IHA Daily Briefing: July 12

Friday, July 12, 2019
IHA Alert: Oppose Setting Payment Rates in Law
IHA Board Discusses Assessment, Surprise Bills, Scheduling
CMS Proposes New Home Health Benefit Changes
CDC: AFM Season is Nearing
IHA Strategic Partner Rated Top in Staff Resourcing

IHA Alert: Oppose Setting Payment Rates in Law
Yesterday, the U.S. Energy and Commerce Health Subcommittee passed the No Surprises Act (H.R. 3630), and the full committee is expected to consider the bill next week. The No Surprises Act would protect patients from surprise medical bills and set a benchmark rate for payment to providers for certain out-of-network and emergency services and specified out-of-network facility-based providers providing services at an in-network facility unless the patient has been notified of their out-of-network status and chooses to accept the services. The benchmark rate would be based on the 2019 median in-network rate for a geographic area for that payer, with an index for increase each year.

The bill’s authors, who are the chair and ranking member of the full committee — Reps. Pallone (D-NJ) and Walden (R-OR) — agreed to continue discussions before the full committee mark-up next week. One possible compromise would set payment parameters for providers and insurers, and then force them into arbitration if they fail to reach an agreement.

Illinois members of the House Energy and Commerce Committee include: Reps. Robin Kelly (IL-2); Adam Kinzinger (IL-16); Bobby Rush (IL-1); Jan Schakowsky (IL-9) and John Shimkus (IL-15).

IHA is asking members to reach out to the Illinois Representatives on the Energy and Commerce Committee, as well as your Representative and Senators, urging them to oppose setting payment rates for hospitals in law. Tell him/her why a government-mandated rate, which would become a default rate for additional services, could threaten already limited hospital resources and create a disincentive for health plans to establish adequate coverage networks. This government overreach could disproportionately harm patients and hospitals in rural and underserved communities. 

To send email messages to your members of Congress on this critical issue, click here.

See IHA’s advocacy alert for more details.

IHA continues to urge the Illinois congressional delegation to support a dispute resolution process, such as arbitration, to resolve payment disputes between providers and health plans. See our letter to the delegation here and our federal issue paper here.


IHA Board Discusses Assessment, Surprise Bills, Scheduling
The IHA Board of Trustees today engaged in a thorough discussion to begin mapping out IHA’s strategy for Phase 2 of the redesigned Hospital Assessment Program.  Phase 1 of the program will sunset under state law on June 30, 2020.  Key areas discussed included process, environmental factors, principles, and design considerations. As the process for Phase 2 goes forward over the coming months, IHA will be regularly updating members through memos, Constituency Section meetings, Hospital Leader calls and regional meetings (scheduled for October).

The Board also discussed a key issue that Congress is now intensely focusing on this month – surprise medical billing.  While there is bipartisan consensus in Congress on the need to pass legislation to protect patients from surprise bills, there are two competing approaches on settling payment disputes between providers and plans.  Providers support a “baseball-style” arbitration process, while plans back a rate-setting approach.  Working closely with AHA and other national and state partners, IHA is actively working to oppose rate setting and has sent a letter to the Illinois Congressional Delegation and issued three member advocacy alerts in the past three weeks. IHA is urging members to contact their U.S. Representatives to oppose rate setting and support arbitration as the independent dispute resolution process (see story above).

In other business, the Board received an update on the outcome of key issues for the hospital community in the recently completed state legislative session, including blocking nurse staffing ratios and passing Medicaid managed care reforms. (For a comprehensive summary, see IHA’s Overview of the General Assembly’s Spring 2019 Session.)

The Board also focused on a critical issue now playing out in the Chicago City Council this summer, the Fair Workweek Ordinance proposal.  While IHA has been strongly advocating that hospitals should not be included in the work scheduling ordinance, it now appears likely that Mayor Lightfoot and the City Council will include hospitals. IHA is offering a compromise proposal, recommending several key revisions to mitigate the potential negative impacts on patients and hospitals and the timely delivery of healthcare in Chicago.  The ordinance proposal is scheduled to be considered by the council’s Workforce Development Committee on July 22, and possibly by the full council on July 24.


CMS Proposes New Home Health Benefit Changes
Yesterday, the Centers for Medicare & Medicaid Services (CMS) proposed significant changes to the Home Health Prospective Payment System (Home Health PPS), with proposals to implement a new home infusion benefit for beneficiaries. This proposed rule also includes increasing Medicare payments by 1.3% ($250 million), as well as proposals protecting against fraud and abuse.

The rule includes proposals for the permanent home infusion therapy benefit to be implemented in calendar year 2021, as required by the 21st Century Cures Act. CMS says that this benefit will give beneficiaries the option to receive critical infusion drug therapies at home, like anti-infectives, chemotherapy or treatment for immune deficiencies, instead of in a hospital or doctor’s office.

In response to public feedback, CMS is proposing to allow therapist assistants to perform maintenance therapy (rather than only therapists), which would allow them to practice at the top of their state licensure, give flexibility to home health providers and improve beneficiary access to these services.

CMS is proposing to address potential Medicare fraud by phasing out pre-payments for home health services. Under the proposal, Request for Anticipated Payments (RAP) for existing providers would be phased out over the next year and eliminated completely for 2021. CMS believes that phasing out RAP would help mitigate cash flow concerns by phasing out RAP payments over one year.

In this rule, CMS is also continuing to implement a new case-mix payment methodology – the Patient-Driven Groupings Model, which puts the focus on patient needs by relying more heavily on patient characteristics rather than volume of care to more accurately pay for home health services. Additional information on the home health quality reporting program are available here and details on the home health value-based purchasing model are available here.

More details can be found in a fact sheet.  

Comments on the proposed rule are due to CMS by Sept. 9.


CDC: AFM Season is Nearing
This week, the Centers for Disease Control and Prevention (CDC) is reminding healthcare providers to familiarize themselves with the signs and symptoms of acute flaccid myelitis (AFM) which typically appears in the late summer/early fall season. The CDC says that early diagnosis is critical to providing patients with appropriate care and rehabilitation.

The majority of AFM patients are previously healthy children who had respiratory symptoms or fever consistent with a viral infection less than a week before they experienced limb weakness. Since AFM can progress quickly from limb weakness to respiratory failure requiring urgent medical intervention, rapidly identifying symptoms and hospitalizing patients are important.

Last year, there were 233 reported cases of AFM nationwide with the average age of patients being five years old. The CDC said that it received reports of suspected AFM cases around 18 days after a patient’s limb weakness began.

More information can be found in the CDC’s Vital Signs report.


IHA Strategic Partner Rated Top in Staff Resourcing
FocusOne Solutions, a leading provider of managed services solutions and vendor management software, was rated among the top 13 managed service providers (MSPs) in the nation in the HRO Today Baker's Dozen Customer Satisfaction Ratings.

The recognition shows that hospitals and health systems across the country benefit from the services and expertise FocusOne provides, as well as its working relationships with clients. IHA chose FocusOne as a strategic partner last year because of its proven track record of helping Illinois hospitals, as well as hospitals and health systems nationwide, streamline the staffing process and improve performance.

As the singular point of contact on staffing, FocusOne can help your organization:

  • Efficiently source high-quality staff;
  • Make informed staffing decisions;
  • Save time; and
  • Control spend associated with contingent staffing and direct hires for both clinical and non-clinical positions.

HRO Today analyzed feedback from MSP clients in three subcategories: service breadth, deal sizes and quality. FocusOne is one of few MSPs in the Baker's Dozen dedicated to the healthcare sector. HRO Today editors—in explaining the statistical validity of their ratings—said, "We hope the Baker's Dozen Customer Satisfaction Ratings provides insight into your next RFP process."

Learn how FocusOne Solutions can benefit your organization. Watch an IHA video on the organization and see our flyer. For direct inquiries, please contact Alan Johnson, director of business development, or Courtney Dobernecker, business development executive, both with Focus One Solutions, at 402-938-2040.

Next week, on July 16, FocusOne is hosting an IHA webinar, Solutions for Today’s Healthcare Staffing Challenges, free for IHA members. Register today.