IHA Daily Briefing: April 19
In Today’s Issue
IHA Partner: Strike Staffing Contingency Planning for Hospitals
Illinois House Advances Governor’s Health Insurance Reforms
Rule Finalized on 340B Administrative Dispute Resolution Process
New Public Portal Targets Anticompetitive Healthcare Practices
COVID-19 Information
Briefly Noted
Leading the News
IHA Partner: Strike Staffing Contingency Planning for Hospitals
Ensuring seamless continuity of care is a top priority for hospital leaders during a work stoppage. To aid in contingency planning, IHA Strategic Partner Medical Solutions offers “Strike Staffing”—a comprehensive replacement staffing service—for hospitals with unionized workforces.
Medical Solutions has supported hospitals and health systems before, during and after labor disputes for over 20 years. The company, a leading healthcare talent ecosystem provider, helps hospitals by:
- Working with hospital administration to determine the required staffing levels by unit;
- Managing the recruitment, screening, transportation, housing and scheduling of qualified healthcare staff;
- Maintaining the appropriate hours per week (six 12-hour shifts per week) to maintain sufficient levels of care while making sure contingency staff are well rested and able to function at peak capacity; and
- Delivering a complete employee file for Joint Commission inspections and state health department reviews.
The Medical Solutions Clinical Team specializes in contingency planning, crafting staffing matrices, pre-screening candidates and facilitating logistics analysis. To learn how Medical Solutions can enhance your organizational stability and maintain operational continuity, contact Brian Hall, Vice President of Business Development, at 866-449-3798 or brian.hall@medicalsolutions.com.
Illinois House Advances Governor’s Health Insurance Reforms
Yesterday, legislation advancing Gov. JB Pritzker’s health insurance reform initiatives targeting predatory health insurance practices was advanced by a bipartisan majority in the Illinois House. The bill was introduced by the Governor in his February Budget Address, seeking to improve patients’ access to care and health outcomes. The bill, sponsored by State Rep. Anna Moeller, bans step therapy, bans prior authorization for hospital inpatient mental healthcare, improves network adequacy and ends unchecked rate increases for large group insurance companies. If approved by the General Assembly and signed into law, House Bill 5395 would make Illinois the first state in the country to ban prior authorization for inpatient adult and children’s mental healthcare.
The legislation also cracks down on “ghost networks,” by implementing strict network adequacy and transparency standards that insurance companies must follow. The bill requires insurers to complete internal audits every 90 days to ensure their directories reflect healthcare available to patients in those networks. House Bill 5395 now moves to the Illinois Senate.
Rule Finalized on 340B Administrative Dispute Resolution Process
The U.S. Dept. of Health and Human Services yesterday finalized its rule establishing a 340B Administrative Dispute Resolution (ADR) process. Required by the Affordable Care Act, the rule establishes an ADR process that all 340B-covered entities can use to address claims at dispute with drug companies. The process applies to all 340B entities, regardless of the organization’s size or the claim’s monetary value.
The final rule contains administrative process changes, and identifies a clear timeline for the ADR process—requiring decisions be made within one year of submission of claims for ADR review. The final rule includes a reconsideration process when parties are not satisfied with the initial ADR decision, and also allows claims for ADR panel review even if the particular issue is subject to concurrent federal court review. The final rule also clarifies that an overcharge claim includes circumstances where a drug company has limited a hospital’s ability to purchase 340B drugs at or below the 340B ceiling price.
The final rule will take effect 60 days from publication in the Federal Register on June 18, 2024. IHA is reviewing the final rule; more details about the rule and its implications will be provided to membership in the coming weeks.
New Public Portal Targets Anticompetitive Healthcare Practices
Yesterday, the Dept. of Justice’s (DOJ) Antitrust Division, Federal Trade Commission (FTC), and U.S. Dept. of Health and Human Services (HHS) launched an online portal where the public can report anticompetitive and potentially unfair healthcare practices. At HealthyCompetition.gov the public can report potential violations of federal competition laws to the DOJ and FTC. Complaints will undergo preliminary review by staff at DOJ’s Antitrust Division and FTC. If a complaint raises sufficient concern under the antitrust laws or is related to HHS authorities, it will be selected for further investigation by the appropriate agency. This action may lead to the opening of a formal investigation.
The launch of the complaint portal comes on the heels of other action taken recently by the Administration, which signals a heightened level of antitrust enforcement in the healthcare industry. This includes the withdrawal of longstanding “safe harbor” guidance by the FTC, issuance of new merger guidelines, and the creation of a new Chief Competition Officer position at HHS and Counsel for Health Care positions at DOJ and FTC.
COVID-19 Information
The Illinois Dept. of Public Health (IDPH) has launched a weekly Infectious Respiratory Disease Surveillance Dashboard that will be updated weekly on Friday. This report provides the public with the latest data on hospital visits, seasonal trends, lab test positivity and demographic data.
Click here to visit the IDPH COVID-19 resources webpage. IDPH will continue to report the weekly number of people with COVID-19 admitted to hospitals from emergency departments, deaths and vaccinations, with COVID-19, influenza and respiratory syncytial virus information also reported through the dashboard of the Illinois Wastewater Surveillance System.
Briefly Noted
A new survey released this week found that 40% of U.S. physicians are ready to use generative artificial intelligence (GenAI) this year when interacting with patients at the point of care. The findings reflect a rapid acceptance of the new technology more broadly, with 68% saying they have changed their views over the last year, and are now more likely to think that GenAI would be beneficial to healthcare. Physicians, however, are wary of which GenAI tools they would be comfortable using, with 91% of respondents saying they need to know the GenAI sourced materials were created by doctors and medical experts before using it in clinical decisions. Similarly, 89% report they need vendors to be transparent about where information came from, who created it and how it was sourced.
He thinks his wife died in an understaffed hospital. Now he’s trying to change the industry.
KHN reported (4/19) that, “For the past year, police Detective Tim Lillard has spent most of his waking hours unofficially investigating his wife’s death. The question has never been exactly how Ann Picha-Lillard died on Nov. 19, 2022: She succumbed to respiratory failure after an infection put too much strain on her weakened lungs. She was 65. For Tim Lillard, the question has been why. Lillard had been in the hospital with his wife every day for a month. Nurses in the intensive care unit had told him they were short-staffed, and were constantly rushing from one patient to the next.”
The ‘comfortable’ income threshold in all 50 states
Becker’s Hospital Review reported (4/18) that, “A new study from SmartAsset has determined the minimum salary a single adult would need to live comfortably in each state.”
Health systems undergoing rebrands
Becker’s Hospital Review reported (4/18) that, “In highly competitive markets, hospitals and health systems are rebranding to differentiate themselves and stand out from competitors.”