Affordable Care Act’s benefits for

hospitals aren’t yet clear

Modern Healthcare Hospitals in states that have expanded Medicaid eligibility for low-income adults are seeing a sharp drop in the amount of charity care they’re providing and an increase in admissions. But the uptick in high-deductible plans across the country means they’re seeing higher-acuity patients and losing out to retail clinics and other lower-cost providers for less complex care, a new report found. By the end of 2014, charity care in Medicaid expansion states had fallen to 1.7% of revenue, down from the national average of 3.2% in 2013.

~SDADVS ~ Legislative Report March 1st—March 31st 2015

Mental Health Liaison Groups

Support Eliminating Medicare’s

190-Day Limit

The 40 national mental health organizations that form the Mental Health Liaison Group have sent a letter to the White House support-ing the elimination of the Medicare 190-day lifetime limit on inpatient psychiatric hospital care, which is part of President Obama’s 2016 budget proposal. The group sent a similar let-ter to the House and Senate budget commit-tees, urging elimination of the limit as a way to “equalize Medicare mental health coverage with private health insurance coverage, offer beneficiaries the choice of inpatient psychiatric care providers, increase access for the most seriously ill, improve continuity of care and create a more cost-effective Medicare program.”

Stakeholders Invited to Join Health Care Payment Learning and Action Network

In support of its goals for shifting more Medicare fee-for-service payments into alternative payment models and performance-based payments, the U.S. Department of Health and Human Services (HHS) has launched the Health Care Payment Learning and Action Network. The network is intended to help advance the work underway across sectors to increase the adoption of such care models in both the private and public sector. It will include a diverse set of stakeholders and will serve as a convening body to facilitate joint im-plementation and the sharing of best practices of new models of payment and care delivery; develop com-mon approaches to issues such as beneficiary attribution, financial modeling, benchmarking and perfor-mance indicators; and develop and share implementation guides for payers, purchasers, providers and consumers.

Study Shows Hospital Outpatient Departments Treat Sicker Patients

A study released by the American Hos-pital Association (AHA) reveals that hospital outpatient departments (HOPDs) more often treat sicker and poorer patients than do physician offic-es. The study supports AHA’s position against proposals for Medicare to pay for hospital care at the same rates as physician offices. Prepared by KNG Health Consulting, the study also shows that patients treated in HOPDs are more likely to be uninsured or cov-ered by Medicaid, come from communi-ties with lower incomes and higher pov-erty rates, and have more severe chronic conditions than those treated in physician offices. “The needs of pa-tients cared for in hospitals are different from those seen at physician offices; treating them like they are the same does not make sense,” said AHA Presi-dent and CEO Rich Umbdenstock.

Senate Legislation Would Expand Medicaid Emer-gency Psychiatric Demon-stration Project

Two U.S. senators have introduced legislation to extend the Medicaid Emergency Psychiatric Demonstration project now underway in 11 states and the District of Columbia. Initiated in 2012 under the Affordable Care Act, the demonstration was established to test whether Medicaid programs can support higher quality care at a lower total cost by reimbursing private psychi-atric hospitals for services for which Medicaid reimbursement has historical-ly been unavailable.

The Improving Access to Emergency Psychiatric Care Act of 2015 (S.599) would extend the demonstration until the Secretary of Health and Human Services (HHS) submits recommenda-tions to Congress based on the final evaluation or Sept. 30, 2016, whichever occurs first. HHS would also have the option to recommend extending the demonstration project for an additional three years and/or expanding it to in-clude other states.

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Health officials would add $2 tax to packs of cigarettes in California

Los Angeles Times

After seven failed attempts since 2002, a coalition of health groups and lawmakers is once again pro-posing to increase the tobacco tax in California, arguing that an additional $2 per pack of cigarettes will save lives, in part, by discouraging people from smoking. Sen. Richard Pan (D-Sacramento), a physician, introduced the latest proposal, which would generate $1.4 billion a year to fund smoking prevention, research into smoking-related diseases and expanded treatment services for Medi-Cal patients.

Physicians’ ICD-10 Fears ‘Unfounded,’ Says AHIMA

Health Leaders Media The call by 100 physicians’ socie-ties across the nation for a backup plan if snafus snarl the scheduled ICD-10 rollout in eight months sug-gests that doctors are reconciled to the Oct. 1 start for the diagnostic coding set, the leader of one health information technology trade group says.

The American Medical Association and 99 state and specialty socie-ties, in a March 4 letter to Centers for Medicare & Medicaid Services Acting Administrator Andrew Slavitt, express concerns that no contingency plans are in place to avoid failures that could result “in a significant, multi-billion dollar disruption for physicians and serious access-to-care issues for Medicare patients.”

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CMS Finds Hospital Quality Improvement in

2015

Impact Report

The Centers for Medicare & Medicaid Services (CMS) this week released the 2015 National Impact Assessment of Quality Measures Report, which outlines hospitals’ performance and improvements on federal quality measures. The report concludes that clear progress has been

made in improving the health care delivery system to achieve the triple aim of bet-ter care, smarter spending and healthier people. Among the report’s key findings, CMS found 95 percent of publicly reported measures showed improvement, with 35 percent classified as high performing.

CMS also found that racial and ethnic disparities in pub-licly reported measures de-clined during the study period.

CMS estimates that 7,000 to 10,000 lives were saved between 2006 and 2012 because of pro-viders’ improved performance on inpatient hospital heart failure process measures, and 4,000 to 7,000 infections were averted through improved performance on inpatient hospital surgical process measures.

New legislation would strengthen hospitals’ ability to meet community health needs Assembly member Matt Dababneh (D-Encino) has introduced legislation to provide greater transparency and con-sistency in the reporting and disclo-sure of investments made by nonprofit hospitals to strengthen the health and well-being of the communities they serve. Sponsored by CHA, AB 1046 amends California law so nonprofit hospitals’ community benefit reports will be more accessible to the public. The reports include a hospital’s in-house investments, highlight hospital partnerships with local nonprofits and clinics, and account for costs — above state-funded reim-bursements — to care for patients enrolled in Medi-Cal. The bill would also align federal and state community benefits laws, streamlining administrative mandates so that hospitals can focus on addressing local health care needs. Every year, Califor-nia hospitals provide more than $13 billion in uncom-pensated health care services.

“For more than 20 years, California’s nonprofit hospitals have led the nation in ensuring that vulnerable popula-tions have access to vital health care services and wellness programs in local communities throughout the state.”

U.S. faces 90,000 doctor shortage by 2025, medical school association warns

The Washington Post The United States faces a shortage of as many as 90,000 physicians by 2025, including a critical need for specialists to treat an aging population that will increasingly live with chronic disease, the associa-tion that represents medical schools and teaching hospitals reported Tuesday.

The nation’s shortage of primary care physicians has received considerable attention in recent years, but the Association of American Medical Colleges report predicts that the greatest shortfall, on a per-centage basis, will be in the demand for surgeons — especially those who treat diseases more com-mon to older people, such as cancer.

CHA Urges CMS to Continue Non-Enforcement of Two-Midnight Rule

Current enforcement set to begin April 1 CHA sent the attached letter to Deputy Administrator Sean Cavanaugh of the Centers for Medi-care & Medicaid Services (CMS), advocating for a number of regula-tory priorities ahead of the agency’s annual rulemaking cycle for Medi-care payment regulations. CHA urg-es CMS to consider a number of issues surrounding the two-midnight policy, including the continuation of non-enforcement until at least Oct. 1, and excluding critical access hos-pitals and inpatient psychiatric facili-ties (IPF) paid under the Medicare IPF prospective payment system from this policy. CHA also urges CMS to undertake comprehensive reform of the Recovery Audit Con-tractors program, noting that while recent changes have been a step in the right direction, additional re-forms are necessary. In addition, CHA cautions CMS on congression-al efforts to dismantle the current area wage index system by chang-ing some provisions and not others — specifically, changes in the appli-cation of budget neutrality to the rural floor. Finally, CHA urges CMS

to move forward with the Oct. 1 implementation date for ICD-10.

Obama wants $1.2

billion to battle

bacteria

USA Today President Obama says he has a plan to combat the growing problem of antibi-otic-resistant bacterial in-fections responsible for an estimated 23,000 deaths and two million illnesses in the United States every year. His administration is proposing a series of measures to crack down on over-prescribing, develop new alternative medicines and track infection out-breaks in real time.

Bi-Partisan Legislation for Risk-Adjustment in

Re-admissions Program Introduced in Senate and House Hospitals encouraged to contact representatives in sup-

port

CHA-supported legislation has been introduced in the U.S. Senate and House of Representatives to reform the Affordable Care Act’s Hospital Readmissions Reduction Program so that hospitals serving low-income populations are eval-uated and reimbursed fairly. The Establishing Beneficiary Equity in the Hospi-tal Readmission Program Act (S. 688/H.R. 1343), introduced by a bipartisan group of senators and representatives, would require the Centers for Medicare & Medicaid Services (CMS) to account for patient socioeconomic status when calculating the risk-adjusted readmissions penalties. In addition, the bill would require CMS to use the findings of reports required by the Improving Medicare Post-Acute Care Transformation Act to establish a risk adjustment measure that ensures hospitals serving a greater number of low-income individuals will not be unfairly penalized. CHA encourages members to contact their repre-

sentatives in support of the bill. A one-page summary of the bill is attached.

My Patient Doesn’t ‘Do’ Vaccines

The New York Times The visit started out ordinary enough: a new patient, a healthy man in his late 30s who hadn’t seen a doctor in years. When we got to preventive health, I recommended the flu shot. He politely declined. “I don’t do vac-cines,” he said.

I glanced at the clock, debating wheth-er or not I should wade into those wa-ters. Given that we are knee-deep in flu season, the flu-shot conversation comes up at every single visit every single day, and it can be exhausting.

For those who decline vaccines on principle, I’ve learned from experience that they are unlikely to change their minds no matter what I say. So rather than expend our limited time on this, I simply note their concerns in the chart and move on to other things.

Population Health Management Series April-Oct

National Volunteer Week April 12-18

Hospital Employee Health & Safety Seminar March 24 &

April 2

California Congressional Action Program May 3-6

Upcoming Events

Fran Waller MS

Director of Community Engagement, Outreach & Volunteer Development

Palomar Health

2015 SDADVS Legislative Chair

HQI Seeks Hospital Partners for Next Hospital Engagement Network RFP

The Centers for Medicare & Medicaid Services has posted a request for proposals (RFP) for Hospital Engagement Network (HEN 2.0) contracts through the Partnership for Patients initiative. The Hospital Quality Institute (HQI) intends to respond to the RFP to build on the success of CalHEN 1.0.

HQI needs hospitals’ help in completing a successful proposal by engaging for an additional year in the campaign to advance safer care. HQI requests that

~ SDADVS ~ Legislative Report April 1st—April 30th

House GOP Releases FY 2016 Budget Plan

House Budget Committee Chairman Tom Price (R-

GA) today released a federal fiscal year 2016

budget plan that would overhaul Medicare and fully

repeal the Affordable Care Act (ACA).

The proposed budget would turn Medicare into a

voucher program for anyone 56 years or younger,

as previously proposed by former chairman Rep.

Paul Ryan (R-WI), beginning in 2024. The budget

would repeal the ACA’s Medicaid expansion and

provide a block grant to states for the Medicaid

program, resulting in a cut of $913 billion over 10

years. The budget, which includes $5.5 trillion in

cuts in total over 10 years, does not carry the force

of law if passed, but passage would allow for a

procedural process known as reconciliation.

Reconciliation would allow Congress to approve

other bills with a simple majority vote, avoiding

Democratic filibusters in the Senate. The Senate

Budget Committee is expected to release its own

budget plan tomorrow

CHA Sends Letter in Support of Readmissions Risk-Adjustment Legislation

CHA sent the attached letter today supporting the Establishing Beneficiary Equity in the Hospital Read-mission Program Act (H.R. 1343) to the California congressional delegation. The bill, introduced last week with companion legislation in the Senate (S. 688), would adjust the Medicare Hospital Readmis-sions Reduction Program to account for certain socioeconomic and health factors that can increase the risk of a patient’s readmission. California’s hospitals are committed to reducing preventable readmis-sions. This legislation will address some of the limitations of the current readmissions measures and provide an opportunity to more accurately describe quality of care. CHA encourages hospitals to use the attached letter as a resource for their communications to Congress in support of the legislation.

Health Law Brings No

Drop In Insurance

Enrollment At Work,

Study Finds

Kaiser Health News There has been much hand wring-ing over the health law requirement that large employers this year offer insurance to workers who put in 30 or more hours a week or face

penalties for not doing so. The new rules would cost employers a bun-dle, some fretted, as part-timers clamored for company coverage previously unavailable to them.

Others worried that employers would cut workers’ hours to get un-der the cap.

A new study found that so far there’s little cause for concern: Av-erage enrollment in company plans was essentially unchanged between 2014 and 2015 at 74 percent of all workers.

Despite A Wave Of Data Breaches, Fed Says Patient Privacy Isn’t Dead

National Public Radio It’s hard to keep track of even the biggest health data breaches, given how frequently they seem to be happening.

Just Tuesday, health insurer Premera Blue Cross disclosed that hackers broke into its system and may have accessed the financial and medical records of some 11 million people. Premera’s announcement comes weeks after another health insurer, Anthem Inc., announced that it too had been hacked — and that the records of nearly 80 million people were exposed.

Deadline for Medicare EHR Incentive Program Hardship Exception Approaching

Hardship exception applications due April 1 CHA reminds hospitals that payment adjustments will begin Oct. 1 for eligible hospitals that did not successfully participate in the Medicare Electronic Health Record (EHR) Incentive Program in 2014. Eligible hospitals can avoid the 2016 payment adjustment by applying for a 2016 hardship exception by April 1 at 8:59 p.m. (PT). To file a hardship exception, Medicare-eligible hospitals must:

Show proof of a circumstance beyond the hospital’s control; and

Explicitly outline how the circumstance significantly impaired the

hospital’s ability to meet meaningful use.

Supporting documentation must also be provided. The Centers for Medicare & Medicaid Services will review applications to determine whether or not a hardship exception should be granted. The hardship exception application and instructions for Medicare-eligible hospitals are available on the EHR Incentive Programs website.

Health Workforce Diversity Grants

Available

The Department of Health and Human Services Office of the Assistant Secretary of Health is accepting applications through May 18 for its National Work-force Diversity Pipeline Program Grant. With approximately $2.5 million in funding, the program seeks to address health dispari-ties among racial and ethnic minorities by supporting net-works of institutions focused on increasing minority and disad-vantaged students’ awareness and pursuit of careers in health care and behavioral health. Eli-gible applicants include hospi-tals, state and local govern-ments, and universities, among others. Eight grants will be awarded, ranging from $350,000 to $500,000 per year for up to five years. For more information, visit www.grants.gov/view-opportunity.html?oppId=275242.

Five Years of California Health

Reform: ‘A Tremendous

Designed Experiment’

California Healthline Nadereh Pourat, director of re-search at the UCLA Center for Health Policy Research, gives an involuntary gasp when she’s asked where California’s health care system would be without the reforms and changes of the past five years. “It’s not fathom-able,” Pourat said. “I don’t know where we would be right now. California has made tremendous progress. It’s staggering what has happened in five years.” The state has launched the

Covered California health bene-fit exchange, which has helped enroll 1.4 million into coverage.

California Continues to Face One of Most Severe Droughts on Record

Last week, Gov. Brown announced new emergency drought legislation, calling on all Californians to reduce their water use by 20 percent and prevent water waste. To further strengthen water conservation, the Water Resources Control Board voted last week to ex-pand and extend an emergency regulation to prohibit certain water use, such as washing down sidewalks, and create a minimum standard for outdoor irrigation restrictions by urban water suppliers. Hospitals are encouraged to continue to conserve water where ap-propriate, such as in outdoor landscaping areas.

CHA will continue to monitor the state’s drought response for any impacts to hospital operations and patient care services. For more information about the drought and opportunities for conserving water,

visit www.calhospitalprepare.org/2015-drought.

New Requirement for Pharmacy Labels Begins

April 1

Effective April 1, pharmacies must print patient-oriented prescrip-tion labels in a minimum 12-point sans serif font size (previously, a minimum 10-point font was required). The new requirement follows the Jan. 9 Board of Pharmacy rulemaking to amend Title 16 Cali-fornia Code of Regulations Section 1707.5. CHA encourages phar-macies to ensure their prescription container labels comply with the new font size requirement.

National Volunteer Week April 12-18

Hospital Employee Health & Safety Seminar March 24 & April 2

California Congressional Action Program May 3-6

Upcoming Events

Fran Waller MS

Director of Community Engagement, Outreach & Volunteer Development

Palomar Health

2015 SDADVS Legislative Chair