MHA's Executive Briefing

AHA urges caution on SNF 'parity adjustment'

The American Hospital Association on June 27 urged the Centers for Medicare & Medicaid Services to conduct a more thorough analysis of its proposed recalibration of the "parity adjustment," the mechanism used by CMS to implement October 2010 refinements to the skilled nursing facility prospective payment system in a budget neutral manner. "Given the scope and complexity of these changes, we urge CMS to move slowly in implementing the recalibrated parity adjustment and encourage the agency to phase in this provision," AHA said in comments on the fiscal year 2012 proposed SNF PPS rule.

AHA also encouraged the agency to revise its group therapy proposal by setting a cap on the number of patients eligible for group therapy "rather than limiting this modality to one group size." AHA also expressed support for CMS' proposals to allocate group therapy minutes and to clarify the guidelines on how SNF therapy minutes are reported to CMS for the purpose of setting per diem payment amounts.

Bill to prevent drug shortages introduced in House

Reps. Diana DeGette (D-CO) and Tom Rooney (R-FL) on June 21 introduced a House companion to the Preserving Access to Life-Saving Medications Act (H.R. 2245), American Hospital Association-supported legislation that would give the U.S. Food and Drug Administration tools to better manage drug shortages and prevent them in the future.

"The number of drugs in critically short supply is increasing at an alarming rate and threatens quality of care in hospitals and clinics nationwide," the AHA said in a letter of support. "Many of these drugs play a critical role in life-saving treatments, including cancer therapies, widely used anesthetics, antimicrobials and pain medications. In many cases, therapeutic alternatives are not available or carry increased risk of severe side effects and drug-to-drug interactions. The potential harm to patient safety is of paramount concern."

Sens. Amy Klobuchar (D-MN) and Bob Casey (D-PA) introduced the Senate bill (S. 296) in February.

Rule would expand employers' disclosures about union organizing communications

The Department of Labor on June 21 published a proposed rule that would expand the obligations of employers and labor relations consultants to disclose any agreements or arrangements to persuade employees about the right to organize and bargain collectively. By defining "advice" exclusively as "an oral or written recommendation regarding a decision or a course of conduct," the proposal would narrow significantly the range of activities exempt from reporting under the rule.

Only when a consultant exclusively counsels employers on what they may lawfully say to their employees, ensures compliance with the law, or provides guidance on National Labor Relations Board practice or precedent would reporting not be required. However, reporting would be required for a wide range of activities, the direct or indirect object of which is to persuade employees, including a consultant's preparation or provision of a persuasive script, letter, videotape or other material for use by an employer in communicating with employees, or a consultant's revision of the employer's material or communications to enhance persuasiveness.

"The definition of what triggers reporting in the proposed rule is so confusingly broad that it could include the American Hospital Association's distributing general information and other resources to help our hospital members educate their boards, managers and employees about union organizing," said AHA Assistant General Counsel Lawrence Hughes. DOL will accept comments on the proposed rule until Aug. 22.

NLRB proposes process to speed up union elections

The National Labor Relations Board on June 22 published a proposed rule that would change the process for filing and processing petitions for union representation of employees, essentially speeding up the time between filing a petition and holding an election. The proposed rule would defer resolution of most voter eligibility questions until after the election, consolidate all election-related appeals into a single post-election process, and make board review of post-election decisions discretionary rather than mandatory, among other changes.

"With the demise of the Employee Free Choice Act in Congress, the NLRB seems determined to create an environment that would favor unions, rushing ahead to hold elections without ensuring that employees have enough information to make informed choices," said American Hospital Association President and CEO Rich Umbdenstock. The AHA plans to comment on the proposed rule by the Aug. 22 deadline.

The NLRB indicates that it will hold a public hearing in Washington, D.C., on July 18-19, to get feedback from interested parties on the proposed amendments and other Board case handling procedures.

AHA urges changes to IRF PPS proposed rule

The Centers for Medicare & Medicaid Services should consider only quality measures tested for use in the inpatient rehabilitation facilities as it establishes an IRF quality reporting program, the American Hospital Association said in comments submitted to the agency June 21. In the IRF prospective payment system proposed rule for fiscal year 2012, CMS proposes two new quality measures (catheter-associated urinary tract infections and pressure ulcers) for IRFs to report beginning in October 2012, as required by the Patient Protection and Affordable Care Act.

The AHA urged CMS to refine the proposed measures for use specifically in IRFs and to seek National Quality Forum endorsement through an IRF steering committee. In addition, AHA asked CMS to clarify how it calculates proposed changes to facility-level adjustments for IRFs and urged the agency to release the full set of data needed to model the facility adjustments proposal.

Study shows real-world impact of proposed spending caps

As Congress considers ways to cut federal spending, the American Hospital Association, AARP, American Medical Association, American College of Cardiology, and LeadingAge on June 22 released a study showing the real-world impact of across-the-board cuts on the elderly, children and low-income families. The Lewin Group analysis found that the Commitment to American Prosperity Act, one of many proposals calling for arbitrary spending caps or targets, would cut $4.2 trillion from federal spending between 2013 and 2021, including $859 billion from Medicare and $575 billion in federal Medicaid payments to states.

Among other impacts, such cuts could force most hospitals into the red, physicians out of the Medicare program, 5.1 million people to lose their health insurance, and 1.3 million health care workers to lose their jobs, the study found. "Arbitrary caps that don't take into account the growing health care needs of our aging population are bad news for the patients and communities hospitals serve," said AHA President and CEO Rich Umbdenstock.

In a letter, the groups urged Congress "to reject formulations that include arbitrary spending caps and across-the-board spending triggers that do not adjust to demographic changes or the needs of vulnerable populations."

AHA Regulatory Advisory: Medicaid Non-Payment for HACs Final Rule

On June 6, the Centers for Medicare & Medicaid Services (CMS) issued a final rule outlining its planned implementation of non-payment for Medicaid healthcare-associated conditions (HCAC). The final rule is available here.

The rule implements Section 2702 of the Patient Protection and Affordable Care Act (ACA) of 2010, which prohibits federal payments to state Medicaid programs for the costs associated with HCACs. In addition, the law allows states to identify other conditions for which they may deny provider payments. States must ensure that any non-payment rules they put into effect do not result in a loss of access to care or services for Medicaid beneficiaries.

The rule requires providers to self-report the occurrence of HCACs through their existing claims systems. While the rule's requirements will take effect July 1, 2011, as required by the statute, CMS intends to delay compliance action on the provision until July 1, 2012.

The American Hospital Association has published a detailed summary of the final rule. The summary was prepared for the AHA by Health Policy Alternatives, Inc. If you are a member of MHA and would like a copy of the advisory, please email Shawn Rossi at srossi@mhanet.org.

AHA shares views on deficit-reduction plans with Congress

The American Hospital Association strongly opposes efforts to further cut Medicare and Medicaid payments for hospital services, the AHA said in a statement submitted to the Senate Finance Committee for a hearing June 23 on health care entitlement programs. “The deficit-reduction plans offered thus far fail to consider an important reality: America’s hospitals already are absorbing $155 billion in payment reductions,” AHA wrote.

Any additional cuts to hospitals “could negatively impact patient care: services eliminated; longer waits for care; emergency departments shut down; and staffing reduced,” the association said. President Obama has appointed Vice President Biden to lead a group of House and Senate lawmakers to develop a deficit reduction package, which could draw from a menu of options proposed by others.

Many of those proposals include arbitrary spending caps or targets that would result in across-the-board cuts to health care. “We oppose the use of a trigger that could impede patients’ access to care and further exacerbate the ‘cost-shift,’ which would increase health care costs to employers and other purchasers of private coverage,” AHA told the committee.

Bill would reauthorize H-1C visa program

The House Judiciary Committee on June 23 approved a bill (H.R. 1933) that would reauthorize the H-1C temporary visa program for three years, allowing up to 300 foreign nurses per year to come to the U.S. to work in health professional shortage areas. The program, which expired in 2009, originally provided visas to up to 500 nurses per year.

To participate in the visa program, hospitals must have at least 190 acute care beds, be located in federally designated areas with health care worker shortages, and meet thresholds on Medicare and Medicaid activity, which has limited the number of hospital participants to about 14. The American Hospital Association supports reauthorization of the H-1C program.

Multi-Generational Leadership: How to Bridge Gaps in Age and Understanding

A new generation is formed every 20 years, marked by differences in beliefs, attitudes and behaviors from the generation before them, according to the generationalist theory. There are currently four generations in the American workplace: Traditionalists, Baby Boomers, Generation X and Millennials. Each is distinct, and healthcare workplaces will fare well if leaders appreciate each generation's strengths and weaknesses and work to diminish age-related misunderstandings.

Terrence Cahill, EdD, FACHE, and Mona Sedrak, PhD, PA-C, are professors at Seton Hall University School of Health and Medical Sciences in South Orange, N.J., and have studied generational diversity extensively. They recommend healthcare leaders disregard one-size-fits-all management approaches and be flexible in how they approach older and younger employees.

Here are profiles on the four generations currently in the workforce, along with specific management topics that may require a multi-generational approach in management.