IN THIS ISSUE

Bill Would Block Ergonomics Mandate

House Bill (HB) 5447, legislation to prohibit the Michigan Department of Labor and Economic Growth (DLEG) from promulgating rules establishing workplace ergonomic standards, was passed by the state House of Representatives Wednesday and by the Senate late Thursday. The passage followed months of debate over a controversial effort to make Michigan only the second state in the country to impose ergonomic regulatory standards. The bill now awaits the governor's signature. Rep. Rick Jones (R-Grand Ledge) sponsored the bill that, in addition to prohibiting state-level requirements, would authorize DLEG to provide guidance and information on best practices and to continue its assistance in voluntary ergonomics programs.

The Ergonomics Standard Advisory Committee of the Michigan Occupational Safety and Health Administration (MIOSHA) is currently working on its 12th draft of proposed rules, despite the passage of legislation last year that blocked any state funding for development of such regulations. MIOSHA is administered by DLEG.

Testimony in opposition to HB 5447 came from DLEG, representatives of organized labor and workers with repetitive motion injuries. Because the legislation would protect health care providers and other employers from being required to comply with excessive and unnecessary government regulation, the MHA joined a coalition of business groups in support of the bill, which was led by the Michigan Manufacturers Association, the National Federation of Independent Businesses, and the Michigan Chamber of Commerce. For more information, contact Nancy McKeague at the MHA.

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Early Registration Discount Ends Friday for Leadership Conference

The discount for early registration ends Friday for the MHA Health Foundation Winter Leadership Conference, formerly known as the Small & Rural Hospital Conference. This important event is scheduled for Feb. 22 and 23 at the Shanty Creek Resort – Cedar River Village in Bellaire. Leaders engaged in innovation, supporting a dynamic culture, growth, gold-standard performance and change will receive ideas and tools to take the organization to the next level. Numerous general sessions and learning intensives will deliver the latest strategies for excellence and offer real-time solutions for today's biggest challenges. Questions about the conference or registration process should be directed to Leigh Anne Jewison at the MHA.

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JCAHO Requests Field Review of Two Standards

The Joint Committee on Accreditation of Healthcare Organizations (JCAHO) has introduced for field review a proposed standard for staff influenza vaccination and a revision to the plan of care standard for anesthesia. The deadline for comments on both standards is Feb. 12.

The proposed standard calls for organizations to develop and implement a process to educate and offer influenza vaccinations to hospital staff. It is based, in part, on a statement published in July 2005 by the Centers for Disease Control & Prevention's Advisory Committee on Immunization Practices (ACIP) that included a set of recommendations on the prevention and control of influenza (MMWR, 54(R08); 1-40).

The revision of Standard PC.13.20 – Plan of Care for Anesthesia changes the standard and the element of performance by 1) replacing the word "concur" with "agree," and 2) stipulating in the standards that the practitioner administering the moderate to deep sedation or general anesthesia and the practitioner performing the procedure must agree that the patient is an appropriate candidate for the planned level of sedation or anesthesia. The standards language has also been revised to address the role of a licensed independent practitioner (e.g., a certified nurse midwife and a certified registered nurse anesthetist in some states) when neither the individual performing the procedure nor the person administering sedation or anesthesia are licensed independent practitioners. For more information, contact Sam Watson at the MHA.

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Michigan House Forms Three New Committees

House Speaker Craig DeRoche (R-Novi), after consultation with House Minority Leader Dianne Byrum (D-Onondaga), announced the formation of a new committee to examine tort reform in Michigan, as well as new subcommittees and appointments designed to further improve efficiency in the state House. The new Committee on Tort Reform, to be chaired by Rep. Kevin Elsenheimer (R-Bellaire), was created to help bring greater fairness and efficiency to Michigan's civil justice system in an effort to strengthen the state's economy. DeRoche said Michigan has been a leader in tort reform, but the state must step up its efforts to remain a leader and fight lawsuit abuse. Tort reform committee members also include Reps. Ed Gaffney (R-Grosse Pointe Farms), Joe Hune (R-Hamburg Township), Bill Huizenga (R-Zeeland), Roger Kahn (R-Saginaw Township), Minority Vice Chair Steve Adamini (D-Marquette), Bill McConico (D-Detroit) and Steve Bieda (D-Warren). It is likely the new committee will consider medical malpractice and product liability issues.

The speaker also formed the Tax Policy Subcommittee on Business Tax Restructuring, to be chaired by Fulton Sheen (R-Plainwell), which will research and work to develop an equitable and job-friendly state business tax structure to prepare for the 2009 expiration of the Single Business Tax.

The third group, the Government Operations Subcommittee on School District and Municipal Finance, will be chaired by Rep. Judy Emmons (R-Sheridan) and will review current law regarding state receiverships of school districts and municipalities to ensure they are applicable and up-to-date. Members with questions should contact Dave Finkbeiner at the MHA.

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Hospital Input Solicited on OPPS Claims

As indicated in last week's MHA Monday Report, the Medical Services Administration (MSA) recently announced that the implementation of an ambulatory payment classification (APC) system to replace the current Medicaid fee-based payment system has been postponed from July 1 to Oct. 1, 2006, to allow more time for systems preparation and analysis. The MSA intends to distribute periodic updates to the APC work group, which is comprised of representatives from the MSA, hospitals, Medicaid health plans and the MHA, to identify various policy and system development issues and solicit input. The Medicaid APC system is expected to mirror the Medicare APC system, with adjustments for the pediatric and maternity populations.

Last week, the MSA requested hospital input regarding technical limitations of the current claims processing system, which limits the number of allowable service lines to 50 per hospital claim. When a claim that exceeds 50 service lines is received, the current MSA system separates the claim, adjudicating part of it as a new claim.

Under a Medicaid APC system, the MSA believes there will be more instances where hospital claims exceed 50 service lines, especially for services that require series billing such as physical therapy and dialysis. As a result, the MSA has requested input on the following questions:

The MSA requests that hospitals respond via e-mail to provide answers to the above questions and identify other concerns related to repetitive billing and/or claims that exceed more than 50 service lines. A summary of issues identified and the MSA's responses will be available online. Members with questions should contact Vickie Seal at the MHA.

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CMS Proposes Update to Inpatient Psychiatric PPS

The Centers for Medicare & Medicaid Services (CMS) recently released a proposed rule to update the inpatient psychiatric prospective payment system, effective for cost reporting periods beginning on and after July 1, 2006. The proposal, which includes a 4.5 percent marketbasket increase, would also make several refinements to the payment policies. These refinements include:

• a proposal to adopt a new method for determining inflation in the costs of goods and services provided in inpatient psychiatric facilities (rather than using the acute-care hospital marketbasket, the CMS proposes to develop a new marketbasket to reflect inflation in three types of hospitals excluded from the inpatient prospective payment system, including inpatient rehabilitation facilities, inpatient psychiatric facilities, and long-term-care hospitals)

• a proposal to adopt the Office of Management and Budget geographic area definitions based on the new core-based statistical areas (CBSAs) for wage index purposes

• a proposal to increase the fixed-dollar loss threshold amount for outlier payments from $5,700 to $6,200

• a proposal to increase payment for electroconvulsive therapy (ECT) based on the latest hospital median cost data for ECT

The CMS estimates that, on average, inpatient psychiatric facilities will receive a 4.2 percent increase in their Medicare payments. The CMS is accepting comments on the proposed rule until March 14. The proposal will be published in the Jan. 23 Federal Register, with the final rule to be published later in the spring. The MHA will submit its comments to the CMS and encourages members to do likewise. In addition, the MHA will distribute facility-specific impact reports to the affected facilities in the near future. Members with questions should contact Vickie Seal at the MHA.

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Members in the News

Richard J. Deloof	Sarah Gilbert

Richard J. DeLoof has been named vice president, development, at St. Mary Mercy Hospital, Livonia. DeLoof was previously principal of DeLoof and Associates and also served as the director of capital campaigns and major gifts at the St. John Health Foundation of Detroit. He has 12 years of experience in development, specializing in the health care and educational sectors, and is a member of the Association of Fundraising Professionals and the Association of Healthcare Philanthropy.

In addition, Sarah Gilbert has been named director, strategic capital projects, at St. Mary Mercy, and will oversee hospital construction development, renovations and facility advancements. This includes construction of a new cancer center scheduled to open in 2007 and renovation of the hospital's diagnostic services areas. Gilbert has served at St. Mary Mercy since 1998 as director of rehabilitation services and as director of cancer services.

For the third consecutive year, Bronson Healthcare Group, Kalamazoo, has been named to FORTUNE magazine's list of the "100 Best Companies to Work For." Ranked as 68th on the 2006 list, Bronson is one of nine health care organizations to be named and one of just five Michigan companies on the list. The magazine says, "Nurses are the heart of this hospital, which recognizes their role by including a chief nursing officer on the senior management team."

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Medical Coding Program and Health IT Degree Available Online

The MHA Health Foundation, in partnership with Davenport University, is offering two progressive programs that reduce errors and improve reimbursement, as well as improve health information management practices. The Medical Coding Diploma Program is designed to improve the accuracy of medical records coding and billing. Graduates of the medical coding program are eligible to take the American Health Information Management Association's Certified Coding Associate or the Certified Coding Specialist examination. The Health Information Technology (IT) Associate's Degree offers in-depth education on data collection, quality monitoring, reimbursement, research and patient care evaluation in accordance with legal and regulatory standards. In addition to classroom learning, the associate degree provides valuable additional hours of practice in professional medical settings. The online programs are offered to MHA members at a discounted tuition rate and scholarships are available. For more information on the Medical Coding Diploma Program and Health IT Associate's Degree, contact Lori Lieffers at Davenport University at (800) 632-9569, or explore the program options at the university's Web site. Questions about this service should be directed to Erin Steward at the MHA Health Foundation.

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MHA Keystone DVD Now Available Online

The recently developed MHA Keystone: ICU DVD is now available on the Web site of the MHA Keystone Center for Patient Safety & Quality. The DVD features the quality initiative's latest results in Michigan intensive care units and can also be downloaded to viewers' computers and burned to disc.

The MHA recommends the DVD be shown internally to Keystone Center participants, senior management, hospital boards of trustees and others. This five-minute video is also useful in helping business and community leaders, civic groups, religious congregations, local media, and local and state officials understand the impact of the project.

For more information about MHA Keystone, including fact sheets and media coverage from throughout the state, visit the center online. Members with questions about the DVD should contact Kevin Downey at the MHA.

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Register Now to Review Rehab Facility Reimbursement

The Centers for Medicare & Medicaid Services' Provider Communications Group is hosting a conference call from 2 to 4 p.m. Feb. 2 to review refinements for inpatient rehabilitation facilities (IRFs) based on the fiscal year 2006 final rule to update the IRF prospective payment system. In addition, the call will review how compliance with the 75 percent rule is determined.

Participants must register for the call by 5 p.m. Jan. 30, and dial-in information will be provided upon registration. Registration is also available by calling (800) 289-0579 and supplying the passcode 1437704. A PowerPoint slide presentation can be viewed during the call and the presentation will be followed by a question-and-answer session. For more information regarding the IRF 75 percent rule or the conference call, contact Vickie Seal at the MHA.

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Hospitals Must Apply for National Provider Identifiers

Last year, the Centers for Medicare & Medicaid Services (CMS) announced the availability of a new identifier for use in standard electronic health transactions. The National Provider Identifier (NPI) will be the sole provider identifier, replacing the different provider identifiers currently in use for each health plan. The NPI is a result of a requirement through the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and must be used by most HIPAA-covered entities. The NPI is one of the steps the CMS is taking to improve electronic transactions for health care. Once national standards and identifiers are fully implemented, health care providers will be able to submit transactions electronically to any health plan in the United States.

Implementation of the NPI will eliminate the need for health care providers to use different identification numbers when conducting standard transactions with multiple health plans. Many health plans, private insurance issuers and all health care clearinghouses must accept and use NPIs in standard transactions by May 23, 2007, and small health plans must accept them by May 23, 2008. After these deadlines, health care providers may use only their NPIs to identify themselves in standard transactions. Health care providers can apply for NPIs in one of two ways:

use the Web-based process

complete and mail the NPI Application/Update form

The CMS has issued a new fact sheet explaining the National Provider Identifier. For more information, contact Jennifer Yockey at the MHA.

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Physician Shortage Looms in Michigan

A recent study conducted by the Michigan Department of Community Health (MDCH) shows that just 60 percent of physicians licensed in Michigan are providing patient care services in the state. Of those practicing physicians, 36 percent indicated their practices are nearly full and an additional 6 percent report their practices are full and cannot accept new patients. A separate study done last year by the MDCH and the Michigan Department of Labor and Economic Growth showed that Michigan will need to fill more than 100,000 professional and technical health care jobs in the next decade.

To coordinate state efforts to address the looming shortage, the MDCH is working with other state departments to create the Michigan Healthcare Workforce Center. Key components of the center will be an interactive Web site housing Michigan-specific data and reports and a Careers in Healthcare Web site that will provide critical information for those considering health care careers. For more information, contact Sherry Mirasola at the MHA.

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• The MHA Patient Safety Committee will meet at 9:30 a.m. Thursday at the MHA. The group will discuss the Patient Safety Commission Report and the Joint Commission on Accreditation of Healthcare Organization's 2007 draft patient safety goals. For more information, contact Sam Watson at the MHA.

• The MHA Quality & Compliance Committee will meet at 12:30 p.m. Thursday at the MHA. The group will discuss the Centers for Medicare & Medicaid Services' 8th Scope of Work and the 2006 work plan of the Office of the Inspector General. For more information, contact Sam Watson at the MHA.

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MHA Members can also refer to these items in our Weekly Mailing: Hall Render Non-Monetary Compensation to Physicians Hall Render New Regulations Regarding Military Leave Now Effective MHA Service Corporation Data Points Newsletter - Winter 2006 issue