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Vol. 41, Number 43
 
November 15, 2010

IN THIS ISSUE

MHA Board of Trustees Meeting Highlights
Lame-duck Session Under Way; 2011-2012 State Legislative Leadership Selected
Hospitals to Begin Reporting Central-line-associated Bloodstream Infections
Michigan Harvest Gathering Campaign Concludes
Michigan Hospitals Recognized for Supporting healthcare Workforce
Medicaid Recovery Audit Contractor Proposed Rule Released
Significant Medicare Physician Payment Decreases Take Effect Dec. 1
Medicare Premiums and Deductibles Announced for 2011
Dec. 6 Deadline Approaching for Review of FY 2012 Medicare Wage Index Data
Decline Expected in Medicare Home Health Payments in 2011
News to Know

MHA Board of Trustees Meeting Highlights

During last week's MHA Board of Trustees meeting, Lt. Gov.-elect Brian Calley discussed the new administration's healthcare platform and identified key areas of focus during the administrative transition. Calley expressed the critical importance of bringing back to government "an attitude of crisis," observing that matters such as economic development and the need to move to a "value for money" budgeting process require "urgent attention." Some key appointments have already been made, with the selection of former Lt. Gov. Dick Posthumus as senior advisor and current Democratic House Speaker Andy Dillon as State Treasurer. Calley encouraged the association to identify candidates to fill other key administrative and appointed positions. At the conclusion of his remarks, the association provided him with a document laying out the MHA's Priorities for Michigan's Next Governor, which includes issues regarding delivery system reform, improved Medicaid funding, the preservation of a strong Certificate of Need program and other ideas.

Turning to its policy agenda, the board discussed the looming budget deficit for fiscal year 2012, which is expected to be at least $1.4 billion short of projected revenues. Key budget priorities were highlighted, including needed funding for caseload growth and case-mix severity increases, limits on the state gainshare from hospital tax programs, funding to support reimbursement at cost for outpatient Medicaid services in smaller hospitals, and efforts to achieve coverage expansion and improved payment rates for providers.

Recognizing the association's long-supported principle of coverage for all combined with the escalating cost of uncompensated care, the board approved initiatives to carry out frontline strategies to enroll children who are eligible but not yet enrolled in the state's MiChild and Healthy Kids programs, as well as increase enrollment of residents with pre-existing medical conditions through the state's high-risk insurance pool. Key efforts in this regard will include activities to increase awareness, establish direct contacts and pursue system fixes to reduce barriers to coverage. As integral participants in this effort, MHA-member hospitals will receive toolkits, updates and information in coming weeks and months that will empower them to assist the association in advancing these fronts.

The board also approved the "Four Star Healthy Eating Initiative" designed to combat the state's rapid escalation of obesity, which leads to costly and complex health threats. The board recognized that Michigan's obesity rate is now the 10th worst in the nation, costing the state more than $3 billion in annual medical costs associated with those conditions. Main elements of the initiative include improvements in pediatric patient menus, transition to healthy beverages, cafeteria menu labeling efforts, and strategies to improve the overall health of the food system.

At a strategic level, the board began discussions about key issues and the overall relationship with Blue Cross Blue Shield of Michigan in light of federal health reform. A process to increase dialogue regarding dramatic shifts in the insurance industry will be a key activity of the association in the coming year.

Finally, the board approved the Type III-A membership application of the Detroit Wayne County Health Authority and approved a resolution honoring Janet Olszewski, director of the Michigan Department of Community Health, for her support and leadership of the MHA Patient Safety Organization. Questions regarding the activities of the Board of Trustees should be directed to David Seaman at the MHA.

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Lame-duck Session Under Way; 2011-2012 State Legislative Leadership Selected

Last week, what is expected to be a brief lame-duck legislative session began and the state House acted on legislation pertinent to the healthcare community. The House Health Policy Committee approved House Bills (HBs) 4597-4600, sponsored by Reps. Rebekah Warren (D-Ann Arbor), Tom Pearce (R-Rockford), Bert Johnson (D-Detroit) and Pam Byrnes (D-Chelsea). The bills, supported by the MHA, would provide mental health and substance abuse parity by prohibiting commercial health insurers and health maintenance organizations from imposing cost-sharing requirements and benefit or service limitations for these services that are more restrictive or financially burdensome than other medical services. The MHA and supporters contend that failure to treat a mental health or substance abuse problem ultimately leads to increased costs in related physical health complications. The bills are awaiting approval from the full House.

The committee also reported the MHA-supported HB 5684, sponsored by Rep. Marie Donigan (D-Royal Oak), which would create a Board of Genetic Counseling within the Department of Community Health and require any individual engaging in the practice of genetic counseling to be licensed beginning January 2012. HB 5684 now moves to the House floor for consideration.

The full House of Representatives approved HBs 6240-6241, sponsored by Reps. Marc Corriveau (D-Northville) and Richard Ball (R-Laingsburg), which would codify consumer protections from the Patient Protection and Affordable Care Act into state law by extending the age of dependent coverage to 26, prohibiting restrictions on lifetime and certain annual limits on benefits, and prohibiting the rescission of coverage for health benefit plans. The legislation also prohibits pre-existing condition limitations for children. The bill package was passed on to the Senate for deliberation.

The Legislature is now on a two-week break for the Thanksgiving holiday and is scheduled to complete all legislative activity by Dec. 2; therefore, it is unlikely these bills will complete the legislative process during this session, requiring that the bills be reintroduced to move forward.

Both chambers of the state Legislature held elections to determine the leadership positions for the next session, which begins Jan. 1. Sen. Randy Richardville (R-Frenchtown Twp.) was elected Senate Majority Leader by his Republican colleagues and Sen. Gretchen Whitmer (D-East Lansing) will serve as the Senate Minority Leader, the highest ranking Democrat in the Senate.

The House Republican caucus tapped Rep. James "Jase" Bolger (R-Marshall) to serve as Speaker of the House and Rep. Rick Hammel (D-Mt. Morris Twp.) was selected by the House Democrats to be Minority Leader. Committee chairs and assignments will take place at a later date. For more information, contact Chris Mitchell at the MHA.

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Hospitals to Begin Reporting Central-line-associated Bloodstream Infections

Beginning January 2011, acute-care hospitals will be required to collect and submit central-line-associated bloodstream infection (CLABSI) rates for intensive care units and high-risk nurseries. Data from CLABSI events occurring on or after Jan. 1, 2011, will be used in determining payment for fiscal year 2013.

In a memo released Nov. 8, the Centers for Medicare & Medicaid Services informed hospitals that the data must be submitted through the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN). The NHSN will automatically report the data through the Hospital Inpatient Quality Reporting Program, formerly known as the Reporting Hospital Quality Data for Annual Payment Update.

Prior to reporting this data, hospitals must complete the required NHSN training; follow the NHSN enrollment process; and print, sign and return the agreement to participate and consent form. (An updated NHSN agreement to participate and consent form will be available this month for hospitals that are not currently submitting information to the NHSN).

Hospitals not currently submitting CLABSI data to the NHSN are encouraged to move forward with completing the required training in preparation for enrollment this month. Hospitals currently submitting CLABSI data to the NHSN should anticipate receiving an alert to re-consent in December by completing and returning the updated NHSN agreement to participate and consent form to the NHSN. Members with questions should contact Sam R. Watson at the MHA.

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Michigan Harvest Gathering Campaign Concludes

Food Bank Council of Michigan Executive Director Jane Marshall (left) presents the council's 20/20 Award to MHA representative Paige Hathaway. The award recognizes organizations that donated more than $20,000 during the Michigan Harvest Gathering's 20th year.

The campaign for the 2010 Michigan Harvest Gathering came to an official close last week with a celebration luncheon at the University Club of Michigan State University in Lansing. As of Wednesday's event, the statewide campaign had resulted in donations of more than 136,770 pounds of food and about $816,900 to help hungry families across the state.

Representatives of several MHA-member organizations attended the luncheon and were recognized for giving generously to their communities at a time of great need. Among them was St. Joseph Mercy Livingston Hospital, Howell, which raised $21,800 that was doubled with a business match to $43,600. The hospital is planning to contribute even more than this monetary gift by holding a food drive in the upcoming week.

About 90 hospitals have been conducting food drives at their facilities this fall and many participating facilities have now reported their results. As of last week, the MHA, its members and the Michigan Association of Healthcare Advocates had donated nearly 110,800 pounds of food and approximately $124,240 during the 2010 campaign to benefit the Food Bank Council of Michigan and its member food banks. Additional reports are expected as more facilities complete their individual campaign efforts, and an organization-specific report of food drive results will be sent to members in the near future. Hospitals participating in the Michigan Harvest Gathering are reminded that they must submit report forms for their totals to be included in the overall MHA-member contributions to this important effort. To learn more about the MHA's participation in the Michigan Harvest Gathering, contact Paige Hathaway at the MHA.
 

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Michigan Hospitals Recognized for Supporting healthcare Workforce

During the annual meeting of the Michigan Health Council last week, several MHA-member hospitals were recognized with the council's Building Michigan's Healthcare Workforce Award. The award program was created to recognize Michigan healthcare organizations and educators who are designing and implementing creative approaches to recruit and retain a skilled and diverse healthcare workforce in the state.

McLaren Health Care Corporation, Flint, received the award in the category of Education and Training for the McLaren Leadership Academy, designed as a systemwide corporate university devoted to providing a structured forum for personal and professional development for leadership employees of McLaren.

Saint Joseph Mercy Health System, Ann Arbor, was presented with the award in the category of Recruitment in recognition of its firstChoice Flex Solution. This in-house, agency-style system staffing pool promotes work-life balance, flexible scheduling and premium pay for the system's nurses.

Oakwood Healthcare Inc., Dearborn, received awards in both the Cultural Competency & Diversity category and the Retention category. Oakwood's Interpretive and Translation Services program adds value to the experience of patients with limited English proficiency, as well as quality to their clinical encounters, creating measurable improvements in safety and outcomes. The system's Graduate Nurse Residency Program is designed to positively impact new graduate nurses in their socialization to the professional role, accelerate skill acquisition and retain the graduate nurses within the health system.

Also recognized in the category of Retention was Children's Hospital of Michigan, Detroit. Its Retaining the Best New Graduate Nurses program is a 16-week transition residency program designed to enhance knowledge and skills of registered nurses and provide them with the support they need to feel secure and committed to the hospital.

The University of Michigan Health System, Ann Arbor, was a third winner in the Retention category for its Career Launch annual event. The program helps new graduates in the state transition from student to practicing nurse. It includes a New Nurse Panel comprised of six nurses who have been practicing for less than a year who share their experiences and answer questions.

Other award winners included the Greater Flint Health Coalition (Regional Collaboration); the Bay Arenac Intermediate School District Career Center, in partnership with Bay Regional Medical Center, Bay City (Health Occupations Students of America Trailblazer Award); and Northern Michigan University, Marquette (Education and Training).

For more information, contact Clark Ballard at the MHA.

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Medicaid Recovery Audit Contractor Proposed Rule Released

The Centers for Medicare & Medicaid Services (CMS) recently released a proposed rule for the Medicaid Recovery Audit Contractor (RAC) program to identify underpayments and overpayments to providers and recoup overpayments. While the Patient Protection and Affordable Care Act requires state Medicaid programs to establish their RAC programs by Dec. 31, the proposed rule extends the deadline to April 1, 2011.

The proposed rule codifies requirements included in the CMS guidance provided to states last month, while maintaining significant flexibility in the design and implementation of state programs. The requirements relate to coordination with other government auditors, RAC contingency fees and due process for providers.

The Medical Services Administration (MSA) has not finalized its plan for implementation of this regulation, but currently intends to use HMS, the current third-party liability vendor, for this process. The MSA also has not determined whether the Medicaid health maintenance organization activity will be subject to the same Medicaid RAC process.

The MHA will make its comments available in the next few weeks and encourages hospitals to review the proposed rule and submit their own comments to the CMS. Members with questions should contact Jason Jorkasky at the MHA.

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Significant Medicare Physician Payment Decreases Take Effect Dec. 1

The Centers for Medicare & Medicaid Services recently released a final rule to update the Medicare physician fee schedule for 2011. The Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 had delayed the cut in physician payments scheduled for June 2010 and provided a 2.2 percent increase in payment from June 1 through Nov. 30. However, beginning Dec. 1, Medicare physician payments will decline approximately 23 percent, with an additional 2 percent decline in January. As cuts of this magnitude are unsustainable, the MHA, the American Hospital Association and others continue to urge Congress to permanently fix the flawed physician payment formula. Members with questions should contact Vickie Seal at the MHA.
 

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Medicare Premiums and Deductibles Announced for 2011

The Centers for Medicare & Medicaid Services (CMS) recently announced the Medicare premiums and deductibles for beneficiaries in 2011. Under Medicare Part A, which pays for inpatient hospital, skilled nursing facility, hospice and home healthcare services, beneficiaries will see their deductible increase by $32, to $1,132. For Medicare Part B, which covers a portion of the cost of physicians' services, outpatient hospital services, certain home health services, durable medical equipment and other items, approximately 27 percent of beneficiaries will pay 4.4 percent more, with the monthly 2011 premium increasing to $115.40. Based on legislated income thresholds amounts, the majority of the remaining three-fourths of Medicare Part B beneficiaries will continue to pay the same $96.40 monthly premium, which has been in effect since 2008. The Medicare Part B deductible for 2011 is $162. Additional information regarding the 2011 premiums and deductibles is available via a CMS fact sheet. Members with questions should contact Vickie Seal at the MHA.

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Dec. 6 Deadline Approaching for Review of FY 2012 Medicare Wage Index Data

In early October, the Centers for Medicare & Medicaid Services (CMS) released preliminary hospital wage and occupational mix data that will be used to develop the Medicare area wage index for fiscal year (FY) 2012. The wage data were reported by hospitals on Medicare cost reports for periods ending between Sept. 1, 2008, and Aug. 31, 2009. The occupational mix data, which are updated every three years, were reported on the occupational mix survey submitted by hospitals for the period July 1, 2006, through June 30, 2007. Hospitals have until Dec. 6 to review their data and submit requests for changes to fiscal intermediary National Government Services. Requests must be received by this date, as a postmark will not suffice.

To assist hospitals in reviewing their data, last month the MHA distributed hospital-specific worksheets to provide a four-year comparison of the data to members. In addition, the MHA hosted annual wage index workshops to inform hospitals regarding the latest CMS interpretations. Materials from the workshops are available by contacting Donna Conklin. Members with questions should contact Vickie Seal at the MHA.

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Decline Expected in Medicare Home Health Payments in 2011

The Centers for Medicare & Medicaid Services (CMS) recently released a final rule to update the Medicare prospective payment system (PPS) for home health (HH) providers effective Jan. 1, 2011. The rule contains changes that will result in substantial reductions in HH payments. Highlights of the rule include:

  • A 5.2 percent decrease in the standardized 60-day episode payment rate, resulting from a 2.1 percent marketbasket increase that is lowered by the 1.0 percentage point reduction mandated by the Affordable Care Act (ACA) and the negative 3.79 percent coding adjustment. The payment rate is then further reduced by an ACA provision that modifies the HH outlier policy.
  • The ACA mandated a reduction to the HH outlier pool from 5 percent of total payments to 2.5 percent effective Jan. 1, 2011. Implementation of this provision requires the CMS to maintain the HH outlier pool at 2.5 percent of total payment and reduce HH payment rates by 2.5 percent, removing the funding from the HH PPS entirely rather than returning it to the standard episode payment rate.
  • Finalization of the CMS's proposal to reduce the number of outcome measures used under the HH pay-for-reporting program from 12 to 10 beginning in July 2011. The CMS will discontinue the public reporting of three outcome measures and add one new pressure ulcer measure. Providers that fail to successfully report quality data will be subject to a 2 percentage point reduction to their HH PPS marketbasket update.
  • A decrease in the low utilization payment adjustment (LUPA) add-on from $94.72 in 2010 to $93.31 in 2011.
  • Implementation of the ACA-mandated 3.0 percent add-on to the national standardized 60-day episode rate, national per-visit rates, LUPA add-on amount and nonroutine supplies conversion factor for HH services provided in rural areas. As mandated by the ACA, the rural add-on will continue through Dec. 31, 2015.

The MHA will provide a detailed summary of the final HH rule, scheduled for publication in the Nov. 29 Federal Register, and facility-specific impact analyses for hospital-based HHs in the coming weeks. Members with questions should contact Vickie Seal at the MHA.  

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  • The MHA Health Foundation webinar Telemedicine and Privileges: The CMS Proposed Rule, originally scheduled for Tuesday, has been canceled. For more information, contact Leigh Anne Jewison at the MHA.
  • Earlier this year, Clifton Gunderson, the Medical Services Administration (MSA) contractor for the federally required Medicaid disproportionate share hospital audits, completed its audit work for state fiscal years (FYs) 2005, 2006 and 2007. The MSA must submit those audit reports to the Centers for Medicare & Medicaid Services by Dec. 31. Early in 2011, Clifton Gunderson will begin audit work for state FY 2008. The MHA will host an informational kick-off session for the audits from 1 to 4 p.m. Jan. 26 for representatives of the MSA, Clifton Gunderson and hospitals. Additional information will be provided in the near future, and members with questions should contact Vickie Seal at the MHA.

MHA Members can also refer to these items in our Weekly Mailing:

AB 1299 Medicare Outpatient Prospective Payment System FY 2011 Final Rule 
AB 1300 MSA Work Group Meeting 
MHA Share Your Hospital's Patient Safety Achievements
MHA Summary of HRA & GME Payments for FYE 9/30/09
MHA Upcoming MHA Events

Michigan Health & Hospital Association

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www.mha.org

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