MHA's Executive Briefing

Stricter self-referral rules may end some physician contracts with hospitals

Sweeping changes to the federal anti-self-referral rules, approved more than a year ago, will take effect Oct. 1, potentially causing many physician-hospital arrangements to fall out of compliance if doctors are not prepared. Being unaware of the Stark law revisions or the structure of a particular deal will not excuse physicians from liability, legal experts say.

Learn more here.

AHA urges changes to proposed home health rule

In a comment letter on Sept. 28, the American Hospital Association expressed concern with a proposed 2.75% reduction in Medicare home health payments in calendar year 2010 to adjust for coding changes. Among its concerns, the association cited the impact of this cut on hospital-based agencies, especially in light of substantial home health cuts in 2008, 2009 and 2011 and further cuts being considered by the Centers for Medicare & Medicaid Services for 2010 and 2011.

In other comments, the association asked CMS to clarify how it will monitor Medicare payments for high-cost home health cases, known as outliers, and identify cases that exceed its proposed 10% cap on such cases. It also said CMS should delay implementing its new OASIS-C patient assessment tool by at least six months, citing a lack of interpretive guidelines, vendor preparation and training.

In addition, the AHA called for changes to the proposed restriction on home health agencies sharing, leasing or subleasing a practice location with or to another Medicare-enrolled HHA or supplier. “This requirement would impose harmful and unnecessary restrictions on hospital-based agencies that are part of an organization that also has a hospital-based supply business under Medicare for durable medical equipment,” the AHA said.

Measure would give states break on repaying feds

States would have up to one year to repay the federal government a share of the money they recoup from fraudulent or improper Medicaid payments, under an amendment approved by the Senate Finance Committee.

Under current law, once state inspectors identify fraudulent practices, they have 60 days to return a portion of the federal dollars back to the government. Under the new amendment, states would instead have a full year to make those payments while expanding the role of recovery audit contractors.

States' Medicaid agencies have long struggled with snuffing out improper payments, and many of them have “turned a blind eye” because of the complexity of the problem, said Sen. Thomas Carper (D-Del.), who inked the amendment. The reform bill aims to strengthen fraud detection within Medicare and Medicaid.

Carper's provision costs $100 million, but would be offset by an expansion of the controversial Recovery Audit Contractor program. The Finance bill would extend the RAC to Medicare Advantage, the prescription drug program Medicare Part D and Medicaid. Carper's amendment requires the CMS to implement RAC programs in Medicare and Medicaid by the end of 2010 while requiring the CMS to submit an annual report on its effectiveness. The CMS would also coordinate the Medicaid RAC program with states.

[ via Matthew DoBias, Modern Healthcare's Daily Dose ]

House votes to prevent hike in Part B premiums

The House voted 406-18 to approve an emergency measure that would prevent certain Medicare beneficiaries from facing increases in their 2010 Medicare Part B premiums.

The bill was introduced in anticipation of a Part B premium increase that’s expected next year for nearly 30% of Medicare seniors who do not fall under a specific “hold harmless” policy that prevents seniors from seeing a decrease in their Social Security checks if the Part B premium increase is projected to be greater than the increase in Social Security. The bill would extend the current “hold harmless” policy to all Medicare enrollees.

“This will help 11 million seniors and states struggling with their budgets” that cover premiums for low-income seniors, House Speaker Nancy Pelosi (D-Calif.) told reporters.

Rep. Joe Barton (R-Texas), ranking member of the House Energy and Commerce Committee, questioned the Democratic sponsors’ assertions that the bill would be fully paid for by taking money from the Medicare Improvement Fund, a set-aside fund in Medicare. “It’s wrong to say that we’re not adding to the deficit,” as the bill would also be taking money out of Medicare’s trust fund, which is going bankrupt, to help pay for the legislation, Barton said.

[ via Jennifer Lubell, Modern Healthcare's Daily Dose ]

Physician Employment 2.0

Like they did in the 1990s, hospitals are starting to employ more physicians. By aligning goals and integrating physicians, hospitals can avoid the mistakes of the earlier era.

Read morehere.

AHA publishes 2010 Environmental Scan

The American Hospital Association’s 2010 Environmental Scan appears in this month’s Hospitals & Health Networks and Trustee magazines. Compiled from nationally recognized sources with recommendations from select AHA governance committees, the Environmental Scan helps hospital and health system executives better understand the health care landscape and the critical trends and issues their organizations will likely face in the foreseeable future.

Areas covered include consumers and demographics, economy and finance, human resources, information technology and e-health, insurance and coverage, political issues, provider organizations and physicians, quality and patient safety, and science and technology. In January, AHA President and CEO Rich Umbdenstock and Vice President of Strategic and Business Planning Gene O'Dell will discuss the 2010 Environmental Scan in an available-on-demand Webcast at www.hhnmag.com.

Medicare proposes bundling payments for outpatient dialysis session

The Centers for Medicare & Medicaid Services on Sept. 15 issued a proposed rule bundling Medicare payments for all services related to an outpatient dialysis session. The rule would establish a base bundled payment rate of $198.64 and adjust it for case-mix factors such as the patient’s age, gender, body size and time on dialysis. Additional adjustments would be made for co-existing medical conditions and high-cost cases, as well as geographic differences in labor costs and low-volume facilities.

Required by the Medicare Improvements for Patients and Providers Act of 2008, the new payment system would apply to dialysis services provided to Medicare beneficiaries with end-stage renal disease effective Jan. 1, 2011. The rule also proposes three quality measures and a conceptual model for a quality incentive program for dialysis services and providers beginning in calendar year 2012.

CMS will accept comments on the proposed rule through Nov. 16 and expects to issue a final rule next year.

[ via AHA News Now ]

Legislation would allow hospitals to report Stark overpayments

The American Hospital Association on Sept. 15 voiced support for legislation introduced by Rep. Jim McDermott (D-WA) that would establish a process for hospitals to report Medicare overpayments under the Stark law. The bill (H.R. 3556) would enable the Centers for Medicare & Medicaid Services to accept and settle disclosures of overpayments that do not involve fraud.

McDermott hopes to attach the legislation to the House’s health care reform bill (H.R. 3200) as an amendment. “Your amendment would provide necessary clarification to hospitals that face uncertainty over how to comply with existing requirements under the Stark law,” AHA said in a letter of support.

The Stark law prohibits physicians from referring patients to certain entities with which they have a financial relationship as well as payment for such services.

How A New 'Public Plan' Could Affect Hospitals' Finances And Private Insurance Premiums

According to the authors of this report, published in Health Affairs, a new government-run plan could sharply increase private insurance premiums if the plan were to include large portions of those who currently have private health insurance. Because reimbursements offered by the public plan would likely be below hospitals’ costs, hospitals might attempt to shift costs to those who remain in private plans, thus driving up private premiums.

However, according to the authors, a new public option could bolster hospital margins if enrollment in the plan were dominated by those who are currently uninsured. The study, funded jointly by Dobson Davanzo and America’s Health Insurance Plans, relies on 2007 data from the California Office of Statewide Health Planning and Development.

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Federal bill would drop antitrust exemption for health, malpractice insurers

A new bill has been introduced in the Senate that would repeal the antitrust exemption health and medical insurers currently enjoy. The bill, which is backed by Sen. Patrick Leahy (D-VT), would bring these insurers under the watchful eyes of the Federal Trade Commission and Department of Justice. Leahy told CQ Politics that the bill would make the insurance industry more competitive, and possibly drive down costs.

The bill would take away the exemption in cases where the insurers had committed serious violations of antitrust law, such as big rigging and price fixing. However, it would leave states' ability regulate insurance companies in place.

To learn more about this bill, read this Kaiser Health News piece.

[ via Anne Zieger, Fierce Healthcare ]