Hospitals sue HHS for unfair Medicare practice   11/01/2012
The AHA and four hospital systems today filed a federal lawsuit challenging the Department of Health and Human Service's refusal to reimburse hospitals for reasonable and necessary care that recovery audit contractors later decide could have been provided in an outpatient setting. The complaint asks the U.S. District Court for the District of Columbia to overrule the nonpayment policy and reimburse hospitals that were denied payment. "What the federal government is doing is wrong, unfair and a clear violation of federal law," said AHA President and CEO Rich Umbdenstock. "Doctors and nurses provide the best care possible using their medical judgment and training. Allowing government auditors to second-guess these difficult medical decisions about where to best treat a patient years later based on a cold record and then refuse to pay for that care is indefensible."
CMS releases final CY rules for outpatient departments, physicians   11/01/2012
The Centers for Medicare & Medicaid Services today released its final rule for calendar year 2013 for the outpatient prospective payment system and ambulatory surgical centers. The rule will increase OPPS payments by 1.8% and ASC payments by 0.6%. Relative payment weights will be based on geometric mean costs, as proposed. CMS states that basing the outpatient PPS payments on mean costs better reflects average costs of services and aligns the metric used in rate-setting for the outpatient PPS with the inpatient PPS. CMS also released a final rule for the physician fee schedule that will reduce physicians Medicare payments by 26% on Jan. 1. The final rules will be available on the Federal Register's Public Inspection Desk. AHA members will receive a Special Bulletin tomorrow with further details.
MedPAC recommends reforming outpatient therapy payment   11/01/2012
The Medicare Payment Advisory Commission today unanimously voted to recommend changes to reform the Medicare benefit for outpatient physical and occupational therapy and speech-language pathology. The final recommendations include reducing the therapy cap to $1,270 (from its current level of $1,880) and applying a manual medical review process for all requests that exceed the cap amount; permanently including services delivered in hospital outpatient departments under the cap; and reducing the practice expense payment by 50% when multiple therapy services are provided to the same patient on the same day. The commission stated that the changes would ensure program integrity of outpatient therapy services, ensure access to outpatient therapy services while managing Medicare's cost, and improve management of the benefit in the longer term. The Patient Protection and Affordable Care Act requires MedPAC to report recommendations to Congress on changes to outpatient therapy services by June 15, 2013.
FDA working to alleviate injectable drug shortages   11/01/2012
The Food and Drug Administration is working to address a shortage of certain critical injectable drugs, which increased when Ameridose recalled all of its drug products yesterday. The recall included six injectable drugs on the FDA list of critical shortage drugs: sodium bicarbonate, succinylcholine, atropine sulfate, bupivacaine hydrochloride, lidocaine hydrochloride, and furosemide. FDA saidit is working to help companies initiate or increase production of these critical injectable drugs, and to import safe foreign drugs to address the U.S. shortages. For example, Hospira plans to release additional sodium bicarbonate beginning this week. FDA encouraged health care providers to notify FDA staff at if they believe a drug is entering shortage. For supply updates on these and other shortage drugs, see the FDA's drug shortage index. For more on the Ameridose recall, visit
Study: Health care spending, use vary within hospital referral regions   11/01/2012
Payment reforms based on Hospital Referral Regions may not promote the best use of health care resources, because health care spending and use vary widely within a region, according to a study published in today's New England Journal of Medicine. Based on a random sample of Medicare beneficiaries between 2006 and 2009, the study found substantial variation in spending for medical care and drugs across hospital service areas in a referral region, with many high-spending regions containing low-spending service areas and vice versa. "This analysis suggests that policies focused exclusively on the HRR may be too blunt to promote the best use of health care resources," the authors said.
HHS declares public health emergency in NY state   11/01/2012
Health and Human Services Secretary Kathleen Sebelius yesterday declared a public health emergency for the state of New York in the aftermath of Hurricane Sandy, which will enable the agency to temporarily waive or modify certain Medicare, Medicaid and Children's Health Insurance Program requirements. HHS said it also is working with states and regional networks to respond to public health, medical and human services needs, and that more than 500 HHS personnel have been deployed to provide assistance.
AHA fellowship helps senior leaders transform health care   11/01/2012
Senior health care leaders can apply through January to participate in the next AHA Health Care Transformation Fellowship, a six-month program that helps participants implement new care delivery and payment models, manage risk, develop physician leaders and manage population health. The program includes learning retreats, webinars, a fellowship project and advisory sessions. For more information and an application, visit