IHA continues to work on resolving and coordinating efforts to address the serious concerns surrounding the controversial “clarification and restatement” of the direct physician supervision requirements included in the outpatient Prospective Payment System/ambulatory surgical center final rule for 2010.  The key issue being addressed surrounds the Centers for Medicare & Medicaid Services’ (CMS) requirement that a supervisor be immediately and physically present throughout the duration of outpatient therapeutic services.

IHA has been meeting in-person with each of the offices of Iowa’s congressional delegation and has drafted a delegation letter to CMS urging immediate action on this issue.  To date, Senator Tom Harkin, and Representatives Leonard Boswell, Steve King, Tom Latham, and Dave Loebsack have all confirmed their support on the issue and have agreed to sign onto the letter.  Staff from the offices of Senators Chuck Grassley and Harkin have also been in contact directly with CMS to outline their concerns and staff for Senate Finance Committee Chair Max Baucus have been in communication with CMS on this issue as well.

Earlier this week, CMS hosted a rural health open door forum conference call and spent most of the time discussing physician supervision.  CMS acknowledged the arising complications and encouraged hospitals to continue reaching out to help CMS understand the “real-world” impact of its policy.

CMS verbally qualified its position by stating that physicians or other allied professionals, recognized in the outpatient rule should be “fairly immediately available” and recognized that the rule doesn’t anticipate clinicians “hanging around the emergency department” with no knowledge of anticipated patient arrivals.  CMS stated that determination of “immediately available” is essentially at the discretion of the hospital.  CMS also acknowledged that this billing policy predominantly creates an issue with observation status, which is currently billed as a therapeutic service.  However, CMS stopped short of backing away from the rule as written, but confirmed that further written guidance will be provided on this topic.

IHA will continue working with Iowa’s Congressional Delegation, the Senate Finance Committee staff as well as the American Hospital Association to seek clarification and resolution of this issue.  Pending further guidance from CMS, IHA will survey Critical Access Hospital members to further refine its understanding of the scope of the problem and potential solutions.

President Barack Obama held a press conference Wednesday outlining his plans on health care reform that has stalled in Congress.  As was predicted, the president asked Congress to schedule a final “up-or-down” vote on health care reform legislation and took it a step further by adding his endorsement of using the budget reconciliation process to finish the process.

“I believe the United States Congress owes the American people a final vote on health care reform,” Obama said.  He continued by mentioning a myriad of other bills that were passed with a simple majority rather than the currently required “super-majority” of 60 votes needed in the Senate to pass legislation.

The Democrats held onto a 60 vote majority until the election of Republican Scott Brown in Massachusetts.

Republican lawmakers insist that using the reconciliation procedure would cause outrage in the public and further the intense partisan gridlock facing the Congress.  Regardless, Obama requested that Congress take action in the next few weeks.  The president also highlighted the Republican ideas that he has agreed to include in his proposal and again told Republicans that starting over is not an option.

IHA will continue to monitor the process along with the new budget numbers and coverage estimates that result from the president’s new proposal.

President Obama has called for a bipartisan health care reform summit to be held on February 25.  The meeting is expected to bring together members from both parties to discuss action moving forward.

Speaking on behalf of the administration this week, Secretary of Health and Human Services Kathleen Sebelius held a press conference to discuss health care reform and told reporters that that President Obama is willing to “add various elements” to health care legislation suggested by Republican lawmakers during the proposed summit.   But she said he won’t change the entire plan and he is “absolutely not” hitting the reset button on the legislative process.

Obama’s refusal to start at square one has upset several Republicans, who have started to question whether or not they will attend the summit, unless the option to start over is on the table.  Obama has hinted that he may be open to rebooting the process, but doesn’t want Congress wasting another year of partisan tactics and bickering only to end up in the same place.

Sebelius said that the president views the bipartisan meeting as a needed pivot to move reform forward.  Asked if the president will expedite the legislative process following his various sit-downs with congressional Republicans, she replied “I certainly think so.  I think he sees this as a step to actually accelerating the process forward.  He wants to move forward.  He wants a bill at his desk and he sees this as kind of closing the loop and let’s go.”

Meanwhile, in Congress, with nearly all of Washington D.C. “closed” because of back-to-back blizzards, relatively little, if any, progress has been made on health care reform in the past few weeks.  House lawmakers leaving a Democratic Caucus meeting last week said they’re waiting for signals from the Senate on health reform before deciding on a strategy, even as they prepare for stand-alone votes on one or more small-scale provisions.  They said they’re taking time off from health care reform discussions to reconnect with the public and find out what measures can pass the House and Senate.

Senate Finance Committee Chair Max Baucus (D-MT) told reporters following a budget hearing that it will be more clear “in the next couple days” on whether health reform could move through reconciliation.

Speaker of the House Nancy Pelosi (D-CA) announced that she wants to move forward with smaller, more manageable portions of health care reform next week with a repeal of anti-trust exemption for health insurers.  Other possible carve-out bills include the medical loss ratio, banning health plan rescissions and other smaller provisions that can’t be tackled through the complicated reconciliation process, and have enough support to pass.

Congress is scheduled for a week-long recess beginning February 12.

One major sticking point in the ongoing health care reform debate has been over the so-called “public option,” a proposed government-sponsored health care plan.  The primary point of contention came among the Democratic party itself as liberal Democrats wanted a “robust” public option, while more moderate Democrats, largely concerned over costs, were  more interested in a weaker public option.

This disagreement has stalled progress in the Senate for weeks, but after several behind-the-scenes negotiations, Senate Majority Leader Harry Reid (D-NV) announced a tentative agreement among Democrats this week moving the issue forward.

At issue, however, are early reports that the proposal will contain a major expansion of the Medicare program in exchange for either a weaker public option, or no public option at all.  The Medicare expansion would allow citizens aged 55 or older to buy into the Medicare program (versus the current age of 65 or older) which would add millions of Americans to the program.

IHA takes issue with this proposal as the Medicare program does not pay hospitals and other health care providers 100 percent of the actual cost of care.  In other words, if a patient on Medicare receives $1000 worth of health care, Medicare reimburses the hospital between $300-$600.  Though Medicare payment rates vary from state to state, compounding this issue is that Iowa receives some of the lowest Medicare reimbursements in the nation.  IHA data shows that in the most recent fiscal year, Iowa hospitals lost more than $100 million due to Medicare shortfalls.

What’s more, the Senate is also proposing a massive expansion in eligibility to the Medicaid program which reimburses Iowa hospitals even less than Medicare with an estimated $200 million shortfall that increases annually.

By adding millions of Americans to these programs that do not pay the full cost of care would be extremely damaging to Iowa hospitals as the shortfalls would increase dramatically.

IHA opposes the expansion absent Congress acting to correct the historical imbalance of payments among hospitals.  IHA has proposed language to correct this imbalance and Iowa Senator Harkin, a leader in Senate negotiations, should fight to make sure Iowa hospitals are not further disenfranchised by this expansion.

The full proposal will be released after being “scored” for costs by the Congressional Budget Office expected in the coming days.

Featuring hospital and health care headlines from the media and Web from November 21-November 25.

Iowa Headlines

Iowa health official: Future of long-term care facilities cloudy
MASON CITY — State budget cuts could result in the closing of a significant number of long-term care facilities, a state health care official said Monday.  “We’re probably facing the most difficult time we’ve had in the last 30 to 40 years and it’s not just because of what’s going on at the state level, but also what’s going on at the national level,” said Steve Ackerson, executive director of the Iowa Health Care Association (IHCA) and the Iowa Center for Assisted Living. (November 23, Mason City Globe Gazette)

U.S. Headlines

Poll: Americans conflicted over health overhaul
Most Americans don’t expect a health care overhaul to affect their lives directly, but those who worry about the fallout outnumber those expecting to come out ahead, a poll out Tuesday has found.  The survey by the nonpartisan Robert Wood Johnson Foundation finds that Americans are tuning in to the debate in Washington, with 60 percent saying they’re following it very closely or fairly closely. (November 22, Associated Press)

In Cancer Testing, Less Is Now Better
Worries that widespread screening for breast and cervical cancers can yield limited benefit and lead to unnecessary harm prompted decisions this week by two medical organizations to recommend less preventive testing. (November 21, Wall Street Journal)

How to Find Mental Health Care When Money Is Tight
Imagine this situation. You fall into a deep malaise. Friends say you need help, but you don’t have insurance (or the insurance you do have has very limited mental health benefits), and you worry that extra bills will only add to your malaise. So you do nothing. (November 20, New York Times)