AHA wants more changes on new MSSP anti-kickback rules

The American Hospital Association (AHA) wants the U.S. Department of Health and Human Services (HHS) to loosen its new proposed rules regarding kickback prevention in Medicare accountable care organizations (ACOs), saying that in some areas it will actually impede the delivery of healthcare services.

The HHS' Office of Inspector General proposed changes to the safe harbor rules for kickbacks and gainsharing civil monetary penalties for Medicare Shared Savings Programs (MSSP) in October. The changes acknowledge the role that hospitals play in providing a continuum of care for patients, but the AHA claims they do not go far enough.

The Centers for Medicare & Medicaid Services released its proposal on program changes earlier this week, including pushing back financial penalties levied on poorly performing MSSP ACOs for three years.

In particular, the AHA raised issues with proposed rules governing the transportation of patients after they have been discharged from the hospital. It wants HHS to waive a requirement that hospitals only transport "established" patients and a restriction of such transports if they exceed 25 miles.

"Hospital responsibility for patient care no longer begins and ends at the inpatient setting or any other site of care provided by the hospital," wrote AHA Executive Vice President Rick Pollack to HHS Inspector General Daniel R. Levinson, noting that without reliable transporation systems, "this literally can mean the difference between a patient receiving or not receiving necessary care."

The AHA also objected to a change that would require organizations to notify patients about shared savings or quality programs that involved gainsharing transactions.

"The general experience of beneficiaries receiving boilerplate Medicare notifications is confusion. In addition, a physician's responsibility and interaction with the patient would not be affected by the existence or non-existence of a notification," Pollack wrote. "Physicians would continue to have the same responsibility to make medically appropriate decisions in consultation with the individual patient."

In addition to the AHA's concerns, the Premier group purchasing alliance also objected to the notification rule, observing in a statement from Senior Vice President of Public Affairs Blair Childs emailed to FierceHealthFinance that "patients already have to deal with lots of issues when they are admitted to a hospital and their capacity to absorb information about unfamiliar matters, such as gainsharing arrangements, is likely to be compromised due to the nature of their medical condition."

The proposed rule changes would likely take effect in 2015.

To learn more:
- read the AHA letter (.pdf)

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