affordability of health insurance, and is greatly influenced by political and fiscal realities.”

Cover the Uninsured Week - April 2008

Visit www.CoverTheUninsured.org to start planning now! AHA is a national partner in the Robert Wood Johnson Foundation’s annual Cover the Uninsured Week. Hospital and other participants promote awareness about the 47 million uninsured Americans and help those who are eligible enroll in low-cost or free health coverage programs. Planning events during Cover the Uninsured Week? Let us know by sending an email to ahawashdc@aha.org.

Report Examines Use of Online Health Communities - April 2008

A new report from the California HealthCare Foundation examines the use of online communities and blogs by consumers to exchange health and medical information. Among the sites discussed in the report are DiabetesMine, a blog for people with diabetes and their caregivers; PatientsLikeMe, a social health network and online forum; and WEGO Health, a health information portal. "People with chronic conditions are sharing their stories with each other, not just for emotional support, but for the clinical knowledge they gain in an online community,” the author said. “Doctors are meeting online to share quandaries about challenging cases and solutions that work. And researchers are coming together with patients to learn about side effects in real-time to improve therapeutic regimens."

Monograph Helps Hospital Boards Guide P4P Programs - April 2008

A new monograph from the Center for Healthcare Governance provides hospital boards with a primer on pay-for-performance programs. The monograph explores the growth of the pay-for-performance movement, typical components of P4P programs, challenges they may hold for participants, and best practices to help board members understand and guide hospital involvement. The publication can provide background information for new trustees or a board education session or retreat, and serve as a resource for the board’s quality committee or board members participating in hospital quality improvement efforts. To order any Center monograph, visit the Center’s Web site or contact the Center at (888) 540-6111 or info@americangovernance.com. The Center for Healthcare Governance is the AHA’s resource for governance information, tools and counsel to promote excellence in health care governance.

House Passes Bill Blocking Medicaid Rules - April 2008

The House voted 349-62 today to approve H.R. 5613, AHA-backed legislation placing a moratorium through March 2009 on seven Medicaid regulations that would cut billions in funding from the program. The administration has said it will recommend that the president veto the bill. Without congressional action, a moratorium on two of the Medicaid rules that directly impact hospitals will expire May 25.

CMS Releases Reports on Potential Refinements to MS-DRGs - April 2008

The Centers for Medicare & Medicaid Services yesterday released two reports describing potential refinements to the relative weights for Medicare severity-diagnosis-related groups. One report, by RAND, evaluates alternative methods to establish DRG relative weights. The other report, by RTI, analyzes potential refinements to cost-to-charge ratios for calculating ambulatory patient classifications and DRG relative weights. Both reports were to be included in the FY 2009 inpatient prospective payment system proposed rule, released April 14, but were not completed in time. CMS established MS-DRGs in its FY 2008 inpatient PPS rule to more accurately reflect the severity of patients’ conditions. It must adjust the MS-DRGs at least annually by applying relative weights, which reflect changes in treatment patterns, technology and other factors that may change the relative use of hospital resources. CMS will accept comments on both reports and the FY 2009 inpatient PPS proposed rule through June 19.

President Poised to Veto Medicaid Bill - April 2008

The administration will recommend that the president veto H.R. 5613 if Congress passes the bill in its current form, the Executive Office of the President said today. The AHA-supported legislation would place a moratorium through March 2009 on seven Medicaid regulations that would cut billions in funding from the program. “With broad-based bipartisan support for a moratorium on Capitol Hill and among governors, health care providers, consumer and beneficiary advocates, educators, and many others … the administration appears to be the only folks in town who think these regulations are a good idea,” said AHA Executive Vice President Rick Pollack.

Health System Partners with Army to Recruit Health Professionals - April 2008

The U.S. Army Reserve and Inova Health System this week launched a partnership to recruit, train and employ people interested in health care careers. The agreement provides work opportunities at the Alexandria, VA, health system for Reserve soldiers who complete military occupational training in areas of critical clinical support, such as radiology and respiratory therapy. Inova is the first health care employer to participate in the Employer Partnership Initiative, which establishes a process whereby employers and the Reserve may secure and share the talents of trained professionals. “I’m honored that Inova Health System has stepped forward to join the Army Reserve as the first employer partner to create new employment opportunities in the health care area,” said Lt. Gen. Jack Stultz, chief of the Army Reserve.

CIGNA to Stop Paying for Wrong Surgeries, Preventable Errors - April 2008

CIGNA HealthCare will no longer reimburse hospitals for certain “avoidable” conditions and surgical errors, the insurer announced yesterday. Effective Oct. 1, CIGNA said it will not reimburse for surgical procedures performed on the wrong person or site, and may not reimburse for certain “avoidable hospital conditions” when permitted under its hospital contracts. Included among the cited conditions are infections from urinary and central-vein catheters, use of the wrong blood type during transfusions, bed sores and hospital-acquired injuries.

House Panel Passes Bill Extending Medicaid Moratorium - April 2008

The House Energy and Commerce Committee voted 46-0 yesterday to approve H.R. 5613, AHA-backed legislation that would delay until April 1, 2009, implementation of seven Medicaid regulations expected to cut funding to safety-net providers by an estimated $50 billion over five years. The bill could go to the House floor as soon as next week. To pay for the moratoria, the bill would expand Medicaid’s asset verification program to all 50 states and borrow from the physician quality reporting fund. The bill also would provide $25 million a year for the Department of Health and Human Service to investigate fraud and abuse in the Medicaid program. Without congressional action, a moratorium on two of the Medicaid rules that directly impact hospitals will expire May 25.

States to Participate in Quality Improvement Institute - April 2008

Nine states will develop and implement strategies to improve health care quality and efficiency under a project announced last week by the Commonwealth Fund. Colorado, Kansas, Massachusetts, Minnesota, New Mexico, Ohio, Oregon, Vermont and Washington will participate in the State Quality Institute. Each state will convene a team of public officials, health care providers, insurers, employers and others to identify challenges and policy options in areas such as value-based purchasing, data collection and transparency, care coordination and disease prevention. The teams will receive help from experts and share their experiences and successful practices. In a recent report, the National Academy for State Health Policy said efforts to improve health system performance would benefit from opportunities for states to share ideas and lessons learned.

CMS Poised to Release Final Report on RAC Demonstration - April 2008

The Centers for Medicare & Medicaid Services in the next few weeks will release a final report on the overall outcome of the Medicare recovery audit contractor demonstration, CMS officials told the AHA recently. Following the report, the agency plans to announce the permanent RACs for the nationwide rollout. According to CMS, the permanent RACs will conduct outreach and education efforts prior to starting claims audits. Congress in 2006 made the program permanent and required CMS to operate RACs in all 50 states by 2010. RACs review old Medicare claims, and receive a percentage of the improper payments they identify – both overpayments and underpayments. AHA vice president for policy Don May said, "While the changes CMS has made to improve the RAC program based on the demonstration are good, much more needs to be done to ensure that these programs operate properly and fairly." For information on how to prepare for the RAC program and the legislative campaign to slow down the national rollout, visit www.aha.org.

Former Senate Leaders Launch Health Reform Project - April 2008

Former Senate Majority Leaders Howard Baker, Tom Daschle, Bob Dole and George Mitchell today announced a bipartisan project that will recommend U.S. health care system reforms to Congress and the administration. The Leaders’ Project on the State of American Health Care will feature a series of public forums, beginning with an April 24 event in Washington focused on improving the quality and value of health care. Future forums will focus on affordable and accessible health coverage, health care financing mechanisms, and the individual’s role in coverage and costs. Mark McClellan, director of the Brookings Institution’s Engelberg Center for Health Care Reform and former administrator of the Centers for Medicare & Medicaid Services under President Bush, and Chris Jennings, president of Jennings Policy Strategies Inc. and senior health care advisor to President Clinton, will provide guidance to the project, an initiative of the Bipartisan Policy Center.

GAO Urges HHS to Prioritize, Coordinate HAI Activities - April 2008

At a hearing of the House Committee on Oversight and Government Reform today, the Government Accountability Office urged that the Department of Health and Human Services take steps to better integrate its efforts to collect data and recommend practices that would substantially reduce the chance of a patient acquiring a healthcare-associated infection. In a report presented at the hearing, the GAO suggested that if HHS prioritized and coordinated its activities more effectively, hospitals and other health care providers would be better able to understand and implement improvements. The hearing also featured a Michigan Health & Hospital Association initiative that has reduced certain infections in intensive care units to near zero for several years. John Labriola, senior vice president and hospital director for William Beaumont Hospital in Royal Oak, MI, said stronger federal leadership is needed to help reduce hospital-acquired infections, but that “mandatory reporting and bureaucratic programs are not the answer.” Peter Pronovost, M.D., director of the Quality and Safety Research Group at Johns Hopkins University School of Medicine, and scientific leader of the Michigan project, called for appropriate funding to support the development of better science about how to deliver high-quality care.

Hospital prices climb 0.4% in March - April 2008

Overall hospital prices rose 0.4% in March, and were 3.4% higher than a year ago, the Bureau of Labor Statistics reported today. Prices at general medical and surgical hospitals rose 0.5%, and were 3.6% higher than in March 2007, according to the BLS' Producer Price Indices, which measure average changes in selling prices received by domestic producers for their output. For hospitals, this translates into actual or expected reimbursement for a sample of treatments or services. The PPI for hospitals measure changes in actual or expected reimbursement received for services across the full range of payer types. This includes the negotiated contract rate from the payer plus any portion expected to be paid by the patient.

Experts Urge House Panel to Expand Health Coverage - April 2008

The number of uninsured Americans is likely to rise substantially during the current economic downturn, Diane Rowland, executive director of the Kaiser Commission on Medicaid and the Uninsured, told the House Ways and Means Health Subcommittee today. “In the absence of additional federal assistance, the fiscal crises in the states are likely to compromise further their ability even to maintain coverage through the Medicaid and [State Children’s Health Insurance] programs, much less expand coverage,” Rowland said at a hearing on the instability of health insurance coverage. John Ayanian, M.D., professor of medicine and health care policy at Harvard Medical School and a physician at Brigham and Women’s Hospital in Boston, told the panel, “The financial challenge of achieving universal coverage may appear daunting, but the human and economic consequences of inaction are substantial.” Stephen Finan, associate director of policy for the American Cancer Society, said those who are insured also must have adequate coverage, noting that many insured cancer patients cannot afford their out-of-pocket costs.

CMS Withdraws Request for OMB Review of DFRR - April 2008

The Centers for Medicare & Medicaid Services has withdrawn its Sept. 14, 2007 request for Office of Management and Budget clearance on a proposed Disclosure of Financial Relationships Reporting system, and has reissued the proposal as part of the fiscal year 2009 Medicare inpatient prospective payment system proposed rule. The action follows criticism and questions about CMS’ authority to implement the proposal under current regulation. In the proposed rule, CMS admits to higher burden estimates than previously provided to OMB, and requests public input on several questions related to the design of the DFRR and the proposed data collection process. The proposed plan would require an initial 500 to 600 hospitals to disclose information requested on the DFRR and submit related documents on physician investments in hospitals, as well as compensation arrangements between hospitals and physicians that are unrelated to whether those physicians have an investment interest. In an Oct. 10, 2007 comment letter, the AHA urged OMB to deny CMS’ authorization to proceed with the “broad-based, intrusive and extremely burdensome demand on community hospitals.” CMS will accept comments on the proposed rule, released yesterday, through June 13.

AHA Urges CMS to Clarify Interpretive Guidelines - April 2008

The AHA Friday urged the Centers for Medicare & Medicaid Services to clarify language in a recent letter to state survey directors that appears to limit the use of standing orders and protocols. The letter contained interpretive guidelines for regulatory changes to the hospital conditions of participation in Medicare, including language implying that all protocols and standing orders require a physician’s order prior to initiation for each patient. In a letter to CMS, the AHA said the language “likely will lead to patient harm, is counter to accepted standards of care and will impede hospitals’ progress on quality improvement initiatives.” The AHA urged CMS to immediately clarify the interpretive guidelines to reflect the intent of the CoP, which is to require that standing orders and medical staff orders for drugs and biologicals be written in the patient’s chart and later signed by a practitioner responsible for the care of the patient.

AHA Urges Senate to Support Ban on Self-Referrals - April 2008

The AHA, Federation of American Hospitals and Coalition of Full Service Community Hospitals Friday urged Senate leaders to include in a farm policy reauthorization bill (H.R. 2419) a ban on self-referral to physician-owned hospitals. In the letter to Senate negotiators, the hospital groups said, “We must make every effort to ensure fair competition in health care and to protect the Medicare program, the seniors it serves, and the health care networks in communities across the country against the negative effects of physician self-referral to hospitals in which the physician has an ownership interest.” They noted that the House twice passed a ban on self-referral, once in August 2007 with the Children’s Health and Medicare Protection Act (H.R. 3162) and more recently in March 2008 with the Paul Wellstone Mental Health and Addiction Parity Act of 2008 (H.R. 1424).

CMS Releases Proposed Inpatient Rule for FY 09 - April 2008

The Centers for Medicare & Medicaid Services today released its hospital inpatient prospective payment system proposed rule for fiscal year 2009. In the rule, CMS announced a mandated market-basket update of 3.0% for hospitals that report data for 30 selected quality measures. Hospitals not submitting data would receive a 1.0% update. The rule proposes to expand the number of required quality measures to 72 in FY 2010. Some of the proposed measures have been endorsed by the National Quality Forum and adopted by the Hospital Quality Alliance, however, many have not. “AHA has been at the forefront of public reporting of hospital quality information and firmly believes that all measures included should be endorsed by the National Quality Forum as appropriate national standards and adopted by the Hospital Quality Alliance as useful for public reporting on hospital quality of care,” said Nancy Foster, AHA vice president for quality and patient safety. “It is unfortunate that CMS has chosen to propose measures that are neither NQF endorsed nor HQA adopted.” CMS also proposes several changes to the method used to compute the hospital wage index. In addition, the proposed rule would expand the post-acute care transfer policy as it relates to transfers to home with the provision of home health services to within seven days of discharge to home instead of three – a cut of $50 million to hospitals in FY 2009. Comments on the proposed rule will be accepted until June 13. A final rule will be released by Aug. 1, and the policies and payment rates will take effect Oct. 1.

HHS Awards $1.1 Billion for HIV/AIDS Care, Medications - April 2008

The Department of Health and Human Services this week awarded $1.1 billion to U.S. states and territories to support primary care, medications and other services for low-income and uninsured HIV/AIDS patients. Funded under Part B of the Ryan White HIV/AIDS Program, the grants will support state AIDS Drug Assistance Programs ($774 million), home and community-based services, insurance continuation and other services.

Senate Hears From CMS, Experts on SCHIP Directive’s Impact - April 2008

At least nine State Children’s Health Insurance Programs will meet the administration’s August 2007 mandate that they cover 95% of eligible low-income children before enrolling new children from families earning more than 250% of the federal poverty level, a Centers for Medicare & Medicaid Services official told the Senate Finance health subcommittee yesterday. At a hearing on the impact of the Aug. 17 directive, Dennis Smith, director of CMS’ Center for Medicaid and State Operations, said, “The 95% goal is not only achievable, but should be expected and demanded.” Cindy Mann, executive director of the Center for Children and Families, told the panel that Hawaii, New Jersey and New Hampshire expect their enrollment of children above 250% of poverty to fall by 76%, 84% and 97%, respectively, within two years after the directive is applied. Chris Peterson, a specialist in health care financing for the Congressional Research Service, said CMS has not provided “clear and valid” standards for meeting the 95% test. Alan Weil, executive director of the National Academy for State Health Policy, said “the directive adds yet another level of uncertainty” for states striving to cover uninsured children.

OIG Reports Decline in LTCH Short-Stay Outliers - April 2008

The proportion of short-stay patients at long-term care hospitals decreased from 40% in fiscal year 2003 to 27% in FY 2006, according to a recent report by the Department of Health and Human Services’ Office of Inspector General. The OIG observed that the decline coincided with the Centers for Medicare & Medicaid Services’ 2003 implementation of an LTCH prospective payment system and the 2006 implementation of a payment cut for short-stay outliers - patients discharged prior to reaching five-sixths of the average length of stay for their diagnosis. LTCHs treat patients with complex medical conditions and are required to have an average length of stay greater than 25 days.

House Panel Passes Bill Extending Medicaid Moratorium - April 2008

The House Energy and Commerce Health Subcommittee today passed H.R. 5613, AHA-backed legislation that would delay until April 1, 2009, implementation of seven Medicaid regulations expected to cut funding to safety-net providers by an estimated $50 billion over five years. The bill, expected to be considered by the full committee next week, was revised by a manager’s amendment offered by committee chair John Dingell (D-MI) to require a study of the impact of the regulations on the states. The amended bill also would provide $25 million a year for the Department of Health and Human Service to investigate fraud and abuse in the Medicaid program, and contains an offset of the cost of the moratoria to be funded by expanding Medicaid’s asset verification program to all 50 states and by borrowing from the physician quality reporting fund. Without congressional action, a moratorium on two of the Medicaid rules that directly impact hospitals will expire May 25.

CMS Announces 2009 MA Payment Rates - April 2008

The Centers for Medicare & Medicaid Services yesterday announced the Medicare Advantage capitation rates and MA and Part D payment policies for calendar year 2009. The capitation rates for aged and disabled beneficiaries will increase an average 3.6%. Individual counties may see varying increases because CMS rebased the fee-for-service rates and recalibrated its risk adjustment model for 2009. CMS also announced that it will audit the medical records from a sample of MA plans to determine the accuracy of the diagnosis code information they submit. As coding errors are identified, the agency said it will reconcile payments to correct for the errors at the plan level. CMS said the results will help determine whether differences in risk scores between MA plans and fee-for-service Medicare are attributable to differences in coding patterns, and whether an adjustment in rates would be appropriate for 2010.

AHA Updates Hospital Leaders on Health Reform Framework - April 2008

AHA President and CEO Rich Umbdenstock and the association’s chair officers – Chairman Bill Petasnick, Immediate Past Chairman Kevin Lofton and Chairman-Elect Tom Priselac – today updated hospital leaders on the AHA’s health reform framework, Health for Life: Better Health. Better Health Care. For the past year, the AHA has been refining the framework and continues to engage various stakeholders, including organizations representing consumers, business, labor, insurers, physicians, nurses and others. The interactive question-and-answer session capped off the association’s annual meeting. For more information, visit www.aha.org

Brokaw: Health Care Remains Top Concern of Voters - April 2008

Health care continues to be a top concern among voters despite the media’s focus on the economy and the wars in Iraq and Afghanistan, said former NBC Nightly News anchor Tom Brokaw at today’s AHA annual meeting. His remarks were part of a discussion about politics and health care moderated by Susan Dentzer, health correspondent for PBS’ The NewsHour with Jim Lehrer. Of the 2008 presidential race, Brokaw said “whoever gets elected is going to have one of the toughest opening acts [of any president’s term].” He said health care reform is one of the “huge challenges before us,” and will take an effort comparable to the Manhattan Project to tackle. He suggested that politicians should seriously consider means-testing as a way to contain Medicare program costs.

Petasnick: Health for Life Goals Key to Meaningful Health Reform - April 2008

The upcoming presidential election can lead to dramatic change in health care if reform advocates succeed in framing the debate about “ideas and transparency, and not about old dogmas, partisan labels and personal ideologies,” AHA Chairman Bill Petasnick said at his investiture yesterday. Kicking off the 2008 AHA Annual Membership Meeting in Washington, D.C., the president and CEO of Froedtert & Community Health in Milwaukee said that the AHA’s health reform framework, Health for Life: Better Health. Better Health Care., “represents the best chance in a generation to turn desire into action and action into results.” He said meaningful change will not occur without a national commitment to meeting the framework’s goals of keeping people well, providing efficient, affordable care, making the best information available so patients and caregivers can make the best decisions, and providing coverage for all, paid for by all. The AHA wants Health for Life to be “seen as a policy framework that hospitals, physicians, patients, businesses and civic and community leaders can support,” he said.

Umbdenstock: Hospitals Can Help Set Stage for Health Reform - April 2008

Hospitals that lead by example in their communities can help set the stage for meaningful health reform, AHA President and CEO Rich Umbdenstock today told hospital leaders. “We must show the public and policymakers that we are facing the cost, quality and safety issues head on,” he told attendees at the AHA Annual Membership Meeting in Washington, D.C. By improving performance and “making great strides forward in the work we do for our patients,” he said hospitals can bring to the reform debate “not only a vision of better health and better health care, but an unparalleled level of credibility to influence the outcome.” Umbdenstock said hospitals face a tough environment. “Our communities need us more than ever as health care safety nets and as economic cornerstones,” he told AHA members. “Yet, there are those here in Washington who would cut Medicare and Medicaid dramatically; who would reduce - not expand - money to educate tomorrow’s health professionals; and who would leave more people, not fewer, without access to care in a dignified way.” He said hospitals must defeat those efforts, and suggested that the public and policymakers “change the debates over health care as a right versus personal responsibility, and access versus rationing, to a conversation about using a limited, precious resource in a way that gives Americans the greatest return possible in health, national productivity, community stability and quality of life.”

Pollack Outlines AHA Advocacy Agenda - April 2008

At the AHA’s annual meeting today in Washington, D.C., AHA Executive Vice President Rick Pollack called on hospital leaders to press lawmakers for action on hospital issues when they visit Capitol Hill Wednesday. He outlined an AHA advocacy agenda that urges Congress to: extend Medicare provisions set to expire in June, ensure adequate payments for physicians, financially protect rural providers, and prevent the administration from implementing rules that would cut Medicaid funding to hospitals by more than $5 billion over five years. Pollack noted that the House and Senate heeded hospital concerns in rejecting Medicare and Medicaid cuts in their fiscal year 2009 budget plans. While hospitals’ grassroots advocacy helped set this year’s congressional budget debate on the right path, Pollack said hospitals still have much work to do. He told hospital leaders “to welcome being viewed as a ‘special interest,’ because you represent very special places.” He added, “I can think of nothing nobler than educating legislators on these key issues that affect the lives and health of the people you serve.”

CMS Finalizes New Medicare Requirements for Dialysis Centers - April 2008

The Centers for Medicare & Medicaid Services today issued a final rule updating the standards dialysis facilities must meet to participate in the Medicare program. These new conditions for coverage, effective in 180 days, are part of the Medicare survey and certification process. They apply to all dialysis facilities, hospital-based or independent. According to CMS, the rule requires patients to receive a comprehensive assessment, personalized care plan and 30 days written notice before involuntary discharge. Facilities must begin submitting quality data to CMS next Feb. 1, have an on-site defibrillator and process for responding to patient grievances, and inform beneficiaries of their right to an advance directive. The rule also adopts updated guidelines for infection control, water quality and fire safety.

AHA Urges Congress to Delay Medicaid Rules - April 2008

The AHA today warned Congress that it is “absolutely critical” to pass the Protecting the Medicaid Safety Net Act (H.R. 5613). The legislation would delay implementation of seven Medicaid regulations that, if enacted, could cut funding to safety-net providers by an estimated $50 billion over five years, according to a report issued in March by the House Committee on Oversight and Government Reform. Two of the rules directly impacting hospitals are under a congressional moratorium that expires May 25. Testifying for the AHA at a House Energy and Commerce Health Subcommittee hearing on the bill, Jim Buckner, administrator of Uvalde (TX) Memorial Hospital, said that “any changes in Medicaid reimbursement will have a direct impact on our ability to serve the people who need us. With the ranks of the uninsured growing, and the threat of an economic recession looming, the importance of Medicaid to so many people’s lives and health is being magnified even as it is being jeopardized.”

Report Ranks Federal Public Health Spending by State - April 2008

Federal funding for public health programs can vary widely across states, according to a report released today by Trust for America’s Health. The Centers for Disease Control and Prevention distributes the funds for programs ranging from disease and infection prevention to bioterrorism preparedness. Alaska receives more than any other state from the CDC at $69.76 per person, while Kansas receives the least at $13.61 per person. Midwestern states receive an average $16.24 per person, while Southern states receive $29.40. “If we’re serious about improving the health of Americans, we need to make a much bigger investment in disease prevention efforts in every state and every region,” said Jeff Levi, executive director for TFAH.

CMS Final Rule Expands Part D E-prescribing Standards - April 2008

The Centers for Medicare & Medicaid Services today issued a final rule establishing additional electronic prescribing standards for Medicare Part D. Prescribers, dispensers and other providers are not required to implement e-prescribing, but those who do must comply with the new standards for Part D covered drugs effective April 1, 2009. The new standards deal with four types of information: formulary and benefits, medication history, fill-status notification, and identification of individual health care providers.

Report: Self-referral to Hospitals Weakens Health Care Safety Net - April 2008

A new AHA TrendWatch report examines the growing body of research on the negative impact physician ownership and self-referral in hospitals have on the entire health care system. According to today’s report, the number of physician-owned, limited-service hospitals has grown dramatically since the government imposed limits on physician self-referral to new specialty hospitals, but the evidence to date does not support claims that these facilities deliver more efficient or higher quality care. In fact, physician-owned facilities damage the health care system as a whole by driving up utilization and costs and weakening the health care safety net. According to the report, these facilities focus on well-reimbursed services, serve fewer high-acuity patients and treat fewer low-income and uninsured patients, resulting in lost revenue to community hospitals, and compromising their ability to offer essential services such as emergency and trauma services and uncompensated care. AHA Executive Vice President Rick Pollack said, “The evidence is overwhelming. The practice of self-referral tears apart the health care safety net, jeopardizing patients' and communities’ access to vital services, and creates a conflict of interest between a patient's needs and the physician's financial interest.”

Groups Agree on Standards for Physician Performance Reporting - April 2008

Consumer, employer and labor organizations today announced a national agreement with physician groups and health insurers on principles to guide how health plans measure doctors’ performance and report the information to consumers. The Consumer-Purchaser Disclosure Project, which spearheaded the effort, said the agreement will ensure consumers and physicians have input into the measurement and reporting process, and that measurement is based on sound national standards and methodology. Supporters of the agreement include the American Medical Association and other physician groups, America’s Health Insurance Plans, AARP, Leapfrog Group, National Business Coalition on Health and AFL-CIO.

Study Finds Growing Physician Support for Universal Health Coverage - April 2008

Six in 10 physicians support legislation to establish national health insurance, up from five in 10 in 2002, according to a survey reported in today’s Annals of Internal Medicine. More than half of respondents (55%) supported incremental reform to achieve universal coverage. The study was conducted by the Indiana University School of Medicine’s Center for Health Policy and Professionalism Research.

CMS Issues Proposed Rule on Medicaid Home, Community-Based Services - April 2008

The Centers for Medicare & Medicaid Services yesterday issued a proposed rule that would allow states to offer home and community-based services for the elderly and disabled under their regular Medicaid plans. Authorized by the Deficit Reduction Act of 2006, the provision would eliminate the need for states to obtain a demonstration waiver. The services could include case management, homemaker, home health aide, personal care, adult day health and respite care. “Thousands more Medicaid beneficiaries may now be able to opt for needed long-term support services in their homes rather than institutions,” said CMS Acting Administrator Kerry Weems. The rule will be published in the April 4 Federal Register, with comments accepted through June 3.

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