Minnesota Hospital Association


November 11, 2013

MHA Newsline

In this issue

Hospital spotlight: MN hospitals reducing CAUTI

MHA Hospital Engagement Network hospitals that are participating in On the Cusp: Stop CAUTI are making strong improvements in reducing Minnesota’s catheter-associated urinary tract infections. Nine of the 15 participating hospitals have had zero CAUTIs to date. Hospitals are also reducing the number of days patients use catheters. For the period July through September, Minnesota hospitals’ rate was 2.19CAUTIs per 1,000 patient days, below the national comparative rate of 2.47 CAUTIs per 1,000 patient days. Furthermore, Minnesota hospitals report confidence regarding adherence to proper techniques for catheter insertion and catheter maintenance. return to top

HHS’s anti-kickback U-turn for subsidized plans sold on MNsure

Less than a week after issuing a surprising ruling that federal anti-kickback laws do not prohibit hospitals and health systems from paying patients’ premiums for health plans sold through a health insurance exchange, the U.S. Department of Health and Human Services (HHS) reversed course and strongly warned providers that the agency will not condone this kind of financial support for patients.

The first guidance from HHS stated that federally subsidized health plans sold on health insurance exchanges, like Minnesota’s MNsure, are not considered federal health care programs and, therefore, not governed by anti-kickback laws. Many provider organizations interpreted this decision as a window of opportunity to help financially struggling patients retain health coverage and decrease uncompensated care, although Internal Revenue Service rules and state laws could pose other barriers.  

Before definitive analysis could be completed, however, HHS responded to providers’ interest in helping patients with their premium and cost sharing obligations with a statement on Nov. 4. The agency expressed “significant concerns with this practice,” stated that it “discourages this practice” and warned that it “intends to monitor this practice and to take appropriate action, if necessary.”   For more information, contact Ben Peltier, MHA vice president of legal services, 651-603-3513. return to top  

Partial enforcement of CMS two-midnight policy extended

The Centers for Medicare and Medicaid Services (CMS) will move forward with the prepayment “Probe and Educate” audits for inpatient admissions claims submitted by acute care inpatient hospital facilities for admissions claims dated Oct. 1, 2013 through March 31, 2014. This represents a three-month extension from its original guidance. It also now includes prepayment review of critical access hospitals, inpatient psychiatric and long term care hospitals. Initial reviews will be a sampling of 10 claims for most hospitals and 25 for larger hospitals. If the probe discovers lack of medical documentation of necessity, phone calls will be made to the facility.  

In its Nov. 5 update, CMS reiterated the two-midnight benchmark set forth in the inpatient Prospective Payment System (PPS) final rule. Under this final rule, surgical procedures, diagnostic tests and other treatments (in addition to services designated as inpatient-only) are generally appropriate for inpatient hospital admission and payment under Medicare Part A when:

1.  The physician expects the beneficiary to require a stay that crosses at least two midnights; and

2.  admits the beneficiary to the hospital based upon that expectation.

Documentation in the medical record must support a reasonable expectation of the need for the beneficiary to require a medically necessary stay lasting at least two midnights. If the inpatient admission lasts fewer than two midnights due to an unforeseen circumstance, this must also be clearly documented in the medical record. Specific examples of unforeseen exceptions were noted as death, transfer, departures against medical advice and clinical improvement. Other exceptions should be rare or unusual, however hospitals are encouraged to send any additional suggestions for the exceptions list to [email protected] with “Suggested Exceptions to the 2-Midnight Benchmark” in the subject line.  

In general, post-payment reviews for this issue by recovery audit contractors (RAC) for this six-month time span will also be limited.  

CMS also indicates that it will update its website with additional medical review information and that an updated Q&A document will be coming soon. For questions, contact Joe Schindler, MHA vice president of finance, 651-659-1415. return to top  

Cuts to hospital payments still at risk as Congress faces new fiscal deadlines

Congress continues to face several key fiscal deadlines that will be both opportunities for health care policy improvements and risks for hospital funding cuts, including:

  • Dec. 13 - a deadline for budget conferees to have resolved differences in the House and Senate budget resolutions passed earlier this year;
  • Between Jan. 1 and Jan. 15 - a “fix” for physician payments is needed to prevent large cuts from taking place;
  • Jan. 15 - the continuing resolution that is funding the government is set to expire and more defense sequestration cuts take effect; and
  • Feb. 7 - Congress must lift the debt ceiling again sometime after this date.

Relief from sequestration cuts could be on the table as the effects of the defense cuts becomes a reality and this could mean welcome relief for hospitals, but hospital payments could be looked at as a source of replacement savings.  

MHA continues to ask our congressional delegation to support thoughtful policy reforms instead of across-the-board payment reductions.  

MHA Members are encouraged to reinforce the following key messages when reaching out to members of our delegation prior to these deadlines:

  • MHA members are involved in many reforms aimed at improving patient health while lowering costs.
  • Minnesota hospitals are already facing over $2 billion in payment reductions over 10 years as a result of the Affordable Care Act and more than $614 million cuts from sequestration.
  • Federal programs pay Minnesota hospitals less than the actual costs of caring for patients.
  • MHA opposes cuts to the following programs that are under consideration:
  • Cuts to graduate medical education.
  • Cuts to critical access hospital (CAH) funding and arbitrary policy changes that would limit CAH designations.
  • Cuts to outpatient and evaluation management services (E/M)—some of the most common outpatient services provided in hospitals.
  • Cuts to Medicare bad debt payments.

Another deadline looming is the end of the moratorium on enforcement of direct supervision requirements for outpatient therapeutic services delivered in a hospital. This policy change was first announced in 2009 and the federal government agreed to refrain from enforcing it for rural hospitals with fewer than 100 beds through 2013. MHA is pleased that Rep. Colin Peterson (D-MN) co-authored a House bill to change this policy, and that Sens. Al Franken (D-MN) and Amy Klobuchar (D-MN), as well as Rep. Tim Walz (D-MN) have signed on as co-sponsors of the bill in their respective chambers.

In addition, MHA continues to work on securing support for our priority bills. Additional support for these bills will increase the chances they are included in a larger legislative package. For questions, contact Ann Gibson, MHA vice president of federal relations and workforce, 651-603-3527. return to top 

Sample tobacco-free campus policy available for hospitals

Tobacco is a proven health and safety hazard, both to the smoker and non-smoker, carrying very serious health risks. It has been proven to be the leading cause of preventable death in the U.S. and is inconsistent with the health care mission of hospitals. Start Noticing, a coalition working to eliminate the harmful effects of tobacco use and exposure, has developed a sample tobacco-free campus policy for hospitals interested in ending tobacco use on their campuses. Hospitals can download the sample policy here and tailor it to your own facility. 

For questions about the sample policy, contact Susan Vileta with the Start Noticing coalition, 507-847-6930. return to top