American Hospital Association (AHA)

Non-profit tax exemptions under heavy fire

Anne Zieger — Wed, 24 Dec 2008 10:50:42 -0500

Sen. Charles Grassley has been on a tear this year--one that could change the way not-for-profit hospitals defend their tax exemptions for decades to come. Meanwhile, prodded by Grassley and others, the IRS has done its own smackdown on how hospitals report on their charitable activities. And lest you think we're talking mere bureaucratic tweaks here, think again; the new IRS regs are serious business that require non-profits to do a whole lot of 'splainin'.

For one thing, the IRS rolled out new rules about how not-for-profit hospitals govern themselves, and how much subsidized and free care they provide. This included a new supplemental form, Schedule H, to the IRS's Form 990. The problem is, the American Hospital Association has said that these forms needed serious work. The dust is still settling on all of this, and hospitals can expect much wrangling over how the agency interprets the information on these forms in coming years.

In other news, University of Texas M.D. Anderson Cancer Center had to fight to defend its reputation as a charitable institution, especially when Senator Grassley turned his evil eye on them. Meanwhile, we'll have to wait until next year to see if the U.S. Supreme Court decides to take on the case of Vision Service Plan vs. the IRS, in which case their decision could cause a major sea change. More frighteningly, to non-profits, is the prospect that Grassley will, at long last, file legislation that would set a minimum amount of patient revenue (probably 5 percent) that non-profit hospitals will have to spend on charity care to keep their exemption.

Meanwhile, non-profits are facing state and local battles to defend their tax exemptions, too. For example, Provena Covenant continued a long battle to try to regain property tax exemptions this year. Not only that, states and municipalities are eyeing hospitals' property tax exemptions. (Boston's mayor, for one thing, is now trying to get more money out of the city's flush non-profits.) Expect more of the same in 2009--after all, nobody's predicting a magic end to the US recession anytime soon--and tax exemptions are a ripe target. I think we can be sure churches are safe, but hospitals, watch out!

AHA, AMA balk at CMS nonpayment proposals for never events

Anne Zieger — Thu, 04 Dec 2008 03:22:03 -0500

The American Medical Association and the American Hospital Association have come together to challenge CMS proposals that would ban Medicare payments when surgeons operate on the wrong patient, the wrong part of a patient or perform the wrong procedure. While such a rule might sound simple on the surface, the two groups are both arguing that it's not--that CMS will need to do a better job of defining what can be reimbursed and what can't be before it begins withholding funds.

The AMA, for example, argues that the agency shouldn't simply add broad restrictions to its National Coverage Determination process, but should instead, "develop a clear payment policy outlining the circumstances" under which providers would forfeit their payment.

The AHA, for its part, also contended that CMS should determine what costs or services associated with the surgery wouldn't be covered. The hospital group would also like to see CMS provide some help on how it plans to assign responsibility when these errors occur.

To learn more about the study:
- read this Modern Healthcare item

AHA survey: Negative profit margins for hospitals

Anne Zieger — Thu, 20 Nov 2008 10:33:36 -0500

With all the news we've been giving you of hospitals around the country struggling, it should be no surprise that the AHA's new survey results on hospital finances are not good. A quick-response survey about the third quarter of this year showed that hospitals are showing a negative profit margin of 1.6 percent; last year's result was a positive margin of 6.1 percent.

So what are hospitals considering to get their profit margin back on the positive side? More than half are at least thinking about staff reductions, and a quarter of them are trying to decide whether they should reduce their services.

Meanwhile, it could get even worse; as the unemployment rate rises, more people are likely to seek uncompensated care at emergency rooms. The AHA has no magic solution for the problem, but it is pleading with lawmakers to not decrease payments for Medicare and Medicaid. That would just be adding insult to injury.

To learn more about the survey:
- read this Modern Healthcare piece

Outpatient services limited by new Medicaid rule?

Dan Bowman — Fri, 07 Nov 2008 09:56:24 -0500

Intended to curb abuses in billing, the Centers for Medicare & Medicaid Services issued a rule to limit different outpatient services offered by Medicaid. Out of a group of seven rules initially proposed earlier this year, the CMS rule was the only one not overturned by President Bush in June. Both hospitals and patient advocacy groups argued that the seven rules would would eventually cause big cuts in funding.

Richard Pollack, executive vice president of the American Hospital Association, still feels that the lone remaining rule can only be bad news for patients. "This regulation will jeopardize important community-based services, including screening, diagnostic and dental services for children, as well as lab and ambulance services," he said.

In attempting to clarify how the new rule will affect patients, CMS said in a statement that it will "address ambiguity in the definition of outpatient hospital services," to try to make clear the differences between "outpatient hospital facility services" and "other covered Medicaid benefits."

To learn more about this CMS rule:
- read this Modern Healthcare article
- or check out this article

Patients question hospital quality performance on key issues

Anne Zieger — Thu, 30 Oct 2008 09:25:16 -0400

Now here's some data that gives with one hand and takes with the other. On the one hand, patients are apparently giving high approval ratings to hospitals. On the other, the same patient satisfaction data suggests that they feel facilities aren't doing well on some basic quality issues, according to a new study appearing in the New England Journal of Medicine.

Researchers concluded that patients were satisfied that they were getting high-quality care for the four conditions measured by the study, which included acute myocardial infarction, congestive heart failure, pneumonia and prevention of surgical complications.

On the other hand, patients weren't nearly as satisfied with the way hospitals managed pain, communicated about meds or coordinated discharges, according to the researchers, who reviewed data collected by CMS's Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS. The HCAHPS data was cross-referenced with data from the American Hospital Association's annual survey.

All told, hospitals that had more nurses at the bedside received better ratings from patients. Also, the researchers found that the ratio of nurses to patient-days was a predictor of a hospital's performance in HCAHPS results. Specifically, those were the hospitals whose performance on pain control, medication communication and discharge were best.

To learn more about the study:
- read this Modern Healthcare piece (reg. req.)

Related Articles:
HFMA ANI 2008: 'Value' study finds hospital quality high, but price variations wide
Medicare releases volume, customer satisfaction data
Gap widens in patient satisfaction study
"Mystery shoppers" check up on healthcare

Increasing partnerships between hospitals to share expertise

Anne Zieger — Thu, 23 Oct 2008 10:33:40 -0400

Hospitals have, of their own accord, been far more likely to form partnerships to share expertise or learn about particularly successful programs. Rick Wade, senior vice-president of the American Hospital Association, says that this is an increasing trend, especially common between children's hospitals because they share very similar structure and a common mission.

An example of one such partnership is the one about to start in December of this year between Cincinnati Children's Hospital and Arkansas Children's Hospital. In the past, Arkansas children had to travel to Cincinnati to get some specialty procedures, but now physicians will be traveling once a month to perform those procedures closer to home.

In exchange, Arkansas medical personnel are going to be traveling to Cincinnati to teach them about their patient-transport program; Arkansas Children's Hospital is an authority in the area of patient-transport.

Of course, hospitals' willingness to collaborate comes and goes, depending on the political and competitive climate of the day. But given the particularly intense financial pressures on the industry, the need to share clinical data and the industry-wide push to lower infection rates, among other issues, it's hardly surprising that they're more cooperative than usual.

To learn more about these partnerships:
- Read this Kaiser Daily Health Policy Report piece

AHA recommends standardized colors for wristbands

Anne Zieger — Mon, 08 Sep 2008 23:58:36 -0400

Sometimes, choosing a red patient wristband over a yellow one can be the difference between a safe patient and an injured one, which is why the American Hospital Association is pressing hospitals to standardize the colors they use for this humble but critical patient-care device. The AHA would like to see all hospitals use red wristbands for patient allergies, yellow ones for a fall risk and purple for patients who've asked for "do not resuscitate" orders. The AHA's action follows guidelines from 25 state hospital associations, which have provided voluntary recommendations on how to standardize wristband colors for patients. According to the AHA, caregivers working in states that have adopted standardized wristband colors have reported reduced confusion, according to the association.

To learn more about this policy:
- read this Modern Healthcare piece

Related Article:
Study: Bar codes may not fix medication mistakes

AHA asks CMS to review details of 'never event' policy

Anne Zieger — Wed, 03 Sep 2008 15:41:07 -0400

Citing an analysis of patients undergoing the wrong surgery or surgery on the wrong patient or body part, the American Hospital Association has asked CMS to give some thought to the complexities of implementing its 'no pay for mistakes' policy. Before withholding payment, CMS should take several mitigating factors into account, AHA said. For example, it's asking CMS to create a policy to consider mixed events, such as when a provider nearly but doesn't complete a procedure on a wrong site, discovers the error, stops the procedure and begins on the correct site.

The AHA has adopted its own set of principles that describe when hospitals should not expect payment for care related to preventable, serious adverse events. Along those lines, it's asking CMS to consider three key questions as it begins to consider a national coverage determination for the three surgical conditions. These questions include how the adverse event will be defined, how accountability will be assigned and what costs or services should not be covered.

To learn more about the AHA's position:
- read this Healthcare Finance News article

Related Articles:
Medicare to expand 'no-pay' list
By 2008, Medicare won't pay for hospital errors
BCBS plan phasing out pay for errors, 'never events'
SPOTLIGHT: AMA says CMS 'no-pay' list is unrealistic

ALSO NOTED: Medicaid cuts could slice $1B from NY medical education; IL woman wins $15M med mal settlement; and much more...

Wed, 21 May 2008 06:59:50 -0400

> If Medicaid cuts take place as expected, New York's medical education programs could take a big hit. FierceHealthFinance

> An Illinois woman has settled a malpractice suit against a Sandwich, IL hospital for $15 million in one of the largest settlements in the history of the state. Article

> The American Hospital Association has told the IRS that its Form 990 and Schedule H could use some work if they're going to be fair to hospitals, especially small, cash-strapped facilities. FierceHealthFinance

> While sharing clinical data is great, it's not a good idea to make that happen by getting patients to sign blanket consents to share their data, some privacy advocates say. FierceHealthIT

And Finally... For some people, it's publicity at any price. Article

U.S. Reps give boost to physician-owned hospitals

Fri, 11 Apr 2008 06:59:57 -0400

In recent times, physician-owned hospitals have taken a lot of fire in Congress--but at least two U.S. Representatives say that some of the criticism is out of line. In a recent letter, sent by Reps. Sam Johnson (R-TX) and Ruben Hinojosa (D-TX) to their Congressional colleagues, the two contended that information provided by a trio of hospital groups on the subject was inaccurate. They're saying that in its recent recommendations arguing for new limits on such facilities, HHS inappropriately relied, in part, on faulty information provided by the American Hospital Association, Federation of American Hospitals and Coalition of Full Service Community Hospitals. These groups, which feel extremely threatened by the growth of physician-owned specialty hospitals, simply misstated some key facts, the Congressmen say.

Their contention is backed up by Deputy Inspector General Stuart Wright, who says the groups' document includes several statements that misrepresent the IG's findings in a recent report on self-referral. For example, the IG's report, Prohibit Physician Self-Referral, found that 55 percent of physician-owned specialty hospitals have emergency departments, while the groups said "more than half" of such facilities lack such full service EDs.

To learn more about the controversy:
- read this Modern Healthcare piece (reg. req.)

Related Articles:
Congress considers specialty hospital regulation
Physician-owned hospitals: A conflict of interests?
Texas specialty hospitals do lucrative business
Partnership building 10 doctor-owned hospitals