Each day countless hospital horror stories detailing a clinician’s medical error are uploaded to the Internet, says blogger Robert Polzoni. But instead of addressing the issues, the hospitals’ marketing and public relations departments try to ignore the issue, or worse—say “no comment,” he says.
The American Hospital Association is right to raise concerns about proposed rule changes that could adversely affect payments for rural health clinics and federally qualified health centers.
In an Aug. 22 letter to Kerry N. Weems, the Centers for Medicare & Medicaid Services' acting administrator, AHA singled out for criticism the proposal to implement section 1833(a)(3) of the Social Security Act, which requires that beneficiaries' deductibles and coinsurance be subtracted from reasonable costs to determine the amount of the Medicare payment. The proposal would also limit payments to no more than 80% of an amount deemed to be "reasonable and related to the cost of furnishing such services."
Currently, CMS pays RHCs 80% of their all-inclusive rate with a payment limit, but does not factor in coinsurance and deductibles.
In the letter to Weems, AHA Executive Vice President Rick Pollack says that the rule change "will have serious negative implications for the financial viability of RHCs, which will experience substantial reductions in Medicaid payments."
In addition, Pollack notes, the cuts would come at a time when RHCs are already being required to implement mandatory quality assessment and performance improvement, which will drive up operational costs.
What's odd about all of this is the timing. The fact is, the Social Security Act provision has been around for more than 30 years and is as old as the act that created RHCs in the first place. Why has CMS suddenly decided to implement section 1833(a)(3)? In a vaguely worded press release that announced the proposed rule change last June, Weems said: "The flexibilities we are proposing will help to ensure that beneficiaries and Medicare get the best value from RHC providers." The press release also said something about putting RHC reimbursements "in line with statutory requirements."
Well, that answers all our questions!
The fact is, RHCs have proven themselves to be desperately needed, cost-efficient, effective healthcare providers in chronically underserved areas. As Pollack points out, nobody is raising concerns about the growing costs of operating RHCs—not federal advisory committees, nor oversight agencies, nor Congress.
AHA is asking CMS to scrap the idea, or at least to define reasonable costs as those derived from the RHCs' Medicare cost report, rather than blanket-impose the Social Security Act's payment caps.
The rule changes proposal has prompted other concerns. Despite reassurances from CMS, the AHA is concerned that new language used to define the requirements for essential provider exceptions are subjective and ambiguous. AHA is also calling for an explanation and a timeline for the appeals process for RHCs that are denied essential provider status. Additionally, there is concern that a provision requiring a 48-hour window for authentication of patients' health records is unrealistic and would be difficult to enforce for weekend admissions. AHA wants the window pushed back to 72 hours.
CMS is not the bad guy here. The agency oversees massive and vitally important programs and has an obligation not only to its beneficiaries, but to taxpayers as well. But cutting funding for RHCs or bogging them down with vague verbiage or unreasonable timeframes seems counterproductive at a time when rural America is already struggling to find healthcare.
John Commins is the human resources and community and rural hospitals editor withHealthLeadersMedia. He can be reached at jcommins@healthleadersmedia.com.
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The Centers for Disease Control underestimated new cases of AIDS by 40%, and many of those newly infected with the disease are rural people who have not considered themselves at risk. In addition, the Rural Center for AIDS/STD Prevention found that between 1993 and 2003, "AIDS cases in rural areas of the U.S. increased by 202%, compared to an increase of only 147% in large U.S. cities."
Hospital operator HCA Inc. is celebrating its 40th anniversary this month, and in that time has had a huge impact on the business of healthcare. HCA has been the catalyst behind Nashville's reputation as a "Silicon Valley" of healthcare: As many as 150 companies have been started out of HCA or by alumni of the company, the Nashville Health Care Council estimates. Some analysts also suggest that HCA played an even more important role by taking politics out of the medical equation by unmasking the inefficiencies of some county-owned institutions filled with patronage jobs.
A Malaysia-based hospital operator run by Seattle residents and backed by Seattle-area investors says there's money to be made by treating India's upwardly mobile to American-style healthcare. Columbia Pacific, a Seattle investment firm, said it has raised $135 million to go after the Indian market. Its Asian venture, Columbia Asia, has 13 facilities in Malaysia, India, Indonesia, and Vietnam—and expects to have 39 by the end of the decade. The latest investment brings the total equity raised by Columbia Asia to $325 million.
I had the good fortune last week to tour Griffin Hospital, in Derby, CT, a winner of this year's Top Leadership Teams in Healthcare. Griffin has good patient outcomes and physician relations for sure, but it attracts patients from well beyond its target region—and gives tours to hospital leadership teams from around the world—because it has embraced the Planetree model of patient-centered care.
At Griffin, leadership decided many years ago that to be able to extend its mission to the community, all employees had to change fundamentally the way the hospital engages patients and delivers care, and that started by understanding at the deepest level what patients and their families want and need from their caregivers.
As I toured the facility, the byproducts of Griffin's transformation were striking. Despite being a 160-bed facility 10 miles outside of New Haven, Griffin doesn't have the atmosphere of a typical acute-care community hospital. It had many hotel-like touches: natural lighting, music in the lobby, private rooms, carpeting throughout the facility, and valet parking. But it also encouraged engagement with patients and their families: 24-hour visiting, open medical records, comfortable family rooms, signs reminding patients to ask doctors questions, and patient rooms that provide a line of sight to the nurses' station.
Even though these amenities improve care for all patients, they are especially important for those seeking care for elective but necessary procedures. These are the patients that choose to travel past other nearby hospitals to enjoy the comforts and care at Griffin. And no doubt that's how Griffin improves its margin. What's more, the collective power of all of these changes creates a strong and lasting message to patients, family, and hospital staff. The patient comes first. This singular focus has over time improved Griffin's organizational culture to the point that the hospital has been named one of Fortune's 100 Best Companies to Work For—nine years running.
As I walked the halls at Griffin, I was struck by how mature and honest a leadership team must be with itself to embark on this type of organizational evolution. After all, how many hospital CEOs would have been willing to acknowledge that they weren't really putting patients first? That everyone in the organization could do more to better care for patients and their families? That they must change?
The latest news out of the The Joint Commission is that new standards for culturally competent patient-centered care are on the way. I wonder whether similar international standards could be on the way from JCI. For global destination hospitals, the lessons from Griffin should take on even greater significance. New technology and a well-trained medical staff just aren't enough to provide the care that patients expect. Reach out to patients today to find out what they want and then do your best to give it to them.