Minnesota Hospital Association


February 10, 2014

MHA Newsline

In this issue

Don’t miss the chance to earn recognition for your hospital

MHA Awards nominations due Friday, Feb. 14

Is your hospital a best Minnesota workplace? Do you have an innovative patient safety program or exemplary caregiver who deserves recognition? If so, consider submitting a nomination for MHA’s annual awards program. For the past 30 years, the MHA Awards have celebrated outstanding work by Minnesota hospitals and health systems and we want to honor you.  

MHA award categories recognize excellence involving community health, workforce issues, patient care and career promotion, for example. Honors for individuals recognize trustees, volunteers, hospital executives, caregivers and public officials. Additional information on the categories and judging criteria can be found on MHA’s website.  

Entries are due by Friday, Feb. 14; find the entry form here: MHA Awards: Nomination Form 

MHA will notify all entrants whether they have won in mid-March. A reception and dinner will take place Friday, April 25 at the Metropolitan Ballroom in suburban Minneapolis. All MHA members and associate members are invited and encouraged to attend the awards ceremony. Mark your calendars and plan to join us for this celebration of excellence in Minnesota health care.  

For more information, contact Sarah Bohnet, MHA visual communications specialist, 651-603-3494. return to top    

Congress moves closer to Sustainable Growth Rate replacement

Federal legislation to permanently replace the Sustainable Growth Rate (SGR) cuts to physicians’ Medicare payment rates law took another important step forward last week. On a bipartisan basis, congressional leaders from the Senate Finance Committee and the House Ways and Means and Energy and Commerce Committees agreed on terms to repeal the SGR cuts and, instead, provide small rate increases over five years while Medicare transitions to new value-based payment models.  

The Medicare Physician Payment Innovation Act, HR 574, has significant hurdles remaining. Most notably, the agreement among the three committees does not include the difficult cuts to other federal spending that is needed to pay for the costs associated with repealing the SGR. Unless repealed or delayed, the SGR law would impose a 28 percent cut to physicians’ Medicare payments beginning April 1.  

Hospitals and health systems around the country are concerned that Congress will look to cut other providers to finance the change to physician payment rates. MHA will continue to advocate that hospital payments not be used as an offset.  

In previous comment letters and discussions with Minnesota’s members of Congress, MHA encouraged Congress to use the SGR repeal as an opportunity to implement more aggressive reforms that base payment rates on the quality and efficiency of physician services. Accordingly, MHA regards the compromise reached by the three committees as a positive step toward the association’s long-standing priority of reforming Medicare’s payment methodologies.  

At the same time, MHA is disappointed that a provision to reverse Medicare’s direct supervision of outpatient therapeutic services policy, which had been part of the Senate Finance Committee’s version of the legislation, does not appear in the compromise language.  

Lawrence Massa, president and CEO of MHA, said “the SGR bill offers a great vehicle for Congress to correct the deeply flawed direct supervision policy.” He said that if the SGR bill does not include language to reverse that policy, MHA and the American Hospital Association will continue to build support for separate legislation to address hospitals’ concerns on that issue.  

For more information, contact Matt Anderson, MHA vice president of regulatory and strategic affairs, 651-659-1421. return to top  

Two-midnight rule remains in flux

The Centers for Medicare and Medicaid Services (CMS) announced a six month extension of its partial enforcement delay of the new two-midnight policy for inpatient admissions. According to the recent CMS decision, Recovery Audit Contractors (RACs) will not review patient status of paid inpatient hospital claims for admissions between Oct.1, 2013 through Sept. 30, 2014. RACs and other Medicare contractors will conduct pre-payment “probe and educate” audits on select claims for patients admitted during this timeframe.  

Previously, CMS intended to begin two-midnight rule enforcement in April.  

CMS will discuss the two-midnight rule further during a Medicare Learning Network call on Thursday, Feb. 27 at 1:30 p.m. Details on the Feb. 27 call are available on the CMS website.  

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

Dysfunctional website causes another Meaningful Use extension

Unable to log on or complete a registration, inordinately long delays despite a looming deadline. Health care providers have raised these concerns regarding the website that providers must use to attest to meaningful use of electronic health records in order to receive Medicare's 2013 incentive payments for eligible professionals.

Because of multiple problems with its website, the Centers for Medicare and Medicaid Services (CMS) extended the deadline for attestations from Feb. 28 to March 31.

MHA members voiced similar complaints about the website and remain concerned whether the extension will be sufficient. Many MHA members described the website as almost completely inoperable during normal business hours either because providers are unable to log on to the website or because it kicks them out. Those who have been able to access the site describe the process as so slow and tedious that it takes hours to complete the attestation for a mere handful of eligible providers.

Frustrated and concerned about the looming deadline, many MHA members have been resorting to having staff work on the attestation process in the middle of the night and over weekends, when less traffic to the website allows for slightly improved performance.

Despite the extension, MHA members continue to hold concerns about whether they will be able to complete the required attestations for thousands of eligible providers by March 31 if CMS does not repair the website.

For more information, contact Mark Sonneborn, MHA vice president of information services, 651-659-1423. return to top  

DHS reverses its position on Medicaid sequestration cuts

In a welcomed response, MHA was informed last week that the Minnesota Department of Human Services (DHS) has decided to reverse its earlier position of implementing payment cuts to the Medicaid program due to sequestration (see Jan. 20 Newsline).   

Some of the services impacted by the 2 percent sequestration cuts were outpatient facility fees, ambulance, radiology, laboratory, orthotics and prosthetics. A Feb. 5 posting on its website indicates DHS will be refunding the take-backs they’ve collected from providers over the last month.  

In December 2013, DHS began making cuts to Medicaid services that use a Medicare fee schedule as the basis for payment. Their rationale was that Medicare had cut its fee schedules 2 percent due to federal sequestration, therefore the state of Minnesota would follow suit.   

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

Federal legislation introduced to remove the 96-hour physician certification requirement for CAHs

Late last week, U.S. Reps. Adrian Smith (R-NE), Greg Walden (R-OR), Lynn Jenkins (R-KS), and Dave Loesback (D-IA) introduced the Critical Access Hospital (CAH) Relief Act of 2014, H.R. 3991, to remove the 96-hour physician certification requirement as a condition of payment for CAHs.  

MHA staff submitted a request to all of our House Congressional offices encouraging them to co-sponsor the bill. MHA members are encouraged to follow up with their representatives to voice support of this request.  

Under the current requirement physicians at CAHs must certify at the time of admission that a Medicare beneficiary is expected to be discharged or transferred to another hospital within 96 hours of admission as a condition of payment. If something unforeseen occurs and the beneficiary needs to stay longer than 96 hours, the physician must certify and document the changed circumstances in order to still meet the condition of payment.  

There is a separate and distinct condition of participation which requires CAHs to provide acute inpatient care for a period that does not exceed, on an annual average basis, 96 hours per patient. H.R. 3991 does not impact the condition of participation.  

CMS has historically not enforced the condition of payment, but recently published guidance implying that the agency will enforce this condition of payment going forward. This means in many cases CAHs will no longer receive payment from Medicare for medical services requiring a beneficiary stay of longer than 96 hours.  

CAHs typically maintain an annual average of 96 hours per patient, but some of the medical services they offer have lengths of stay greater than 96 hours per patient. For example, a Medicare beneficiary with pneumonia may wish to receive care from the local CAH and remain close to family and home rather than traveling further to an urban or regional prospective payment system hospital. If this condition of payment is enforced, access to care will be compromised for these beneficiaries. MHA strongly supports H.R. 3991 as a solution to this problem.  

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

MN Accountable Health model announces e-health grant program

The Minnesota Accountable Health Model, Minnesota’s State Innovation Model (SIM) grant program, will soon release a request for proposals (RFP) for its e-Health Grant Program. E-Health is a major component of the Accountable Health Model, which will promote community oriented efforts to improve population health and health care quality.  

The future grants will provide funding to community collaboratives to develop a plan for meeting e-health requirements or to implement and expand e-health capabilities for participation in the model. MHA encourages members to consider this opportunity when the RFP is released and will provide additional information when it becomes available.  

For more information, click here. return to top  

Maureen Swan to present opening session at Healthcare Leadership Institute

Maureen Swan, president of Eden Prairie-based MedTrend, Inc., will present the opening session at the Healthcare Leadership Institute this March. During her presentation, Health Care 2015 and Beyond: The Shifting Landscape of the Who, Where and What of Health Care, she’ll discuss the core drivers of change transforming the U.S. health care industry and the role mobile devices, data mining analyzers, health insurance exchanges and national health care marketplaces will play in those changes. She’ll examine the implications of these issues for delivery systems in both rural and urban settings and what this means for the health care industry in Minnesota.  

The conference, “Daring to Lead in Times of Change,” will take place March 5-7 at the Crowne Plaza Minneapolis West in Plymouth. For more information and to register, download the conference brochure or visit MHA’s website. return to top  

Tool provides recommended practices for hospitals to optimize the safety and safe use of EHRs

Electronic health records (EHRs) have the potential to improve the quality and safety of health care. However, EHR users have experienced safety concerns from EHR design and usability features that are not optimally adapted for the complex workflow of real-world practice settings. The Office of the National Coordinator for Health Information Technology (ONC) has released a new suite of guides to help hospitals and health care organizations to optimize the safety and safe use of EHRs. These tools, referred to as the Safety Assurance Factors for EHR Resilience (SAFER) guides, can be used by hospitals to self-assess the safety and effectiveness of their EHR implementations, identify specific areas of vulnerability and change their cultures and practices to mitigate risks. The guides are available for free online. return to top