CMS urged to clarify PCIP payment rule   07/19/2013
The AHA today urged the Centers for Medicare & Medicaid Services to revise an interim final rule that reduced provider payment rates for the Pre-existing Condition Insurance Plan in an attempt to stretch appropriated funds until the program expires Jan. 1. “The AHA is disappointed that the rate reduction was issued without input from the provider community and did not provide a sufficient definition of the rate that will be paid to providers,” wrote AHA Executive Vice President Rick Pollack. “We believe this will lead to confusion during these remaining months of the program....The AHA believes the simplest way to remedy this problem would be to base payment on the current Medicare Advantage out-of-network provider payment guidelines most recently updated in December 2012.” Beginning Jan. 1, health plans will be prohibited from imposing pre-existing condition limitations in their policies under the Patient Protection and Affordable Care Act.
AHA recommends continued work on potential cancer hospital quality measures   07/19/2013
Commenting today on three potential measures for the prospective payment system-exempt cancer hospital quality reporting program, AHA urged the Centers for Medicare & Medicaid Services and measure developers to fully field test each of the measures in dedicated cancer hospitals. “All three measures assess important aspects of cancer care, and the AHA supports their continued development,” wrote AHA Executive Vice President Rick Pollack. “However, we strongly urge the measure developers and CMS to fully utilize field testing in dedicated cancer hospitals to ensure each measure is sufficiently rigorous for a public reporting program and can be feasibly collected without undue burden. We also strongly urge CMS to obtain endorsement of the measures from the National Quality Forum, as well as pre-rulemaking review by the Measure Applications Partnership before formally proposing any of the measures for the PCHQR program.” The potential measures are: initiation of osteoclast inhibitors for patients with multiple myeloma or bone metastases associated with breast cancer, prostate cancer or lung cancer; overuse of imaging for staging breast cancer at low risk of metastasis; and potentially avoidable admissions and emergency department visits among patients receiving outpatient chemotherapy.
Study looks at coverage, cost impact of state decisions not to expand Medicaid   07/19/2013
An estimated 6.4 million fewer people would gain health coverage under the Medicaid expansion if only the current 24 states decide to participate, according to a new report by the Urban Institute for the Kaiser Commission on Medicaid and the Uninsured. As of July 15, 24 states were moving forward with the Medicaid expansion, 21 were not moving forward and six were debating whether to participate, the report notes. Nearly two-thirds of those who were originally expected to be covered by the Medicaid expansion are in these 27 states, the authors estimate. The 21 states that are not expanding Medicaid at this time would forgo $345.9 billion in federal funds over the 2013-2022 period, while the six states debating expansion would forgo $151 billion, the report estimates. Hospitals in these states would still face cuts in Medicare and Medicaid disproportionate share hospital payments, as well as lower Medicare payments, the report notes. “Based on this analysis, we conclude that the economic case for Medicaid expansion for state officials is extremely strong,” the authors state. The AHA-supported DSH Reduction Relief Act (H.R. 1920) would delay cuts to the Medicare and Medicaid DSH programs for two years, giving states additional time to determine the level of health coverage expansions under the law.
Hospitals given extra week to complete AHA RACTrac survey   07/19/2013
The AHA has extended to July 26 the deadline for hospitals to submit data to its quarterly RACTrac survey. The free web-based survey helps AHA gauge the impact of Medicare's Recovery Audit Contractor program on hospitals and advocate for needed changes. To register for the survey or for technical assistance, participants should contact RACTrac support at (888) 722-8712 or For more on the survey, including the latest results, visit
Iowa hospitals provide almost $1.6 billion in community benefits   07/19/2013
Hospitals in Iowa provided nearly $1.6 billion in community benefits in 2012, according to a new report from the Iowa Hospital Association. The total includes more than $1 billion in uncompensated care (charity care and bad debt); $169 million in programs and services such as health screenings, support groups, counseling and immunizations; and $289 million in losses due to Medicare and Medicaid payment shortfalls, a 5.1% increase over last year's report. For more on Iowa hospitals, including community benefits, visit