Bill would remove 96-hour certification requirement for CAHs   02/05/2014
Reps. Adrian Smith (R-NE), Greg Walden (R-OR), Lynn Jenkins (R-KS) and David Loebsack (D-IA) late yesterday introduced the Critical Access Hospital Relief Act (H.R. 3991), AHA-supported legislation that would remove the 96-hour physician certification requirement as a condition of payment for critical access hospitals. Medicare requires physicians to certify that patients admitted to a CAH will be discharged or transferred to another hospital within 96 hours for the CAH to receive payment for the patient’s services under Medicare Part A. The Centers for Medicare & Medicaid Services has not historically enforced the requirement, but in recent guidance related to its two-midnight admissions policy implied that it will, a situation that would threaten patients’ access to longer care when needed. The legislation would not remove the requirement that CAHs maintain an average annual length of stay of 96 hours, nor affect other certification requirements for hospitals.
HRET HEN improves care for 69,000 patients, saves nearly $202 million   02/05/2014
More than 1,500 hospitals participating in the AHA’s Health Research & Educational Trust Hospital Engagement Network improved care for more than 69,000 patients over the past two years while reducing health care costs by nearly $202 million, according to an annual report released today by the network. Among other improvements, participating hospitals reduced early elective deliveries (which can increase complications) by 57%; ventilator-associated pneumonia by 34%; pressure ulcers by 26%; central line-associated blood stream infections in intensive care by 23%; and avoidable readmissions for heart failure patients by 13%. The program is part of the Centers for Medicare & Medicaid Services’ Partnership for Patients initiative. “Hospitals have made incredible strides improving patient safety and reducing costs, and the HEN has been a critically important component of that work,” said AHA President and CEO Rich Umbdenstock. Maulik Joshi, president of HRET and senior vice president for AHA, said the HEN “can serve as a model for many future quality improvement efforts.” AHA, CMS and hospital leaders shared highlights from the report during an AHA Town Hall webcast, available for replay soon at
CMS proposes provider network requirements for federal exchange plans   02/05/2014
The Centers for Medicare & Medicaid Services yesterday issued a draft letter to insurers describing proposed 2015 certification requirements for Qualified Health Plans in federally facilitated marketplaces or the Small Business Health Options Program. The policies articulated in the letter would apply to 2015 and beyond unless superseded by subsequent guidance or regulations, CMS said. Among other provisions, the letter notes that QHPs with provider networks must maintain a network that is sufficient in number and types of providers, including those providing mental health and substance abuse services, to assure that all services will be accessible to enrollees without unreasonable delay. “All issuers applying for QHP certification will need to attest that they meet this standard as part of the certification/recertification process,” CMS said. For the 2015 benefit year, CMS said issuers applying to certify a QHP will be required to submit a provider list that includes all in-network providers and facilities, which the agency will review to ensure reasonable access. CMS said it also intends to propose in rulemaking that provider networks include at least 30% of the Essential Community Providers in the QHP area (an increase from the current 20%), and offer “good faith” contracts to at least one provider in each ECP category for each county served. The ECP hospital category includes Disproportionate Share Hospitals, children’s hospitals, Rural Referral Centers, Sole Community Hospitals, Free-standing Cancer Centers and Critical Access Hospitals. Other ECP categories include Ryan-White HIV-AIDS providers, federally-qualified health centers and others. CMS will accept comments until Feb. 25 on selected elements of the draft letter, including the provider network and ECP provisions.
NLRB reissues proposed rule to expedite union elections   02/05/2014
The National Labor Relations Board today reissued a 2011 proposed rule that would change the process for filing and processing petitions for union representation of employees, essentially speeding up the time between filing a petition and holding an election. After portions of the earlier rule were finalized, a federal district court ruled that the board did not have the statutorily required quorum when it adopted the final rule. Like the previous proposed rule, today’s rule would defer resolution of most voter eligibility questions until after the election, consolidate all election-related appeals into a single post-election process, and make board review of post-election decisions discretionary rather than mandatory, among other changes. The rule will be published in tomorrow’s Federal Register, with initial comments accepted until April 7 and reply comments accepted until April 14. The board also plans to hold a public hearing on the proposed rule during the week of April 7, which will be announced in a future notice. AHA and its American Society for Healthcare Human Resources Administration and American Organization of Nurse Executives affiliates had urged the NLRB to abandon the previously proposed rule in its entirety, and supported the legal challenge to the previous final rule in a friend-of-the-court brief.
ISMP reports continued progress in hospital medication safety practices   02/05/2014
American hospitals continue to make strides in advancing their medication safety practices, according to results from the 2011 Medication Safety Self Assessment for Hospitals, released by the Institute for Safe Medication Practices. Conducted in cooperation with AHA and its Health Research & Educational Trust affiliate, the assessment seeks to raise awareness of the most up-to-date best practices associated with safe medication use; document medication safety progress in U.S. hospitals; and encourage local, state and national initiatives to improve medication safety. More than 1,300 hospitals participated in the 2011 assessment, with the largest percentage improvements related to communication of drug orders, patient education, and quality processes and risk management. For example, the results show significant improvements in maintaining a list of prohibited error-prone abbreviations (18% to 91%); using and monitoring safe methods of communicating medication orders (18% to 68%); requiring a complete new set of orders upon admission/transfer (27% to 82%); and providing customized drug administration schedules to patients at high-risk for non-adherence with drug therapy on discharge (31% to 73%), among other practices. The full results appear in the February Journal on Quality and Patient Safety. The Commonwealth Fund provided funding for the 2011 assessment.