RACs, politics, hospital survival dominate AHA annual membership meeting

The challenges that hospital leaders face were never more apparent this week than during conversations and sessions at the American Hospital Association's annual membership meeting.

Healthcare reform, burdensome regulations and what it takes to survive as an independent hospital were just a few of the themes that dominated breakout sessions and networking opportunities.

Richard Umbdenstock, president and CEO of the AHA, kicked off the trade group's conference by stating hospital leaders must "redefine the H" in healthcare delivery. Almost everything in the industry is on the verge of change, he said, except its main mission: to improve the health of patients and the communities.

If you weren't able to attend this week's conference in the District of Columbia, FierceHealthcare staff covered the event, which provided a glimpse of the current and future landscape of government regulations and policies as well as strategies for success in this ever-changing industry. Here are some highlights.

Politics take center stage

We learned that lawmakers won't give up on the quest to find the funding necessary to finally repeal the sustainable growth rate formula. True Medicare reform can't take place until Congress finds a way to pay doctors for Medicare services, Kevin Brady (R-Texas), chair of the House Ways and Means Subcommittee on Health, told AHA attendees.

And political experts weighed in on the White House administration and how healthcare reform and the disastrous rollout of HealthCare.gov will play out as Democrats and Republicans face each other during the upcoming midterm elections and the 2016 presidential race.

RACs remain a painful thorn in leaders' sides

The AHA intends to continue its advocacy efforts to stop Medicare and Medicaid funding cuts for hospital services, delay enforcement of the two-midnight rule and encourage lawmakers to pass the DSH Reduction Relief Act, which would give hospital's relief from the first two years of scheduled cuts to the Medicare disproportionate share hospital program.

But reining in recovery audit contractors (RACs) dominated most of Rick Pollack's address. Pollack, executive vice president of the AHA, said RACS have "run amok," acting more like "bounty hunters who prosper financially on each rejected claim." He urged attendees to contact their legislators to support the Medicare Audit Improvement Act, which would limit how RACs conduct audits.

"It's time to stop the RAC auditors who are sitting in a cubicle and second-guessing medical decision made by physicians ... sometimes three years earlier," he said.

Hospital survival under the spotlight

There are no easy answers for leaders who run critical access hospitals (CAH) and provide healthcare in rural communities, according to a panel of experts.

"The bigger threat is not CMS and their anti-CAH or anti-rural bias, but members of Congress beginning to catch on and spread that thought," said Lisa Kidder, AHA's vice president of legislative affairs. "They stand up for their hospitals, and they don't want their hospitals within 10 miles to close--but they understand why that hospital in the next state should close."

And although more hospitals turn to mergers to survive in the marketplace, healthcare consultant James Orlikoff provided leaders with questions to consider before pursuing a partnership--a strategy he isn't convinced will work.

Hospital leaders highlight success strategies

Team-based models to promote triple aim initiatives is one solution to complications from increased patient volumes, according to Robert L. Wergin, M.D., president of the American Academy of Family Physicians.

Senior executives from Presbyterian Healthcare Services in New Mexico, Billings Clinic in Montana, and CareMore, a division of WellPoint, shared initiatives that they successfully implemented to integrate and transform their organizations under a value-based business model.

And Chip Caldwell, a consultant and former healthcare executive, also shared three strategies that hospital leaders can follow to transition to a value-based reimbursement system

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