CMS Publishes Evaluation Criteria for FIs, Carriers - June 2008

The Centers for Medicare & Medicaid Services seeks comments through Aug. 26 on its criteria and standards for evaluating the performance of Medicare fiscal intermediaries and carriers in fiscal year 2009, which begins Oct. 1, 2008. According to a notice in the June 27 Federal Register, the agency seeks comments on its FI evaluation criteria in the areas of claims processing, customer service, payment safeguards, fiscal responsibility and administrative actions. CMS said it considers the FI and carrier evaluations when assigning providers or services to an FI or designating regional or national intermediaries.

CMS Proposes 2009 Payment, Policy Changes for Physician Services - June 2008

The Centers for Medicare & Medicaid Services today proposed reducing the 2009 Medicare physician payment update by 5.4%. Under its proposed rule to be published in the July 7 Federal Register, CMS would require physicians who perform diagnostic testing in their offices to enroll as suppliers of these services and meet certain quality and performance standards. CMS also proposed an exception to the prohibition on physician self-referral to allow hospital payments to physicians under incentive payment or shared savings programs under certain conditions. The agency will accept comments through Aug. 29. A final rule is expected by Nov. 1.

Senate Fails toInvoke Cloture on Medicare Bill- June 2008

The Senate yesterday failed to invoke cloture on legislation (H.R. 6331) to prevent a July 1 Medicare physician payment cut. The 58-40 vote fell just short of the 60 affirmatives needed to invoke cloture and begin debate on the bill, which passed the House on Tuesday. Sponsored by Reps. Charles Rangel (D-NY) and John Dingell (D-MI), H.R. 6331 would freeze physician payments for 2008 and provide a 1.1% increase for physicians in 2009. It also contains several rural hospital provisions and would delay for 18 months the competitive bidding program for Durable Medical Equipment (DMEPOS). The measure will be returned to the Senate calendar for consideration after Congress returns from its Independence Day recess. Earlier this month, the Senate failed to invoke cloture on similar legislation (S. 3101) sponsored by Finance Committee Chairman Max Baucus (D-MT).

CMS Proposes Changes to Rural Health Clinic Program- June 2008

The Centers for Medicare & Medicaid Services today published proposed changes to the conditions of participation requirements and payment provisions for rural health clinics and federally qualified health centers. Under the proposed rule, new and existing RHCs would have to be located in shortage areas, whose designation must be renewed at least every three years. Existing RHCs that were no longer located in rural or shortage areas as defined by the proposed rule could keep their designation if they met certain criteria. The rule also revises the payment methodology so it is consistent with statutory requirements setting Medicare payment at no more than 80% of reasonable costs, after application of beneficiary co-payments and deductibles. Further, the rule revises the criteria that allow certain hospital-based RHCs to exceed the per visit payment limit. RHCs also would be required to establish a quality assessment and performance improvement program. CMS will accept comments on the proposed rule through Aug. 26.

Project Examines Options for Financing the Nation's Health System - June 2008

A new report from The Leaders Project on the State of American Health Care examines recent proposals for changing how the U.S. health care system is financed. Options examined include keeping the current mix of revenue but redirecting the funds to more effective uses; paying for new health care subsidies or system investments by allowing certain tax cuts to expire; limiting or ending the exclusion of employer premium contributions from employees’ taxable income; requiring employers to offer insurance to employees or pay a tax to support alternative coverage; and using a value-added tax to supplement or replace certain financing. The project was announced in April by former Senate Majority Leaders Howard Baker, Tom Daschle, Bob Dole and George Mitchell, to recommend U.S. health system reforms to Congress and the administration. They plan to release a final report and recommendations early next year.

Americans Report Declining Access to Medical Care- June 2008

One in five Americans reported forgoing or delaying medical care in 2007, up from one in seven in 2003, according to a new survey by the Center for Studying Health System Change. Cost was the most frequently cited obstacle to care. More than 23 million people reported going without needed care, while roughly 36 million delayed seeking care, the survey found. Uninsured people were more than three times as likely to report going without care as insured people. However, unmet medical needs increased among insured people, which the authors said was likely due to rising out-of-pocket costs. “This is the most up-to-date snapshot of the access problems Americans are facing when seeking medical care, and it’s not a pretty picture, especially for insured people, who increasingly are finding that the access to care once guaranteed by insurance is declining,” said coauthor Peter Cunningham.

CDC: 43.1 Million Americans Uninsured in 2007 - June 2008

An estimated 43.1 million Americans, 14.5% of the population, lacked health insurance when surveyed by the Centers for Disease Control and Prevention in 2007. That’s down from 43.6 million, or 14.8%, in 2006, based on 2007 data released today from the CDC’s latest National Health Interview Survey. However, there was no significant change in the percentage of people under 65 who were uninsured at the time of the interview. An estimated 53.9 million Americans had been uninsured for at least part of the prior year, and 30.6 million had been uninsured for more than a year. Among the 20 largest states, the percentage uninsured at the time of the interview ranged from 5.8% in Massachusetts to 22.8% in Texas. The New England region had the lowest percentage of uninsured residents under age 65 (3.7% of children and 11% of adults), while the Southwest had the highest (18.2% of children and nearly 30% of adults). More on the state and regional estimates can be found in a separate report.

Safety-net Providers Key to Reducing Health Disparities, AHA tells Congress - June 2008

One way Congress can address disparities in care is to approve a moratorium on several proposed Medicaid regulations that would have a devastating effect on safety-net hospitals, the AHA said in a statement submitted today to the House Ways and Means Health Subcommittee. The AHA also urged Congress to support a permanent ban on self-referral to new physician-owned facilities, to ensure that safety net services and full-service hospitals remain viable in communities. “In addition, as Congress considers legislation to implement value-based purchasing, lawmakers should be mindful that minority populations often have unique and vastly different cultural and health needs,” AHA said. “Standardizing delivery of care in order to measure and reward improvement is a laudable goal, but we must ensure that members of minority populations do not slip through the safety net.” The AHA statement came in response to the subcommittee’s invitation for submissions after a June hearing on disparities in health and health care.

House Passes Medicare Bill - June 2008

The House voted 355-59 today to pass H.R. 6331, Medicare legislation that would block a July 1 physician payment cut and includes a number of hospital provisions. The bill would freeze physician payments for 2008 and provide a 1.1% increase for physicians in 2009. Like legislation sponsored by Senate Finance Chairman Max Baucus (D-MT), the bill also would extend the Medicare Rural Hospital Flexibility grant program; provide rebasing for sole community hospitals; extend and expand the outpatient hold-harmless provision for small rural and sole community hospitals; extend Section 508 reclassification; and allow critical access hospitals to receive 101% of reasonable costs for clinical lab services whether the specimen was taken at the hospital or off site. In addition, the House bill would delay for 18 months the competitive bidding program for Durable Medical Equipment (DMEPOS).

Commission Approves 2008 Certification Criteria for EHR Products - June 2008

The Certification Commission for Healthcare Information Technology Friday published its final 2008 certification criteria for inpatient and emergency department electronic health record products. The criteria and associated policy documents can be found at www.cchit.org/. The commission is accepting comments through July 30 on several documents, including its network criteria and test scripts for 2008 certification and a document outlining areas for future certification development. CCHIT is an independent non-profit organization recognized by the federal government as an official certification body for EHR products.

House Poised to Vote on Medicare Bill - June 2008

House Ways and Means Committee Chair Charles Rangel (D-NY) and Energy and Commerce Committee Chair John Dingell (D-MI) on Friday introduced a House Medicare bill similar to S. 3101, the legislation sponsored by Senate Finance Chairman Max Baucus (D-MT). The Medicare Improvements to the Patients and Providers Act of 2008 (H.R. 6331) contains the bulk of S. 3101 and also would delay for 18 months the competitive bidding program for Durable Medical Equipment (DMEPOS). Like the Baucus bill, it would prevent a 10.6% physician payment cut scheduled for July 1 and provide a 1.1% payment update for physicians in 2009. The House expects to vote on the bill tomorrow under suspension of the rules, which means the bill would require a two-thirds majority or 290 favorable votes to pass. The bill text and other details can be found online.

AHA Comments on Proposed IRF Rule - June 2008

Commenting today on the proposed rule for inpatient rehabilitation facilities for fiscal year 2009, AHA urged the Centers for Medicare & Medicaid Services to study the impact of expanding its inpatient pay-for-performance measures before deciding whether to proceed with a parallel plan for other payment systems. The association also said CMS should not extend its inpatient payment policy for hospital-acquired conditions to other payment systems, and that it’s too soon to know whether the Continuity Assessment Record and Evaluation tool for post acute care will help automate the process for collecting and submitting quality data. “The CARE demonstration is in the beginning stages and electronic information has yet to be transmitted between participating organizations,” the letter notes.

AHA Urges CMS to Scale Back Proposed SNF Payment Cuts - June 2008

The AHA today urged the Centers for Medicare & Medicaid Services to scale back the payment cuts in its fiscal year 2009 proposed rule for the skilled nursing facility prospective payment system. CMS has said the cuts are necessary to adjust for greater-than-expected utilization of the nine payment categories that were added to the PPS in 2006. In a letter, the AHA recommended that CMS reduce the proposed $770 million cut to only account for changed coding behavior rather than also adjusting for real case-mix change, and spread out any proposed cut over a two-year period to minimize its impact on providers. The AHA also cautioned CMS against proceeding with pay-for-performance and hospital-acquired conditions policies in the SNF PPS and other payment systems without first studying the operation and impact of these policies on the inpatient PPS. Comments on the proposed rule are due June 30.

AAMC Calls for Limits on Industry Support of Medical Education - June 2008

In a report today, the Association of American Medical Colleges urged all medical schools and teaching hospitals to adopt policies by July 2009 that prohibit drug industry gifts and services to physicians and students, and limit industry support of continuing medical education activities. The report was developed by an AAMC task force that examined the benefits and pitfalls associated with industry funding of medical education. “Interactions between industry and academic medicine are vital to public health,” said AAMC President and CEO Darrell Kirch, M.D. “But they must be principled partnerships effectively managed to sustain public trust in both partners’ commitment to patient welfare and the improvement of health care. The recommendations outlined in this report provide essential guidance for how medical schools and teaching hospitals can achieve this important goal.”

Supreme Court Sides with Hospitals in Challenge to CA law - June 2008

The U.S. Supreme Court today ruled that the National Labor Relations Act preempts a California statute prohibiting employers from using any state funds, including Medicaid dollars, to talk with their employees about union organizing. Noting that the national policy reflected in the NLRA favors “uninhibited, robust, and wide-open debate in labor disputes,” the court determined that California’s funding restriction regulates conduct that Congress explicitly intended to be “protected and reserved for market freedom.” The court’s majority said, “California plainly could not directly regulate noncoercive speech about unionization by means of an express prohibition. It is equally clear that California may not indirectly regulate such conduct by imposing spending restrictions on the use of state funds.” Gail Blanchard-Saiger, the California Hospital Association’s vice president of labor and employment, said, “The statute in dispute was incredibly onerous and an administrative nightmare. Today’s decision takes that pressure off and allows California’s hospitals to focus on patient care and delivery.” In January, the AHA filed an amicus brief supporting the effort to overturn the law. “The AHA is pleased to see that the Court relied heavily on arguments advanced in our amicus brief,” said Lawrence Hughes, AHA assistant general counsel. “The decision clearly recognizes that the California statute inappropriately targets employer speech, and creates prohibitively expensive compliance costs and litigation risks for hospitals and other employers.”

CMS to Rank Nursing Homes; Issues Final Sprinkler Rule - June 2008

Centers for Medicare & Medicaid Services Acting Administrator Kerry Weems today announced that CMS will add a nursing home ranking system to its Nursing Home Compare Web site in December. “The new ‘five-star’ rating system will provide a composite view of the quality and safety information currently on Nursing Home Compare to help beneficiaries, their families and caregivers compare nursing homes more easily,” said Weems. CMS will accept comments on the proposed rating system through July, which may be sent to BetterCare@cms.hhs.gov. The agency said it plans to work with other health care providers and consumers to make similar rating systems available for hospitals. CMS today also published a final rule that requires all nursing homes to have comprehensive sprinkler systems in place by 2013. Prior to today’s rule, the federal government did not require existing homes to have such systems.

AHA Discusses IPPS Concerns with CMS - June 2008

AHA President and CEO Rich Umbdenstock and Centers for Medicare & Medicaid Services Acting Administrator Kerry Weems yesterday met to discuss hospitals’ concerns with the fiscal year 2009 inpatient prospective payment system proposed rule. Umbdenstock reiterated the main messages contained in the AHA’s June 9 inpatient PPS comment letter, which expressed concern over CMS’ proposal to add 43 quality measures hospitals must report on to receive a full market basket update in FY 2010. Many of the new measures have neither been endorsed by the National Quality Forum nor adopted by the Hospital Quality Alliance. The AHA also said CMS should not implement 13 of the 17 conditions for which it would no longer pay a higher diagnosis-related group rate beginning in FY 2009 if the conditions were not present on admission. In addition, hospitals object to CMS’ proposed $50 million in payment cuts related to the wage index, capital payments and the post-acute care transfer policy. A final rule will be released by Aug. 1 and takes effect Oct. 1.

APIC: Health Care Facilities Step Up MRSA Prevention Strategies - June 2008

According to a new poll by the Association for Professionals in Infection Control and Epidemiology, many health care facilities have taken additional action in the past year to prevent the spread of methicillin-resistant staphylococcus aureus. Strategies include staff and patient education; stepped-up hand hygiene, contact precautions, housekeeping and decontamination practices; targeted patient screening; better infection surveillance technology; and additional staff dedicated to infection control. “This poll indicates that many institutions are moving in the right direction,” said APIC CEO Kathy Warye. The findings are based on a recent survey of more than 2,000 APIC members who work in hospitals and other health care facilities.

Joint Commission Releases 2009 Patient Safety Goals - June 2008

The Joint Commission today released the 2009 National Patient Safety Goals and related requirements for its accreditation programs. The goals include three new hospital and critical access hospital requirements related to preventing infections, which will be phased in over 2009; a new requirement to eliminate transfusion errors; new requirements focused on engaging patients in their care; and changes to the requirements for the universal protocol to prevent surgical errors and the medication reconciliation goal.

HHS Declares Public Health Emergency in IA, IN - June 2008

Health and Human Services Secretary Mike Leavitt today declared a public health emergency in the flood-stricken states of Iowa and Indiana. “This designation will allow HHS to immediately assist our beneficiaries and providers in the areas where hospitals and other health care delivery systems have been disrupted,” Leavitt said. Because of flood damage to local health care facilities, beneficiaries have been evacuated to neighboring communities, where receiving hospitals and nursing homes may not have the patient’s health care records or information on their Medicare status. CMS said it is assuring those facilities that the normal burden of documentation will be waived and that they can act under a presumption of eligibility. CMS said it will waive certain requirements for critical access hospitals, skilled nursing facilities, long-term care hospitals and inpatient rehabilitation facilities, and expand the definition of “home” to allow Medicare beneficiaries to receive home health services in alternative sites. For details, see the HHS news release.

AHA Opposes State Matching for Hospital Preparedness Program - June 2008

The AHA today opposed a proposal that would require states and territories that receive grants from the Department of Health and Human Services’ Hospital Preparedness Program to contribute matching funds beginning in fiscal year 2009. In a comment letter, AHA urged HHS not to finalize the proposal, which it said was inconsistent with Congress’ intent and would give states an incentive to shift the matching amount to hospitals and other health care providers. “Already more hospitals are electing not to participate in the Hospital Preparedness Program due to the combination of declining award amounts and increasing requirements and conditions for receiving funding,” AHA said. “…We are concerned that, if hospitals are now forced to contribute to the state matching amount, the exodus of hospitals from the Hospital Preparedness Program will accelerate, to the detriment of health care system preparedness for natural and manmade disasters.”

MedPAC issues June report to Congress - June 2008

The Medicare Payment Advisory Commission Friday released its June report to Congress, which includes the panel’s recent Medicare payment recommendations for hospitals and skilled nursing facilities. In April, MedPAC recommended that Congress take steps toward bundling fee-for-service Medicare physician and hospital payments for all services associated with an episode of inpatient hospital care. It also recommended reducing payments to hospitals with high readmission rates for selected conditions. To improve payment accuracy for SNF patients, the commission recommended changes to adjust for non-therapy ancillary costs and patient characteristics and an outlier policy based on exceptionally high ancillary costs per stay. In addition, it said SNFs should be required to report on patient diagnoses, service use during the SNF stay and nursing costs. Among other issues, the report explores options for collecting data on physicians’ financial relationships with hospitals and others, growth in Medicare spending for hospice care, and issues in creating an entity to compare the effective of alternative therapies.

Bill Would Delay DME Competitive Bidding Program - June 2008

House Ways and Means Health Subcommittee Chairman Pete Stark (D-CA) and Ranking Member Dave Camp (R-MI) yesterday introduced legislation (H.R. 6252) that would delay for 18 months the Medicare competitive bidding program for durable medical equipment, prosthetics, orthotics and supplies. The Medicare DMEPOS Competitive Acquisition Reform Act also would require the Centers for Medicare & Medicaid Services to make changes to the program. “We’re introducing this bill to delay the DME competitive bidding program because the Bush Administration designed this program with blinders on to the needs of beneficiaries and the small companies that make up most of the DME industry,” Stark said. The legislation also is sponsored by Reps. John Dingell (D-MI), Frank Pallone (D-NJ), Charles Rangel (D-NY) and John Boehner (R-OH).

CMS Names MAC for Three States - June 2008

The Centers for Medicare & Medicaid Services has named Pinnacle Business Solutions Inc. the Medicare administrative contractor for Part A and B claims payment in Arkansas, Louisiana and Mississippi. It will serve for up to five years as the point of contact for fee-for-service claims processing and payment for hospitals, skilled nursing facilities, physicians and other health care practitioners in those states. PBSI is the eighth of 15 Part A/B MACs to be awarded under the Medicare Modernization Act, which called for all Medicare fiscal intermediaries and carriers to be replaced by MACs by 2011.

Toolkit Helps Hospitals Implement Quality Improvement Program - June 2008

The Robert Wood Johnson Foundation has released a toolkit to help hospitals implement Transforming Care at the Bedside, a model program that engages nurses and leaders at all levels of the organization to improve the quality and safety of patient care on medical and surgical units. Ten hospitals graduated from the third phase of the five-year program in May.

Allina to Launch Center for Health Care Innovation - June 2008

Allina Hospitals & Clinics in Minneapolis is creating a $100 million Center for Health Care Innovation, which will focus on clinical and population health research, the health system announced yesterday. Allina will contribute $50 million over the next five years and seeks another $50 million in grants and donations from other organizations. The center with start with three new projects, including the Heart of New Ulm, a collaboration with the Minneapolis Heart Institute to eliminate heart attacks in New Ulm, MN. The other projects are the Backyard Project, which will work to improve population health in two Minneapolis neighborhoods, and the Allina Center for Patient Safety, which will work to improve patient care quality. “The Center will advance Allina’s strategic vision and serve as a catalyst for change in health care locally and nationally,” said Allina President and CEO Dick Pettingill.

HHS Contractor to Study Medical Identity Theft Problem - June 2008

The Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology has awarded a contract to assess and evaluate the scope of U.S. medical identity theft. Booz Allen Hamilton will spearhead the effort, which will include a public meeting in October where experts will discuss the problem and how health information technology can be used to prevent and detect it. The project plans to issue a final report that includes possible next steps for the federal government and others to prevent, detect and remediate medical identify theft, which occurs when someone’s identifiable health information is used by another without their consent or knowledge.

Court Reverses CMS Decision Denying Hospital’s Bad-Debt Claim - June 2008

A federal court in Washington, DC recently reversed a Centers for Medicare & Medicaid Services decision denying a hospital’s claim for Medicare bad debt. CMS denied the claim, ruling that the debts could not be deemed “uncollectible” because the hospital had referred them to a collection agency. In a May 30 decision (Foothill Hospital-Morris Johnston Memorial v. Leavitt), the court concluded that CMS’ decision violated a 1987 congressional moratorium prohibiting the agency from making any changes to its bad-debt policy. “[T]his blanket prohibition against reimbursement while collection efforts are ongoing constitutes a change in policy, for this policy did not exist prior to the effective date of the Moratorium,” wrote U.S. District Judge Ellen Segal Huvelle. The 1987 moratorium is still in effect, but only for some hospitals.

CDC Reports Sharp Decline in U.S. Mortality - June 2008

U.S. mortality declined in 2006 for 11 of the top 15 causes of death, led by a 12.8% drop in the death rate for flu and pneumonia, the Centers for Disease Control and Prevention reported today. Other declines were reported for chronic lower respiratory diseases (6.5%), stroke (6.4%), heart disease (5.5%), diabetes (5.3%), hypertension (5%), chronic liver disease/cirrhosis (3.3%), suicide (2.8%), septicemia (2.7%), cancer (1.6%) and accidents (1.5%). Total U.S. deaths fell by 22,117 to 2.4 million, while life expectancy climbed to a record 78.1 years, up from 77.8 in 2005. The report is based on preliminary 2006 data reported to the CDC by states.

FDA Issues Update on Contaminated Heparin Products - June 2008

The Food and Drug Administration is encouraging health care professionals and facilities to ensure all recently recalled heparin products have been removed from drug and device storage areas and are no longer available for patient use. For more on the issue, read the FDA update.

Senate Panel Hears Recommendations for Health Insurance Reform - June 2008

At the third in a series of hearings to prepare for action on health reform next year, the Senate Finance Committee today heard from business, insurance, policy and consumer witnesses about problems in the health insurance market. Lisa Kelly, a leukemia patient, described her costly experience with a limited-benefit health plan. Raymond Arth, a small business owner and past chairman of the National Small Business Association, described his company’s struggle to maintain health coverage for 22 employees in the face of a $40,000 premium increase. To reduce insurance premiums, Ronald Williams, chairman and CEO of Aetna Inc., said the health care system must focus on value, prevention and managing chronic disease. Mark Hall, a professor of law and public health at Wake Forest University, said the most effective insurance markets place people in large groups whose membership is not tied to health risk, which is why large employer groups “remain the best-functioning part of the market.”

Study: 25 Million Adults Underinsured - June 2008

The number of underinsured U.S. adults under age 65 increased 60% in the past four years to more than 25 million, according to a study released today by the Commonwealth Fund. Based on a nationally representative survey, the study found that 42% of the nation’s 75 million adults were either uninsured or underinsured in 2007, up from one-third in 2003. The study defined underinsured adults as insured adults who spent 5%-10% or more of their income on out-of-pocket medical expenses, or whose deductible equaled 5% or more of their annual family income. Underinsured and uninsured adults were more likely than other adults to go without needed care and less confident in their ability to access high-quality care when needed, the study found. They also were more likely to report care coordination problems and difficulty paying medical bills.

AHA Backs NQF Framework for Culturally Competent Care - June 2008

The AHA today expressed its support for the National Quality Forum’s proposed endorsement of a framework and preferred practices for measuring and reporting culturally competent care. “We agree that the domains of the framework – leadership; integration into management systems and operations; patient-provider communication; care delivery and supporting mechanisms; workforce diversity and training; community engagement; and data collection, public accountability, and quality improvement – delineate the core competencies of culturally competent care,” AHA said in a comment letter. The letter also applauds NQF’s proposed endorsement of the Health Research & Educational Trust Disparities Toolkit to collect race, ethnicity and primary language data from patients. “Without accurate information, we cannot begin to determine what disparities in care may exist,” AHA said. The toolkit was developed with support from national experts and has been extensively tested in hospitals. HRET is an AHA affiliate.

AHA Comments on Inpatient Proposed Rule - June 2008

The AHA today commented on the Centers for Medicare & Medicaid Services’ proposed rule for the fiscal year 2009 inpatient prospective payment system. CMS proposes to expand to 72 the number of quality measures required to receive a full market basket update in FY 2010, more than doubling the number of required measures in one year. “Adding 43 disparate quality measures in one year is an unfocused approach to quality reporting that will be detrimental to quality improvement,” AHA said in the letter. “With this broad list of disparate measures, there is no indication that CMS thought carefully or strategically about identifying the most important areas where resources and attention should be focused to advance quality and patient care.” In addition, AHA questions the selection of many of the proposed measures. “In drafting this proposal, CMS has not followed the Deficit Reduction Act of 2005 requirement that it choose measures that represent a ‘consensus among affected stakeholders,’ as it has proposed measures that are not endorsed by the National Quality Forum and adopted by the Hospital Quality Alliance,” the letter states, noting that any measures selected for reporting should “first go through the rigorous, consensus-based assessment processes of both the NQF and the HQA.” AHA also objects to payment cuts related to the wage index, capital payments and the post-acute care transfer policy – a cut of $50 million to hospitals in FY 2009. A final rule will be released by Aug. 1, and the policies and payment rates would take effect Oct. 1.

Hospital Employment Climbs 0.30% in May - June 2008

Employment at the nation's hospitals rose 0.30% in May to a seasonally adjusted 4,631,700 people, the Bureau of Labor Statistics reported today. That's 14,000 more than in April and 132,100 more than a year ago. Without the seasonal adjustment, which removes the effect of fluctuations due to seasonal events, hospitals employed 4,619,700 people in May, 17,500 more than in April and 131,100 more than a year ago. The nation's overall unemployment rate rose by one-half of a percentage point in May to 5.5%.

CMS Updates Chemotherapy Coverage Reference - June 2008

The Centers for Medicare & Medicaid Services has revised the list of resources that Medicare local contractors use to determine whether a cancer chemotherapy drug should be covered under Medicare Part B. The agency added the National Comprehensive Cancer Network Drugs & Biologics Compendium to the list and removed the American Medical Association Drug Evaluations compendium, which is no longer updated or maintained. CMS Acting Administrator Kerry Weems said “today's ever-expanding industry of drug treatments is dynamic, requiring the constant monitoring and assessment of new interventions.”

CMS to Challenge Certain RAC Denials that were Reversed on Appeal - June 2008

The Centers for Medicare & Medicaid Services plans to challenge certain Medicare recovery audit contractor denials that were reversed on appeal in the five RAC demonstration states, the agency told AHA recently. Specifically, CMS plans to challenge RAC denials that were overturned by administrative law judges because the RACs lacked “good cause” to audit claims more than a year old. CMS plans to challenge all “good cause” ALJ decisions at the Medicare Appeals Council level, claiming the ALJs lack jurisdiction on this issue and the RACs demonstrated “good cause.” It’s unclear how many ALJ decisions this could affect in the demonstration states: Florida, New York, California, Massachusetts and South Carolina. In related news, CMS recently disclosed that some RAC audits exceeded the four-year look-back period allowed under the demonstration program. It plans to refund any hospital payments that resulted from the inappropriate audits.

HHS Issues Draft Guidance for Pandemic Flu Readiness - June 2008

The Department of Health and Human Services will accept comments through July 3 on three proposed pandemic flu preparedness guidance documents. The documents provide interim guidance on the use and purchase of respirators and facemasks by individuals and families; proposed guidance on antiviral drug use during a flu pandemic; and proposed considerations for antiviral drug stockpiling by employers. The guidance on antiviral drug use replaces recommendations developed in 2005 that were published as part of HHS’ pandemic preparedness and response plan. The employer guidance encourages but does not require employers to stockpile antiviral medication for use during a pandemic. It also encourages employers to coordinate their plans for antiviral stockpiling with state and local public health agencies to improve community-level response during a pandemic.

Study Finds Racial, Ethnic Disparities in Patient Safety Events - June 2008

African Americans and Asian-Pacific Islanders in 2005 had higher rates of sepsis after an operation than whites, according to a new report from the Agency for Healthcare Research and Quality. The report looks at racial and ethnic disparities in rates of hospital patient-safety events based on data from AHRQ’s Healthcare Cost and Utilization Project. Minority groups generally had higher rates of postoperative complications than whites. However, African Americans and Hispanics generally had lower obstetrical complication rates than whites.

HHS Issues Health IT Strategic Plan - June 2008

The Department of Health and Human Services has issued a five-year federal plan to promote widespread use of electronic health records and health information exchange. “Together with our colleagues in the private sector, we will assure that health IT can enable patient-focused health care and improve population health,” said Robert Kolodner, M.D., national coordinator for health information technology. The plan details federal goals and strategies to achieve a national, interoperable health IT infrastructure as well as progress since 2004, when President Bush called for most Americans to have access to EHRs by 2014.

Senate Passes Budget Resolution - June 2008

The Senate today voted 48-45 to approve a conference agreement on the fiscal year 2009 budget resolution, which reject the president’s proposed Medicare and Medicaid budget cuts to hospitals. The House is expected to approve the budget blueprint tomorrow. The agreement includes deficit-neutral reserve funds for State Children’s Health Insurance Program legislation and Medicare program improvements. The non-binding budget resolution serves as a blueprint for the congressional appropriations committees.

Senate Finance Committee Focuses on Health Reform - June 2008

The Senate Finance Committee today heard testimony from health policy, business and labor representatives at a hearing on health care reform. Elizabeth McGlynn, associate director of RAND Health, called health information technology “the starting point” for improving quality. “It is hard to imagine how any of the other solutions are possible or as effective in the absence of a modern information system,” she said. Felicia Fields, group vice president of human resources and corporate services for Ford Motor Co., called for funding to create regional health information exchanges, and legislative and regulatory reforms to support wellness programs, among other proposals. Other witnesses included Paul Ginsburg, president of the Center for Studying Health System Change, and Arlene Holt Baker, executive vice president of the AFL-CIO. On June 16, the committee will hold a congressional summit to discuss options for health care reform in 2009.

AHA Applauds Budget Conferees for Rejecting Medicare, Medicaid Cuts - June 2008

The AHA today commended House and Senate conferees for rejecting the administration’s proposed Medicare and Medicaid cuts to hospitals in their fiscal year 2009 budget conference report. “By rejecting proposed Medicare and Medicaid cuts for hospitals, the Budget Conference Committee recognizes the serious challenges hospitals face,” AHA said in a letter to House Budget Committee Chairman John Spratt (D-SC). “At a time when the number of uninsured individuals is rising, Medicare and Medicaid currently reimburse hospitals for less than the cost of providing health care services. At the same time, hospitals need to make significant investments to continue their mission, including improving information technology systems to address patient safety and quality of care, and preparing to respond to emergencies ranging from natural disasters to pandemic diseases or to the threat of terrorism.” The House and Senate could begin debate on the budget conference report as soon as tomorrow.

HHS Awards Hospital Preparedness Funding - June 2008

The Department of Health and Human Services has awarded $398 million to help hospitals and other health care organizations prepare for public health emergencies, the agency announced today. The Hospital Preparedness Program funds will support interoperable communication systems, systems to track available hospital beds, advance registration of volunteer health professionals, processes for hospital evacuations and facility management, and community partnerships. The funding went to states, territories and four metropolitan areas: New York, Chicago, Los Angeles County and Washington. HHS also awarded $704.8 million in grants to support public health readiness.

CMS: Some Providers May Qualify for NPI Financial Hardship Payments - June 2008

The Centers for Medicare & Medicaid Services today reminded health care providers that advance or accelerated payments may be available for Medicare providers that experience cash flow problems related to the new National Provider Identifier standard. CMS said Medicare providers that experience problems should contact their Medicare contractor, who will determine if they qualify for an advance or accelerated payment. CMS and its Medicare contractors will consider such payments “where facts and circumstances fall within the scope of the CMS regulations and/or manual requirements for such payments,” CMS said. “In general, entities who bill without an NPI do not warrant consideration for an advance or accelerated payment since Medicare providers have been given ample time to secure an NPI.”

Joint Commission Board Delays Medical Staff Standard - June 2008

The Joint Commission’s Board of Commissioners on Friday agreed to suspend implementation of its MS 1.20 standard, which addresses medical staff bylaws, rules and regulations, and interaction between medical staff and hospital leadership. The standard was slated to take effect Jan. 1, 2009, a deadline that would have been difficult for hospitals needing to change their medical staff bylaws to comply with the standard. The suspension was recommended by a task force studying how to mitigate concerns about revisions made to the standard in mid-2007, which include confusing language regarding the term “organized medical staff.” The standard also appears to diminish the responsibility and authority of the hospital board and medical executive committee. The board agreed to give the task force more time to prepare a report on its full recommendations, which the board will review at its August meeting. The task force includes AHA representatives.

Survey Examines What Women Want From Health System - May 2008

A new survey by the American Academy of Family Physicians examines what women want from the U.S. health care system as health care decision makers for their families. Seven in 10 women said same-day appointments with primary care physicians for unexpected illnesses were extremely or very important. Six in 10 said a relationship with a doctor who knows their family’s medical history was extremely or very important, as was technology that enables doctors to send medical records and patient histories electronically to other doctors. Details on the survey can be found online.

Report: 13.7 Million Young Adults Uninsured - May 2008

An estimated 13.7 million adults aged 19-29 lacked health insurance in 2006, according to a report released today by the Commonwealth Fund. Roughly three in 10 of them had household incomes under 200% of the federal poverty level. Extending Medicaid and the State Children’s Health Insurance Program eligibility beyond age 18 “would have the biggest impact in terms of reducing the number of uninsured young adults,” the authors said. They estimate an extension to age 25 would cover up to 7.6 million.

CMS Issues Advisory Opinion Related to EHR Software - May 2008

A hospital system’s proposal to pay for customized software to facilitate communication between its electronic health record system and EHR software used by affiliated physicians would not constitute a prohibited compensation arrangement under physician self-referral laws, the Centers for Medicare & Medicaid Services said in a May 28 advisory opinion. CMS said the proposal would not be a prohibitive arrangement because the hospital ensured that the software would be used solely to order or communicate results of tests and procedures furnished by the hospital, noting that the arrangement only would allow physicians to perform functions they already perform at the hospital. The software also could not be modified to perform an alternate function and could not be resold, transferred or assigned by an affiliated physician practice. CMS did not address whether the arrangement complies with physician self-referral exceptions, including the exception established in 2006 for arrangements involving certain donated EHR technology.

AHIP Proposes Strategy to Reduce Health Care Costs - May 2008

America’s Health Insurance Plans today proposed a five-point strategy for reducing health care costs and insurance premiums. The report calls for a national entity to compare the clinical and cost effectiveness of new technologies; leadership to encourage adoption of electronic health records and other health information technologies; an independent administrative process to resolve medical liability disputes; payment reforms to reward quality and value; and incentives and other strategies to promote healthy behavior and prevent disease.

Web site Compares Hospitals Based on Dartmouth Data - May 2008

Consumer Reports today launched a Web site that lets consumers compare how intensely hospitals treat patients with certain serious chronic conditions, based on data from the Dartmouth Atlas Project. The tool does not provide information on the quality of hospital care. It is the first undertaking of the magazine’s new online Health Ratings Center, which will feature health care cost, quality and safety information for consumers.

CMS Issues Final Rule on Hospice Conditions of Participation - May 2008

The Centers for Medicare & Medicaid Services Tuesday issued a final rule revising the conditions of participation that hospices must meet to participate in the Medicare and Medicaid programs. The rule includes a requirement that hospices implement a data-driven approach to quality assessment and performance improvement, but does not prescribe the precise areas that each hospice must examine or the precise mechanisms for how to do so. It states, “Each hospice is free to decide how to implement the QAPI requirement in a manner that reflects its own unique needs and goals.” About 25% of community hospitals have hospice programs, according to the 2006 AHA annual survey. The rule will be published in the June 5 Federal Register.

Study: Many with Heart Disease Don't Recognize Heart Attack Signs - May 2008

Nearly half of patients with a history of heart disease have poor knowledge about the symptoms of a heart attack and do not believe they have a higher cardiovascular risk, according to a report in the May 26 issue of Archives of Internal Medicine. Researchers from the University of California at San Francisco School of Nursing surveyed 3,522 patients who had previously suffered a heart attack or had undergone a procedure, such as angioplasty, for heart disease. They found that 46% of them scored poorly (answered less than 70% of questions correctly) on a true-false test measuring how knowledgeable they were about heart attack symptoms. Women in general, along with patients who had taken part in cardiac rehabilitation, those with higher education, younger people and those were treated by a heart specialist rather than a family doctor, tended to score better on the test. Clinical history was not a significant predictor of knowledge.

Scorecard Examines Child Health Care by State - May 2008

Children’s quality of care and access to care varies widely from state to state, according to a Commonwealth Fund report released today. If all states performed as well as the top states, then an additional 4.6 million children would be insured and 11.8 million more children would get yearly medical and dental checkups, according to “U.S. Variations In Child Health System Performance: A State Scorecard.” The report found that states in the Northeast and upper Midwest generally ranked higher on health indicators such as access, quality, costs, equity and healthy outcomes. States with the lowest rankings tend to be concentrated in the South and Southwest. “This scorecard serves notice that children’s health and well-being are at risk,” said co-author and Commonwealth Fund President Karen Davis. “We must invest in children’s health and health care to ensure that they have the opportunity to become healthy and productive adults.” The report points to the need for adequate funding for the State Children’s Health Insurance Program and notes that congressional efforts to expand SCHIP have reached an impasse in Washington. “Reaching agreement over the future direction of SCHIP may be essential to continued progress in covering uninsured children,” the report states.

CMS Extends Eeadline for Hospice CoPS Final Rule - May 2008

The Centers for Medicare & Medicaid Services today announced that it has extended until next May the publication of a final rule setting the criteria for hospitals and other providers to qualify for Medicare hospice reimbursements. The proposed Medicare hospice rule was issued on May 25, 2005, and the Social Security Act requires the agency to publish a final rule no more than three years later unless there are “exceptional circumstances.” Citing that provision, CMS extended the date for a final rule to May 25, 2009. “We are not able to meet the three-year timeline for publication of the final rule due to the complexity of the rule and the large number of public comments we received,” CMS said in a notice published in today’s Federal Register.

AHA Urges HRSA to Withdraw Proposed Rule - May 2008

The AHA today urged the Health Resources and Services Administration to withdraw a proposed rule changing how it designates medically underserved populations and health professional shortage areas. In a comment letter to HRSA, AHA called for further field testing and analysis to determine the impact of the proposed changes. “First, it is impossible to determine with any certainty what designation or funding level a health center, clinic, population or area will receive under the index of primary care underservice,” AHA said. “Second, the rule’s analysis uses nearly 10-year-old data from 1999. Finally, the analytical model HRSA developed to assess the potential impact of these proposed changes has not been widely distributed – making it difficult for communities and facilities to adequately assess the impact of the proposed rule.” The HRSA designations are used to distribute funding to assist areas with a shortage of health care providers.

HHS Developing New Safety System for Medical Products - May 2008

The Department of Health and Human Services is developing a national electronic system to monitor the safety of drugs and other medical products on the market. It announced the initiative today with the release of a Centers for Medicare & Medicaid Services final rule that makes it possible to use Medicare Part D prescription drug claims data for the system, which the Food and Drug Administration expects to pilot in about a month. HHS said the Sentinel System will capitalize on existing large electronic claims and medical records data maintained by private and government entities that agree to participate in the nationwide effort. “With the Sentinel System we will no longer have to wait years to see how a drug or medical device is affecting millions of people,” said FDA Commissioner Andrew von Eschenbach, M.D.

Senate Approves Medicaid Moratorium, Self-Referral Ban - May 2008

The Senate today approved by a veto-proof margin an amendment to the Iraq spending bill that contains AHA-backed language to extend a moratorium on seven Medicaid regulations and ban self-referral to new physician-owned hospitals. The president has threatened to veto the bill, which now goes to the House for a vote following the Memorial Day recess. Today’s amendment, approved by a 75-22 vote, contains a provision that would postpone the Medicaid rules until April 2009. The administration yesterday voluntarily agreed to delay until Aug. 1 the two rules related to limiting payments to public providers and graduate medical education, which were slated to take effect Monday. Those rules are expected to cut hospital funding by more than $5 billion over five years. The AHA and other hospital organizations have challenged the public provider rule in federal court; a decision on the case is expected by tomorrow.

CMS Launches Hospital Compare Ads Policy - May 2008

The Centers for Medicare & Medicaid Services today launched a national advertising campaign in 58 major daily newspapers to promote the Hospital Compare Web site. The campaign was undertaken independently of the other members of the Hospital Quality Alliance. The ads contain two Hospital Compare scores for a sample of hospitals in each newspaper’s market: an HCAHPS score for the percentage of patients who said they always received help when they requested it, and a score for the percentage of patients given antibiotics one hour prior to surgery. CMS Acting Administrator Kerry Weems said the measures were chosen because “they would be interesting to consumers and will drive them to the Web site for more information.” AHA President and CEO Rich Umbdenstock, who chairs the HQA, said, “Hospitals have led the effort to make useful information about hospital quality available to the public through Hospital Compare. We hope that people who see the ads will be motivated to look at the full range of information available on the Web site.”

CBO: Health IT Alone Won't Reduce Health Spending - May 2008

Estimates that health information technology could save the nation about $80 billion annually “are not an appropriate guide” for estimating the effects of legislative proposals to boost health IT use, the Congressional Budget Office concludes in a new report. “Research indicates that in certain settings, health IT appears to make it easier to reduce health spending if other steps in the broader health care system are also taken to alter incentives to promote savings,” CBO said. “By itself, the adoption of more health IT is generally not sufficient to produce significant cost savings.” The report adds, “If policymakers are interested in promoting health IT, some version of a requirement or an explicit or implicit penalty for providers who fail to adopt health IT is likely to be more cost-effective for the federal government than a subsidy.” The report was requested by the chairman of the Senate Budget Committee.

Supreme Court Upholds Tax-Exempt Bond Policy - May 2008

The U.S. Supreme Court yesterday issued a decision expected to help stabilize the municipal bond market - a major source of financing for non-profit hospitals. In Department of Revenue of Kentucky v. Davis, the court held that a state may exempt from its income tax, interest income derived from in-state municipal bonds, while treating interest income from bonds issued in other states as taxable. Delivering the opinion for the court, Justice Souter said, “The question here is whether Kentucky’s version of this differential tax scheme offends the Commerce Clause. We hold that it does not.” If the Supreme Court had ruled against Kentucky, states would have two choices: eliminate the tax exemption on all municipal bonds or exempt all municipal bond income from tax. Many bond analysts believe both options would have increased the cost of borrowing, especially for hospitals in small states.

Hospital Prices Climb 0.1% in April - May 2008

Overall hospital prices rose 0.1% in April, and were 3.5% higher than a year ago, the Bureau of Labor Statistics reported today. Prices at general medical and surgical hospitals rose 0.1%, and were 3.6% higher than in April 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.

Hospitals Honored for Environmental Health - May 2008

Practice Greenhealth today announced the winners of its 2008 Environmental Excellence Awards, which recognize 141 hospital and health care organizations for their healthy environmental practices. “Health care organizations from across the country have made the commitment and are making the investment to go green,” said Bob Jarboe, executive director of Practice Greenhealth, the result of a recent merger between Hospitals for a Healthy Environment and the Green Guide for Health Care. The organization plans to plant in India 100 trees for each award recipient to improve the health of the planet. The awards will be presented tonight in Pittsburgh at CleanMed 2008, a global conference on environmentally sustainable health care. A list of winners will be available soon at www.practicegreenhealth.org.

Medical School to Offer All Students Full-Tuition Scholarships - May 2008

The Cleveland Clinic Lerner College of Medicine of Case Western Reserve University will provide all students with full-tuition scholarships beginning with its incoming class this July, Cleveland Clinic announced last week. Created nearly five years ago, the college trains physician scientists to conduct medical research and bring advanced treatments to the patients’ bedside. “By providing full tuition support, we want to ensure that debt does not hinder the ability of our graduates to pursue academic careers as physician scientists,” said Cleveland Clinic President and CEO Toby Cosgrove, M.D.

CMS Awards DMEPOS Contracts - May 2008

The Centers for Medicare & Medicaid Services today announced it has awarded contracts to 325 suppliers for its durable medical equipment, prosthetics, orthotics and supplies competitive bidding program. The DMEPOS program goes into effect July 1 in 10 metropolitan statistical areas and applies to 10 of the top product areas, including power wheelchairs, oxygen equipment and supplies, and hospital beds and accessories. CMS will expand the program to 70 additional MSAs in 2009 and to additional areas and items in 2010. Earlier this month, the AHA urged Congress to allow hospitals to continue to provide equipment and supplies directly to their patients by accepting the price set through the competitive bidding process, without being required to submit a bid.

Senators Urge Congress to Extend Section 1011 Program - May 2008

A bipartisan group of 15 senators Friday urged congressional leaders to extend Section 1011 of the Medicare program, which helps reimburse hospitals for emergency services provided to undocumented immigrants. “Section 1011 plays a critical role in helping to stabilize our states’ health care safety net and preserve access to care,” the group said in a letter to leaders of the Senate and its Finance Committee. “We hope that you concur and include a two-year extension of Section 1011 in this year’s Medicare bill.” Authorized by the Medicare Modernization Act of 2003, the program is set to expire Sept. 30. Congress authorized $250 million annually for the program in fiscal years 2005-2008. Under the Emergency Medical Treatment and Labor Act, hospitals must treat anyone who needs emergency care, regardless of their ability to pay.

Hospital Leader Appointed to Baldrige Award Board - May 2008

U.S. Commerce Secretary Carlos Gutierrez has named John Heer, president and CEO of North Mississippi Health Services in Tupelo, to a three-year term on the Board of Overseers for the Malcolm Baldrige National Quality Award. The board advises the commerce secretary on the conduct of the awards program. North Mississippi won a Baldrige Award in 2006. Heer also has served as president and CEO for Baptist Hospital in Pensacola, FL, which won a Baldrige Award in 2003.

Report Offers Ways to Reduce ED Crowding - May 2008

A new report by a task force of the American College of Emergency Physicians offers hospitals low-cost ways to avoid holding patients in the emergency department after they’ve been admitted to the hospital, a problem that can result from shortages of staff and beds on other floors. Among other solutions, the report recommends EDs move admitted patients to inpatient areas such as hallways and conference rooms, discharge patients before noon to make more beds available, and schedule elective procedures more evenly throughout the week. “Some hospitals have found ways to improve patient flow by making changes in routine administrative procedures and by freeing up additional resources in the emergency department,” said ACEP President Linda Lawrence, M.D. “This report describes those success stories.” The report was developed in cooperation with AHA.

Senate Panel Gives Nod to Medicaid Moratorium and Self-Referral Ban - May 2008

The Senate Appropriations Committee yesterday approved an Iraq supplemental appropriations bill that would postpone seven controversial Medicaid regulations until April 2009, and ban physician self-referral to new hospitals in which the physicians have an ownership stake. The bill also would set aside 60,000 visas for foreign-born registered nurses and physical therapists to work in the U.S., where hospitals and other health care providers face a critical shortage of caregivers. The Senate is expected to take up the bill early next week. Both the House and Senate versions of the Iraq spending bill would impose a moratorium on the Medicaid rules, including two that would cut hospital funding by more than $5 billion over five years unless Congress acts by May 25.

House Adds Medicaid Moratorium to Iraq Spending Bill - May 2008

The House today voted to attach H.R. 5613, the Protecting the Medicaid Safety Net Act, to the Iraq supplemental spending bill. The AHA-backed measure, part of a $21-billion domestic spending amendment to the bill (H.R. 2642), would postpone until April 2009 seven controversial Medicaid regulations that would cut billions of dollars from the program. Two of the rules would cut hospital funding by more than $5 billion over the next five years. They would take effect May 26 unless Congress acts to block them. The House approved the domestic spending amendment on a 256 to 166 vote. At News Now deadline, the Senate Appropriations Committee was drafting an Iraq supplemental funding bill that also contains a moratorium on the seven Medicaid rules. The full Senate is expected to consider the bill early next week.

Providers Use EHRs to Measure Quality - May 2008

A new report from the Commonwealth Fund examines how five health care providers are using electronic health records to measure quality of care. In Minneapolis, HealthPartners used its EHR system to compile blood pressure measures, while Park Nicollet Health Services developed a composite measure for care of people with diabetes. Also examined are case studies at Geisinger Health System in Danville, PA; Kaiser Permanente of the Northwest in Portland, OR; and Billings (MT) Clinic. “The providers’ successes in implementing their respective EHR-based quality measures demonstrates that such measures are adaptable to different EHR systems, amenable to improvement and worth pursuing,” the authors said.

Report Looks at Ways to Communicate Patient Financial Responsibility - May 2008

A new report from the Healthcare Financial Management Association suggests strategies to help hospitals communicate accurate and timely information about patient financial responsibility. For example, Saint Luke's Health System, an 11-hospital system with headquarters in Kansas City, MO, uses a centralized service to provide customized quotes to people who request one. Florida's Orlando Regional Healthcare, a seven-hospital system, offers extensive reimbursement and professionalism training, starting with six days of classes for new hires. The Patient Friendly Billing Project, spearheaded by HFMA with support from the AHA and others, promotes clear, concise and correct patient-friendly financial communications.

CMS: RACs Collected $980 Million in Three-Year Demonstration - May 2008

The Centers for Medicare & Medicaid Services expects to issue its final report on the Medicare recovery audit contractor demonstration in late May and announce by summer the four RACs that will run the national program, a CMS official said yesterday. Addressing a Health Affairs teleconference on RACs, Timothy Hill, director of CMS’ Office of Financial Management, said the RACs collected a total of $980 million in overpayments from health care providers during the three-year demonstration, which ran from March 2005 to March 2008. About 84% of that was collected from inpatient hospitals, and 14% from hospital outpatient departments, inpatient rehabilitation facilities and skilled nursing facilities. Many providers have filed appeals challenging the collections, with many appeals decided in favor of the provider. Don May, AHA vice president for policy, told participants that hospitals want to bill accurately the first time, but rolling out the RAC program nationally should be slowed down until transparency and oversight of the program can be improved.

IA Governor Signs Law to Cover All Uninsured Children - May 2008

Iowa Gov. Chet Culver yesterday signed legislation providing $25 million over three years to extend health care coverage to all uninsured children in the state. The law also ensures that young adults through the age of 25 are covered under their parents’ insurance, eliminates pre-existing condition barriers when migrating between group and individual coverage, and sets the goal of developing a statewide health information technology plan. In addition, it sets the goal of covering all uninsured residents by 2013. Kirk Norris, president and CEO of the Iowa Hospital Association, said the bill reflects “the priorities and principles that Iowa’s hospitals actively supported throughout the legislative session” and builds on “Iowa’s strengths as a proven leader in providing high-quality, low-cost care.” A separate bill signed by the governor establishes a 1% Medicaid rate increase for health care providers, with the hospital increase devoted to raising nurse salaries.

Group Releases Health Reform Proposal - May 2008

The Healthcare Leadership Council today issued a proposal to expand access to U.S. health care and improve quality. HLC Chairman Denis Cortese, M.D., president and CEO of the Mayo Clinic, said the proposal targets health coverage for every American, better outcomes for patients and lower cost. The plan calls for “fully funding” public health insurance programs, and using Medicaid and State Children’s Health Insurance Program dollars to help workers afford employer-based coverage. It also calls for tax incentives to help individuals and low-income Americans purchase health coverage; payment reforms to encourage and reward quality care and evidence-based medicine; and financing mechanisms to help health care providers invest in information technology. The group plans to share the proposal with congressional leaders and candidates in the 2008 election.

CMS Approves SCHIP Expansion for Indiana - May 2008

The Centers for Medicare & Medicaid Services has approved an Indiana plan to expand its State Children's Health Insurance Program to children in families earning up to 250% of the federal poverty level. That’s about $53,000 for a family of four. The state expects the plan to cover about 10,000 more children, officials said Friday. Allison Wharry, vice president of government relations for the Indiana Hospital Association, said, “This is more good news for Indiana and the Healthy Indiana Plan. In the long run, we hope to see the expansion of health coverage for well over a hundred thousand Hoosiers.”

Foundation Issues Plan to Cover 44 Million Uninsured Americans - May 2008

The Commonwealth Fund today unveiled a proposal to provide health coverage to 44 million uninsured Americans. The proposal would create a national health insurance “connector” open to everyone without large-employer insurance or Medicare. The connector would offer a choice of private plans as well as a Medicare option called Medicare Extra for people under 65. Employers that do not provide health coverage would be required to pay 7% of payroll into a pool to help finance coverage, and Medicaid and the State Children’s Health Insurance Program would be expanded to cover all legal residents below 150% of the federal poverty level. Health insurance would be mandatory, with tax credits offered to keep premium costs under 5%-10% of income. Analysts at the Lewin Group estimate the proposal could save $1.6 trillion over 10 years if coupled with other reforms, such as health information technology, evidence-based medicine, Medicare payment changes, negotiated prescription drug prices, and public health efforts to reduce smoking and obesity.

AZ Governor Directs State to Promote E-prescribing - May 2008

Arizona Gov. Janet Napolitano recently issued an executive order directing state agencies to work with the Arizona Health-e Connection initiative, health plans and providers to increase the use of electronic prescribing and other medication safety tools. The Arizona Hospital and Healthcare Association (AzHHA) is a participant in Arizona Health-e Connection, a public-private partnership to promote electronic medical records. “E-prescribing is a critical aspect of this initiative and hospitals, along with the rest of the state’s medical community, will no doubt have much to contribute to the development of e-prescribing in Arizona,” said AzHHA President and CEO John Rivers. AzHHA also helped to create “The Med Form,” a medication safety tool that the state will promote. The free tool allows consumers to maintain a record of their medications, immunizations and allergies to share with health care providers.

Hospitals Encouraged to Participate in Retirement Survey- May 2008

AHA Solutions, an AHA subsidiary, has launched its sixth annual survey of retirement plan trends in health care. Hospitals and health systems are encouraged to complete the survey online. Respondents will receive a copy of the survey results, prepared by Diversified Investment Advisors, which they can use to evaluate and compare their organization’s retirement benefits to those of their peers. Individual survey responses will be kept confidential. Those who complete the survey by May 23 will receive a $5 gift card. A report on the survey findings will be released this fall.

AHA, IHA File Brief in Support of IL Medical Liability Reforms - May 2008

The AHA yesterday joined the Illinois Hospital Association and other Illinois health care associations in filing an amicus brief in support of medical liability reforms enacted by the state of Illinois. A circuit court decision declaring one of the reforms, a cap on non-economic damages, unconstitutional, is being appealed to the Illinois Supreme Court. The brief argues that the reform legislation was a "careful and constitutional solution" to a problem confronting many states - "preserving access to health care in the face of skyrocketing medical liability costs." The associations add, "Legislatures must be free to make judgments balancing competing interests to serve [the] public good."

House Bill Would Nullify SCHIP Directive - May 2008

Reps. Frank Pallone Jr. (D-NJ) and Carol Shea-Porter (D-NH) yesterday introduced legislation that would nullify an August 2007 letter in which the Centers for Medicare & Medicaid Services placed new limits on states that extend State Children’s Health Insurance Program coverage to children in families above 250% of the federal poverty level. Congressional leaders claim CMS has used the directive to effectively impose without authority an income eligibility cap in the SCHIP and Medicaid programs. New Jersey, New York, Illinois, Maryland and Washington have challenged the CMS letter in court, and the Government Accountability Office last month said the letter qualifies as a rule and “must be submitted to Congress and the Comptroller General before it can take effect.” The bill (H.R. 5998) has 31 cosponsors.

CMS Issues Proposed Rule for Medicare Advantage, Part D - May 2008

The Centers for Medicare & Medicaid Services today proposed tightening market standards for the Medicare Advantage and Part D prescription drug programs in order to increase protections for beneficiaries. Specific proposals include a prohibition on cold-calling; cross-selling of non-health care-related products to prospective MA or Part D enrollees; sales activities at educational events and certain other areas; and an expansion of the current prohibition on door-to-door solicitation to cover other unsolicited circumstances. In addition, CMS proposes limiting the value and type of promotional items offered to potential enrollees. Under the proposed rule, CMS could fine plans up to $25,000 for violations for each enrollee affected, or likely to be affected, by the violation. The rule also would streamline eligibility determinations for extra help to low-income beneficiaries, limit beneficiary liability and add new protections for beneficiaries enrolled in special needs plans. CMS will accept comments on the proposed rule through July 15.

CMS Issues Letter Clarifying SCHIP Directive - May 2008

In a letter yesterday to state health officials, the Centers for Medicare & Medicaid Services said that requirements announced last August to prevent the State Children’s Health Insurance Program from replacing private coverage apply only to new enrollees with incomes above 250% of the federal poverty level. CMS also said the requirements do not apply to unborn children, and that it will consider exceptions for other enrollee categories if the state can show “a low substitution risk.” The agency also said it will consider alternatives to its one-year waiting period for new enrollees in families above 250% of FPL ($53,000 for a family of four) if the state can show they would be equally effective at preventing the substitution of SCHIP for private coverage.

PHS Issues Clinical Guideline for Smoking Cessation - May 2008

The U.S. Public Health Service today issued an updated clinical practice guideline to help health care providers reduce patients’ use of tobacco. The guideline recommends clinicians and health care delivery systems consistently identify tobacco users seen in the health care setting, and offer every patient who uses tobacco some of the treatments recommended in the guideline. It also recommends insurers cover the counseling and medications identified as effective. A companion consumer guide and pocket guide for clinicians are available online.

CMS Launches Personal Health Record Pilot in SC - May 2008

Medicare beneficiaries in South Carolina can use an online personal health record to privately track their health and health care services, the Centers for Medicare & Medicaid Services announced today. Key information from hospital and provider medical claims will be automatically entered into the PHR when a beneficiary registers for the voluntary program and requests the data. The beneficiary will control who is able to see and access the data, from health care providers to caregivers and family members. CMS Acting Administrator Kerry Weems said the 12-month pilot “will help CMS understand how to best educate beneficiaries on the use of a PHR so that we can encourage use of these tools in the future.” CMS plans to inform providers about the project through newsletters and its Region IV office in Atlanta. More on the project is available at www.myphrsc.com.

CMS Names MAC for Four States - May 2008

The Centers for Medicare & Medicaid Services has selected National Heritage Insurance Corp. to serve as the Medicare Administrative Contractor for Part A and B claims payment in Alaska, Idaho, Oregon and Washington. Under the contract, NHIC will serve for up to five years as the point of contact for fee-for-service claims processing and payment for hospitals, skilled nursing facilities, physicians and other health care practitioners. The seventh MAC to be named by CMS under Medicare contracting reform, NHIC expects to assume full responsibility for the work by Dec. 31. The Medicare Modernization Act called for all Medicare fiscal intermediaries and carriers to be replaced by MACs.

Hospitals Rally Congressional Support to Ban Self-Referral - May 2008

Community hospital leaders were in Washington today to rally support on Capitol Hill for legislation banning self-referral to physician-owned hospitals. Speaking at the event, AHA Vice President for Federal Relations Tom Nickels said, “We’ve got the votes. We just need to find a vehicle because we have to make this happen.” The House has twice passed legislation to ban self-referral, but action stalled in the Senate. According to a recent AHA TrendWatch report, self-referral to physician-owned facilities damages the health care system by driving up utilization and costs and weakening the health care safety net. The Congressional Budget Office estimates a ban could save taxpayers $2.4 billion over 10 years.

HHS Likely Violated Medicaid Moratorium, Judge Says - May 2008

Speaking from the bench, Federal District Court Judge James Robertson today said he was inclined to rule that the Department of Health and Human Services violated a May 25, 2007 congressional moratorium preventing the department from promulgating its Medicaid cost-limit rules. However, he also indicated he was inclined to rule that neither of the Medicaid rules at issue themselves violated federal law. The judge warned that his written opinion could be different. AHA, in collaboration with Alameda County Medical Center and other hospital associations, brought suit in March challenging the administration’s authority to implement new Medicaid regulations that would limit payments to public hospitals to cost, and limit which hospitals would be eligible to contribute the non-federal share of Medicaid. AHA also challenged HHS’ surreptitious effort to avoid the congressionally-enacted moratorium on the Medicaid rules. A final ruling on the case is expected by May 23.

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 o