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The AHA has testified before Congress to protect their turf. They want the whole hospital exception in Congress' legislation changed so they will not have to compete. The problem is that CMS is going after the reimbursements for all hospitals. They also will not extend the moratorium on physician owned specialty hospitals. The community hospitals got what they deserved.
CMS has issued its report to Congress on the Specialty Hospitals. They stated they will change the DRGs to more accurately reflect those with a higher care need to be paid more. This is for all hospitals. For all ASCs, including those run by hospitals, there will be a study to determine which of the procedures now paid at a higher rate in hospital outpatient facilities should be paid at a lower ASC rate. They tried to define a hospital and came up with that it mainly takes inpatients, which allows specialty hospitals in the door. They could not come up with needed changes in their enrollment procedures for any hospital that meets the "primarily engaged" in inpatient care criteria. The CMS determined that all hospitals do not need an emergency room but all should accept transfers, even if there is no ED. They did not speak to the on call provisions. The CMS will continue to study the specialty and community hospital settings.
CMS is also considering the refusal of payment for hospitalizations which result in "never events". These are wrong sided surgery, mismatched blood and other such horrific mistakes.
The Health Resources and Services Administration has proposed that hospitals be added to the reporting to the Data Bank. The AHA has stated n a letter that they do not believe that peer review of a practitioner would affect the reporting of a hospital. The new reporting would affect hospitals if an accreditation agency (JCAHO or its ilk) gave less than full accreditation. The AHA believes that only final actions and not those which can be appealed should be reported. The AHA is not sure how the organization will be affected if the hospital is purchased by another. I believe it should stay with the hospital no matter who the owner is, just like it does with a physician no matter where they go.
The California Senate has blasted UC Irvine for their lack of accountability in their liver transplant scandal. They had turned down appropriate transplantable livers since they had no surgeon. They also had problems with potential and actual nepotism. The Senate Committee is looking but will fail to decrease the funding to Irvine unless they have better oversight over their problems. It is a shame that Kaiser being private can not be skewered as well.
The hospitals of the The People's Republic of Massachusetts are in for a good time now that the "legislature" has passed a nurse ratio bill. This is much better than the ill thought out California bill. Here the Department of Public Health will regulate the ideal number of patients per nurse. This number could be flexible. The hospitals love it as much as the California hospitals do, especially the ones that have gone out of business or closed parts of the hospitals due to the lack of nurses. The bill does not include LVNs or aides. One should make note that the California bill has not increased the nurses at all. In fact, California has the lowest nurse to population ratio in the country.
The Iowa Department of Health has finally caught up to the 21st century. They are allowing, as most states already do, hospitals to have extended care facilities within their hospital. The idiocy of having to build another hospital for the care of these patients when beds are available in the community hospital is evident finally. Of course, Iowa still has the dreaded CON law and the extended care will have to pass that. Top
The US Congress has questioned Dennis O'Leary the forever retiring head of JCAHO. They asked about the Shared Vision Project and confects of interest between the organization and its subsidiaries. They want a list of all funds that went between JCAHO and JCR. This is a follow up of the GAO investigation of the organization. The conflicts are the accreditation by the same agency that also sell products and services to the hospitals to pass the accreditation. The Congress will introduce legislation to have more accountability by the organization to Congress. Top
CMS has been busy. They have ordered Medicare Advantage fee for service plans to increase their payments for care to include the recent raise of the Deficit Reduction Act. They have been ordered to fund the raise from January 1.
See above for their stance on payments to all hospitals as related to severity adjusted. The community and specialty hospitals are now on equal footing for payment for equal severity patients. Top
DISCLAIMER: Although this article is updated periodically, it reflects the author's point of view at the time of publication. Nothing in this article constitutes legal advice. Readers should consult with their own legal counsel before acting on any of the information presented.