Minnesota Hospital Association


August 12, 2013

MHA Newsline

In this issue:

Hospital spotlight: Fairview Health Services helps feed the pipeline of future physicians

Fairview Health Services partnered with St. Olaf College since 1999 to create a pipeline of future physicians. The Fairview/St. Olaf J-Term program provides exposure to St. Olaf students who are considering a career in health care, particularly as physicians. The efforts earned the partnership the MHA Health Care Career Promotion Award for a large hospital earlier this year. The students observe a surgery at the University of Minnesota Medical Center, Fairview; shadow physicians several days a week; attend lectures; research and present a health care topic of interest; keep a journal of their experiences; and write a reflection paper. This J-term interim course allows students interested in a medical career to experience the real world of medicine to help them make informed decisions. Students shadow physicians and other patient care professionals in hospital and clinic settings, and an attempt is made to place students in their areas of interest. The program requires each student to spend a portion of his or her time in a primary care setting. return to top 

Register now: Enrolling patients through MNsure

Hospital financial and patient services reps encouraged to attend Sept. 6 program

Beginning Oct. 1, Minnesota's hospitals and health systems will play important roles in helping our patients enroll in state public programs and new subsidized coverage options through Minnesota's new Health Insurance Exchange. David Van Sant, navigator broker manager, MNsure, will provide the most comprehensive and up-to-date information available about how hospitals and health systems will fulfill these roles. This program offers a unique opportunity for MHA members to learn about MNsure's Consumer Assistance Partner program, get questions answered, and help prepare for the enrollment and coverage expansion activities on the near horizon. Other trainings from MNsure are expected to be web-based and not in-person, so MHA urges your attendance at this program.  

The program is designed for CEOs, CFOs, financial counselors, business office managers, social workers, patient services and government relations officers. The program begins at 10 a.m. at the Ramada Plaza in Minneapolis. Please share this information with the relevant people within your organization and encourage them to attend. Click here to register. return to top  

MnDOT steps up heliport regulatory activity at hospitals

The Minnesota Department of Transportation (MnDOT) has regulatory authority over heliport facilities in the state and has begun more oversight of heliports recently. Based on conversations with the MnDOT Office of Aeronautics staff, MHA notified several individual members that MnDOT would be contacting them to confirm that their hospitals do not operate heliports or to ensure that all operational heliports are appropriately licensed and comply with safety regulations. MnDOT plans to inspect all hospital-operated heliports over time. 

In MHA’s communications with members and MnDOT officials, the Association has emphasized hospitals’ commitment to the safety of helicopter flights for the patients, pilots and crew, hospital staff and nearby property owners. MHA committed to help members by researching issues or concerns, clarifying laws and regulatory interpretations with MnDOT, connecting members with architects and other consultants familiar with heliport design and regulations to ensure that their facilities are appropriately licensed, compliant and safe. In addition, MHA hopes to collaborate with MnDOT to develop guidance for municipal zoning laws that will protect designated flight paths to and from hospital heliports from future construction, trees, fences, billboards, or other potentially dangerous obstructions for helicopters.  

Since its communication with members, MHA has received many questions about hospitals’ responsibility for or compliance obligations with respect to landing areas that are not located on hospital property; requirements to take remedial steps, such as cutting trees, lowering fences or installing lights, especially in areas outside of the hospital campus; and potential funding sources to help offset hospitals’ costs of remedial actions necessary to continue heliport operations. The Association is actively working to get the necessary clarifications and information for members, and is investigating potential grants or loans to help its members improve the safety of their heliports.  

Although MnDOT has had statutory authority to regulate heliports for many years, the department’s staffing capacity has limited its ability to undertake routine and ongoing inspections and compliance efforts. With recent staffing changes, the agency is conducting on-site inspections. Hospitals have 30 days to address any licensing or safety concerns resulting from the inspection to retain their heliport license.  

MHA members with questions about MnDOT’s heliport licensing or inspection activities are encouraged to contact Matt Anderson, MHA vice president of strategic and regulatory affairs, 651-659-1421. State and federal statutes, regulations and other information about heliport operations can be found on MnDOT’s website. For MHA members seeking architectural advice about their heliport facilities, several MHA associate members have experience with such projects and working with MnDOT:

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MHA member input sought on physician data transparency

The Center for Medicare and Medicaid Services (CMS) has requested feedback on how it should make Medicare’s physician claims data more transparent, especially for quality and cost improvement initiatives; view request here. MHA is preparing a comment letter to provide CMS with members’ perspectives, concerns and suggestions. 

In particular, CMS asked for comments on the following issues:

  • whether physicians have a privacy interest in information concerning payments they receive from Medicare and, if so, how to properly weigh the balance between that privacy interest and the public interest in disclosure of Medicare payment information, including physician-identifiable reimbursement data;
  • what specific policies CMS should consider with respect to disclosure of individual physician payment data that will further the goals of improving the quality and value of care, enhancing access and availability of CMS data, increasing transparency in government, and reducing fraud, waste, and abuse within CMS programs;
  • and the form in which CMS should release information about individual physician payment, should CMS choose to release it (e.g., line item claim details, aggregated data at the individual physician level).

MHA encourages members to provide feedback or concerns for MHA to include in its comment letter by sending them to Matt Anderson, MHA vice president of strategic and regulatory affairs, by Thursday, Aug. 29. return to top  

Medicare Part A transition to NGS is successful

The new Medicare administrative contractor (MAC) for Minnesota is National Government Services (NGS). One of their primary functions is to process claims invoices from hospitals for payment. The change for hospitals means sending Medicare Part A claims to NGS rather than Noridian Administrative Services.  

As of today, National Government Services announced a successful transition of the Minnesota Part A Title 18 contractor workload to the new National Government Services Jurisdiction 6 (J6) MAC on Aug. 10, 2013.  

In addition to claims process, NGS will also e handling the reimbursement and audit functions for processing of the Medicare Cost Reports filed by hospitals.  MHA hosted a meeting on Aug. 5 between hospital reimbursement managers and the NGS audit lead for Minnesota, Pam Chelf. There was a good, open discussion of what to expect from the NGS audit team and a sharing of Minnesota-specific functions that create value for cost report accuracy.  

There will be a second cut-over date on Sept. 7 for the Medicare Part B physicians claims function from Wisconsin Physician Services Insurance (WPS) to NGS.  

For more information, contact Joe Schindler, MHA vice president of finance, 651-659-1415. return to top  

VA offers resources for homeless veterans

The U.S. Department of Veteran Affairs (VA) is engaged in a campaign to end veteran homelessness by the end of 2015 (see fact sheet). The VA has a number of resources available to veterans, and is asking for help from community stakeholders to spread the word on how veterans can access these resources. They have developed a National Call Center for Homeless Veterans (1-877-4AID-VET) that connects homeless or at-risk veterans with trained professionals. In addition, several public service announcements are available for specific professions, including :

Wallet cards are also available that you can print out and give to veterans so they know where they can get help. Other outreach resources can be ordered online. Hospitals are encouraged to use these resources to help spread the word to let veterans know that a single call can connect them with the services they have earned. return to top  

Board of Nursing, EMS Board have openings

The Minnesota Board of Nursing and the Emergency Medical Service Board have posted vacancies. The EMS Board has a vacancy for an emergency physician certified by the American Board of Emergency Physicians. The Board of Nursing has an opening for a public member.  

It is important for the Board of Nursing to have perspectives from people who understand care delivery challenges, the emerging importance of team-based care models, and the need for innovation and flexibility at the local level. MHA members are encouraged to ask a trustee or other interested person from their communities to apply.  

For more information and to apply, visit the Secretary of State’s website. return to top  

MHA thanks Sen. Franken for supporting Minnesota’s future health care workforce

MHA appreciates Sen. Al Franken’s support of S. 577, the Resident Physician Shortage Act of 2013.This legislation would lift the 1996 cap on residency slots and  increase the number of Medicare-supported training positions to at least 15,000 new resident positions. This represents about a 15 percent increase in residency slots. This legislation is particularly important to Minnesota’s future health care workforce as statistics demonstrate that in order for our future doctors to remain in Minnesota they must first train in Minnesota. The Association of American Medical Colleges estimates that by 2015 there will be a deficit of 62,900 physicians and by 2025 that shortage is likely to have doubled. MHA continues to support lifting the 1996 cap on residency slots as a key component to addressing the projected shortage of physicians. Minnesota Rep. Keith Ellison is already a co-sponsor of the House companion bill, H.R. 1180. MHA members are encouraged to contact the rest of the Minnesota delegation to request their support for the House or Senate version of the bill respectively. If you have any questions, contact Ann Gibson, MHA vice president of federal relations and workforce, 651-603-3527. return to top  

Congress’ August recess offers opportunity to connect with federal leaders

Invite federal leaders to your organization during the next five weeks

The U.S. Congress has adjourned for its annual August recess, so members of the Minnesota congressional delegation are expected to be back in the state for about the next five weeks. Now is a good time to invite our federal lawmakers to your organization to see firsthand the nation-leading care provided in Minnesota hospitals and health systems and showcase the work you do for, and in partnership with, your communities.  

The August recess also provides an opportunity to ask our federal lawmakers to sign on as co-sponsors to some key pieces of legislation, or in some cases to thank them for their support. MHA in partnership with the American Hospital Association is urging our lawmakers to support the following bills:

H.R. 2801/S.1143, the Protecting Access to Rural Therapy Services Act of 2013 (PARTS), would adopt a default standard of “general supervision” (rather than “direct supervision”) by a physician or non-physician practitioner for outpatient therapeutic services. Sens. Amy Klobuchar (D) and Al Franken (D) have signed on to the Senate version of the bill and Rep. Collin Peterson (D) introduced the House version of the bill.

H.R. 1250/S.1012, the Medicare Audit Improvement Act of 2013, would establish a consolidated limit for medical record requests, impose financial penalties on Recovery Audit Contractors (RACs) that fail to comply with program requirements, make RAC performance evaluations publicly available and allow denied inpatient claims to be billed as outpatient claims when appropriate. Reps. Betty McCollum (D) and Peterson have signed onto the House version.

H.R. 1787/S.842, the Rural Hospital Access Act of 2013, would provide for an extension of the Medicare-dependent hospital program and increased payments under the Medicare low-volume hospital program. Reps. Keith Ellison (D) and Peterson have signed onto the House version and Sens. Klobuchar and Franken have signed onto the Senate version.

H.R. 2578, the Rural Hospital Fairness Act of 2013, would reinstate the outpatient “hold harmless” payments to certain sole community hospitals and rural hospitals with no more than 100 beds. Rep. Peterson has signed onto the House version.

H.R. 1180/S. 577, the Resident Physician Shortage Act of 2013, would lift the 1996 cap on residency slots and increase the number of Medicare-supported physician training positions to at least 15,000 new resident positions. Rep. Ellison has signed onto the House version and Sen. Franken has signed onto the Senate version.

H.R. 1920, the DSH Reduction Relief Act of 2013, would eliminate the first two years of the Affordable Care Act’s cuts to the Medicare and Medicaid DSH programs to allow expansion of health coverage to become more fully realized.

H.R. 2931, the Fairness in Health Care Claims Guidance and Investigations Act, would amend the False Claims Act by assuring that unintentional billing disputes aren’t penalized as harshly as fraud.

When Congress resumes this fall they will be working to pass a fiscal year 2014 budget and address the deficit. Our messaging will continue to focus on how Minnesota hospitals and health systems’ access to care will be threatened by continued ratcheting of Medicare and Medicaid payments for hospital services. Instead of blunt, across-the-board cuts, MHA supports continuing to move the payment system toward one that rewards value over volume. August recess also provides an opportunity to discuss how recent federal budget cuts have impacted your facility and the services that you have had to consider reducing or eliminating.  

For more information please contact Ann Gibson, MHA vice president of federal relations and workforce, 651-603-3527. return to top  

MHA Annual Meeting for hospital leaders Sept. 18-20

The MHA Annual Meeting, which will be held Sept. 18-20 at Madden’s on Gull Lake in Brainerd, is just over a month away. The deadline to register for accommodations at Madden’s is Aug. 20.  

The program features economist and futurist Lowell Catlett; Blue Zones author Dan Buettner; and physician and teacher Steve Bedwell.  

A favorite at MHA conferences, Lowell Catlett will provide thought-provoking information on future trends and evolving technologies during his presentation, “New Game, New Rules, New Reality.”   

Through his work as a National Geographic writer Dan Buettner identified best practices in longevity and well-being in people’s lives. His presentation, “Blue Zones: Secrets of a Long Life,” will leave you with an action plan for a longer, healthier life.  

Bedwell will outline a psychological blueprint for thinking clearly, involving powerful and time efficient, evidence-based tactics that you can put to work immediately. He will share strategies on how to sidestep devastating tactical mistakes executives sometimes make.   

For more information, view the full brochure or visit MHA’s website; click on Events and log-in to register. Room reservations can be made online at www.maddens.com/mha.html

Continuing Education

The Minnesota Board of Examiners for Nursing Home Administrators has approved the conference content for a total of 9.5 clock hours. return to top 

12 MN hospitals recognized for organ donation efforts

The U.S. Department of Health and Human Services recently recognized 12 Minnesota hospitals for their efforts to educate and register new organ, eye and tissue donors from September 2012 to May 2013 as part of the Workplace Partnership for Life Hospital Campaign. The hospitals increased the number of registered potential donors by educating staff, patients, visitors and community members about the critical need for donors. Minnesota hospitals have long been supporters of organ and tissue donation, working to support families through end-of-life care and honor the donation decisions of individuals across our state. return to top  

Rural Palliative Care Networking Group meeting

Hospitals are invited to participate in the Sept. 19 Rural Palliative Care Networking Group to discuss symptom management at the end of life. One of the key pillars of palliative care is the ability to manage pain and other symptoms. This two-part educational series will focus on the non-pain symptoms that people experience at end of life. Part I will cover the gastrointestinal (GI) symptoms of anorexia and cachexia, dehydration, nausea and vomiting, bowel obstruction, constipation and diarrhea. Part II (on Jan. 28, 2014) will cover non-GI symptoms (e.g. anxiety, delirium, depression, dyspnea, fatigue and pressure ulcers).  

The session will convene at 10 a.m. on Sept. 19 in person at St. Gabriel’s Hospital in Little Falls or via conference call. To learn more, click here, or to register, contact Matt Ellis at Stratis Health, 952-853-8539. The Rural Palliative Care Networking Group is coordinated by Stratis Health and supported with funding from UCare. There is no fee to participate. return to top

CMS finalizes inpatient PPS payment rule Aug. 5

The Centers for Medicare & Medicaid Services (CMS) finalized the fiscal year (FY) 2014 payment rule for inpatient hospital services.  Effective Oct. 1, 2013, the CMS rule finalized a standard operating payment amount of $5,370.28, a 0.4 percent increase. While the standardized capital rate is finalized at $429.31, a 0.9 percent increase.

The final FY14 Hospital Inpatient Prospective Payment System (IPPS) rule will increase hospital payments by $1.2 billion. However, the initial 2.5 percent market basket update was reduced 0.5 percentage points by a productivity adjustment, 0.3 percentage points by a mandated cut from the Affordable Care Act (ACA), 0.8 percentage points required by the American Taxpayer Relief Act to reclaim documentation and coding changes from FY10 through FY12, and a 0.2 percentage point cut to offset projected increases from changes to admission and medical review criteria for inpatient services.

Some changes sought by hospitals were not included in the final rule. One example is CMS’ attempt to clarify inpatient admission criteria for reasonable and necessary payment as an admission spanning two midnights. This however is counter-balanced with a presumption that admissions spanning less than two midnights are not medically necessary.

The methodology for calculating Medicare DSH, add-on payments to recognize high Medicare, Medicaid and uninsured utilization, will be significantly changed in FY2014.  Since the affordable care act’s provision for mandated coverage begins in 2014, the Medicare DSH formula is being adjusted to better reflect expectedly higher rates of insured patients. One quarter of the formula payment will stay the same and 75 percent will be based on a proportion of each hospitals’ charity care costs. MHA and the hospital field commented that this provision should be delayed until we have a chance to see the actual impacts of expanded coverage options.

MHA will send final rule financial impact reports in the next week or so. The reports will be accompanied by a complete summary of all the major provisions from this rule. For more information, contact JoeSchindler, vice president of finance, (651) 659-1415. return to top