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CDC brief highlights unique needs of rural hospital patients   04/23/2014
Inpatients at rural hospitals are more likely to be over age 65 and on Medicare than those in urban hospitals, according to a new report by the National Center for Health Statistics at the Centers for Disease Control and Prevention. Rural inpatients also are less likely than their urban counterparts to have procedures performed during their hospitalization, possibly due to a shortage of specialty physicians in rural areas, and are more likely to be discharged to other short-term hospitals or long-term care facilities, the report states. Inpatients at urban hospitals are more likely to be covered under Medicaid than those in rural hospitals, based on 2010 data from the CDC’s National Hospital Discharge Survey. About 12% of U.S. hospitalizations are in rural hospitals, the report notes. Congress this month extended the Medicare-dependent Hospital Program, low-volume adjustment and ambulance add-on payment for rural hospitals until April 2015 as part of legislation to stave off scheduled cuts to Medicare physician payments. AHA advocated for the provisions and continues to urge Congress to remove a 96-hour physician certification requirement for critical access hospitals, and to suspend enforcement of the direct supervision policy for outpatient therapeutic services furnished in CAHs and small rural hospitals.
CDC studies highlight American Indian/Alaska Native health disparities   04/23/2014
The overall death rate for American Indians and Alaska Natives was 46% higher than for non-Hispanic whites between 1999 and 2009, according to a new study by the Centers for Disease Control and Prevention. The authors linked U.S. National Death Index records with Indian Health Services registration records to more accurately identify AI/AN deaths, focusing on the IHS Contract Health Service Delivery Area. Cancer was the leading cause of AI/AB deaths, followed by heart disease. Regional death rates for AI/AN people varied as much as 50%, with the lowest rates in the East and Southwest and highest in the Northern and Southern Plains. Part of a series of CDC reports on AI/AN health trends published online by the American Journal of Public Health, the study concludes that the mortality patterns are strongly influenced by high rates of diabetes, smoking, problem drinking and health-harming social determinants. “Having more accurate data along with our understanding of the contributing social factors can lead to more aggressive public health interventions that we know can make a difference,” said IHS Acting Director Yvette Roubideaux, M.D.
Moody's: Hospital expenses continue to outpace revenues   04/23/2014
Expense growth continued to outpace revenue growth in the not-for-profit hospital sector in fiscal year 2013, leading to lower operating and cash flow margins for the second year in a row, according a report released today by Moody’s Investors Service. “Factors leading to the decline in performance include low rate increases from commercial payers and rate cuts from Medicare and Medicaid,” said Moody’s Analyst Jennifer Ewing. “There has also been a shift in the mix of payers to more governmental ones from commercial ones.” Also contributing to the decline is an increase in high-deductible health plans, which leave patients with larger bills and hospitals with more bad debt; and a shift from inpatient admissions to lower reimbursed outpatient visits and observation stays, the report states. The preliminary financial ratio medians are based on FY 2013 audited financial statements from about 45% of Moody’s rated portfolio of 448 nonprofit hospitals and health systems. “We expect the final medians to show weaker operating performance than the preliminary medians due to the inclusion of more hospitals with calendar year-end audits after Sept. 30, 2013 as well as hospitals concentrated in geographic regions with weaker economies,” Moody’s said.
Appeals court denies request to review FTC challenge of hospital merger   04/22/2014
The 6th Circuit Court of Appeals today denied ProMedica’s request to review a Federal Trade Commission decision ordering it to divest an Ohio hospital that merged with the health system in 2010. “We are extremely disappointed by today’s decision and intend to appeal,” ProMedica said in a statement. “We are committed to exhausting all of our legal options. As we continue this legal journey, we would like to emphasize that St. Luke’s Hospital remains a member of ProMedica, continues to serve patients, and all health plans currently accepted at St. Luke’s will continue to be accepted.” In a friend-of-the-court brief filed in 2012, AHA urged the court to consider three trends that are changing the health care landscape – reimbursement reductions and changes, electronic health records and limited access to capital – as “proper indicators of future ability to compete” when determining whether, absent a merger, an acquired hospital can constitute a meaningful competitive force.
Report calls for incentives to spur high-value medical technologies   04/22/2014
A report released today by RAND Corp. proposes policy options to reduce health care spending by creating incentives for the development and use of high-value medical technologies. Among other policies, the report calls for more creativity in funding basic science; offering prizes for drug or device inventions that satisfy pre-specified performance criteria; purchasing patents on products that could decrease spending but are financially unattractive to inventors and investors; establishing a public-interest investment fund for products that reduce spending; and expediting Food and Drug Administration reviews and approvals for medical products that are expected to substantially reduce spending. Among other options, the report proposes that Medicare payment and coverage policies encourage technologies that decrease spending, and calls for more and timelier assessments of the cost effectiveness of drugs, devices and procedures.
Study: Initiative improves treatment time, outcomes for stroke patients   04/22/2014
More than 1,000 hospitals participating in a national initiative launched in 2010 to reduce door-to-needle times for intravenous tissue plasminogen activator (tPA) in patients with acute ischemic stroke also reduced in-hospital death and intracranial bleeding and increased the portion of patients discharged to their home, according to a study in the April 23/30 issue of JAMA, a neurology theme issue. National guidelines recommend that hospitals begin intravenous tPA therapy for eligible patients within 60 minutes of hospital arrival. Participants in the American Heart Association/American Stroke Association initiative received strategies, protocols, screening tools and other resources to help hospitals and clinicians improve door-to-needle times. The average door-to-needle time fell to 67 minutes from 77 minutes between January 2010 and September 2013, while tPA administration of 60 minutes or less increased to 53% from 30%. “These findings further reinforce the importance and clinical benefits of more rapid administration of intravenous tPA,” the authors said.
AHA Workforce Center extends survey on interdisciplinary care teams   04/21/2014
The AHA Workforce Center is surveying hospital CEOs to learn more about how their organizations are training and implementing interdisciplinary care teams. Results will be compared with 2013 baseline data and used to inform AHA workforce strategies as they relate to new care delivery models. A link to the online survey was emailed to all hospital CEOs April 2 and will be active until May 2. For more information, contact Veronika Riley at vriley@aha.org.
AHA urges CMS to revise proposed consumer assister requirements   04/21/2014
AHA today expressed concern with the Centers for Medicare & Medicaid Services’ proposed new requirements for consumer assistance entities beginning in 2015 under the Affordable Care Act, which would establish Civil Money Penalties for any breach of federal rules by any party. “The establishment of CMPs is an extreme response when applied to all applicable federal rules, especially when other compliance enforcement mechanisms already exist,” wrote Linda Fishman, AHA senior vice president of public policy analysis and development. “The AHA believes applying CMPs to individual and institutional assisters, especially voluntary [Certified Application Counselors], would have a chilling effect on some hospitals continuing to serve in that role.” Fishman urged CMS “to reconsider application of CMPs to voluntary assisters, and limit CMPs in general to egregious violations of selected requirements in which there are no other enforcement mechanisms already in place.” The letter also suggests improvements to the proposed rule’s standards for the Transitional Reinsurance Program and Temporary Risk Corridor Program, among other changes. 
HFMA webinar tomorrow on health care price transparency   04/21/2014
The Healthcare Financial Management Association will host a webinar tomorrow on new price transparency recommendations for health plans, health care providers and others, released last week by a task force whose members include the AHA. The webinar will review the task force recommendations and guide to help consumers estimate the cost of care, and present examples of organizations that are leading the way toward improved price transparency. For more information or to register, click here. Online registration is open today until midnight CT. To register tomorrow, call 800-252-4362, ext. 2 by 1 p.m. CT. The webinar also will be available for viewing on-demand after the event.    
IV saline and other drug shortages are FDA priority, agency tells AHA   04/21/2014
The Food and Drug Administration does not have the authority to require a manufacturer to make a product or direct a manufacturer’s business decisions about manufacturing capacity, but “will take every action within its authority to help alleviate the shortage of IV saline and other drugs and increase supplies in the marketplace,” FDA Commissioner Margaret Hamburg, M.D., told AHA today. “Please be assured that the prevention and mitigation of drug shortages is a key priority for FDA,” Hamburg said in a letter to AHA Executive Vice President Rick Pollack. She said the agency “will continue to work with manufacturers, providers, patients, patient advocates, and other stakeholders to protect patients and identify solutions to this serious problem.” Pollack last month urged the agency to vigorously pursue additional supplies and suppliers of normal saline and other intravenous fluids that are fundamental to patient care in hospitals, to ease the severe, long-standing shortage of these products and prevent future shortages. For IV fluid conservation strategies, see the AHA’s March 20 Quality Advisory for members.