President Obama's budget director appeared to soften on the administration's insistence that a healthcare reform bill be delivered by August. The administration's effort to overhaul the nation's healthcare system hit a bump after the director of the Congressional Budget Office said a preliminary analysis found that the bills working their way through the House of Representatives would not reduce health costs over the next decade.
Introduced on Tuesday and cited as the work of three different House committees, America's Affordable Health Choices Act of 2009 addresses multiple long-term care issues.
Of most concern to long-term care providers and industry leaders are the proposed cuts in Medicare payments to skilled nursing facilities (SNF), which would add up to approximately $44 billion over the next 10 years. The cuts are included in multiple provisions of the bill, but the proposed changes with the most significant impact on SNF reimbursement are as follows:
On January 1, 2010, the SNF market basket update implemented on October 1, 2009 will be removed.
The SNF market basket will be further reduced by a productivity adjustment.
As of October 1, 2010, SNFs will only be paid a certain percent of the charges on a claim if the resident was readmitted to a hospital within 30 days of his or her initial discharge. For fiscal year 2011, the percent paid would be 0.993.
Ninety-five of the bill's 1018 pages fall under Subtitle B, or the Nursing Home Transparency Act, which could also have a negative impact on SNF reimbursement. The provisions included in Subtitle B aim to further standardize skilled and non-skilled facilities through more easily accessible information, stronger enforcement, and detailed staff training programs. Among the proposed regulation changes are:
Required disclosures of facility ownership
Accountability requirements that include compliance and ethics programs
A national independent monitor pilot program focusing on the oversight of chain facilities
Notification of facility closures
Dementia and abuse prevention training
Study and report on training required for certified nurse aides and supervisory staff
The bill also calls for the secretary of Health and Human Services to develop a plan for post-acute care payment reform that includes bundled payment specifications. In addition, the secretary will be able to incorporate payment bundling into a voluntary pilot program.
Despite budgets ravaged by the recession, at least 13 states have invested millions of dollars this year to cover 250,000 more children with subsidized government health insurance. The expansions have come in the five months since Congress and President Obama used the reauthorization of the Children's Health Insurance Program to increase its funding and encourage states to increase enrollment.
Inova Health System has filed an application with Virginia health officials for a certificate of public need to build a hospital in Loudoun County. The move is the latest step in a years-long battle over where Loudon County's next hospital will be. It highlights the ongoing tension between Inova and the Hospital Corporation of America, which has sought unsuccessfully to build a hospital there.
Two nurses who lodged a complaint with the Texas Medical Board about a physician's standard of practice at a West Texas hospital face up to 10 years in prison after being indicted on charges of misuse of official information. Clair Jordan, executive director of the Texas Nurses Association, called the case bizarre and said it would discourage other whistle-blowers from coming forward "especially if they lose their jobs," as the two nurses have.
The Jackson Health System, Miami-Dade County's government safety net for healthcare, is facing growing numbers of destitute people getting free care in its emergency rooms at a time when its tax revenues are falling steadily. And even if the economy turns around, Jackson's leaders say its financial support system is broken and needs to be fixed, either with an additional half-penny sales tax or by setting up a new taxing structure similar to the ones used by public hospitals in Broward County, FL.
The New Jersey Nursing Initiative is a new $22 million program aimed at averting a critical nursing shortage in the state. A 2002 study released by the U.S. Department of Health and Human Services predicted a nationwide shortfall of about 800,000 registered nurses by 2020. In 2007, the New Jersey Collaborating Center for Nursing at Rutgers calculated that a third of New Jersey nurses would retire within 10 years.
The Pennsylvania Insurance Department announced that it planned to investigate whether any of the state's four Blue Cross & Blue Shield insurance companies have engaged in "anticompetitive or unfair trade practices" that violate the law. Examinations of Blue Cross of Northeastern Pennsylvania, Capital BlueCross, Highmark Inc., and Philadelphia-based Independence Blue Cross are to be finished by early 2010.
This fall Illinois will start publishing data about hospitals' performance on a public Web site, according to officials from the Illinois Department of Public Health. The data will include rates of hospital-acquired infections such as MRSA, the ratio of nurses to patients, and information about the cost and volume of 30 leading procedures performed by hospitals and ambulatory surgery centers.
Large, urban teaching hospitals are facing the possible loss of hundreds of millions of dollars under national healthcare reform as rural lawmakers on Capitol Hill wage a fight to win more federal cash for their local institutions. Big hospitals affiliated with medical schools around the country receive heftier reimbursements for treating elderly patients covered by Medicare. Rural members of Congress, however, are demanding a bigger share of the pie for smaller hospitals that serve remote populations.
