AHA briefing highlights RAC overreach   07/26/2013
Leaders from four hospitals and health systems today briefed congressional staff on the problems they face due to inappropriate payment denials by Medicare recovery audit contractors. Gretchen Case, director of compliance and revenue integrity at Cedars-Sinai Medical Center, discussed the difficulty of explaining to patients why a short-term inpatient stay has been denied by a RAC and the resulting financial consequences the Medicare beneficiary faces. Case explained, “RACs are causing a great deal of uncertainty and expense for hospitals and also for patients. This is money that cannot then be directed toward patient-related care. Furthermore, our patients are either angry or confused when they learn these audits have caused an increase in their out-of-pocket payments or prevented them from qualifying for additional care following their stay in the hospital.” Other hospital and health system participants at the AHA-sponsored event were Steven Hanks, M.D., executive vice-president and chief medical officer of the Hospital of Central Connecticut; John Kerndl, chief financial officer, LifePoint Hospitals; and Don Sipes, vice president for regional services for Saint Luke’s Health System in Missouri and CEO of St. Luke’s North Hospital-Smithville.
Hospital's TRICARE contract qualifies as federal subcontract   07/26/2013
Florida Hospital of Orlando’s TRICARE contract qualifies as a federal subcontract as a matter of law and would permit the Office of Federal Contract Compliance Programs to review and enforce various affirmative action compliance obligations on the hospital, the Administrative Review Board of the Department of Labor determined in a 3-2 decision Monday. However, the board remanded the case back to the administrative law judge to determine whether OFCCP is barred from asserting jurisdiction over the hospital because the hospital’s TRICARE reimbursements constitute “federal financial assistance” exempt from OFCCP oversight and enforcement. The board specifically instructs that on remand the most critical question is whether Congress intended that TRICARE be a federal financial assistance program. Two dissenting judges in the decision said that Congress’ enactment of the TRICARE exemption in Section 715 of the National Defense Authorization Act categorically eliminates OFCCP's jurisdiction over the hospital. This new decision results from the board simultaneously granting OFCCP’s November 2012 motion to reconsider the October 2012 board decision. 
Report compares dual-eligible demonstrations in six states   07/26/2013
A new report from the Kaiser Commission on Medicaid and the Uninsured compares the features of six state projects to integrate care and align financing for people dually eligible for Medicare and Medicaid. The first State Financial Alignment Demonstrations approved by the Centers for Medicare & Medicaid Services, the projects expect to enroll a total of nearly one million beneficiaries in California, Illinois, Massachusetts, Ohio, Virginia and Washington. The report compares their target populations, enrollment, care delivery models, benefits, financing and ombuds programs.
Monograph offers perspective, tools for making the volume-to-value shift   07/26/2013
The latest monograph from the AHA’s Center for Healthcare Governance provides perspective for boards and hospital leaders on factors influencing the shift from volume to value in health care, and tools to help them guide their organizations in making the transition. Strategy consultant Rita Numerof, president of Numerof & Associates Inc., reviews the drivers underlying this major shift for health care payment and delivery, applies lessons learned from other industries that have experienced significant shifts, and shows how the volume to value shift in health care is already changing the way providers market, price and deliver care and services. The guide includes a brief self-assessment for evaluating how well current board practices drive an organizational focus on improving value, and questions boards can ask to help guide their organizations in areas such as bundled pricing and clinical performance improvement. The Center is AHA’s resource for information, tools and counsel to promote excellence in health care governance.
2013 TRUST Award recipient honored   07/26/2013
Health care leaders last night gathered in San Diego to honor 2013 TRUST Award recipient Karen Davis, former president of The Commonwealth Fund and a nationally recognized economist, for her dedication to achieving better health care access, quality and efficiency. Established in 2003, the annual award by the AHA's Health Research & Educational Trust affiliate honors individuals who have exhibited visionary leadership in the health care field, and who symbolize HRET’s mission to use research and education to improve health care quality in policy and practice. “People, communities, organizations and national policies are better off due to her dedication, and this award reflects her years of service and passionate advocacy for quality improvement, said Michael Rock, M.D., chief medical officer at Mayo Rochester Hospitals/Mayo Foundation and chair of the HRET Board of Trustees. For more information, visit www.hret.org/trust.