MHA's Executive Briefing

Clinton, Obama offer patient safety centered malpractice bill

Senators Hillary Rodham Clinton (D-NY) and Barack Obama (D-IL) have proposed legislation aimed at giving physicians and hospitals protection in exchange for full disclosure of errors and adverse events. Their plan was outlined in the May 25 New England Journal of Medicine.

The plan, filed as the National Medical Error Disclosure and Compensation Bill, would offer four major components:

• reduce the rates of medical errors
• increase communication between caregivers and patients
• provide for patient access to "fair compensation for legitimate medical injuries"
• reduce malpractice premiums

The current efforts to reform malpractice claims address only a few of these major issues, according to Clinton and Obama. The two senators claim all four must be dealt with to truly reform malpractice law.

To read the complete commentary, click Here.

[ via Patient Safety Monitor ]

Some hospitals underfunding pension plans: S&P

A number of not-for-profit hospitals and health systems have not adequately funded their defined-benefit pension plans in recent years, and mounting obligations now represent a threat to their liquidity and credit ratings, Standard & Poor's said in a research report. Not-for-profit providers often underfunded pensions in the face of competing demands for capital, such as construction and new technology, and now many may have "no clear plan for funding growing shortfalls," S&P said.

An aging workforce and poor investment returns have contributed to double-digit increases in pension contributions, S&P said. Assumptions for investment returns fell to between 6% and 7% in 2004-05, from between 9% and 10% previously, reflecting recent lower returns, S&P analyst Ken Rodgers said. While investment returns have rebounded in the past 18 months, the immediate effect is limited, Rodgers said.

[ via Melanie Evans, Modern Healthcare ]

Congress opens JCAHO/JCR investigation

Three members of Congress last week opened an investigation into the JCAHO and its subsidiary, Joint Commission Resources Inc. (JCR),

Senators Chuck Grassley (R-IA), and Max Baucus (D-MT), and Representative Pete Stark (D-CA) announced the investigation in a press release that included a letter to JCAHO President Dennis O'Leary asking for a lengthy list of information by June 8.

According to the May 19 press release, the Congressmen are seeking information about the relationship and possible conflicts of interest between the JCAHO and JCR and to account for results of the new survey process. And the letter represents a continued effort to "improve the performance and accountability of the accreditation process so that quality-related problems in hospitals are more readily identified and addressed, rather than missed entirely or allowed to persist."

The investigation follows a 2004 Government Accountability Office (GAO) investigation also requested by Grassley, Baucus, and Stark. That investigation found deficiencies in JCAHO surveys when compared to Centers for Mediare & Medicaid Services (CMS) surveys, particularly in enviornment of care areas. The JCAHO answered that report by adding Life Safety Code® engineering surveyors to survey teams in hospitals with 200 beds or more.

Legislation sponsored in 2004 by Grassley, Baucus, and Stark would have brought JCAHO's accreditation process under the authority of CMS. Congress did not act on their legislation. Grassley, Baucus, and Stark said in the press release that they will introduce revised legislation based on "a number of factors including any new findings of the GAO."

"It's very important to determine whether or not the new accreditation process is delivering results and overcoming the shortcomings of the old system," said Grassley, chairman of the Senate Committee on Finance. "Approval from the Joint Commission should be the gold standard, not a rubber stamp."

Click here to see the JCAHO's response to the press release and the letter to O'Leary.

[ via Accreditation Connection ]

CMS releases supplemental instructions for Medicare occupational mix survey

The Centers for Medicare & Medicaid Services has released supplemental instructions for the Medicare occupational mix survey currently in the field. The instructions, which were sent to fiscal intermediaries this week and will be posted soon to the American Hospital Association’s Web site, clarify that only nursing employees assigned to the cost centers listed in the survey instructions should be included in the nursing category; other occupations that may provide similar services as nursing personnel but are not included in the definitions should not be included on the nursing category; and on-call hours for the occupational mix surveys must be treated the same as on the Worksheet S-3 wage data.

The occupational mix adjustment is applied to the Medicare inpatient prospective payment system area wage index and is used to control for the effects of hospitals’ employment choices – such as the use of registered nurses versus licensed practical nurses – rather than geographical differences in the costs of labor. Data from January 1 through June 30 were initially supposed to be collected by July 31; however as a result of a recent court case, hospitals are now required to submit data for the first calendar quarter of the year by June 30. That data will be used to adjust the FY 2007 area wage index.

[ via AHA News ]

Senate immigration bill passes; contains provisions to address workforce shortages

The Comprehensive Immigration Reform Act (S. 2611), which passed the Senate on May 25, includes several provisions to address caregiver shortages. The bill would extend permanently the State 30 J-1 visa program, which is set to expire June 1. The program allows foreign workers training in a U.S. residency program under a J-1 visa to remain in the country after completing their studies if they agree to practice in an underserved rural community for three years.

In addition, the bill would allow more qualified internationally trained nurses to work in the U.S. Under current law, 140,000 employment-based visas are available each year for skilled professionals, subject to per-country caps. The bill would exempt nurses and physical therapists from the caps – an exemption that would expire in 2017. During that period, the Department of Health and Human Services and Institute of Medicine would study staffing issues and recommend to Congress ways of increasing the domestic supply of nurses and physical therapists.

The Senate now will need to reconcile its version with the House bill, which passed last December.

[ via AHA News ]

The Check Is Not In the Mail

Claims-processing company Athenahealth presented a rare warts-and-all look at how well the nation's seven biggest health insurers pay their bills. Not well enough, in many cases, according to the data and to experts who say the survey provides the most comprehensive look yet at the state of accounts payable vs. accounts receivable in the healthcare system. Weighing all the factors in the survey, Athenahealth gave Humana the top overall ranking, closely followed by the federal Medicare program. The commercial insurer WellPoint ranked last. Because of all the caveats required to understand and justify those overall rankings, experts said the more useful comparative look might be at individual categories, like average number of days between the medical service and the payment.

For the full story from The New York Times, click here.

House subcommittee marks up health IT legislation

The House Ways & Means/Health Subcommittee marked-up and approved the Health Information Technology Promotion Act (H.R. 4157) on May 24 along an 8-5 party-line vote. The American Hospital Association supports provisions that would adopt the modernized ICD-10 coding system by October 2009 and would take steps to move toward uniform privacy and security standards. The AHA also backs a measure that would exempt from anti-kickback and physician self-referral (so-called “Stark”) laws hospitals that share hardware, software or information training and support services primarily to exchange health information electronically with physicians. However, the AHA is disappointed that an amendment sponsored by Mike Thompson, D-CA to provide federal funding to help hospitals bear the initial costs of IT adoption failed along a party-line vote.

“It’s clear that many members appreciate the cost of implementing health information technology systems, but unfortunately, few Republicans are willing to step up and offer a comprehensive plan to help pay for the technology,” said AHA Executive Branch Relations Director Kristin Welsh. Health Subcommittee Chair Nancy Johnson, R-CT, who sponsored the bill, expects the full Ways & Means Committee to take up the measure shortly.

[ via AHA News ]

In search of a sustainable future for suburban hospitals

Many suburban community hospitals are caught in a strategic vise, facing competitive pressure at the upper end of their service spectrum from academic medical centers and sophisticated regional providers and at the lower end from physician- and investor-owned freestanding diagnostic and treatment centers. These competitive pressures are particularly problematic because the services affected — procedurally based inpatient acute care and ambulatory diagnostic and treatment services — are typically important factors in the bottom line of most community hospitals.

Read the full article in hfm magazine from the Healthcare Financial Management Association.

A partnership with convenience clinics

"Convenience clinics," where patients can get quick and inexpensive care for routine problems without an appointment, in an accessible location and at an affordable price, need not be enemies of hospitals and healthcare systems. In fact, the two groups can form a mutually beneficial partnership. Clinics can inexpensively handle cases that don't require a physician's expertise, including those patients who inappropriately head to an emergency room. They can also provide routine care such as immunizations and blood pressure checks. Finally, they can refer patients to health systems or hospitals, helping build patient trust with an organization.

Read the full article in H&HN online.

IRS sends questionnaire to tax-exempt hospitals

The Internal Revenue Service (IRS) has recently begun sending tax-exempt hospitals a detailed inquiry known as a “Compliance Check Questionnaire” seeking information about their operations. The questionnaire includes sections on uncompensated care policies, community care programs, compensation practices, and board organization. The compliance check is not an audit but an examination of tax-exempt entity compliance with rules and regulations. However, the IRS noted in a teleconference last week that some examinations this year have resulted in audits. These recent mailings are part of an investigation into tax-exempt entities that the IRS has conducted for the past year.

[ via AHA News ]