Thursday, May 17, 2012
New HHS Tool Tracks Health System Performance Online
HHS has launced a new Web-based tool to bring together data sets from across the federal government in one place so Americans can monitor and measure how the nation’s health care system is performing. The new site was announced by Health and Human Services Secretary Kathleen Sebelius on Tuesday (May 15).
Known as the Health System Measurement Project, it is intended to allow policy makers, health care providers and the public to develop consistent data-driven views of changes in critical U.S. health system indicators, HHS officials said. The public can view data by age, income level, ethnicity, and other factors.
According to HHS: Using the Measurement Project, one can quickly view data on a given topical area from multiple sources, compare trends across measures and compare national trends with those at the state and regional level. For example, an individual could use the Measurement Project to monitor the percentage of people who have a specific source of ongoing medical care or track avoidable hospitalizations for adults and children by region or ethnic group.
“Ensuring all Americans have access to these data is an important way to make our health care system more open and transparent.” Sebelius said in a written statement.
Find Secretary Sebelius's entire statement at: http://www.hhs.gov/news/press/2012pres/05/20120515c.html.
The project includes data from topical areas, such as access to care, cost and affordability, prevention and health information technology. It presents these indicators by population characteristics, such as age, sex, income level, insurance coverage, and geography.
The tool contains information on how the measures were calculated and provides users with direct links back to the original data sources, HHS officials said.
To access the Health System Measurement Project, go to https://healthmeasures.aspe.hhs.gov/.
Wednesday, May 9, 2012
Non-Profit Hospitals Deal with Financial Stress
Kaiser Health News reports on a Columbus, Ohio patient “Sued Over an $1800 Hospital Bill”.
Find this article at Kaiser Health News: http://www.kaiserhealthnews.org/Stories/2012/April/27/charity-care-nonprofit-hospitals-patient-debt.aspx.
Here is a story of a working family, “living paycheck to paycheck” and a debt collector for a local non-profit hospital demanding a minimum payment of $400 instead of the $20 the patient Lori Duff said she could afford to pay at the time.
KHN reports that “Duff was likely eligible for free care under the Mount Carmel Health System’s financial assistance policy, which offers medical care at no charge for patients earning less than 200 percent of the federal poverty level. But the debt collector kept calling and soon informed her that the hospital was planning to sue her for the money.”
Duff was one of nearly 1,600 people Mount Carmel sued in county court between 2009 and 2011. Most of them were patients like Duff who did not pay their medical bills. And apparently Duff was doing the right thing. When she became pregnant, she went straight to the local hospital to make sure mother and child were healthy and safe. “She assumed the care would be provided for free, either through an emergency Medicaid option offered to pregnant women or through the hospital’s financial assistance policy. But then, a few months after Henry was born, she started getting the letters and phone calls from the debt collector.”
Often, patients who have filled out financial assistance applications while at the hospital, assume their bills will be covered, and do not learn they owe money until collection agents begin calling.
So here’s the point of the article: Nonprofit hospitals, which pay no federal, state or local taxes (“giving them a competitive edge over their for-profit counterparts”) are “expected” to offer a free and discounted care for low-income patients. But even as more and more Americans need extra help after losing their jobs and health insurance in the recession, studies suggest that on average, nonprofits provide only slightly more free and reduced-cost care than for-profit hospitals.
Patient advocates argue the line dividing nonprofit hospitals and for-profit hospitals, which do not receive the tax exemption, has blurred.
The hospital in question doesn’t dispute its efforts to collect payments after services rendered. The health system's mission is to provide care to everyone, regardless of their ability to pay, explains the VP for patient financial services: "In order to provide charity in the community—and we provide a lot and do a lot of good – we have to collect payment from those who can afford to pay us."
The tax code requires nonprofits to provide a "community benefit" to maintain their federal tax exemption. An important part of that benefit is free and reduced cost care for the poor, though the requirement is not specific about how much is expected. The article cites a 2006 study by the Congressional Budget Office found that on average, nonprofits provide only slightly more uncompensated care than for-profit hospitals. On the other hand, the article also cites a separate study by the Internal Revenue Service of more than 500 nonprofit hospitals. That study suggests non-profits do more than their share: it found that 9 percent of hospitals provided 60 percent of all charity care.
Provisions in the 2010 health care law crafted by Sen. Chuck Grassley, R-Iowa and Sen. Max Baucus, D-Mont require non-profit hospitals to publicize their financial assistance policies and prohibits them from charging higher rates to uninsured patients or taking extreme collections efforts against patients who may qualify for free care.
Specifically, new rules that went into effect last year under the new health care law:
1) Prohibit non-profit hospitals from charging uninsured low-income patients higher rates that the lowest amounts billed to individuals with insurance
2) Require non-profits to have clearly written financial assistance policy describing who is eligible for free or reduced cost care (The policy must be widely publicized in the community served by the hospital.)
3) Prohibit non-profits from enforcing “extraordinary collections actions” against patients before determining whether the patient qualifies for financial assistance
4) Require non-profits to conduct assessments of the health needs of the community they serve and implement a strategy to meet those needs
The American Hospital Association says that non-profit hospitals support more transparency on these policies. The KHN reports that “the AHA estimates that nonprofit hospitals spend an average of 11 percent of their total expenses on benefits to their communities, though the calculation also includes bad debt, which they have tried and failed to collect, and shortfalls from the rates paid by Medicaid and Medicare, which hospitals say do not cover their costs.”
Given this, it’s worth considering a recent Moody’s report on the non-profit sector as well.
Reuters reports: “Nonprofit US hospitals to do more with less.” Find the article here: http://www.reuters.com/article/2012/05/09/us-usa-healthcare-nonprofits-idUSBRE84805520120509.
Here is the problem: “Nonprofit hospitals in the United States face a future of rising costs and dwindling funds as the healthcare reform is implemented and the Congress battles over the budget”.
Here is the solution: “To survive what the rating agency is calling a "transition period," the hospitals, which frequently provide free or discounted care for lower-income patients, will have to drastically cut spending.”
And the source of the problem, according to Moody’s: “At the heart of the matter lies Medicare, the health insurance program for seniors which currently serves 49 million beneficiaries. Last month, an annual federal report on the Medicare fund found it is headed for exhaustion in 2024. Costs for the $549 billion-a-year program will likely leap from about 3.7 percent of gross domestic product in 2011 to 5.7 percent by 2035. Moody's said some of the health reform law's changes to how Medicare pays for procedures will stress nonprofit hospitals' finances. The law, which the Supreme Court could overturn in coming months, has lowered annual increases to Medicare payment rates.”
The article is written by Jenny Gold of Kaiser Health News. Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a non-profit, non-partisan health policy research and communication organization not affiliated with Kaiser Permanente. The story was produced in collaboration with NPR, National Public Radio.
Find this article at Kaiser Health News: http://www.kaiserhealthnews.org/Stories/2012/April/27/charity-care-nonprofit-hospitals-patient-debt.aspx.
Here is a story of a working family, “living paycheck to paycheck” and a debt collector for a local non-profit hospital demanding a minimum payment of $400 instead of the $20 the patient Lori Duff said she could afford to pay at the time.
KHN reports that “Duff was likely eligible for free care under the Mount Carmel Health System’s financial assistance policy, which offers medical care at no charge for patients earning less than 200 percent of the federal poverty level. But the debt collector kept calling and soon informed her that the hospital was planning to sue her for the money.”
Duff was one of nearly 1,600 people Mount Carmel sued in county court between 2009 and 2011. Most of them were patients like Duff who did not pay their medical bills. And apparently Duff was doing the right thing. When she became pregnant, she went straight to the local hospital to make sure mother and child were healthy and safe. “She assumed the care would be provided for free, either through an emergency Medicaid option offered to pregnant women or through the hospital’s financial assistance policy. But then, a few months after Henry was born, she started getting the letters and phone calls from the debt collector.”
Often, patients who have filled out financial assistance applications while at the hospital, assume their bills will be covered, and do not learn they owe money until collection agents begin calling.
So here’s the point of the article: Nonprofit hospitals, which pay no federal, state or local taxes (“giving them a competitive edge over their for-profit counterparts”) are “expected” to offer a free and discounted care for low-income patients. But even as more and more Americans need extra help after losing their jobs and health insurance in the recession, studies suggest that on average, nonprofits provide only slightly more free and reduced-cost care than for-profit hospitals.
Patient advocates argue the line dividing nonprofit hospitals and for-profit hospitals, which do not receive the tax exemption, has blurred.
The hospital in question doesn’t dispute its efforts to collect payments after services rendered. The health system's mission is to provide care to everyone, regardless of their ability to pay, explains the VP for patient financial services: "In order to provide charity in the community—and we provide a lot and do a lot of good – we have to collect payment from those who can afford to pay us."
The tax code requires nonprofits to provide a "community benefit" to maintain their federal tax exemption. An important part of that benefit is free and reduced cost care for the poor, though the requirement is not specific about how much is expected. The article cites a 2006 study by the Congressional Budget Office found that on average, nonprofits provide only slightly more uncompensated care than for-profit hospitals. On the other hand, the article also cites a separate study by the Internal Revenue Service of more than 500 nonprofit hospitals. That study suggests non-profits do more than their share: it found that 9 percent of hospitals provided 60 percent of all charity care.
Provisions in the 2010 health care law crafted by Sen. Chuck Grassley, R-Iowa and Sen. Max Baucus, D-Mont require non-profit hospitals to publicize their financial assistance policies and prohibits them from charging higher rates to uninsured patients or taking extreme collections efforts against patients who may qualify for free care.
Specifically, new rules that went into effect last year under the new health care law:
1) Prohibit non-profit hospitals from charging uninsured low-income patients higher rates that the lowest amounts billed to individuals with insurance
2) Require non-profits to have clearly written financial assistance policy describing who is eligible for free or reduced cost care (The policy must be widely publicized in the community served by the hospital.)
3) Prohibit non-profits from enforcing “extraordinary collections actions” against patients before determining whether the patient qualifies for financial assistance
4) Require non-profits to conduct assessments of the health needs of the community they serve and implement a strategy to meet those needs
The American Hospital Association says that non-profit hospitals support more transparency on these policies. The KHN reports that “the AHA estimates that nonprofit hospitals spend an average of 11 percent of their total expenses on benefits to their communities, though the calculation also includes bad debt, which they have tried and failed to collect, and shortfalls from the rates paid by Medicaid and Medicare, which hospitals say do not cover their costs.”
Given this, it’s worth considering a recent Moody’s report on the non-profit sector as well.
Reuters reports: “Nonprofit US hospitals to do more with less.” Find the article here: http://www.reuters.com/article/2012/05/09/us-usa-healthcare-nonprofits-idUSBRE84805520120509.
Here is the problem: “Nonprofit hospitals in the United States face a future of rising costs and dwindling funds as the healthcare reform is implemented and the Congress battles over the budget”.
Here is the solution: “To survive what the rating agency is calling a "transition period," the hospitals, which frequently provide free or discounted care for lower-income patients, will have to drastically cut spending.”
And the source of the problem, according to Moody’s: “At the heart of the matter lies Medicare, the health insurance program for seniors which currently serves 49 million beneficiaries. Last month, an annual federal report on the Medicare fund found it is headed for exhaustion in 2024. Costs for the $549 billion-a-year program will likely leap from about 3.7 percent of gross domestic product in 2011 to 5.7 percent by 2035. Moody's said some of the health reform law's changes to how Medicare pays for procedures will stress nonprofit hospitals' finances. The law, which the Supreme Court could overturn in coming months, has lowered annual increases to Medicare payment rates.”
The article is written by Jenny Gold of Kaiser Health News. Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a non-profit, non-partisan health policy research and communication organization not affiliated with Kaiser Permanente. The story was produced in collaboration with NPR, National Public Radio.
Thursday, May 3, 2012
Observation status can trigger significant hospital fees for drugs
USA TODAY reports on “Patients held for observation can face steep drug bills”.
Find the article at USA TODAY Money http://www.usatoday.com/money/industries/health/drugs/story/2012-04-30/drugs-can-be-expensive-in-observation-care/54646378/1.
The article features a diabetic patient in the hospital for sudden chest pains whose charge for insulin during her 18-hour would have been enough to cover her out-of-pocket expenses for a three-month supply under her private Medicare Advantage plan.
Even though her health plan covers medical and drug expenses, her policy would not pay the hospital drug bill because the hospital never formally admitted her; instead, it billed the visit as observation care, which is considered outpatient service.
The “observation label” reportedly excludes thousands of patients every year from full Medicare coverage. Many have spent more than a day in the hospital and had regular hospital rooms and service and never realized they weren't admitted. These “observation patients” face paying a larger share of their hospital bills than inpatients, since they usually have a co-payment for doctors' fees and each hospital service.
The problem in many of these instances is that Medicare does not pay for routine drugs that observation patients need for chronic conditions such as diabetes, high blood pressure or high cholesterol — drugs that they could have brought from home if the hospital allowed it and the patient had time to get them. Apparently Medicare has no rules for what hospitals can bill for non-covered drugs, so they can charge any amount. The article reports that Medicare officials recommend to hospitals — but do not require — that patients remain under observation for no more than 24 to 48 hours. After that, the patients should be switched to inpatient status or discharged, the officials recommend. But patients can linger in observation for several days and often don't know they haven't been admitted.
Medicare does not limit the prices for drugs that it does not cover, hospitals use their pharmacies to help generate revenue to subsidize the other operating costs of the facility, said Miriam Mobley Smith, dean of the College of Pharmacy at Chicago State University. She said the "upcharge" is based on numerous factors, including personnel, insurance and facility costs. And the article states that even patients with private Medicare Part D drug insurance may find that their policies don't cover their everyday — or "self-administered" — drugs given to them in the hospital: "These drugs may be covered under certain circumstances," according to the Medicare website. But there is no requirement that Part D beneficiaries must be fully reimbursed for these drugs.
USA TODAY reports that the most recent government statistics show the number of observation claims that hospitals submitted to Medicare rose 46% to 1.4 million from 2006 to 2010, and the number of cases lasting longer than 48 hours more than tripled. The article also states that the American Hospital Association, in a 2010 letter to Medicare officials, cited several factors to explain that growth, including increasingly restrictive Medicare criteria for the hospital admission and rising use of audits to monitor hospital decisions and billing. In addition, it said, physicians sometimes try to keep seniors in the hospital because they may not be well enough to be home, even when they're not sick enough to be admitted.
There is a class-action lawsuit, filed by the Center for Medicare Advocacy, based in Connecticut, against the federal government on behalf of “observation patients” – who, because of their observation status, become ineligible for Medicare coverage for nursing home care when they leave the hospital. The lawsuit seeks to either eliminate the “observation status” or require hospitals to tell patients when they are admitted for observation and allow them to appeal the designation.
The article is written by Susan Jaffe of Kaiser Health News. Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a non-profit, non-partisan health policy research and communication organization not affiliated with Kaiser Permanente.
Find the article at USA TODAY Money http://www.usatoday.com/money/industries/health/drugs/story/2012-04-30/drugs-can-be-expensive-in-observation-care/54646378/1.
The article features a diabetic patient in the hospital for sudden chest pains whose charge for insulin during her 18-hour would have been enough to cover her out-of-pocket expenses for a three-month supply under her private Medicare Advantage plan.
Even though her health plan covers medical and drug expenses, her policy would not pay the hospital drug bill because the hospital never formally admitted her; instead, it billed the visit as observation care, which is considered outpatient service.
The “observation label” reportedly excludes thousands of patients every year from full Medicare coverage. Many have spent more than a day in the hospital and had regular hospital rooms and service and never realized they weren't admitted. These “observation patients” face paying a larger share of their hospital bills than inpatients, since they usually have a co-payment for doctors' fees and each hospital service.
The problem in many of these instances is that Medicare does not pay for routine drugs that observation patients need for chronic conditions such as diabetes, high blood pressure or high cholesterol — drugs that they could have brought from home if the hospital allowed it and the patient had time to get them. Apparently Medicare has no rules for what hospitals can bill for non-covered drugs, so they can charge any amount. The article reports that Medicare officials recommend to hospitals — but do not require — that patients remain under observation for no more than 24 to 48 hours. After that, the patients should be switched to inpatient status or discharged, the officials recommend. But patients can linger in observation for several days and often don't know they haven't been admitted.
Medicare does not limit the prices for drugs that it does not cover, hospitals use their pharmacies to help generate revenue to subsidize the other operating costs of the facility, said Miriam Mobley Smith, dean of the College of Pharmacy at Chicago State University. She said the "upcharge" is based on numerous factors, including personnel, insurance and facility costs. And the article states that even patients with private Medicare Part D drug insurance may find that their policies don't cover their everyday — or "self-administered" — drugs given to them in the hospital: "These drugs may be covered under certain circumstances," according to the Medicare website. But there is no requirement that Part D beneficiaries must be fully reimbursed for these drugs.
USA TODAY reports that the most recent government statistics show the number of observation claims that hospitals submitted to Medicare rose 46% to 1.4 million from 2006 to 2010, and the number of cases lasting longer than 48 hours more than tripled. The article also states that the American Hospital Association, in a 2010 letter to Medicare officials, cited several factors to explain that growth, including increasingly restrictive Medicare criteria for the hospital admission and rising use of audits to monitor hospital decisions and billing. In addition, it said, physicians sometimes try to keep seniors in the hospital because they may not be well enough to be home, even when they're not sick enough to be admitted.
There is a class-action lawsuit, filed by the Center for Medicare Advocacy, based in Connecticut, against the federal government on behalf of “observation patients” – who, because of their observation status, become ineligible for Medicare coverage for nursing home care when they leave the hospital. The lawsuit seeks to either eliminate the “observation status” or require hospitals to tell patients when they are admitted for observation and allow them to appeal the designation.
The article is written by Susan Jaffe of Kaiser Health News. Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a non-profit, non-partisan health policy research and communication organization not affiliated with Kaiser Permanente.
Congressional interest emerges in Accretive Health story
We blogged last week about the report on practices uncovered by the Minnesota Attorney General – results of the Minnesota attorney general's inquiry, released last week in a six-volume report that suggests Accretive Health violated federal laws while under contract with a Minneapolis hospital.
See New York Times article “Debt Collector Is Faulted for Tough Tactics in Hospitals” by Jessica Silver-Greenberg (April 24, 2012) at http://www.nytimes.com/2012/04/25/business/debt-collector-is-faulted-for-tough-tactics-in-hospitals.html.
This week ModernHealthcare.com reports “Lawmakers request client list from Accretive,” by Melanie Evans (posted May 2, 2012 - 1:45 pm ET).
Find this article here: http://www.modernhealthcare.com/article/20120502/NEWS/305029985?AllowView=VW8xUmo5Q21TcWJOb1gzb0tNN3RLZ0h0MWg5SVgra3NZRzROR3l0WWRMVGJVZjBERWxiNUtpQzMyWmV1NTM0WUpiU2s=&utm_source=link-20120502-NEWS-305029985&utm_medium=email&utm_campaign=hits.
Now, Members of Congress are in the fray.
The findings raise questions about how common such practices may be, said Reps. Henry Waxman, (D-Calif.), Diana DeGette, (D-Colo.), and G.K. Butterfield, (D-N.C.), in a letter to Accretive CEO Mary Tolan (PDF). These Members of the U.S. House asked Accretive Health's CEO for a list of clients and information on the company's policies on compliance with federal emergency room access, patient privacy and debt collection laws. The request comes ahead of a scheduled May 4 congressional briefing by Accretive Health.
Accretive Health has rejected the attorney general's report and said findings “grossly distort and mischaracterize” its services. In an April 29 statement, ModernHealthcare.com reports that “the company said that more than 90% of the revenue Accretive Health collects comes from third-party payers.” “The suggestion that our focus or practice is to put bedside pressure on patients to pay their medical bills out of pocket is a flagrant distortion of fact,” the statement said.
Find its April 29 statement here or here: http://www.modernhealthcare.com/assets/pdf/CH79306429.PDF.
The congressional letter requests that Accretive Health provide by May 14 a list of clients as well as information on guidance related to patient registration and collection efforts prior to treatment; policies and procedures related to EMTALA (Emergency Medical Treatment and Active Labor Act), federal private and debt collection laws; information on complaints and how the company estimates prices and patient bills; policies about refunds and information about whether its practices are standard across the industry.
The company faces interest on other fronts. Rep. Pete Stark (D-Calif.) last week called for HHS and the CMS to investigate Accretive Health.
See a follow-up New York Times article “In Congress, a Move to Look Into a Medical Debt Collector” by JESSICA SILVER-GREENBERG (April 26). Find this article here: http://www.nytimes.com/2012/04/27/health/in-congress-stark-of-california-seeks-inquiry-into-accretive-health.html?_r=1.
Rep. Pete Stark, a Democrat and highest ranking member of the subcommittee that oversees Medicare and other health services, on April 26, asked Marilyn B. Tavenner, the acting administrator for the Medicare and Medicaid agency, to investigate the company’s practices. He sent an identical letter to the inspector general of the Department of Health and Human Services, Daniel R. Levinson.
Specifically, Stark has urged officials at the CMS and HHS' inspector general's office to examine possible violations of federal law by Accretive. The California Democrat also asked that he be informed of enforcement measures and that Medicare-participating hospitals be notified immediately if any violations are found.
Find his letter here: http://stark.house.gov/index.php?option=com_content&view=article&id=2401:news-stark-calls-on-administration-to-crack-down-on-debt-collectors-in-hospital-ers-patient-rooms&catid=89:press-releases-2012&Itemid=500235.
Links to the New York Times article may also be found here: http://www.stark.house.gov/index.php?option=com_content&view=article&id=2405:e-alert-cracking-down-on-abusive-debt-collection-in-hospitals&catid=87:e-alerts-2012&Itemid=500238.
See New York Times article “Debt Collector Is Faulted for Tough Tactics in Hospitals” by Jessica Silver-Greenberg (April 24, 2012) at http://www.nytimes.com/2012/04/25/business/debt-collector-is-faulted-for-tough-tactics-in-hospitals.html.
This week ModernHealthcare.com reports “Lawmakers request client list from Accretive,” by Melanie Evans (posted May 2, 2012 - 1:45 pm ET).
Find this article here: http://www.modernhealthcare.com/article/20120502/NEWS/305029985?AllowView=VW8xUmo5Q21TcWJOb1gzb0tNN3RLZ0h0MWg5SVgra3NZRzROR3l0WWRMVGJVZjBERWxiNUtpQzMyWmV1NTM0WUpiU2s=&utm_source=link-20120502-NEWS-305029985&utm_medium=email&utm_campaign=hits.
Now, Members of Congress are in the fray.
The findings raise questions about how common such practices may be, said Reps. Henry Waxman, (D-Calif.), Diana DeGette, (D-Colo.), and G.K. Butterfield, (D-N.C.), in a letter to Accretive CEO Mary Tolan (PDF). These Members of the U.S. House asked Accretive Health's CEO for a list of clients and information on the company's policies on compliance with federal emergency room access, patient privacy and debt collection laws. The request comes ahead of a scheduled May 4 congressional briefing by Accretive Health.
Accretive Health has rejected the attorney general's report and said findings “grossly distort and mischaracterize” its services. In an April 29 statement, ModernHealthcare.com reports that “the company said that more than 90% of the revenue Accretive Health collects comes from third-party payers.” “The suggestion that our focus or practice is to put bedside pressure on patients to pay their medical bills out of pocket is a flagrant distortion of fact,” the statement said.
Find its April 29 statement here or here: http://www.modernhealthcare.com/assets/pdf/CH79306429.PDF.
The congressional letter requests that Accretive Health provide by May 14 a list of clients as well as information on guidance related to patient registration and collection efforts prior to treatment; policies and procedures related to EMTALA (Emergency Medical Treatment and Active Labor Act), federal private and debt collection laws; information on complaints and how the company estimates prices and patient bills; policies about refunds and information about whether its practices are standard across the industry.
The company faces interest on other fronts. Rep. Pete Stark (D-Calif.) last week called for HHS and the CMS to investigate Accretive Health.
See a follow-up New York Times article “In Congress, a Move to Look Into a Medical Debt Collector” by JESSICA SILVER-GREENBERG (April 26). Find this article here: http://www.nytimes.com/2012/04/27/health/in-congress-stark-of-california-seeks-inquiry-into-accretive-health.html?_r=1.
Rep. Pete Stark, a Democrat and highest ranking member of the subcommittee that oversees Medicare and other health services, on April 26, asked Marilyn B. Tavenner, the acting administrator for the Medicare and Medicaid agency, to investigate the company’s practices. He sent an identical letter to the inspector general of the Department of Health and Human Services, Daniel R. Levinson.
Specifically, Stark has urged officials at the CMS and HHS' inspector general's office to examine possible violations of federal law by Accretive. The California Democrat also asked that he be informed of enforcement measures and that Medicare-participating hospitals be notified immediately if any violations are found.
Find his letter here: http://stark.house.gov/index.php?option=com_content&view=article&id=2401:news-stark-calls-on-administration-to-crack-down-on-debt-collectors-in-hospital-ers-patient-rooms&catid=89:press-releases-2012&Itemid=500235.
Links to the New York Times article may also be found here: http://www.stark.house.gov/index.php?option=com_content&view=article&id=2405:e-alert-cracking-down-on-abusive-debt-collection-in-hospitals&catid=87:e-alerts-2012&Itemid=500238.
Thursday, April 26, 2012
Inspector General Calls for More Disaster Preparations
CQ HealthBeat reports that a new report by the Office of Inspector General for the Department of Health and Human Services concludes that nursing homes were not adequately prepared for Hurricane Katrina. An report also concludes that many still lack enough safeguards in case of flood, fire or storm.
Find "Gaps Continue to Exist in Nursing Home Emergency Preparedness and Response During Disasters: 2007-2010 (April 2012)" at the Office of Inspector General (Report OEI-06-09-00270).
The Centers for Medicare and Medicaid Services (CMS) requires that homes have detailed written emergency plans and also train staff on how to be prepared for disasters. The OIG’s office reviewed national survey data on those preparations.
In addition, OIG staffers visited 24 nursing homes that were struck by wildfires, floods and hurricanes in 2007 through 2010. Overall, disaster hit 210 nursing homes in seven states during that period, prompting evacuations and “shelter in place” decisions by administrators.
“Administrators and staff from 17 of the 24 selected nursing homes reported facing substantial challenges in responding to disasters, whether they evacuated or sheltered residents in place,” said the OIG report, which was requested by Senate Aging Committee Chairman Herb Kohl, D-Wisc. Kohl had held a hearing on this issue.
The report says, “Challenges included difficulty following emergency plans as written, logistical problems related to transportation and communication, and negative effects of evacuation on resident health. Further, most nursing homes that experienced challenges reported that they had not collaborated with local emergency management agencies to prepare for disasters.”
CQ HealthBeat reports that "Often the homes did not follow checklist tasks recommended by CMS" and that the report indicated that "state long-term care ombudsmen didn’t have any contact with nursing home residents until the disaster was over, and other state officials who deal with the licensing of nursing homes played a limited role."
OIG officials interviewed nursing home administrators, local emergency managers, state officials who oversee nursing homes and representatives from state long term care ombudsman programs.
Most nursing homes met the CMS requirements for both written plans and training, said the OIG report. But there were gaps, and many of them were the same ones identified by the OIG in an earlier study. The 2006 study was the result of the numerous hurricanes in 2004 and 2005, including Katrina, and the concerns they raised about how nursing homes could keep their residents safe. Find "Nursing Home Emergency Preparedness and Response During Hurricanes (August 2006) at the OIG (Report OEI-06-06-00020)
On paper, the homes appeared to be ready for problems. Among more than 16,000 nursing homes surveyed in 2009 and 2010, the OIG found 92 percent met federal regulations for emergency planning, though that was a slight decrease from the 94 percent that were in compliance in 2004-05. A lower percentage, 72 percent, met standards for training, compared to 80 percent in the earlier report.
In real life, the experiences were different. “For example, one administrator of a nursing home that was flooded reported that its emergency plan did not include procedures for responding to floods, although the nursing home was in a flood plain,” said the OIG. “Administrators of two nursing homes reported that they did not consult their written emergency plans to prepare for evacuation. They reported piecing together transport by calling upon other nursing homes and local emergency entities to evacuate their residents.”
The OIG recommended that:
• CMS should be even more specific about items that should be included in emergency planning lists. The agency also should specify minimum federal standards for the frequency and extent of disaster response training, exercises and drills.
• CMS should develop better guidance for state officials on how they are to review the homes’ emergency plans.
• CMS should do more to promote the use of emergency preparedness checklists by homes.
• The Administration on Aging should develop models for state long term care ombudsmen to follow during disasters to help protect nursing home residents.
CQ HealthBeat reports that Marilyn Tavenner, CMS acting administrator, in a letter agreed with all of the recommendations and said they would be implemented.
Finally, in a memorandum report (OEI-06-09-00271), the OIG outlines specific guidance that CMS can consider when revising the checklist for health care facilities.
SOURCE: CQ HEALTHBEAT NEWS (April 16, 2012)
"Nursing Homes Need to Step Up Disaster Preparations, OIG Says"
By Jane Norman, CQ HealthBeat Associate Editor
CMS Contracts With 27 ACOs Covering 375,000 Medicare Beneficiaries
In a press release dated April 10, CMS announced contracts with 27 Accountable Care Orgnizations, launching a new program authorized by the Affordable Care Act that is intended to help physicians, hospitals, and other health care providers work together to improve care for people with Medicare.
Under the new Medicare Shared Savings Program (Shared Savings Program), 27 Accountable Care Organizations (ACOs) have entered into agreements with CMS, taking responsibility for the quality of care furnished to people with Medicare in return for the opportunity to share in savings realized through improved care.
The Shared Savings Program and other initiatives related to Accountable Care Organizations were authorized by the Affordable Care Act, the health care law of 2010. Participation in an ACO is purely voluntary for providers and beneficiaries and people with Medicare retain their current ability to seek treatment from any provider they wish.
Accounding to CMS, the first 27 Shared Savings Program ACOs will serve an estimated 375,000 beneficiaries in 18 States. This brings the total number of organizations participating Medicare shared savings initiatives on April 1 to 65, including the 32 Pioneer Model ACOs that were announced last December, and six Physician Group Practice Transition Demonstration organizations that started in January 2011. In all, as of April 1, more than 1.1 million beneficiaries are receiving care from providers participating in Medicare shared savings initiatives.
Under the new Medicare Shared Savings Program (Shared Savings Program), 27 Accountable Care Organizations (ACOs) have entered into agreements with CMS, taking responsibility for the quality of care furnished to people with Medicare in return for the opportunity to share in savings realized through improved care.
The Shared Savings Program and other initiatives related to Accountable Care Organizations were authorized by the Affordable Care Act, the health care law of 2010. Participation in an ACO is purely voluntary for providers and beneficiaries and people with Medicare retain their current ability to seek treatment from any provider they wish.
Accounding to CMS, the first 27 Shared Savings Program ACOs will serve an estimated 375,000 beneficiaries in 18 States. This brings the total number of organizations participating Medicare shared savings initiatives on April 1 to 65, including the 32 Pioneer Model ACOs that were announced last December, and six Physician Group Practice Transition Demonstration organizations that started in January 2011. In all, as of April 1, more than 1.1 million beneficiaries are receiving care from providers participating in Medicare shared savings initiatives.
According the CMS, anyone who has multiple doctors may have experienced the frustration of fragmented and disconnected care: lost or unavailable medical charts, trouble scheduling an appointment or talking to a doctor, duplicated medical procedures, or having to share the same information over and over with different doctors.
Accountable Care Organizations are designed to lift this burden from patients, while improving care and reducing costs. The Shared Savings Program was created by the Affordable Care Act after a number of efforts in the private sector showed that improving care can lead to lower costs. The selected ACOs include more than 10,000 physicians, 10 hospitals, and 13 smaller physician-driven organizations in both urban and rural areas. Their models for coordinating care and improving quality vary in response to the needs of the beneficiaries in the areas they are serving. CMS is reviewing more than 150 applications from ACOs seeking to enter the program in July.
To ensure that savings are achieved through improving and providing care that is appropriate, safe, and timely, an ACO must meet strict quality standards. For 2012, CMS has established 33 quality measures relating to care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and the patient and caregiver experience of care.
CMS also announced today that five ACOs are participating in the Advance Payment ACO Model beginning April 1. This model will provide advance payment of expected shared savings to rural and physician-based ACOs participating in the Shared Savings Program that would benefit from additional start-up resources. These resources will help build the necessary care coordination infrastructure necessary to improve patient outcomes and reduce costs, such as new staff or information technology systems. CMS is reviewing more than 50 applications for Advance Payments that start in July.
To learn more about the ACOs announced today, visit: http://www.cms.gov/apps/media/fact_sheets.asp
For more information on the Advanced Payment ACO Model, including the participating ACOs, visit: http://innovations.cms.gov/initiatives/ACO/Advance-Payment/
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Accountable Care Organizations are designed to lift this burden from patients, while improving care and reducing costs. The Shared Savings Program was created by the Affordable Care Act after a number of efforts in the private sector showed that improving care can lead to lower costs. The selected ACOs include more than 10,000 physicians, 10 hospitals, and 13 smaller physician-driven organizations in both urban and rural areas. Their models for coordinating care and improving quality vary in response to the needs of the beneficiaries in the areas they are serving. CMS is reviewing more than 150 applications from ACOs seeking to enter the program in July.
To ensure that savings are achieved through improving and providing care that is appropriate, safe, and timely, an ACO must meet strict quality standards. For 2012, CMS has established 33 quality measures relating to care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and the patient and caregiver experience of care.
CMS also announced today that five ACOs are participating in the Advance Payment ACO Model beginning April 1. This model will provide advance payment of expected shared savings to rural and physician-based ACOs participating in the Shared Savings Program that would benefit from additional start-up resources. These resources will help build the necessary care coordination infrastructure necessary to improve patient outcomes and reduce costs, such as new staff or information technology systems. CMS is reviewing more than 50 applications for Advance Payments that start in July.
To learn more about the ACOs announced today, visit: http://www.cms.gov/apps/media/fact_sheets.asp
For more information on the Advanced Payment ACO Model, including the participating ACOs, visit: http://innovations.cms.gov/initiatives/ACO/Advance-Payment/
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Debt Collectors Find Their Way Into Hospitals
The New York Times reports that “Hospital patients waiting in an emergency room or convalescing after surgery are being confronted by an unexpected visitor: a debt collector at bedside.” Go to http://www.nytimes.com/ to find the article, "Debt Collector is Faulted for Tough Tactics in Hospitals," in the NYT Business Day (April 24, 2012).
The online article, by Jessica Silver-Greenberg , continues: “This and other aggressive tactics by one of the nation’s largest collectors of medical debts, Accretive Health, were revealed on Tuesday by the Minnesota attorney general, raising concerns that such practices have become common at hospitals across the country.”
The article also indicates tactics of embedding debt collectors as employees in emergency rooms who would be expected to demand that patients pay before receiving treatment.
To patients, the debt collectors may look indistinguishable from hospital employees. They may demand that the patient pay outstanding bills and may discourage the patient from seeking emergency care at all. According to reported allegations, Accretive Health employees were told to stall patients entering the emergency room until they had agreed to pay a previous balance.
The report indicates that in some cases these workers would have access to health information while asking patients to pay overdue bills, what the Minnesota attorney general speculates may be a violation of federal privacy laws. The Minnesota general asserts that “the hounding of patients violated the Emergency Medical Treatment and Active Labor Act, a federal law requiring hospitals to provide emergency health care regardless of citizenship, legal status or ability to pay,” and that “by giving its collectors access to health records, Accretive violated the Health Insurance Portability and Accountability Act.” In addition, the attorney general says that the company broke state collections laws by failing to identify themselves as debt collectors when dealing with patients.
It is noted that hospitals “have long hired outside collection agencies to pursue patients after they have left hospital facilities,” and “to achieve promised savings, hospitals turn over the management of their front-line staffing — like patient registration and scheduling — and their back-office collection activities.”
According to the New York Times report, “Accretive says that it trains its staff to focus on getting payment through revenue cycle operations. Accretive fostered a pressurized collection environment that included mandatory daily meetings at the hospitals in Minnesota, according to employees and the newly released documents. Employees with high collection tallies were rewarded with gift cards. Those who fell behind were threatened with termination.”
The Minnesota attorney general is currently in discussions with state and federal regulators about a coordinated response to Accretive Health’s practices across the country.
The online article, by Jessica Silver-Greenberg , continues: “This and other aggressive tactics by one of the nation’s largest collectors of medical debts, Accretive Health, were revealed on Tuesday by the Minnesota attorney general, raising concerns that such practices have become common at hospitals across the country.”
The article also indicates tactics of embedding debt collectors as employees in emergency rooms who would be expected to demand that patients pay before receiving treatment.
To patients, the debt collectors may look indistinguishable from hospital employees. They may demand that the patient pay outstanding bills and may discourage the patient from seeking emergency care at all. According to reported allegations, Accretive Health employees were told to stall patients entering the emergency room until they had agreed to pay a previous balance.
The report indicates that in some cases these workers would have access to health information while asking patients to pay overdue bills, what the Minnesota attorney general speculates may be a violation of federal privacy laws. The Minnesota general asserts that “the hounding of patients violated the Emergency Medical Treatment and Active Labor Act, a federal law requiring hospitals to provide emergency health care regardless of citizenship, legal status or ability to pay,” and that “by giving its collectors access to health records, Accretive violated the Health Insurance Portability and Accountability Act.” In addition, the attorney general says that the company broke state collections laws by failing to identify themselves as debt collectors when dealing with patients.
It is noted that hospitals “have long hired outside collection agencies to pursue patients after they have left hospital facilities,” and “to achieve promised savings, hospitals turn over the management of their front-line staffing — like patient registration and scheduling — and their back-office collection activities.”
According to the New York Times report, “Accretive says that it trains its staff to focus on getting payment through revenue cycle operations. Accretive fostered a pressurized collection environment that included mandatory daily meetings at the hospitals in Minnesota, according to employees and the newly released documents. Employees with high collection tallies were rewarded with gift cards. Those who fell behind were threatened with termination.”
The Minnesota attorney general is currently in discussions with state and federal regulators about a coordinated response to Accretive Health’s practices across the country.
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