In North Carolina, more than any other state, the recession has triggered a burgeoning medical crisis. A steep rise in unemployment has fueled a commensurate increase in the number of people who do not have health insurance. In the past two years, North Carolina's number of uninsured has climbed 22.5%, the biggest jump in the nation, according to an analysis by the North Carolina Institute of Medicine, a quasi-state agency. Nationwide, about 22% of adults do not have health insurance.
Attorneys for more than 400 plaintiffs filed a class-action lawsuit against Nationwide Insurance this week, claiming that the company sold Washington consumers illegal health plans that left them with insufficient coverage. The suit alleges that the insurer "unfairly and deceptively" sold fixed indemnity plans, which feature lump-sump payment limits. Plaintiffs said the plans do not comply with laws requiring certain minimum benefits.
The FTC's proposed interim rule governing security for electronic health records expands responsibility for maintaining patient confidentiality to include third-party vendors, enhances patient notifications for breaches, and sends a clear signal that the federal government will crack down on violators.
"It's a tremendous scare," says Tom Green, senior director of sales and marketing for Premier Insurance Management Services Inc., a subsidiary of Premier Inc. "If patient health information is not properly safeguarded or encrypted or they don't have the necessary policies and procedures in place to ensure safe-keeping, you are opening yourself up to significant civil fines and penalties in addition to some potential lawsuits, not to mention the public relations issues you could be facing."
In addition to providing about $36.3 billion to offset hospitals' and physicians' costs for installing interoperable EHR, the stimulus package also includes mandates to strengthen privacy and security protections. The FTC and HHS are drafting a report due next February that will establish threshold requirements. Until then, the FTC will operate under the proposed interim rule, which was unveiled last week for a public comment period that ends June 1.
The interim rule would apply to entities that traditionally have been beyond FTC's jurisdiction, including "vendors of personal health records and other non-HIPAA covered entities," regardless of whether they fall within the FTC's jurisdiction. "Thus, the proposed rule would apply to entities such as nonprofit entities that offer personal health records or related products and services, as well as nonprofit third-party service providers," the FTC notice says.
The proposed rule also includes stepped up patient notification provisions after a breach. Whereas HIPAA only requires that steps be taken to mitigate damages after a breach, the new rule requires notifying affected patients. If more than 500 patients' records are compromised the local "prominent media" must be told. "This is going to really create a huge potential public relations exposure for these entities," Green says. "When these breaches are occurring, you are seeing breaches in the thousands. Five hundred is something that could happen very easily."
While the new rule may seem stringent, Green says no one should be surprised by the stepped-up enforcement. "The public has been calling for this level of protection for some time," he says. "As we become a society that relies more upon electronic means for transmission of information, utilization of different IT, it's appropriate that these safeguards are taken to protect against identity theft."
Green says everyone affected by the interim rule needs to read up on the new proposal. That includes examining existing security measures, ensuring that employees are properly trained and informed, and reviewing the security measures of vendors who may have access to EHR.
The FTC anticipates that 900 entities – including vendors and other "non-HIPAA covered entities" -- will now be covered by the proposed rule and saddled with an annual cost of more than $1 million to cover the breach notification provisions, including approximately 200 vendors, 500 related entities, and 200 third-party service providers. These entities are expected to average 11 breaches a year that warrant notification, and there is a three-page explanation for how the FTC got those figures in the public comments notice. The bottom line is that the estimated annual cost of the breach notifications is $1,020,625: $83,402 for costs associated with investigating breaches, drafting notifications of breaches and notifying the FTC; $74,240 for costs associated with notifying consumers; and $862,983 for costs associated with establishing toll-free numbers. (The FTC says these figures might be overstated because they assume all breaches will require notification.)
Green says the eventual permanent rules governing EHR security won't be much different from what's already been proposed in the interim rule. "There will be a little bit of tweaking to some of the regulations, but the essence of the rules as stated are probably going to be advanced as they are," he says. "A few states have already enacted similar laws, such as California. This is really broadening it to the federal level."
Peggy Naas, MD, discusses various ways to structure service lines in ways that partner with physicians rather than direct them as in a traditional employer/employee relationship.
We know you have plenty of spare time as you lead your hospital through an economic recession where the uninsured knock on your door and the insured don't answer the door when you come knocking for payment.
In your search, you will find 13 references, all under the Health Information Technology for Clinical and Economic Health (HITECH) Act, or Title XIII. Each one affects your HIPAA Security Rule compliance program in light of the new laws.
The problem?
No one knows what that means, exactly—at least not at this moment.
Congress gave the Department of Health & Human Services (HHS) 60 days from the February 17 signing of the Act–or Friday, April 17–to define "unsecured protected health information." So far, there has not been an announcement. If no definition is released, it goes to a default–one that includes all protected health information that is not secured by an encryption standard endorsed by the National Institute of Standards and Technology (NIST).
So how do you prepare now without that key definition? After all, the HITECH Act calls for strict notification requirements, all of which hinge upon breaches of "unsecured protected health information." The new requirements include:
Notification of all individuals whose unsecured PHI may have been disclosed or accessed
60-day window to notify those patients
Requirement to explain why you had to use the full 60 days to notify
Notification of prominent media outlets when breaches of unsecured PHI include 500 patient records or more
Immediate notification of the secretary of HHS on breaches of at least 500 patients
So, you can kind of see why this definition is important. Or is it? Should you be watching ever so closely for a definition?
"Don't hold your breath," says Kate Borten, CISSP, CISM, president of The Marblehead Group in Marblehead, MA.
Borten thinks the definition will matter, but she does not see it including any earth-shattering content that strays too far from what's already out there.
For instance, the Security Rule of 2003 already establishes encryption as a necessity for PHI flowing over the Internet and open networks. That encryption mandate goes back to the 1998 proposed Security Rule, Borten says. And the Healthcare Financing Administration came out with an Internet Security Policy in 1998.
"We've known we need to encrypt confidential data over the Internet for over a decade," Borten says.
Further, when you've got a federal department with no permanent leader–President Barack Obama nominated Kathleen Sebelius as the new secretary of HHS, but she has not been confirmed–how much can you do anyway?
Dena Boggan, CPC, CMC, CCP, HIPAA privacy/security officer for St. Dominic Jackson Memorial Hospital in Jackson, MS, says organizations have come a long way encrypting data already.
"We've come so far along making sure we've got under the Security Act everything protected, encrypted, and how to have a secure firewall, a hacker-proofed system and all of that," she says.
Organizations that have encrypted data are in good shape.
However, as Johnnie Cochrane might say, if you don't encrypt, you must equip. Look for any potential unsecured PHI and evaluate the need for encryption.
"It's free," Borten says. "We pay for it with our tax dollars. The resource is fabulous."
For the record, the general default definition of unsecured PHI in the HITECH Act is: "Protected health information that is not secured by a technology standard that renders protected health information unusable, unreadable, or indecipherable to unauthorized individuals and is developed or endorsed by a standards developing organization that is accredited by the American National Standards Institute."
When can they change the default definition? That's unclear now. Ultimately, things may not change a whole lot.
"As long as you're buying products that use known algorithms, you really should be fine," Borten says. "I don't think HHS or Congress expect organizations to throw out what they've done so far."
Hospitals and physicians will spend many hours over the next two years researching and implementing electronic health records to take advantage of the $36 billion slated for health IT in the stimulus law. While providers perform most of the heavy lifting, another healthcare segment might actually benefit more from better health information exchanges.
"With billions in new funding and government regulations, the health IT market will balloon far beyond the provider segment, providing new opportunities for health plans, pharma companies, and other vendors," wrote PricewaterhouseCoopers.
With employers dropping their coverage and laying off insured employees, and federal policymakers exploring a public insurance option to compete against private insurers, PricewaterhouseCoopers' statement is a rare piece of good news for health insurance companies. The report suggests that health insurers could lead an effort to improve health IT exchange, which could lead to a quality healthcare system that allows providers easy access to patient records, lets health insurers gain a complete picture of their members' health, engages patients to take better care of themselves, and provides businesses more information about their employees' health.
"The practical reality is that the providers are spending the big investment upfront to put these [EHR] systems in and to digitize our health records. The opportunity for payers then is to figure out effective ways to combine that data to be statistically relevant and interject that information into the healthcare delivery process," Dan Garrett, managing director of health IT at Pricewaterhouse Coopers Health Industries Advisory Practice, tells HealthLeaders Media.
Garrett says payers are uniquely able to combine their administrative data with patient records information to create "powerful, value-added offerings to patients, employers, and potentially even healthcare delivery professionals," he says.
"Now that we are pretty certain that we are going to digitize all the data, the next question becomes who in the industry wants to play a significant role in aggregating that data into statistically relevant information and driving that information into a continual improvement cycle in the healthcare delivery process," says Garrett.
Greater health IT means health insurers can take part in a number of different potential partnerships and structures, but health insurers will need to clear potential hurdles. For instance, if health plans are to take a leadership role in health IT, they will need to build bridges to providers, who are usually suspicious of any health insurer initiative.
There are also other issues to iron out, such as how to make the information available to the larger system while protecting patient privacy and security.
Though there are many issues to iron out and plenty of work needed to create larger health IT networks and systems, Garrett says most healthcare officials are looking at the bigger picture—how do we use EHRs to deliver healthcare more effectively and efficiently.
"It's a trying time for the providers because of the challenges, but it's an exciting time for the industry, and for most providers," says Garrett.
For one Washington hospital, making the move from Joint Commission accreditation to DNV Healthcare, Inc.'s NIAHO accreditation was a matter of research, timing . . . and moving at a lightning pace.
Group Health Central Hospital is part of Group Health Cooperative, an integrated delivery and financing system providing care to approximately 400,000 residents of Washington and Northern Idaho. The organization operates 26 primary care centers, three specialty centers, and one hospital.
"It all started out at the annual Institute for Healthcare Improvement National Forum," says Elizabeth Rosen, RN, BSN, director of quality and regulatory compliance for Central Hospital. "DNV was there, and I discussed the situation with them, and came back to share my interest with our leadership."
The hospital's chief of hospital medical staff, director of clinical operations, and Rosen met with DNV first to determine whether the change was worth pursuing. Next, they brought in hospital administration, the chief nursing officer, the vice president of acute care, and legal counsel.
"I had outlined a proposal with a comparison of The Joint Commission and NIAHO standards," says Rosen. "People were all positive, though there was some concern about the timeframe."
And what a timeframe it was—the hospital was due for a Joint Commission survey any time after January 1. Regardless of whether it was changing accrediting organizations, Group Health was subject to the survey, and could not change accrediting organizations if it had any outstanding requirements for improvement with the old accrediting organization.
The decision went from hospital leadership to the CEO of the overall organization.
"The CEO, in consultation with the board of trustees, made the final decision," says Rosen. "At the same time, this decision-making process was going on, we did a high level gap analysis to look at the differences between DNV and the Joint Commission, to understand where our focus areas would be."
The hospital's legal counsel reviewed the contract template, and the application was filled out during the decision-making process because everyone involved knew the change would have to happen fast.
"We made the final decision to withdraw from The Joint Commission, and immediately following withdrawal sent our application to DNV," says Rosen.
After signing the contract, the hospital began working with DNV to establish a timeline for the survey process—all in all, there was about a month between the signing of the contract and the arrival of DNV surveyors.
"We had to move very quickly," says Mary Lou Calise, RN, BS, MSQA, CPHQ, quality consultant for Group Health. "We needed to be very compliant in a very short time period."
Because there would be a time gap between Joint Commission and DNV accreditation, Rosen worked with the state Department of Health and the local CMS office to keep it up to speed about the hospital's accreditation status.
Leaving The Joint Commission
After submitting the withdrawal notice, the Group Health hospital administrator received a call from The Joint Commission account representative to schedule an exit interview.
"Toward the end of the interview they wanted to know the actual date of withdrawal," says Rosen. The letter had said "immediately." Whatever date is specified for the withdrawal, The Joint Commission sends a notification to CMS to say that the facility is no longer subject to The Joint Commission accreditation. It was unclear what implications, if any, the notice to CMS might have concerning the hospital's continuing Medicare certification.
"Our understanding was that our [Joint Commission accreditation] certificate was effective through mid-March 2009," says Rosen.
According to The Joint Commission representative, the minute you withdraw, however, you go into non-accreditation status, she says. Which left the hospital in a quandary—if you do not withdraw immediately, you are still subject to a Joint Commission survey at any time, even if the hospital is in the process of changing to a different accreditation body.
"We were a little surprised at that," says Rosen. "So we reviewed the situation with our attorney and with our accreditation consultant at The Greeley Company, and were assured it was not a significant issue."
Once NIAHO accreditation has been achieved, the next step will be implementing the second component to DNV accreditation—use of ISO-9001.
"ISO-9001 is centered around quality," says Calise. "Industry has been doing it for a long time. It's looking at processes, making sure you're meeting the standards you're reaching for, and if not, adjusting them to make sure you do."
Why is it that many of the same companies appear repeatedly on lists of the best places to work, the best providers of customer service, and the most profitable in their industries? When we talk with the leaders of these organizations, some of who have changed the rules for competing in entire industries, they point to culture as a primary reason for their success. Just as important, culture is an advantage that competitors find hard to duplicate.
What do managers at the best places to work understand that others don't? For one thing, they recognize that culture is anything but the soft, mushy set of platitudes some leaders think it is. They understand that the identification of organization values is meaningless without a determination of the behaviors, measures, and actions that reinforce those values. They know that strong cultures can lead to success or to failure—depending on their capability to foster and deal with change. That may be another reason culture gets a bad rap in some corporate circles.
People like Al Stubblefield, CEO of Baptist Health Care in Pensacola, FL, understand that strong and adaptive cultures can foster innovation, productivity, and a sense of ownership among employees and customer—all important elements in leveraging value over costs. Stubblefield knows that it's possible to develop a strong and adaptive ownership-based culture where one hasn't previously existed.
Owners are employees who go the extra mile to recommend friends and others as potential colleagues. They suggest ways of improving products, services, processes, and relationships. Our research into a group of world-class companies that foster employee ownership reveal four practices that help explain how they got there.
1. Create a strongly shared sense of purpose, falling just short of that of a cult. Purpose is self-evident in the work of some organizations. Few would question that Baptist Health Care is in the business of saving and improving the quality of lives.At Baptist, the quest is to provide superior service to "customers" (not patients) and to "improve the quality of life for people and communities served." To accomplish this goal, hospital employees as well as physicians must exhibit behaviors that are not typical of their professions.For example, those who engage customers directly must be able to work in teams, something that is difficult for many medical practitioners, especially doctors who have been placed on a pedestal in the past. Senior management must be willing to spend time on the front lines making the rounds with employees. In short, at Baptist Health Care, quality care and phenomenal levels of patient satisfaction require adherence to unconventional practices.Constructing such a culture begins with the creation of a working environment that will attract the most talented employees—those who can establish extended, profitable relationships with targeted customers.2. Establish a clear set of values and behaviors that embody a shared purpose. Stubblefield engaged Baptist Health Care's entire organization in establishing a new set of values and behavior. The process began with a two-day meeting for the senior management team, who then spent four months enlisting everyone else to discuss the following three questions:
Why do we exist? (What is our mission?)
What are we striving to become? (What is our vision?)
What guides our everyday behavior? (What are our values?)
The discussions took place among focus groups throughout the organization, with senior management involvement at several levels. During these meetings, leaders also posed the question, "What makes a great culture?" The employee responses helped outline critical core behaviors: open communication of performance feedback and ideas for doing things better, a "no secrets" environment in which the bad news is shared along with the good, and a "no excuses" environment in which employees are accountable for actions and results. The organization-wide outcome appears in the Baptist Health Care Vision, Values, and Five Pillars of Operational Excellence.3. Constant communication of purpose and values through senior management behavior, organization-wide performance metrics, and corrective actions when necessary. Communication is constant and multifaceted at Baptist. Both good and bad news regarding organization performance is regularly posted in the cafeteria. Employee forums, where letters from customers are often read, are videotaped for distribution and later viewing. And the company's intranet is heavily used.Communication can take unusual forms. For example, BHC "borrowed" what is known as the Daily Line-Up from the Ritz-Carlton, in which employees participate in a daily lineup at the start of their shifts. During each lineup, managers present one new service initiative or behavior, entertain suggestions, and recognize any employees who have demonstrated outstanding performance. BHC Daily Line-Up works in the same way. Every team convenes for a few minutes a day to share a concept and suggest a training idea.
In BHC's Listening and Learning program, managers lead discussions on subjects such as survey results, and they solicit ideas for ways to improve customer service. The resulting "customer snapshot reports" compile all of the employees' observations and ideas for general distribution.
4. Strong leadership that both reinforces the culture and preserves its adaptability. Cultures take shape with or without leadership, but rarely does a competitively superior culture emerge without it. Effective leaders set the tone for an organization through their own behaviors. For example, at Baptist, people at all levels are encouraged to engage in several "Baptist behaviors" that are peculiar to the organization—and sometimes startling to customers—but have a functional purpose. One of these is the custom of picking up trash (something Bill Marriott also does at his company's hotel properties).
Then there is the "Baptist shuffle," in which leaders take the time to erase scuff marks left by shoes on polished floors. Another is walking people in need of direction to their destinations. Everyone, starting with Stubblefield, does these things all the time, in part because they foster a sense of being part of a culture that is something special.
Good leaders reinforce culture by demonstrating accountability for behaviors and results that foster the same attitude among employees. At Baptist, this begins with "Traditions," a two-day orientation. Half the time is focused on BHC's culture. This session is followed by "ServU," a half-day refresher course for employees who are completing six months of service and have had a chance to observe and work in the culture.
ServU focuses almost exclusively on the way employees understand and experience the BHC culture. In particular, the discussion covers the standards of performance for 10 specific behaviors: attitude, appearance, communication, call lights (which all hospital employees are responsible for answering), commitment to coworkers, customer waiting, elevator etiquette, privacy, safety awareness, and sense of ownership. The BHC employee standards team also devises ways of celebrating the "standard of the month" on a rotating basis.
The BHC story shows clearly how a strong culture creates the potential for high performance. We say "potential" because some of our other research has suggested that strong cultures by themselves are not enough to drive long-term success. Leaders who foster a strong ownership culture must also preserve its ability to adapt to a changing environment. They do it by emphasizing practices that help the organization and its people grow: continuous improvement, "best practice" exchange, innovation in products and services, as well as management systems, education for personal development, and—again—communication, communication, communication.
The perils of success
Building and maintaining a winning culture takes work and constant vigilance. By the time we caught up with Stubblefield in late 2006, the organization's dilemma reflected the success of previous years. Baptist's customer satisfaction scores had fallen back to the 98th percentile. Everyone knew about it because the practice of sharing good and bad news involved, among other things, posting scores in the company cafeteria.
As Stubblefield put it, "When we dropped to 98 after seven years at 99, [the employees] panicked. They had a 'back to basics' course—put every employee in the organization through it. Because we fell to the 98th percentile." Notice that it was the employee owners who panicked and got to work to reinforce the culture at BHC.
Indeed, culture may truly represent a source of competitive advantage that most organizations have ignored. No wonder Rackspace CEO Lanham Napier says, "Our culture and the awesome people we have are the things I am most proud of, as well as creating an environment where people get to do what they do best. I would say it's impossible for our competitors to copy. They'd have to start over and build it from scratch."
James L. Heskett and W Earl Sasser, Jr. are both Baker Foundation professors at Harvard Business School. Joe Wheeler is the executive director of the Service Profit Chain Institute. All are co-authors of The Ownership Quotient: Putting the Service Profit Chain to Work for Unbeatable Competitive Advantage.
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The answer is: yes, according to recent research out of the University of Connecticut.
Rexford Santerre, a professor of finance and healthcare management at the university, says his research on a data set of 30 nonprofit hospitals in Connecticut shows that incentives at most nonprofit hospitals and health systems drive the nonprofit healthcare CEO to increase the occupancy rate of privately insured patients at the expense of uncompensated care and public-pay patients. Basically, the research, at least in Connecticut, says that CEOs are much more driven by the "five Ps: pay, perquisites, power, patronage, and prestige" than they are at maximizing the hospital's charitable mission.
When I first looked at Rex's paper, I said, so what? We at HealthLeaders Media see nonprofit CEOs trying to build replacement hospitals among the well-insured suburban population every day. And when's the last time you drove by the local successful nonprofit hospital and didn't see a crane or two at work?
So what?
Well, the "so what" gets to what many in Congress see as a perversion of the supposed charitable mission nonprofit hospitals are supposed to pursue in return for generous tax exemptions at the municipal, state, and federal level. The idea, so the thinking goes, is that you, as the hospital's leader, should do a better job seeking out the underprivileged and providing them care, even to the detriment of your bottom line.
The hospital CEOs I talk to—and I've spoken with dozens of them over the nearly nine years I've been here at HealthLeaders Media—pretty much make no secret of the fact that seeking out paying patients is critical to their hospital's survival in an era in which even those covered by Medicare and Medicaid seldom pay the cost of their care. Add as many paying patients and the amenities that attract them to the mix as possible, and you just might survive—even thrive.
Rex's study is scientific. It looks for incentives that encourage nonprofit CEOs to increase the amount of charity care they provide, and doesn't find many.
"When they serve more uncompensated patients, they're paid less," he says. "So it's not surprising that they would seek to maximize their pay."
We're going to get into some economics-speak here, so bear with me. The question is: What drives their pay at the margin? CEOs, says Santerre, have to make a marginal decision on what type of action they attempt to maximize. So they focus on activities that maximize net revenues. Not profits, or margin, but revenues.
"They get pleasure out of running larger organizations," he says. "If they have more revenues, there are some discretionary places where they can spend the revenue."
As I mentioned before in this column, I'm not really surprised at these findings. It's good that someone's quantified them scientifically, but what do they mean for the real world you find yourself in—running a hospital?
I'm sympathetic to you as a nonprofit hospital CEO.
Say you do go against every fiber of your being that tells you to run a fiscally healthy, thriving organization that can afford to spend the cash you need to in order to make your hospital or health system attractive to those who are interested in quality of care and the latest technologies. Say you seek out nonpaying patients. Say you squander your carefully built investment portfolio on providing care to those patients who lose you money. Besides the fact that you'd be quickly cutting your own throat, career-wise—if you're allowed to continue this exercise, your hospital would slowly become an organization that lives at the margin. As we've seen, the government, at least up to now, isn't going to make up for all that money you're losing treating the uninsured.
So it's not your problem, it's the system. Santerre's idea is to change the system of incentives.
"You could explicitly tie their tax exemption to the community benefit they provide over and beyond some expected amount," he says, explaining that for-profit hospitals provide community benefit, too. They also provide uncompensated care.
"Look at for-profits as a benchmark," Santerre says. "So we could provide [nonprofits] a tax relief subsidy based on what benefits they provide over and above what's provided in the for-profit setting."
Now that's a potential solution that might have some legs.
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A group of 12 healthcare organizations, including the American Hospital Association, has urged CMS to withdraw or delay the recent policy change regarding physician supervision of hospital outpatient services, according to an April 15 article on the AHA's Web site, AHA News Now. The organizations recommended that CMS suspend enforcement of the policy until the agency can address all related concerns.
The policy, which CMS announced in the 2009 OPPS final rule, requires a physician privileged by the hospital to be present in a department of the hospital, or its outpatient departments furnishing outpatient therapeutic services, both on and off campus.
In its April 15 letter to CMS, the group says the policy "places a considerable burden on hospitals, requiring them to engage more physicians for direct supervisory coverage without a clear clinical need."
The letter also states that "the impact will be particularly severe for small or rural hospitals, such as critical access hospitals, which are often the only source of outpatient hospital services within many miles and which are in locations which may have only one or two physicians in the entire community."
Kimberly Anderwood Hoy, JD, CPC, director of Medicare and compliance for HCPro, Inc., in Marblehead, MA says the letter is "a good start, because certainly hospitals have felt that this was an onerous burden."
In the 2009 OPPS final rule, CMS stated that lack of direct physician supervision was a quality concern. The letter responds that "beyond this statement, CMS offers no evidence to support the assertion that quality is affected at these sites of service when there is no direct supervision. If quality is one of the reasons for imposing this new requirement, then CMS must make available the data that supports this contention."
Hoy points out that many of the services affected by the current policy (for example, infusion and wound care) are also delivered by home health nurses in a patient's home without a physician present. "It doesn't make sense for CMS to limit coverage of these services without a physician present in the outpatient department, when they are being done safely, without a physician present by home health nurses in patient's homes," she says.
Second, CMS argued in the final rule that the policy was a clarification rather than a change. The letter draws attention to the confusion this position has caused within the industry: "CMS' intent…was not clear in the 2009 OPPS proposed rule. There was a clear lack of effective and adequate notice about the CMS policy change . . . therefore, many in the field missed the opportunity to address the substantial impact this policy change would have on providers and physicians."
Hoy says that even if opponents of the policy were to concede to CMS that this policy has always been its intent, that doesn't mean that CMS shouldn't take a look at how delivery of health care has changed in the past ten years. "They may need to re-examine the policy in light of the lack of safety concerns that have arisen," she says.
Hoy adds that a strength of the letter is that many reputable associations without a common agenda back it. She suggests that while CMS could dismiss the concerns of individual hospitals as biased, a letter from the principal associations commands more attention.
The letter concludes with a call upon CMS to hold a special Open Door Forum or Town Hall meeting to address the policy and the problems it is creating. This, it says, "would be an important first step . . . ensure it provides the hospital and physician community with the opportunity to provide full feedback on the new policy's impact."
Hoy says such a meeting would offer the industry an opportunity to discuss the CMS basis for saying that the policy is necessary for quality.
Bryn Evans, CPC-A, is a managing editor withHCPro, Inc.
