AHA, hospitals oppose government's effort to dismiss rebilling lawsuit   06/28/2013
The AHA and five hospital systems Thursday opposed the government’s attempt to dismiss the lawsuit filed last November against the Centers for Medicare & Medicaid Services to challenge the agency’s continuing refusal to pay for certain claims denied by Recovery Audit Contractors, despite the agency’s recent concession that the previous payment denial policy was unlawful (American Hospital Association v. Sebelius). The filing responds directly to the government’s attempt to dismiss the lawsuit on procedural grounds, including its suggestion that the issues would be resolved when the pending rulemaking on rebilling is finalized. “Having abandoned one rationale for refusing to pay hospitals hundreds of millions of dollars to which they are legally entitled, the Secretary…now asks this Court to completely insulate her latest justification from judicial review,” the plaintiffs state. “The Court should decline this invitation.” The AHA and its hospital co-plaintiffs – Missouri Baptist Sullivan Hospital, Munson Medical Center, Lancaster General Hospital, Trinity Health Corp. and Dignity Health – ask the federal district court in Washington, D.C., to deny the government’s attempt to place CMS’ rebilling policy “beyond the reach of judicial review.”
AHA-supported bill would reinstate TOPs for small, rural hospitals   06/28/2013
Rep Bruce Braley (D-IA) today introduced the Rural Hospital Fairness Act (H.R. 2578), AHA-supported legislation that would reinstate “hold harmless” Transitional Outpatient Payments through 2013 for certain eligible Sole Community Hospitals and rural hospitals with up to 100 beds. Without TOPs, which expired last year, these hospitals are paid an average of just 75% of their Medicare costs. With such a large gap between payments and costs, it is difficult for these vulnerable hospitals to continue providing critical outpatient services, such as emergency care and chemotherapy.
CMS proposes 1.1% payment cut for hospital-based home health agencies   06/28/2013
The Centers for Medicare & Medicaid Services yesterday issued a proposed rule that would reduce home health payments by 1.5% ($290 million) in calendar year 2014, although hospital-based agencies would face a slightly smaller reduction of 1.1%. The total reduction reflects a 2.4% market basket increase, minus 3.4% for proposed rebasing adjustments and 0.5% for coding changes related to the transition to ICD-10. The Patient Protection and Affordable Care Act requires CMS to rebase the HH PPS over four years beginning in 2014. The rule proposes a cumulative 14% payment cut as a result of this proposed rebasing process, which is intended to adjust for changes in the mix, intensity and cost of services in the HH 60-day episode since the HH PPS was implemented in 2000. The proposed rule also would establish quality reporting requirements for rehospitalization and emergency department use during the first 30 days of a HH stay. The rule will be published in the July 3 Federal Register with comments accepted through Aug. 26.
Inpatient psychiatric facility quality data submission delayed   06/28/2013
Inpatient psychiatric facilities will be unable to submit quality data to the QualityNet website beginning July 2 as scheduled due to system constraints, the Centers for Medicare & Medicaid Services announced today. CMS said it will inform facilities via QualityNet and the IPF quality reporting List Serv when the web application becomes available, and if the current Aug. 15 data submission deadline changes. IPFs and separately licensed, distinct-part psychiatric units in acute care hospitals paid under the IPF prospective payment system are eligible to participate in the IPF quality reporting program. Beginning with fiscal year 2014 payments, eligible facilities must comply with all IPFQR data submission requirements and deadlines to receive a full annual payment update. Questions about the data submission process can be directed to Telligen, CMS’ support contractor for the IPFQR, at (888) 961-6425 or IPF-PCHQRSupport@telligen.org.
AHA comments on risk-based regulatory framework for health IT   06/28/2013
The AHA today submitted comments to a work group advising the Food and Drug Administration on a risk-based regulatory framework and strategy for health information technology, which sought public input on the scope and range of health IT, balance between risk and innovation, and areas of possible regulatory overlap. “America’s hospitals take very seriously their responsibility to ensure that care is safe,” wrote Linda Fishman, AHA senior vice president of public policy analysis and development. “…Therefore, it is very important to know that the tools deployed in hospitals also are safe, as developed and sold.” The FDA Safety and Innovation Act requires FDA to propose a strategy and recommendations for the framework, in coordination with the Office of the National Coordinator for Health IT and Federal Communications Commission.
CDC: Cesarean birth rate levels off after years of rising   06/28/2013
The U.S. cesarean delivery rate for single births held steady at 31.3% between 2009 and 2011, halting a 12-year increase, according to a new report from the Centers for Disease Control and Prevention. The cesarean rate for early-term births declined 4% over the three-year period, while the rate for full-term births rose 3%. The proportion of early-term births also fell by 2 percentage points over the period, consistent with efforts to reduce non-medically indicated deliveries before 39 weeks of gestation to improve health outcomes for mothers and babies. While these efforts are mainly focused on induction of labor, women who have been induced are nearly twice as likely to deliver by cesarean, the report notes.