AHA

AHA asks CMS to reconsider 2009 quality measures, payment rates

Anne Zieger — Fri, 29 Aug 2008 09:49:06 -0400

The American Hospital Association isn't too happy about the quality-reporting requirements in the new proposed outpatient prospective system rule for 2009, and it would like to see CMS make some changes. For one thing, it doesn't like the medical-imaging efficiency measures, which haven't gone through the National Quality Forum endorsement process, or been adopted by the Hospital Quality Alliance. The AHA argues that the measures should be vetted by both groups.

Meanwhile, the AHA says CMS hasn't demonstrated that creating two cost centers for drugs--which will impose new accounting and billing burdens on hospitals--will actually improve payment accuracy. Also, the group argues that the proposed payment rate for separately covered outpatient drugs is based on a method that contains flaws. The proposed payment rate, at an average sales price plus 4 percent, doesn't represent the acquisition cost of outpatient drugs. AHA is recommending a rate of the average sales price plus 6 percent, as paid to physician offices.

On the other hand, the AHA supports the CMS process for validating outpatient quality data, which AHA says will improve the accuracy of quality data, and already improves on the inpatient program, as well as its proposal to pay for partial hospitalization programs using two new ambulatory payment classes. AHA would like to see hospital-based partial hospitalization rates paid for both ambulatory payment classes.

To learn more about the letter:
- read this Modern Healthcare article
- read the AHA letter (.pdf)

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AHA says CMS hospital quality measures aren't ready

Wed, 11 Jun 2008 06:59:57 -0400

As things stand, hospitals soon will have to report on 72 quality measures (up from 30) if they want to receive full Medicare reimbursement. However, most of the new quality measures proposed by CMS for its fiscal 2009 budget aren't ready to be reported on yet, according to the American Hospital Association.

Of the 43 new measures CMS has proposed, only 10 have been adopted by the Hospital Quality Alliance, and what's more, many have not been endorsed by the National Quality Forum, wrote the AHA in a letter to the agency. AHA doesn't believe that the 33 measures not yet adopted by the Hospital Quality Alliance are ready for reporting. What's more, adding that many more measures may actually confuse hospitals as to what their priorities should be, according to AHA Executive Vice President Rick Pollack.

To learn more about the AHA's concerns:
- read this Modern Healthcare article (reg. req.)
- read the AHA's comments (.pdf)

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AHA wants review of blockbuster PA health plan merger

Thu, 08 May 2008 06:59:58 -0400

The planned merger between Pennsylvania health plans Highmark and Independence Blue Cross has dragged out a while now, partly because of the size of the deal. The new entity would be a giant, with $22 billion in operating revenue, making it one of the country's largest health plans. While the boards of both plans announced the merger more than a year ago, the Pennsylvania Insurance Department hasn't approved the deal and, in fact, won't even begin hearings on the deal until this summer. In the meantime, those who oppose the merger as concentrating too much bargaining power in one entity have had time to get in gear.

Now, the American Hospital Association has joined the list of challengers questioning the merger. The AHA has sent a letter to the U.S. Department of Justice asking the agency to investigate--and maybe even block--the deal between the two large health plans. The department and the FTC, both of which have the right to intercede in mergers, didn't object when the deal initially was announced. However, the two plans must refile some deal-related document since the deal hasn't closed. This gives the department's Antitrust Division another chance to review the deal. The AHA would like the department to look into possible provider rate increases and fewer health plan choices in the state.

To learn more about the merger's progress:
- read this Modern Healthcare article (reg. req.)

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Farm bill would restrict MD-owned specialty hospitals

Mon, 21 Apr 2008 06:59:58 -0400

In a piece of gamesmanship worthy of Capitol Hill, legislators behind a pending agriculture bill have slipped in a provision that would ban physician ownership of specialty hospitals. Versions of the measure already had been passed by the House and Senate without such provisions, but the ban was added during the final process of reconciling the House and Senate bills. The notion is that this would somehow help to pay the costs of the $280 million farm bill by generating some $2.4 billion in new money. (It appears that this involves some form of Medicare savings.) The AMA, of course, is hopping mad, particularly given the last-minute nature of the ban's inclusion. The AHA and the Federation of American Hospitals support the provision, not surprisingly given their consistent opposition to competition from such hospitals.

To learn more about this bill:
- read this Modern Healthcare piece (reg. req.)
- read this statement from the AMA

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