This week, President Obama released his $3.8 trillion FY 2013 budget proposal that includes $268 billion in Medicare cuts and $52 billion in Medicaid cuts over 10 years.  Many of the Medicare and Medicaid proposals included in the president’s budget are the same put forward during last year’s deficit reduction negotiations.  The president’s budget also offers alternatives to the across-the-board sequestration cuts required under current law to begin January 1, 2013.  The sequestration cuts, including the 2 percent reduction in Medicare reimbursement, were triggered when the “super committee” failed to reach agreement on how to reduce the federal deficit last fall.

Highlights of the president’s budget include:

• Critical Access Hospital (CAHs) program reform:  Beginning in FY 2013, CAH payments would be reduced from 101 percent to 100 percent of reasonable costs.  Beginning in FY 2014, CAH designation for hospitals that are less than 10 miles from the nearest hospital would be eliminated.  It is unclear as to how the mileage would be measured and whether the nearest hospital would need to be a Prospective Payment System hospital or CAH.  There is precedent, however, for using road miles for other payment policies that rely on a mileage requirement.
• Reductions in Medicare funding for Graduate Medical Education:  Indirect medical education adjustment would be reduced by 10 percent beginning in 2014. 
• Reductions in assistance to low-income Medicare beneficiaries (bad debt): Bad debt payments would be reduced to 25 percent over three years beginning in FY 2013.
• Medicaid Disproportionate Share Hospital (DSH) payments:  In 2021, Medicaid DSH payments would be rebased to reflect hospitals’ reduced level of uncompensated care as the Affordable Care Act (ACA) is implemented.
• Strengthen the Independent Payment Advisory Board:  The board would be allowed to issue recommendations triggered by a lower threshold of overall cost increases than ACA originally provided.
• Reconfigure Federal Medical Assistance Percentage:  In 2017, the president’s budget would replace the various federal matching rates at which states are reimbursed for their Medicaid and Children’s Health Insurance Program costs with a lower, single, blended rate for each state.

While the president’s budget contains several troubling proposals for hospitals, it is largely a political document and not expected to serve as the framework Congress uses to develop next year’s budget.  However, as Congress continues to look for ways to reduce the federal deficit, the president’s proposals continue to serve as a menu of options for reducing entitlement spending. 

Iowa hospital CEOs and IHA staff met with lawmakers in Washington, D.C. this week and expressed concerns about the president’s proposals (click here to hear a radio interview with IHA Board Chair Gary Riedmann).  IHA will continue to work with Iowa’s lawmakers to explain the negative impact such proposals would have on Iowa hospitals and the communities they serve.  Questions may be directed to Abigail Stork at IHA.

Late this week, congressional leaders reached an agreement on how to prevent the 27.4 percent cut in Medicare payments to physicians that was scheduled to take effect March 1 as well as how to extend the Social Security payroll tax holiday, unemployment insurance benefits and several expiring Medicare payment policies.  The president is expected to sign the bill as both chambers head home for the week-long Presidents’ Day recess.

According to the legislative language released, the deal would:

• Extend through December the Medicare hospital outpatient hold-harmless for small rural hospitals and Sole Community Hospitals (SCHs) with not more than 100 beds.
• Extend through March the Section 508 reclassification program.
• Extend through December the ambulance add-on payments.
• Reduce payments to inpatient hospitals for assistance to low-income Medicare beneficiaries (bad debt) to 65 percent beginning in FY 2013.  For Critical Access Hospitals, beginning in FY 2013, payments will be reduced to 65 percent over three years (88 percent in FY 2013, 76 percent in FY 2014, 65 percent in FY 2015).
• Temporarily extend the current cap on therapy services and the exceptions process to those services provided in hospital outpatient departments through December.  This cap currently only applies to services provided in nursing homes and other freestanding facilities.   
• Rebase Medicaid Disproportionate Share Hospital funding in 2021.
• Reduce the Affordable Care Act Prevention Fund by $5 billion.

Thanks to the many Iowa hospital advocates who weighed in with their lawmakers, the deal does not contain several harmful provisions that had been part of earlier discussions, including:

• Severe reductions in hospital outpatient payments for evaluation and management services.
• New authority for the Centers for Medicare & Medicaid Services to make additional across-the-board coding reductions to inpatient hospitals.
• Relaxing of the current law with respect to the prohibition on physician self-referral to new physician-owned hospitals or the restrictions for growth on grand fathered facilities. 

While IHA supports several provisions included in the bill, IHA is disappointed to see the shortsighted payment cuts to hospitals included, the short extension of the 508 program and the elimination of the extension of the hold harmless payments to SCHs with more than 100 beds as of March 1.  Questions may be directed to Abigail Stork at IHA. 

In December 2011, the Iowa Healthcare Collaborative (IHC) received approval from the Center for Medicare and Medicaid Innovation Center to be the Hospital Engagement Network (HEN) for Iowa.  All Iowa hospitals have signed on to the national Partnership for Patients initiative with national quality goals and indicated their unanimous commitment to join this initiative.

To date, 97 hospitals have returned HEN charters announcing their intention to participate.

IHA fully supports IHC’s work as the Iowa HEN and encourages hospitals to sign and return the charter to IHC by the extended deadline of February 24.

IHA district meetings will focus on the Iowa HEN program.  Hospital CEOs, nurse leaders, quality directors and physician leaders should plan to attend.  Questions can be directed to Perry Meyer, Laura Malone or Art Spies at IHA or hospitals can contact their IHC-assigned improvement advisor.

IHA is urging all Iowa hospital advocates to attend IHA Legislative Day on February 29 at Veterans Memorial Convention Complex and the State Capitol in Des Moines.  Legislative Day is the largest gathering of hospital advocates in the state and a pinnacle event that supports IHA’s legislative agenda while promoting positive health care policy for hospitals.

The Legislative Day program is free and lunch is provided.  All advocates are part of the hospital advocacy team and all are invited to attend.  Hospital employees, trustees and volunteers are encouraged to ask their CEOs about plans to bring a group to this important event.

A large showing at the Capitol sends a clear signal to Iowa’s legislators that hospitals are deeply involved in policy issues and advocates are willing to come from far and wide to make their voices heard.

Program registration has been extended to February 21.  IHA asks all hospitals to have registrations in by that time. Limited onsite registration is available, though onsite registrants are not guaranteed a lunch. Hospitals bringing large groups will be mailed participant name badges and materials prior to arrival to reduce registration time at the event.

New this year, all registrants will receive a parking pass via e-mail.  Participants who are not arriving with a large group by bus will need this parking pass to gain access to the parking lots north of Veterans Memorial Convention Center.  More detailed information will be provided early next week via e-mail.

Contact Dan Royer or Stacey Nay at IHA with questions or for more information.

The mission of ServiShare (SSI) is to provide products and services to IHA members that will allow them to operate efficiently and cost effectively.  This includes minimizing the time spent by Iowa hospitals identifying and evaluating potential business partners and products.  If that mission is accomplished and hospitals purchase those products, SSI will reap the financial benefit of that support through commissions and administrative fees. Why is that important? Because, on average, those commissions and fees provide $750,000 annually to IHA. That is accomplished through sponsorships and purchased services.

That is a significant enough portion of the IHA budget (13 percent) that, without SSI, IHA’s ability to provide cutting edge leadership would be somewhat diminished.  While SSI doesn’t play a direct role in such efforts as Triple Aim, it does provide the financial resources that help the IHA maintain its leadership role in these efforts.

The challenge for SSI is to provide products that are so compelling that Iowa hospitals welcome the opportunity to purchase quality products that, in the end, support IHA. This year SSI will focus on several key areas of product enhancements.

First, the health insurance program through LaMair Mulock Condon and Wellmark will focus on opportunities to combine health insurance coverage with the workers’ compensation program.  At first glance, those products seem dissimilar.  But “upon further review,” as sports replay officials call it, there is significant opportunity to better educate and train employees, better coordinate benefits and analyze employee injuries that will almost certainly lower costs over the long run.  One can argue the health insurance program is already cutting edge through the creation of a tiered premium review system that provides for a blend of individual and group rate review that will almost always minimize premium increases.  This new workers’ comp focus should provide even more “SSI value” to health insurance participants.

Just last week, as noted in The Friday Mailing, SSI announced a partnership with SUNRx for a 340B pharmacy program. This program will almost certainly provide cost saving and revenue opportunities to Iowa hospitals that may well turn out to be remarkable.  New legislation, among other things, allows Critical Access Hospitals to participate in this program.  Initial estimates indicate that a hospital may increase revenue between $250,000 and $7 million annually by participation in this program.  That is “value.”

Additionally, SSI is working with LaMair Mulock Condon to create a new way of doing business when it comes to general and professional liability insurance.  All insurance programs need to be about managing the risk.  In the SSI workers’ comp program, that philosophy rules the day.  That program has been very successful in analyzing claims data to provide state-of-the-art risk management programs to participants.  The intent is to use that model to create the same risk management success for liability insurance.

A risk management committee will be formed that analyzes statewide data to help IHA members participating in this program to greatly improve their ability to “manage their risk.”  That group will also advise and direct educational programming throughout the year to improve the body of information available to all Iowa hospitals.  The end result should be lower premiums, or at the very least, minimal increases.

SSI will continue its focus on all insurance products and group purchasing but the above will be the focus points for 2012.  SSI’s message to all IHA members is “we are never going to ask you to do something that is not in your best interest.”  If it's a “tossup,” or if we do have a superior product, we are not going to be bashful about asking for your support.

As you can see, that support of SSI also provides direct support to the leadership of IHA. Thank you, in advance, for that continued support.

– Dennis White, Vice President

It’s been a quiet Iowa winter, but have the storms really subsided in your hospital’s marketing and public relations office?  With the lingering and unpredictable winds of change blowing in from Washington, D.C. and Des Moines and the constant barrage of requests, both expected and unexpected, from internal and external customers – well, it really hasn’t been that quiet at all, has it?

So the time is right for hospital communications professionals to take some shelter, gather their best ideas and most pressing questions and share it all with colleagues at the Iowa Society for Healthcare Marketing and Public Relations (ISHMPR) Spring Conference, scheduled for April 30-May 1 at the Holiday Inn-Jordan Creek in West Des Moines.

ISHMPR’s 2012 conference features an outstanding slate of expert speakers addressing the marketing and public relations topics that Iowa hospitals care about, from effectively using social media and other outlets to targeting the mature marketplace to dealing with a real storm – like the one that slammed Joplin, Missouri last spring.  All of this year’s presenters are experienced, engaging and enthusiastic, with plenty of real and ready “take-home” ideas.  But even more important, dozens of other hospital communications professionals will be on hand for networking, strategizing and sharing.

This is the conference hospital marketers wait for all year; there simply is no other conference that is as focused on what they need to effectively communicate the hospital message.

For more information about the 2012 ISHMPR Spring Conference and other IHA programs and to register online, visit the IHA education calendar.

The ServiShare Spring Workers’ Compensation Program. co-sponsored by LaMair Mulock Condon Co. and Farm Bureau Financial Services, is scheduled for April 24.  The morning will begin with an update on the 2012 Iowa legislative session.  The next session will outline what makes obesity a medical cost driver, identify proven alternatives to achieve better health outcomes and review research on safe lifting programs and workplace injuries.

The afternoon will open with a discussion of protective measures to better protect sites from frequently encountered threats, followed by a peer hospital highlighting the steps it took to develop and implement a security system.  The day will end with an overview of the pre-employment and return to work physical assessments survey results.

This program will be held at the Farm Bureau Financial Services Auditorium in West Des Moines.  For more information about this program and other IHA education programs and to register online, visit the IHA education calendar.

The online 2011 American Hospital Association (AHA) Annual Survey is now open for data submission and Audubon County Memorial Hospital in Audubon was the first to submit its data.

Log-on information was e-mailed to designated contacts for each Iowa hospital earlier this week.  A link to informational documents was also included to assist data collection.

All hospitals must complete the AHA Annual Survey and the utilization and financial information to be in compliance with Iowa Department of Public Health reporting requirements.  Hospitals are to report individually, with one survey per Iowa hospital license.  The completeness and timeliness of this survey is important as the data is used extensively by IHA and AHA for informational activities and reports.  Surveys are due March 9.

Hospital data is to be reported for a full 12-month period – the complete 2011 fiscal year (365 days).  Hospitals need to be consistent in using the same reporting period for responses throughout the various sections of this survey.  Links to the AHA submission site and helpful documents for completing the survey are available from the IHA website.

Questions regarding the AHA Annual Survey can be directed to Dustin Wagner at IHA.

IHA is launching a “Door-to-Doc” learning network on February 24.  Door-to-Doc is a reengineering of patient flow in the emergency department (ED) that alleviates long patient wait times.  Creating a “no-wait ED” is known to increase patient satisfaction, increase patient safety and decrease the number of patients who leave without treatment.

Door-to-Doc is a program that re-imagines the ED process and patient experience. Its model can be instituted in any hospital ED without major capital expenditures. The interventions of Door-to-Doc are more about realigning resources and rethinking process.

The learning network is free and coordinated by the Health Research & Educational Trust (HRET) of the American Hospital Association and the Iowa Hospital Association.  The faculty consists of two members of the tool design team from Phoenix-based Banner Health in (Mary Ellen Bucco and Kevin Roche) as well as Joseph Guarisco, M.D., from Ochsner Health in New Orleans, who directs all of that system’s EDs.  As one of the early implementers of Door-to-Doc, he brings both considerable clinical and engineering expertise.

During this free one-hour introductory Web conference, Door-to-Doc processes and theory will be introduced and a readiness assessment will be explained and distributed to all interested ED teams.

The faculty will select a limited number of hospitals to participate in the learning network, based on the readiness assessments.  Because of the intensive, interactive nature of the network, the teams must agree to participate in all network Web conferences and trainings and to bring a senior leader to the two in-person events.  It is necessary to include a senior leader who is a champion of Door-to-Doc to make it work in an ED.

For more information about this and other IHA education programs and to register online, visit the IHA education calendar.  Questions can be directed to Laura Malone at IHA.

Modern Healthcare magazine has announced Terri Christoffersen of Cedar Rapids as its 2012 Trustee of the Year for a Large Hospital.  Christoffersen joined the St. Luke’s Hospital board of trustees in 2000, chairing the board from 2005-2007 and the governance effectiveness committee from 2008 to 2010.  Currently, she is chairwoman of St. Luke’s Health Care Foundation and a trustee of St. Luke’s parent organization, Iowa Health System, where she chairs the quality committee.  She also is an ex-officio trustee at St. Luke’s.

According to the publication, Christoffersen stated she was most proud of shepherding improvements in the governance structure, emphasizing board, committee and individual accountability for performance.  This occurred while she was board chair.  “One of the things I find remarkable about her is she just keeps going,” said Ted Townsend, CEO of St. Luke’s and an IHA Board Member.  “She is always willing to put her shoulder to the wheel.”

Christoffersen gained firsthand insight on what it was like to be a family member of a St. Luke’s patient while her late husband battled cancer during the second half of 2005.  She shared her concerns about some aspects of her experience with Townsend, who recalled, “She was very insistent that we needed to improve.  And she was right.”

Focused attention on patient satisfaction has led to better scores. St. Luke’s moved from the 75^th percentile for inpatient care on Press Ganey rankings in 2004 to the 90^th percentile in 2005.  Scores have hovered at the 90^th percentile since then.

“I knew we had an opportunity – and I always look at it as an opportunity – to make things better,” Christoffersen says.

The Iowa Healthcare Collaborative (IHC) will be hosting the Partnership for Patients Hospital Engagement Network (HEN) Learning Communities on March 6 and March 8.  These educational programs will bookend the 7^th Annual Patient Safety Conference on March 7 and will be the first in a series of education programs designed for hospitals including, on March 28, IHC the first session of the Medical Home Learning Community.

Sessions for the HEN Readmissions Learning Community on March 6 include:

• Readmissions Work Plan
• Measuring Data for Improvement
• Building Your Cross-Continuum Care Team
• Meet your HEN IHC Improvement Advisor

Register for the Readmissions Learning Community here.

Sessions for the Patient Safety Conference on March 7 include:

• The National Patient Safety Foundation:  Working With You to Get Results
• Voice of the Patient
• High Alert Medications and What They Mean to Patients and Facilities
• Inaugural Patient Safety Award Presentations (Hospital Acquired Infections; Hospital Acquired Conditions; Adverse Drug Events; Transitions of Care and Leadership and Culture of Safety)

Register for the Patient Safety Conference here.

Sessions for the HEN Hospital Acquired Conditions (HAC) on March 8 include:

• Patient Safety – Is Your Hospital Ready?
• Creating Your Team
• Is there Value in Data?
• Assessing, Studying and Creating a Vibrant Culture of Safety
• Meet Your HEN IHC Improvement Advisor

Register for the HAC Learning Community here.

Sessions for the IHC Medical Home Learning Community on March 28 include:

• Iowa Models - Pioneer Accountable Care Organizations (ACO)
• You Gotta Measure – Data Discussion
• Certification Challenges – Three Different Journeys
• Iowa Medicaid Update
• Does This Really Work? The Oklahoma Experience For Medical Home
• Office Stories for Improvement

Register for the March 28 Medical Home Learning Community here.

Jim FitzPatrick has announced his resignation as CEO of Mercy Medical Center-North Iowa in Mason City effective March 30.  FitzPatrick, who has been CEO at Mercy-North Iowa since 2001, will become vice president of network management and development for Mercy Medical Center-Des Moines beginning April 2.  FitzPatrick served on the IHA Board from 1996-2003 and was Board Chair during 2001-2002.  In 1992, he received the IHA Outstanding Young Executive Award and in 2009 he received the IHA Excellence in Leadership Award.

John O’Brien will be CEO at Manning Regional Healthcare Center beginning February 20.  O’Brien was CEO at Ellsworth Municipal in Iowa Falls from 1996 to 2010.  Prior to that, he worked at hospitals in Detroit and Pittsburgh.  O’Brien served on the IHA Board from 2005-2010.

Ray Brownsworth is no longer CEO of Keokuk County Health Center in Sigourney.  Brownsworth had been at the hospital since 2008.  CFO Matt Ives is serving as interim CEO.