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Hospitals Line Up Behind Congress' Patient Care Act

By John Commins  
   May 25, 2016

The Helping Hospitals Improve Patient Care Act has bipartisan support in the House, addresses key reimbursement issues created with the passage of the Bipartisan Budget Act of 2015, and has the support of the AHA and other hospital groups.

Hospital lobbyists are backing a bipartisan bill in Congress that would ease payment restrictions for some outpatient services and adjust 30-day readmissions penalties to account for socioeconomic disparities.

The Helping Hospitals Improve Patient Care Act (H.R. 5273) has bipartisan sponsors in the House Ways and Means Health Subcommittee, is paid for with offsetting budget cuts, and addresses what its backers say are Medicare reimbursement problems created with the passage of the Bipartisan Budget Act of 2015.

In a letter this week to senior committee members on the House Ways & Means Committee, the American Hospital Association urged the lawmakers to pass the bill, after spelling out the problems created by the BBA.


Related: Letter to Senior Committee Members


"Under current law, facilities operating before Nov. 2, 2015 are 'grandfathered' and

can continue to be paid at the hospital outpatient department (HOPD) rate, while new facilities

opening after Nov. 2, 2015 are capped at the lower Physician Fee Schedule rate," AHA Executive Vice President Tom Nickels said in the letter.

"The BBA did not provide for HOPDs that had already begun construction and spent millions of dollars and countless man hours to build facilities based on the prior reimbursement amounts."

"In addition, the way BBA was developed, with no hearings or Committee consideration, with legislative text released approximately one week before it was signed into law, put those HOPDs in an unfair and untenable situation," the AHA continued.

Calendar Adjustment

The bill moves the grandfather date from Nov. 2, 2015 to Dec. 31, 2016, or 60 days after enactment, whichever is later.

While the adjustment creates "significant relief" for hospital HOPDs caught in that time period, Nickels noted that "some HOPDs that were underway on Nov. 2, 2015 will not be completed by Dec. 31, 2016 in order to qualify for the grandfather. We would like to continue to work with the Committee to find additional ways to address the issue."

Safety Nets React

America's Essential Hospitals praised a provision in the bill that amends and adjusts the Medicare Hospital Readmissions Reduction Program "to level the playing field for hospitals that are disproportionately penalized by the program: those that care for large numbers of low-income and other disadvantaged patients."

The adjustment would act as a "bridge" while data is being compiled under the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT).

Until then, the bill allows the Secretary of Health and Human Services to compare performance of hospitals that service similar proportions of Medicare/Medicaid dual eligible patients when applying readmissions adjustments.

When IMPACT data is obtained, HHS would adjust performance payments based on that research.

Community and Rural Hospitals React

The Federation of American Hospitals also backs the bill, which federation President Chip Kahn said "recognizes the importance of access to hospital care for millions of Americans. That is why I am pleased to offer the support of the FAH for this targeted, thoughtful measure that would, among other provisions, allow community hospitals to finalize essential outpatient arrangements in order to better serve patients in their communities."

"At the same time," he said, "while the reduction might be viewed as minor, the effects of cumulative cuts on hospitals are taking a toll, and further cuts must be avoided."

The bill also extends for five years the Rural Community Hospital Demonstration Project, which Nickels told lawmakers "has become vital to participating hospitals and is providing valuable data on potential new models for these vulnerable hospitals."

Other provisions include:

  • A "mid-build" exception to the current law on increasing the number of beds for long-term care hospitals;
     
  • Modification of the treatment of ambulatory surgery center patient encounters for the meaningful use program;
     
  • A delay in CMS authority to terminate contracts for Medicare Advantage plans failing to achieve minimum quality ratings while CMS conducts research and reports on socioeconomic status and quality ratings;
     
  • A requirement that CMS report Medicare enrollment data by Congressional district.
     
  • A "cross walk" of 10 inpatient surgical codes that will be linked to outpatient surgical codes.

The bill is sponsored by Reps. Pat Tiberi (R-OH), House Ways and Means Health Subcommittee chairman, and Jim McDermott (D-WA), the subcommittee's ranking member.

John Commins is a senior editor at HealthLeaders.


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