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AHA sends Congress suggestions for regulatory relief

The American Hospital Association has forwarded some options to Congress to consider for regulatory relief for healthcare organizations.

Tom Nickels, the AHA’s executive vice president for government relations and public policy, told Congress that although the government has eased some  rules, a huge burden on hospitals remains.

He wrote: “Indeed, the regulatory burden faced by hospitals is substantial and unsustainable. In addition to the sheer volume, the scope of changes required by the new regulations is beginning to outstrip the field’s ability to absorb them.

 Here are a few highlights as summarized by FierceHealthcare:

  • “Offer an Anti-Kickback safe harbor and Stark exemption for clinical integration agreements and patient assistance, as these laws can hinder care coordination.
  • “Issue an enforcement moratorium on the ‘96-hour’ rule, which requires critical access hospitals to certify that a patient could reasonably be transferred or discharged within 96 hours.
  • “Allow providers access to patient substance abuse treatment records without an individual patient’s consent.
  • “Suspend the “deeply flawed” star ratings on Hospital Compare, which Nickels said experts have disputed as accurate indicators of clinical quality.
  • “Reduce the number of clinical quality measures to the ones that ‘matter,’ as the Centers for Medicare & Medicaid Services currently uses upwards of 90 measures.
  • “Protect Medicare payments to disproportionate share hospitals.
  • “Adjust readmission rate evaluations to account for social risk factors.
  • “Make bundled-payment programs voluntary.”

To read the AHA letter, please hit this link.

To read the FierceHealthcare commentary, please hit this link.

Seeming success in a CMS bundled-care pilot


Although the jury remains out on many bundled-payment programs, the success of a Centers for Medicare & Medicaid Services pilot program at Baptist Health on San Antonio in saving $1 million in its first year while improving outcomes has led 360 more providers to  try the program. Further,  a total of 1,755 other providers will partner with them and assume the same financial risk for care episodes.

The project was centered on joint replacements. Under the pilot with CMS, Baptist received a lump sum for each procedure priced at 3 percent below what it normally received from Medicare to perform the procedures.  “If it kept costs below that threshold and maintained high-quality outcomes, Baptist got to keep the difference,” FierceHealthFinance reported.

CMS reported that changes to in-hospital processes saved nearly $300 per patient, saving about $1.1 million based on the number of patients that received treatment through the  bundle.

“Baptist Health also took hard looks at nearly automatic referrals for physical therapy, home nurse visits and nursing homes. Such referrals account for nearly half the cost of a joint replacement procedure. Instead, under the pilot program the patient was more likely to receive therapy at home. The health system also re-examined the use of particular blood thinners, compression stockings and canes for each patient, ” Fierce reported.



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