IHA Daily Briefing: Oct. 7

Thursday, October 7, 2021 
IHA: Surprise Billing Rule Misses the Mark 
Feds Approve IL SPA for End of SMART Act Cuts 
Preckwinkle Unveils FY2022 Budget Proposal 
MAPS Workshop on 10/28: Boost Patient-Family Efforts 
IHA Partner Addresses Hospital Staffing Shortages 
State, National, Global COVID-19 Updates 
Briefly Noted

IHA: Surprise Billing Rule Misses the Mark
IHA President & CEO A.J. Wilhelmi sent a letter to the Illinois Congressional delegation today expressing “deep concern” regarding a Sept. 30 rule released by the U.S. Departments of Health and Human Services, Treasury and Labor (the Departments), implementing certain provisions of the No Surprises Act, which Congress passed in Dec. 2020.

"IHA supported this legislation to protect patients from surprise out-of-network medical bills, in part because it enumerated multiple factors arbiters must consider during an independent dispute resolution process (IDR) to ensure fair reimbursement for care provided to patients. Unfortunately, we believe the September 30 rule fails to reflect Congressional intent and respectfully request that you urge the Departments to make immediate changes,” Wilhelmi wrote.

The No Surprises Act provides that in arbitrating disputes over payment for out-of-network services, the independent dispute resolution entity must consider a number of factors to determine the reasonableness of the proposed payments—one of which is the plan’s median in-network rate. However, the interim final rule establishes the median in-network rate in a geographic area as the primary factor to be considered. IDR entities must initially presume the median in-network rate is the most appropriate rate for the out-of-network services and essentially requires providers to prove otherwise.

In a statement released last week, American Hospital Association executive vice president Stacey Hughes said: “Today’s rule is a windfall for insurers. The rule unfairly favors insurers to the detriment of hospitals and physicians who actually care for patients. These consumer protections need to be implemented in the right way, and this misses the mark.”

Earlier this week, U.S. House Ways and Means Committee chairman Richard Neal (D-MA) and ranking member Kevin Brady (R-TX) sent a letter to the Departments stating that by using a process for determining provider payment that uses the median contracted rate as the default payment amount in the IDR process, the rule fails to align with the law Congress passed. “Such a standard affronts the provisions enacted into law, and we are concerned that this approach biases the IDR entity toward one factor (a median rate) as opposed to evaluating all factors equally as Congress intended,” they wrote. The letter further states that “the September 30, 2021, interim final rule with comment strays from the No Surprises Act in favor of an approach that Congress did not enact in the final law and does so in a very concerning manner.”


Feds Approve IL SPA for End of SMART Act Cuts
The Illinois Dept. of Healthcare and Family Services (HFS) has received approval from the Centers for Medicare & Medicaid Services (CMS) of its State Plan Amendment (SPA) (21-0012) ending the 3.5% SMART Act Medicaid cut to hospitals under PA102-0016, legislation that IHA successfully advocated for in the Spring 2021 General Assembly session.

In an Aug. 26 pprovider notice, HFS indicated that the repeal of the SMART Act reduction for hospital services was effective with inpatient admissions and outpatient dates of service on or after July 1, 2021. With the federal approval, claims that HFS had been holding are being released, processed, and priced accurately. If a claim is rejected, a provider will have 180 days from the date of release to resubmit.

HFS has also received CMS approval of its SPA (21-0013) increasing the per diem rate for Safety Net Hospitals to $630 for inpatient psychiatric services.


Preckwinkle Unveils FY2022 Budget Proposal
Cook County Board President Toni Preckwinkle today presented an $8 billion Budget Recommendation for Fiscal Year 2022, which she says equitably addresses the County’s ongoing pandemic response efforts while not increasing taxes or cutting critical services.

Preckwinkle noted that the County was able to close a $121 million budget gap without raising new revenue, through a combination of financially responsible efforts, federal relief and recovery aid, and higher than previously forecasted revenue, including revenues from newer tax sources like cannabis, gaming, and online sales.

Under Preckwinkle’s budget proposal, Cook County will use nearly a quarter of the billion American Rescue Plan Act dollars to fund various programs including:

  • $80 million dollars to fund economic development initiatives like cash assistance programs and a guaranteed income pilot, short and long-term housing support, workforce development program expansions and assistance to small businesses.
  • $60 million toward healthcare and access initiatives like increased behavioral health and mental health programming and services as well as initiatives promoting access to food and nutrition.
  • $60 million for equity and justice initiatives like alternatives to 911 for mental health crises, expansion of permanent housing for re-entry populations and expansion of violence prevention programs and support for youth and young adults.

Preckwinkle also noted that the budget for next year includes $384 million in charity care, or more than 50% of charity care in the County.

For more details, go to the Cook County budget website; also, see the Budget at Glance document here and Preckwinkle's budget address here.


MAPS Workshop on 10/28: Boost Patient-Family Efforts
Prioritizing patient and family engagement (PFE) can advance quality and safety, improve health outcomes and enhance staff retention within your organization, according to the Agency for Healthcare Research and Quality (AHRQ).

During the 2021 MAPS PSO Culture of Safety Workshop on Oct. 28, PFE advocates Lindsey Galli and Libby Hoy of PFCCpartners will share strategies to enhance PFE during, “Bringing the Patient and Family Perspective into Organizational Safety Practices,” a breakout session.

Hoy is the founder and CEO of PFCCpartners, a California-based nonprofit focused on improving quality, safety and patient experience. She and Galli, the organization’s director of education, will collaborate with members on:

  • Practical methods for effective PFE;   
  • The benefit of advisory groups; and   
  • The link between PFE and safety culture.

In a recent interview with AHRQ, Hoy described PFE as an “active partnership and conversation in which we co-produce the outcomes we need.” Her own firsthand experience navigating the healthcare system—as the mother of three sons living with mitochondrial dysfunction—will enlighten leaders, clinicians and professionals in quality improvement, patient safety, risk management, social work and psychological services.

The workshop, offered virtually, is complimentary for MAPS members as a part of their membership and open to IHA members who are not part of MAPS. The Illinois Association for Healthcare Quality (IAHQ) is sponsoring the workshop, which is also open to IAHQ members. See our event page for the full agenda, continuing education credits available and registration fees.

Register today.


IHA Partner Addresses Hospital Staffing Shortages
A recent Mercer report showing a deficit of over 8,600 registered nurses in Illinois adds to the well-documented staffing shortages that existed before the pandemic. The strain of COVID has exacerbated staffing concerns for hospitals and health systems, according to Nhat H. Ngo, Chief Commercial Officer at Medical Solutions, an IHA Strategic Partner.

“The emergence of COVID-19 accelerated the labor shortage challenge while hospital units across the country experienced rapid, unanticipated patient surges—only amplifying the issue,” Ngo said in a recent Medical Solutions blog post.

The blog post—“How the Pandemic Reshaped Healthcare Staffing Strategies”—notes that despite a projected 7% annual growth among nurses nationwide, earlier-than-expected retirements are adding to the pressure on hospitals to meet healthcare demands during COVID.

“While the initial wave of COVID-19 led to an aggressive and unprecedented plan of action for rapid nurse deployment, clinical staffing demand remains high and retention has only become more important,” Ngo said. “Staffing partners need to demonstrate their value beyond simply filling contracts.”

At Medical Solutions, staffing experts work hand-in-hand with hospitals and health systems to:

  • Ensure accurate forecasting of projected needs based on geography;   
  • Increase traveler retention by focusing on skillset and culture fit; and   
  • Develop longstanding, personal relationships with clients and travelers to find the optimal fit for every assignment.

Medical Solutions is one of the largest providers of total workforce solutions, with a 95% traveler assignment completion rate nationwide. Integrating the Medical Solutions Clinical Team into your hospital’s hiring process brings in top clinicians, reduces time-to-fill rates, increases completion and fill rates, and enhances continuity of care.

To learn more, please contact Dobernecker at Courtney.Dobernecker@medicalsolutions.com or 402-225-0483.


State, National, Global COVID-19 Updates
The Illinois Dept. of Public Health (IDPH) today reported 3,371 new confirmed and probable COVID-19 cases, including 36 additional deaths.

Currently, IDPH is reporting a total of 1,647,364 cases, including 25,189 deaths. In the past 24 hours, laboratories have reported 163,742 specimens for a total of 32,793,074. As of last night, 1,676 individuals in Illinois were reported to be in the hospital with COVID-19. Of those, 409 patients were in the ICU and 216 patients were on ventilators.

The preliminary seven-day statewide positivity for cases as a percent of total tests is 2.2%. The preliminary seven-day statewide test positivity is 2.6%. The latest daily case positivity rate is 2.06%.

The seven-day rolling average of vaccines administered daily in Illinois is 33,510 doses, with 47,306 doses administered in the past 24 hours. IDPH reports 64.5% of adult Illinoisans (18 years and older) have been fully vaccinated, while 81.9% have received at least one vaccination dose. For the Illinois population 12 years and older, 62.9% have been fully vaccinated, while 80.4% have received at least one vaccination dose.

Today’s Centers for Disease Control and Prevention (CDC) figuresshowed more than 43.9 million confirmed and presumptive positive cases of COVID-19 in the U.S. (a daily increase of more than 102,000 cases; seven-day moving average of more than 96,000 cases), with 707,065 deaths (a daily increase of 1,850).

Today’s WHO Coronavirus Disease Dashboard showed more than 236.1 million COVID-19 cases globally (a daily increase of more than 448,000 cases), with more than 4.82 million deaths. The Region of the Americas (includes the U.S.) continues to lead the world with more than 90.8 million cases and more than 2.23 million deaths. 


Briefly Noted
Pfizer and BioNTech today submitted their request to the Food and Drug Administration for emergency use authorization of their COVID-19 vaccine in children ages 5 to 11 years.