CMS issues guidance to address concerns related to hospital inpatient orders   09/06/2013
The Centers for Medicare & Medicaid Services last night issued guidance interpreting its new requirements for admission and medical review criteria for hospital inpatient services under Medicare Part A. The five-page document clarifies the types of practitioners who may furnish orders for inpatient services and the types of information that must be included in those orders. Specifically, CMS indicates that the order may be documented by an individual who is not a physician – such as physician assistants, residents or registered nurses – provided the documentation is consistent with state law, hospital policies, and medical staff bylaws and rules. CMS is expected to issue additional guidance in the coming weeks.
AHA urges CMS to extend direct supervision enforcement moratorium   09/06/2013
AHA today urged the Centers for Medicare & Medicaid Services to extend for at least one more year the enforcement moratorium on the outpatient therapy direct supervision policy for critical access hospitals and small and rural prospective payment system hospitals. Commenting on the proposed calendar year 2014 rule for the hospital outpatient prospective payment system, AHA expressed disappointment that CMS proposes to end the enforcement moratorium this year. “Imposing this policy in rural hospitals is not only unnecessary, but also would result in reduced access to care for Medicare beneficiaries,” wrote AHA Executive Vice President Rick Pollack. Among other comments, AHA urged CMS to adopt changes to the supervision regulations, and to reject using the new computed tomography and magnetic resonance imaging cost-to-charge ratios in setting outpatient payment rates in CY 2014. AHA also recommended that CMS not adopt four proposed quality measures in the outpatient setting in CY 2014 because they are not yet adequately tested or feasible to collect in hospitals. AHA will submit separate comments on proposed changes in OPPS packaging, comprehensive ambulatory payment classifications and hospital outpatient visit coding and payment. CMS yesterday extended the comment deadline for these elements of the rule due to related technical corrections.
AHA comments on heart failure, pneumonia cost measures in development   09/06/2013
The heart failure and pneumonia 30-day episode-of-care payment measures being developed by the Yale-New Haven Health Systems Corp./Center for Outcomes Research and Evaluation are “not appropriate for assessing hospital-level performance on cost,” the AHA today told the Centers for Medicare & Medicaid Services. “We strongly agree that rigorous cost and resource use measures, when coupled with information on quality, can help hospitals enhance the ‘value’ of care – that is, delivering the same or better outcomes at lower cost,” wrote Linda Fishman, AHA senior vice president for policy analysis and development. “However, the proposed HF and PN episode-of-care measures reflect the care of multiple providers across the health care delivery system, and like other measures that reflect the actions of many, attributing the results solely to one part of the system (i.e., hospitals) is unfair. The only appropriate application of these measures is in a bundled payment context where the agency seeks to provide the broader system with incentives to coordinate and provide an appropriate level of care.” AHA also recommended that Yale and CMS improve the measures’ accuracy by adjusting for complicating disease conditions patients have prior to the start of a 30-day care episode, and by excluding transfer patients from the measure calculation.
IRS issues proposed ACA health coverage reporting rules   09/06/2013
The Internal Revenue Service yesterday issued proposed rules implementing the Patient Protection and Affordable Care Act’s information reporting requirements for minimum essential coverage and for large employers subject to the law’s shared responsibility provisions, which were recently delayed until 2015. The ACA requires insurers, self-insuring employers and others that provide health coverage to provide a list of covered individuals and the months they were covered. It also requires employers with more than 50 full-time workers to provide information about the coverage offered to each, by month, including the cost of self-only coverage. Among other provisions, IRS said the rules would eliminate the need to determine whether particular employees are full-time if adequate coverage is offered to all potentially full-time employees, and allow employers to report the specific cost to an employee of purchasing employer-sponsored coverage only if the cost is above a specified dollar amount. The proposed rules will be published in the Sept. 9 Federal Register with comments accepted for 60 days. The agency said it will encourage covered entities to voluntarily implement information reporting in 2014, when reporting will be optional, to enable real-world testing of reporting systems before the provisions are fully implemented in 2015.
New report helps hospitals assess future workforce needs   09/06/2013
A report released today by the AHA Workforce Center, a joint effort of the AHA, American Organization of Nurse Executives and the American Society for Healthcare Human Resources Administration, seeks to help hospital leaders develop more effective workforce planning models by better defining their needs and improving their recruiting, sourcing, retention, retirement and onboarding strategies. The white paper also is accompanied by an assessment tool to help organizations develop effective workforce planning models. AONE is an AHA subsidiary; ASHHRA is an AHA personal membership group.
Study seeks successful hospital-public health partnerships   09/06/2013
Former AHA Trustee Larry Prybil, professor of health care leadership at the University of Kentucky College of Public Health, is seeking successful collaborations involving hospitals and public health departments to participate in a study that will identify and share lessons learned from their efforts to improve community health. To nominate well-established operational models that demonstrate the characteristics of successful partnerships, click here. For more on the study, contact Larry Prybil at or Ann Kelly at
Hospitals add 900 jobs in August   09/06/2013
Employment at the nation's hospitals rose by 0.02% in August to a seasonally adjusted 4,830,400 people, the Bureau of Labor Statistics reported today. That's 900 more people than in July and 35,800 more than a year ago. Without the seasonal adjustment, which removes the effect of fluctuations due to seasonal events, hospitals employed 4,833,800 people in August – 6,000 fewer than in July and 32,900 more than a year ago. The nation's overall unemployment rate fell by 0.1 percentage point in August to 7.3%.