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We’ve been working on this notion of a One Team Culture for nearly three years. Why One Team? Because the work we do matters to the lives of millions of Californians who need health care or benefit from social programs organized or funded by our hospitals.
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The Centers for Medicare & Medicaid Services (CMS) regularly provides important updates about post-acute care quality reporting programs (QRPs), including training opportunities, public reporting, and reminders of data submission and review deadlines.
Inpatient Rehabilitation Facilities
QRP training
CMS will host two webinars for inpatient rehabilitation facilities (IRFs) on proper coding of Section M Skin Conditions (Pressure Ulcer/Injury) and Section N of the IRF Patient Assessment Instrument Version 2.00. Updated reporting requirements for Sections M and N became effective on Oct. 1 for IRF providers. See the IRF Quality Reporting Training web page for details.
Long-Term Acute Care Hospitals
Provider preview reports
CMS has informed long-term acute care hospitals (LTCHs) that previous provider preview reports for the Discharge to Community – PAC measure contained an error. Preview data released in June 2018 incorporated only seven of eight required quarters of data. Data from October through December 2016 were inadvertently omitted.
CMS has reissued the LTCH provider preview reports, and corrected reports are now available via CASPER system folders. LTCH providers have until Aug. 31 to preview the corrected data in advance of public reporting for the September 2018 LTCH Compare Refresh.
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California’s nine-month legislative session will take its summer recess in mid-July and rev back up in mid-August for what will be a frenetic final four weeks to send bills to the Governor’s desk. CHA has been tracking hundreds of health care-related bills, and actively working on dozens on behalf of hospitals and health systems.
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Earlier this week, nearly 50 of California’s hospital and health system leaders trekked almost 3,000 miles to Washington, D.C. Their purpose: to share with members of Congress the legislative changes they need to successfully meet their mission of care back home.
It was an impressive showing for this year’s joint advocacy program, hosted by your California Hospital Association and the American Hospital Association. I am grateful to have been able to spend time with John Muir Health President & CEO Cal Knight, CHA’s Board Chair, along with Stanford Health Care President and CEO David Entwistle, and Alameda Health System CEO Delvecchio Finley, California’s representatives on AHA’s Board of Trustees.
From left to right: Delvecchio Finley, CEO, Alameda Health System; AHA Board of Trustees Chair Brian Gragnolati, President & CEO, Atlantic Health System; Carmela Coyle, President & CEO, CHA; Cal Knight, President & CEO, John Muir Health; David Entwistle, President/CEO, Stanford Health Care
House Speaker Nancy Pelosi, who represents San Francisco, was a keynote speaker and touched on some of the major issues facing the nation and health care in particular.
“We have a common goal of affordable quality health care for all,” Pelosi said.
She then thanked California’s hospital leaders for joining her on that path.
I, too, would like to extend my thanks to all who were there. It is when we stand together that we are strongest, and our federal representatives – through meetings with nearly every member of California’s congressional delegation, and in social events – heard loud and clear three key messages.
First, health care affordability must be addressed, and hospitals are ready to do their part. That said, Medicare for All is not the right solution. Rather, tailored policies (many of which require federal support) that account for the unique needs of different communities should be employed.
Second, patients should be protected from “surprise” medical bills, which often result from “surprise” insurance claim denials. This should be done by supporting effective, fair state laws and by enacting comprehensive federal legislation that does not rely on artificial price regulation.
Third, none of these efforts should impede hospitals’ ability to care for those in need. Proposals that would diminish already stretched hospital and health system resources (like the impending $4 billion disproportionate share hospital payment cut) jeopardize both access to care and the quality of care. Instead, legislators should support initiatives that promote access and quality.
Amid the cacophony on Capitol Hill these days, it can be easy for hospitals’ voice to get lost in the din. This week’s efforts represent another way that your CHA is working to make sure hospitals are heard by those in power, so our messages are not dismissed, and so that the life-saving and life-changing work you do continues.
— Carmela
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The Centers for Medicare & Medicaid Services (CMS) has issued its federal fiscal year (FFY) 2021 inpatient prospective payment system (IPPS) proposed rule. In addition to annual payment and quality program updates, the proposed rule would require certain payer-negotiated rates to be reported on the cost report, make changes to Medicare disproportionate share (DSH) payments, and establish a new Medicare Severity-Diagnosis Related Group (MS-DRG) payment for Chimeric Antigen Receptor T-cell (CAR T) therapy.
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Today, the Centers for Medicare & Medicaid Services (CMS) issued its final rule updating the outpatient prospective payment system (OPPS) for calendar year (CY) 2019, which also includes payment updates for ambulatory surgical centers. Despite strong opposition from CHA and the hospital field, CMS finalized an expansion of its site-neutral payment policies.
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With the legislative year coming to an end in Sacramento last week, and important signing decisions yet to be made by the Governor, our advocacy in Washington, D.C., is heating up.
Congress returned Sept. 9 facing a full legislative agenda. Because neither party wants another government shutdown, the House of Representatives passed a measure to keep funding flowing through Nov. 21. The Senate is expected to consider that legislation in the next few days.
There’s also a full slate of health care issues up for debate in the coming months, so it was important that we took the opportunity last week, alongside nearly two dozen of California’s hospital CEOs, and with our partners at the American Hospital Association, to spend time with members of the California congressional delegation to discuss the issues most important to your hospitals and your patients.
As we made the rounds on Capitol Hill, some common themes emerged:
• Surprise billing: This issue is top of mind for Congress. Over the summer, one House committee reported legislation, the No Surprises Act; two others are expected to craft additional bills, and we could see a House floor vote sometime this fall. This week, the issue took on a new depth when the House announced an investigation into private equity firms that own physician-staffing companies, and whether they use out-of-network billing as an intentional strategy. In the meantime, we’ll keep reinforcing our message that hospitals support taking patients out of the middle when it comes to out-of-network bills, but we stand firmly against rate setting as part of the solution.
• Eliminating payment cuts to Medicaid disproportionate share hospitals (DSH): Set to take effect Oct. 1, cuts to Medicaid DSH hospitals will be unsustainable for many hospitals and could sever the safety net for your most vulnerable patients. We’re fighting hard on this one, urging that the cuts be eliminated or – at a minimum – delayed. The good news is that we have strong support in Congress, and a delay in the cuts for the first quarter of the 2020 fiscal year is part of the current House bill to temporarily fund the government. It’s good to be part of “must-pass” legislation, and we’ll keep pressing to get this done.
• Drug pricing: Reducing consumer drug prices remains a high priority for both Congress and the president. As we monitor those evolving efforts, we’re engaged in discussions with California congressional leaders to fully understand the various forms any pending legislation might take, as well as any impact on patients and hospitals.
As we continue to fight for policies that help you care for your patients and communities, last week’s meetings in the nation’s capital make clear that our greatest strength is in our unity, and when you lend your personal voice to the conversation, our message resonates. Thanks to all of our AHA regional policy board representatives who traveled to set the stage for our senators and representatives as they prepare to make decisions that will affect all of your hospitals.
— Carmela
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The Centers for Medicare & Medicaid Services (CMS) has issued its federal fiscal year (FFY) 2021 inpatient prospective payment system final rule. The final rule is effective Oct. 1.
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California’s 120 state assemblymembers and senators, like the rest of us, have been grappling with the new reality that COVID-19 has wrought. For the legislators and those who seek to influence them, it meant doing business very differently as they were pressed for time and consensus-building. It also meant a unique focus on taking action to mitigate COVID-19’s impact on Californians.
Health care decisions should be made by clinicians, not insurance companies that profit while patients suffer.