Minnesota Hospital Association


December 16, 2013

MHA Newsline

In this issue

Hospital spotlight: FirstLight Health System works to reduce CAUTIs

Health care-associated infections are the most common complication of hospital care. Hospitals across Minnesota are engaged in reducing catheter-associated urinary tract infections, and, as a result, there has been a 23 percent reduction among MHA hospital engagement network participating hospitals. FirstLight Health System in Mora sought to implement a nurse-driven protocol to remove catheters when no longer necessary and engage staff to ensure they were removed in a timely manner. Read more about FirstLight’s efforts. return to top  

Congress passes budget including a short-term patch to prevent cuts to physician’s payment rates

In a separate bill Congress is working toward a permanent legislative fix for the physician payment formula that currently contains relief for supervision rules related to outpatient therapeutic services

On Thursday, Dec. 12, Congress passed a bipartisan budget deal by 332-94, reducing the risk of a government shutdown. The deal contains several hospital-related provisions and is a mixed bag of news with some big disappointments.  

Minnesota Reps. Walz, Kline, Paulsen, McCollum, Peterson and Nolan voted in favor of the bill, and Minnesota Reps. Ellison and Bachmann voted against the measure.  

The Bipartisan Budget Act of 2013 contains $85 billion in spending cuts and new revenue to replace $63 billion in sequester cuts. In addition, an amendment to the bill allows for a three-month patch to prevent cuts to physician’s Medicare rates that are scheduled to be reduced by 20.1 percent on Jan. 1. The following hospital-related provisions were included in the bill:

  • Disproportionate Share Hospital (DSH) payments – Eliminates Medicaid DSH payment cuts in Fiscal Year (FY) 2014 and delays the scheduled FY 2015 DSH reductions until FY 2016. However, Medicaid DSH cuts would also be extended by one year to FY 2023.
  • Medicare sequester cuts – Extends the 2 percent sequester cuts to Medicare providers through 2023 — two years longer than cuts set by the Budget Control Act of 2011. This results in an estimated $154.7 million loss for Minnesota hospitals.
  • Long-term Care Hospital payments – New criteria requiring that patients who stay longer than three days in an intensive care unit or are on a ventilator, will qualify for a higher payment rate, while all other cases will be reimbursed at the equivalent of an inpatient stay.
  • Extender provisions – Retroactively extends the Medicare-dependent hospital program payments through March 2014; extends the Medicare low-volume hospital payment through March 2014; extends the Medicare therapy cap exceptions process through March 31, 2014; extends increased Medicare rates for ambulance services, including those in “super rural” areas, until April 1, 2014. The Medicare-dependent hospital program extension is worth $555,000 to Minnesota hospitals and the low-volume extension is worth $5 million.

As of Dec. 16, the Senate is expected to approve the bill early in the week and President Obama has indicated he will sign the bill into law.  

In the meantime, the House Ways and Means Committee and the Senate Finance Committee approved different versions of bipartisan legislation to permanently repeal and replace the Medicare Sustainable Growth Rate (SGR) formula for physician payments. Both bills would replace the SGR with a value-based program starting in 2017. The House bill would provide for a 0.5 percent annual update through 2017, and the Senate bill would freeze current payment levels through 2023.  

The Senate bill contains a provision that has been long-supported by MHA and American Hospital Association to address the issue of direct supervision of outpatient therapeutic services.  

The Congressional Budget Office estimates that replacing the SGR will cost about $116 billion over 10 years, and, at this time, neither bill specifies a funding source for the changes. The House and Senate will take the bills back up after the holiday recess. For questions, contact Ann Gibson, MHA vice president of federal relations and workforce, 651-603-3527. return to top 

2013 amendments to SQRMS published

The Minnesota Department of Health published the 2013 amendments to the Statewide Quality Reporting and Measurement System (SQRMS), a standardized set of quality measures for health care providers across the state. The Commissioner of Health is required to annually evaluate the measures included in the standardized set of quality measures. These rules were adopted in December 2009 and amended in November 2010, 2011, 2012 and 2013. The 2013 amendments to Minnesota Rules, Chapter 4654, Permanent Rules Relating to Health Care Quality Measures, were approved by the Office of Administrative Hearings on Oct. 25. A summary of the changes can be found here. The final and adopted rule and appendices as well as frequently asked questions can be found here. return to top  

CMS updates Hospital Compare data

Last Thursday the Centers for Medicare & Medicaid Services updated the Hospital Compare website with new measures, as well as refreshed performance data on some existing measures. CMS is publicly reporting new measures of hospital performance on stroke and venous thromboembolism care, as well as the rates of two new healthcare-associated infection measures – methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C. diff). MRSA and C. diff data is not reported for all hospitals because some hospitals may not have a sufficient sample size to report statistically meaningful rates. The agency also updated data on five readmission measures and one complication measure that it had previously suppressed due to issues with calculating performance benchmarks. The affected measures are heart attack, heart failure, pneumonia, hip and knee replacement, and hospital-wide readmissions; and hip and knee replacement complications. Click here to view the data updates. return to top  

Attorney general to clarify hospital trustees’ fiduciary duties at upcoming conference

Minnesota Attorney General Lori Swanson will discuss the unique fiduciary duties of nonprofit hospitals and health system trustees, including oversight of patient safety and care quality performance, financial assistance and charity care policies, and billing and collections practices during a presentation at the January Trustee Conference.  

Pressures for greater collaboration and financial sustainability often put trustees in the position of sorting through the merits and drawbacks of mergers, acquisitions and affiliations. As one of the state’s regulatory and enforcement authorities with respect to charities and nonprofit organizations, Attorney General Swanson’s presentation aims to clarify her perspectives on these duties and the important role hospital and health system trustees play in health care. 

The conference has been approved for up to 14.75 clock hours Minnesota Board of Examiners for Nursing Home Administrators.  

The Winter Trustee Conference takes place Jan. 10-12, 2014 at the Minneapolis Marriott Northwest in Brooklyn Park. Click here to learn more about the conference sessions or to register.  

The deadline for accommodations at the Marriott is Dec. 19. Click here to reserve your room online. return to top  

Newsline holiday schedule

Newsline will publish next Monday, Dec. 23 and take a holiday break until Monday, Jan. 6. return to top