The year 2012 was filled with unprecedented events in health care. The most significant were the political campaigns and subsequent elections and the U.S. Supreme Court ruling on the constitutionality of the “Patient Protection and Affordable Care Act” (ACA).
Anticipating these events and the potential outcomes, the AHA board focused on the work that needed to be done to prepare for 2013 regardless of the election results. The nation’s deficit and spending will continue to be a major concern for the administration and Congress – the entitlement reform discussions are just beginning. Your board was keenly aware that the association needed to be ready with options and proposals to address health care spending, therefore, developing recommendations to improve health care while reducing costs was the board’s major focus throughout 2012. Entitlement reform and deficit reduction. In its work on entitlement reform and deficit reduction, the board heavily engaged the regional policy boards, the governing councils, and AHA committees to take a comprehensive look at health care spending in Medicare and Medicaid. It was a tremendously productive process, and we identified:
• deficit reduction alternatives in health care – other than provider payment reductions – that would save nearly $2 trillion over 10 years, and
• principles on an effective care model for individuals eligible for both Medicare and Medicaid (the dual-eligible population), indicating a policy preference for Medicare to assume financial responsibility and coverage of these patients.
A comprehensive report was compiled entitled “Ensuring a Healthier Tomorrow: Actions to Strengthen Our Health Care System and Our Nation’s Finances.” It includes potential actions by providers, government, insurers, employers and individuals to improve outcomes and reduce spending by promoting and rewarding accountability and using limited health care dollars wisely. ACA coverage expansion and state-level activities. With last summer’s Supreme Court decision, coverage expansions contained in the ACA will, in large part, be determined at the state level. Developed with the state hospital associations, the board approved an initiative to assist them by funding research, advertising, grassroots key contacts development, studies and reports, and enrollment programs. The AHA is also working with the Department of Health and Human Services (HHS) on ACA implementation and deploying other strategies to expand coverage under the ACA. Medicare wage index. In July 2011, the board appointed the AHA’s Task Force on the Medicare Area Wage Index to examine and respond to policy proposals addressing area wage index calculations. Virtually all in the hospital field agree that the current methodology is flawed, and alternatives to the current process have already been developed by the Medicare Payment Advisory Commission, the Institute of Medicine, and the Centers for Medicare & Medicaid Services.
The task force identified five top-level concerns: accuracy and consistency, volatility, circularity, labor markets and reclassifications/ exceptions. Through an extensive process to gain member input, the task force shared principles for guiding change and at the fall meetings, presented recommendations based on revised principles. Materials were also shared with state and other allied hospital associations, and these association’s board chairs were invited to regional policy boards to participate in discussions. At its November meeting, the board accepted the task force’s report and asked the AHA staff to further model, communicate the impact of the recommendations and assess the political environment before introducing the report.
Other policy positions discussed this year include principles on hospital-acquired conditions, early-term elective deliveries, an update of AHA’s “2003 Principles and Guidelines on Hospital Billing and Collection Practices,” physician lifelong learning, payment differentials for evaluation and management services, and inpatient versus outpatient observation status. Performance improvement. As part of the AHA’s commitment to performance improvement, Hospitals in Pursuit of Excellence and the Health Research & Educational Trust (HRET) continued to provide reports, case studies, and other materials to aid hospitals in achieving their outcomes goals.
In addition, HRET directs the nation’s largest Hospital Engagement Network (HEN), which includes 33 state hospital associations and nearly 2,000 hospitals. The HENs are part of the Partnership for Patients, an HHS publicprivate collaborative designed to reduce inpatient harm by 40% and readmissions by 20% over a threeyear period. HRET is publishing best practices among participants, providing peer group learning, and sharing information and methods.
Two AHA standing committees have produced especially valuable reports, which were reviewed by AHA’s governance and policy development groups and approved by the AHA board.
The AHA’s Committee on Research looked closely at patient and family engagement, producing “Engaging Health Care Users: A Framework for Healthy Individuals and Communities.” The Committee on Performance Improvement focused on care coordination in two reports – “Advanced Illness Management Strategies” and “Advanced Illness Management Strategies: Engaging the Community and a Ready, Willing and Able Workforce.” Policy development structure.
The board created a Specialty Committee on Clinical Leadership by merging the Committee on Health Professions and the Physician Leadership Forum advisory committee to strengthen clinical input to the AHA advocacy and public policy process. Serving as a clinical resource on policy issues and discussing standards and clinical education programs and activities, membership continues to include physicians, nursing and pharmacy representatives.
AHA member participation. The AHA’s success depends on the support, expertise and experience of its members. I want to thank you for participating in shaping the AHA’s 2012 policy development and advocacy, and contributing in so many ways to making the association’s vision a reality. It was a true honor to serve as your chair, and we should all be proud of the many accomplishments in 2012 designed to enhance the care of our patients and health of our communities.
Fontenot is president and CEO of Woman’s Hospital in Baton Rouge, LA, and immediate past chair of the AHA.