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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.  
Study: ACO outpatient care patterns suggest accountability challenges   04/21/2014
About one-third of Medicare beneficiaries assigned to accountable care organizations in 2010 or 2011 were not assigned to the same ACO in both years and much of the specialty care received was provided outside the patients’ assigned ACO, suggesting challenges to achieving organizational accountability, according to a study reported today by JAMA Internal Medicine. Beneficiaries who were not consistently assigned included patients in high-cost categories, such as those with end-stage renal disease, disabilities and Medicaid coverage. About 9% of office visits with primary care physicians and two-thirds of office visits with specialists were provided outside the assigned ACO. Less than 40% of outpatient Medicare spending billed by ACO physicians was for care provided to beneficiaries assigned to their ACO. “Although the structure of ACOs and their responses to new payment incentives will evolve over time, baseline outpatient care patterns among Medicare beneficiaries served by ACOs suggest distinct challenges in achieving organizational accountability,” the authors said. “Monitoring the constructs we examined may be important to determine the regulatory need for enhancing ACOs’ incentives and their ability to improve care efficiency.” To address challenges posed by the current system of assigning patients to ACOs, AHA recently recommended that CMS implement a voluntary sign-up process whereby Medicare beneficiaries can choose to receive their care from an ACO.    
AHA releases patient blood management toolkit   04/18/2014
AHA and its Physician Leadership Forum have released a toolkit developed with AABB and others to help hospitals and health systems implement a patient blood management program. The resources include a tool to help senior management, quality leaders and others assess their hospital’s readiness to adopt a formal PBM program, a May 1 webinar and other resources for clinicians, and a patient handout that answers common questions about transfusion and PBM. In a white paper last year on appropriate use of medical resources, AHA identified appropriate blood management in inpatient services as one of the “top five” hospital-based procedures or interventions that should be reviewed and discussed by a patient and physician before proceeding. The PLF plans to release a toolkit on each of the five areas over the next year. For more on the PBM toolkit, see yesterday’s AHA Quality Advisory.    
CMS call Tuesday on e-template for physician HH documentation   04/18/2014
The Centers for Medicare & Medicaid Services on Tuesday will host the first in a series of conference calls to receive feedback on a proposed electronic template for physicians documenting a face-to-face encounter with patients transitioning from hospitals and other settings to home care. Medicare requires a physician to meet face-to-face with patients transitioning to home care to certify that home care is medically necessary. The template is not intended as a data entry form but would allow electronic health record vendors to create prompts for physicians documenting the encounter.