MHA's Executive Briefing

Legislation Would Stop Cuts to Disproportionate Share Payments

Rep. Ann Marie Buerkle (R-N.Y.) has introduced legislation that would repeal a section of the federal healthcare reform law that cuts Medicare disproportionate share hospital payments. Read more from Becker's Hospital Review here.

Better Patient Flow in the ED

As health care transitions to a performance-based payment model, the importance of efficient patient flow has never been greater. In particular, the Door-to-Doc ED model can play a major role in reducing waits and enabling hospitals to provide a consistently high level of care.

Read more from H&HN Magazine here.

AHA comments on CMS’ proposed regulatory relief rule

The American Hospital Association appreciates the Centers for Medicare & Medicaid Services’ proposal to amend several Medicare and Medicaid rules to promote efficiency and transparency and reduce administrative burden, but is concerned with two of its recommendations related to ambulatory surgical centers, the association said in comments submitted Dec. 22. Specifically, AHA said the proposed rule should retain the list of emergency equipment ASCs must have to protect the safety of patients, and should continue to require ASCs to report infection control problems to the appropriate authorities.

The proposed rule implements elements of the Department of Health and Human Services’ preliminary plan for review of regulations, in accordance with the president’s Jan. 18 executive order. In its comments, the AHA reiterated its additional recommendations for regulatory relief as specified in June.

“We acknowledge that some progress has been made on a few of these recommendations,” AHA said, noting the proposed overhaul of the hospital conditions of participation and the one-year postponement of Stage 2 meaningful use requirements for electronic health records. “But substantially more needs to be done, and it would be helpful to know CMS’ plans with respect to all these recommendations and those of others who commented this summer.”

House and Senate Pass Two-Month Physician Fix: No Cuts to Hospitals Included

The House and Senate on Dec. 23 gave final approval to a two-month extension of the Social Security (SS) payroll tax holiday and emergency unemployment insurance (UI) benefits, along with a two-month extension of the current Medicare physician payment rates, thereby preventing a 27.4% cut to Medicare physician payments that was scheduled to take effect Jan. 1. The bill also includes extensions of the so-called health care “extenders” due to expire this year for an additional two months. The president is expected to sign the bill into law shortly.

Congress ultimately rejected a number of payment reduction options to hospitals to fund the legislation, including those passed by the House in H.R. 3630. This was in large part due to the grassroots efforts of hospital leaders throughout the country. Reports from Capitol Hill indicated that legislators were hearing from their hospital constituents, and that those contacts made the difference.

This development means that, while we avoided new payment reductions in the short term, we will be back debating these same issues early next year. The extensions will expire Feb. 29, so there will once again be pressure to identify offsets to finance the SS tax holiday, emergency UI benefits, and physician payment fix. Consequently, we will need to remain vigilant against unwarranted cuts in payments for hospital services as we begin the new year and the Second Session of the 112th Congress convenes.

During the negotiations – and earlier in the bill passed by the House – issues of serious concern to hospitals remained in play, including:

• Reductions in bad debt payments to hospitals for Medicare beneficiaries;
• Reductions in payments for evaluation and management services provided in hospital outpatient departments;
• Extending the current cap on therapy services – and the exceptions process to it – to those services provided in hospital outpatient departments (this currently applies only to services provided in nursing homes and other freestanding settings);
• Significantly weakening the prohibition on the establishment of new physician-owned specialty hospitals, and relaxing the restrictions for growth on those that exist; and
• Providing the Centers for Medicare & Medicaid Services with new authority to make additional across-the-board cuts to Medicare inpatient hospital rates through the use of retrospective coding adjustments for fiscal years 2010 and 2011.

All of these critical issues will again be on the table when Congress returns in January, facing a new deadline for action by the end of February. The American Hospital Association and Missisisppi Hospital Association staff will immediately begin to develop our advocacy strategy for the next stage of this process. We will be back in touch with you after the holidays to again make sure that our voices are heard on behalf of the patients and communities we serve.

 

No objections filed to new congressional redistricting

No one filed objections to new congressional districts drawn by federal judges by a last week's deadline, which could clear the way for judges to ratify the districts following a Dec. 28th hearing. Read the full story from the Mississippi Business Journal here.

NLRB issues final rule on union elections; Chamber/CDW sue

The National Labor Relations Board on Dec. 21 issued for publication in the Dec. 22 Federal Register a final rule amending its rules and regulations for filing and processing petitions for union representation. The rule takes effect on April 30.

On Dec. 20, the U.S. Chamber of Commerce’s National Chamber Litigation Center and the Coalition for a Democratic Workplace filed a federal lawsuit claiming the final rule violates the National Labor Relations Act, Administrative Procedure Act, Regulatory Flexibility Act, and free speech and due process constitutional rights. According to the NCLC, “The rule drastically speeds up the election process, depriving employers of a fair opportunity to explain to employees the costs of unionizing and curbing employers’ opportunities to bring legal challenges to proposed representation elections.”

The American Hospital Association, a member of CDW, is reviewing the rule and will have more information for members in January. In November, the NLRB voted to include in the rule provisions giving the hearing officer authority to limit the pre-election hearing to matters relevant to the question of whether an election should be held and to decide whether to permit briefing of pre-election issues; end the practice of delaying the scheduling of elections to permit time for a pre-election appeal; consolidate pre- and post-hearing appeals into a single post-election procedure and eliminate appeals of issues that become moot because of the election result; and give the Board discretion to hear and decide any appeals to the election process.

Report seeks fixes for primary-care shortages

The Patient Protection and Affordable Care Act included measures to boost the primary-care workforce, but according to a new report, more needs to be done to address looming shortages in the near future—such as relaxing scope-of-practice laws and enacting payment reforms. Read more from Modern Physician here.

House rejects consideration of Senate compromise on H.R. 3630

The U.S. House of Representatives on Dec. 20 voted 229-193 to reject consideration of bipartisan Senate amendments to the Middle Class Tax Relief and Job Creation Act (H.R. 3630) and request a conference with the Senate on the legislation. In a statement, Senate Majority Leader Harry Reid said the chamber would not negotiate until the House passes the compromise measure.

Passed by the Senate on Dec. 18, the compromise bill would extend current Medicare physician payment rates for two months to prevent a 27.4% cut effective Jan. 1 without cutting hospital payments. It also includes several American Hospital Association-supported rural Medicare "extenders."

The House-passed bill, strongly opposed by the AHA, would offset the cost of a two-year physician pay fix by cutting hospital payments by nearly $20 billion.

HFMA: Ways to improve patient collections

Hospitals must sharpen their skills - both technologically and socially - in order to improve their patient collections rate, according to a presentation at last week's Healthcare Finance Management Association (HFMA) virtual conference. Learn more here.

Demand for health IT professionals continues to rise

There is a significant demand for health IT professionals with medical experience, says a new report from MedZilla.com, a job site specializing in healthcare and life sciences. MedZilla estimates that 50,000 new health IT-related jobs have been created since the passage of the HITECH Act in 2009, which authorizes billions of dollars in incentives for showing Meaningful Use of electronic health records.

Learn more here.