fah hospital policy blog

Perspectives on health policy affecting America’s hospitals and the patients we serve.

Hospitals Lead Way Towards ‘History Making’ Price Growth Slowdown

April 12, 2019 | FAH Policy Blog Team

Category: Research, Spending Slowdown

Altarum released its monthly Health Sector Economic Indicators reports today, noting a “history making” ongoing stretch of economy-wide prices growing faster than health care prices. Hospitals led the way in March.

The pricing report found annual year-over-year health care price growth of only 1.2 percent in March 2019, its lowest growth rate since September 2017. Year-over-year hospital price growth also fell to its lowest point since September of 2017, falling from 1.9% in February to 1.6% in March of this year. Private pay hospital price growth “fell sharply” from 2.8 percent in February to 1.7 percent in March.  

 Altarum wonders if “the phenomenon of economy-wide prices growing more quickly than the HCPI (health care pricing index) for 19 months and counting” is indeed a “new normal.”

Regarding spending, Altarum noted that over the past 12 months, expenditures for hospital care grew 2.9% in January 2019, the slowest rate among the major categories, and a key reason why overall national health spending slowed to 4.1 percent – the 16th consecutive month health spending grew less than GDP.

To view the full reports from Altarum click here and here.

ICYMI: Sanders’ Medicare for All Means Higher Taxes, No Private Plans

April 11, 2019 | FAH Policy Blog Team

Category: Legislation

Sen. Bernie Sanders (I-VT) reintroduced the latest edition of his signature Medicare for All legislation in the Senate Wednesday, offering no mention of how it’s massive price tag will be paid for. While Sen. Sanders’ bill would add coverage for long-term care in home and community settings, it would also all but abolish private and employer-based health insurance plans.

FAH President and CEO Chip Kahn released a statement on the legislation saying, “Medicare for All's promises can't be kept. Medicare for All means that Americans would lose the coverage they trust. Medicare for All repeals the ACA, it repeals the employer-based coverage 180 million people depend upon, it repeals Medicare, it repeals Medicaid and throws millions of kids off the insurance they have today. It will force patients into an untested system that will disrupt care for every American.” To read Chip’s full statement click here.

Here’s what others are saying about this legislation:

Axios delves into “How your health care would change under ‘Medicare for All,’” highlighting the legislation’s tax increases. Axios points out “you could not keep your existing plan” and your “taxes would go up. A lot. That’s the tradeoff for eliminating premiums and deductibles. Sanders has not said which taxes he would raise.”

NBC focuses on the massive price tag associated with Sanders’ Medicare for All Plan noting that “critics challenged the new Sanders bill over its cost — $32 trillion over 10 years, according to one estimate by the conservative Mercatus Center — and its elimination of existing private plans.”

CNN’s article, "Bernie Sanders to unveil new Medicare for all bill as the party rallies around Obamacare," points out that “Sanders' plans to pay for a program that could virtually wipe out the private insurance industry. More than 150 million Americans are currently covered by private insurance through their employers and tens of millions more through Medicare Advantage. Millions more buy coverage via the Affordable Care Act's exchanges.”

An op-ed in The Hill simply states that “There are so many flaws with 'Medicare for all.'” A doctor writes that “this bill seeks utopia by giving government centralized power and control over every aspect of medicine via a single-payer model, and comes with an astronomical price tag. The cost in dollars is in the trillions, but there is also another, hidden cost: the elimination of the conscience rights of nurses and doctors.”

Politico points out that the Medicare for All bill does not include “a price tag or specifics on what tax increases would be needed to pay for a coverage expansion that analysts project could cost upwards of $30 trillion over a decade — a sticking point critics have seized on in dismissing the concept as a pipe dream.”

In another article, Axios explains how “Medicare for All redistributes who pays for health care.” It projects workers and wage earners will foot the bill of the massively expensive plan: “A 4% "income-based premium" for workers who make more than $29,000 and a 7.5% "income-based premium" on employers (exempting the first $2 million in payroll) are two of the financing options. Most economists assume that the employer tax would get passed onto employees through lost wages.”

FAH Leader Reacts to Bernie Sanders' Medicare for All Bill

April 10, 2019 | Chip Kahn

Category: Legislation

FAH President and CEO Chip Kahn released the following statement on the introduction of Bernie Sanders' Medicare for All legislation:

Medicare for All’s promises can’t be kept. Medicare for All means that Americans would lose the coverage they trust. Medicare for All repeals the ACA, it repeals the employer-based coverage 180 million people depend upon, it repeals Medicare, it repeals Medicaid and throws millions of kids off the insurance they have today.  It will force patients into an untested system that will disrupt care for every American.

Hospitals have long been committed to assuring that everyone has access to high quality, affordable health coverage, but this isn’t the way to accomplish that goal.

We oppose this bill and urge lawmakers to do the same. We should be working on increasing options and affordability for patients and consumers, not creating a one-size-fits-all system that needlessly upends coverage for hundreds of millions and limits access to care.

FAH Supports STAR Act

April 08, 2019 | FAH Policy Blog Team

Category: Legislation

FAH sent a letter to the House Ways and Means Committee Chairman Richard Neal (D-MA) and Ranking Member Kevin Brady (R-TX) in support of the Prescription Drug Sunshine, Transparency, Accountability and Reporting (STAR) Act.

In the letter, FAH applauds the Committee’s bipartisan effort to address the rising cost of prescription drugs, calling the legislation an “important step in beginning to find solutions to lower prescription drug costs for patients.” The STAR Act seeks to provide price transparency by requiring certain drug manufacturers to report on product samples provided to particular health care providers.

FAH also highlighted in the letter the recent drug pricing study we released along with the American Hospital Association (AHA) and the American Society of Health-System Pharmacists (ASHP). It detailed how continued rising drug prices, as well as shortages for many critical medications, are impacting patient care and putting strains on hospital budgets and operations. According to the study, the average total drug spending per hospital admission increased by 18.5% between FY2015 and FY2017.

To read FAH’s full support letter click here.

ICYMI: JAMA Report says Medicare for All Would Hit Hospitals Hard

April 05, 2019 | FAH Policy Blog Team

Category: Legislation, Medicare

Leads to Massive Funding Cuts, Extensive Job Losses

An article published this week in The Journal of the American Medical Association (JAMA) highlights the devastating effects of Medicare for All on community hospitals, which include massive cuts to financial resources and extensive job losses.

The authors looked at what would happen to hospital funding if a Medicare for All system extended the current fee schedule to all patients.

Among the eye-opening findings:

  • A loss of $150 billion per year to the nation’s hospitals.
  • An estimated 1.5 million in hospital clinical and administrative jobs could be cut.

If payment rates for Medicare were raised to 100% of cost - as some plans have proposed – the JAMA article says “annual Medicare spending by the federal government would increase by $40.7 billion and annual Medicaid spending by the federal and state governments would increase by $25.6 billion.”

A price tag that would have to be absorbed by American families through massive tax increases.

This is the latest report to show the destructive effects of a single-payer system or public option on hospitals and access to care.

Last month, FAH and AHA released a report showing the impact a Medicare public option could have on the ability of hospitals and health systems to continue to provide access to high-quality care to their patients and communities. The study found that such a proposal, which would create a government-run Medicare-like health plan on the individual exchange, would lead to the largest ever cut to hospitals - nearly $800 billion over 10 years. This sort of plan would also be particularly disruptive to the employer-sponsored health insurance market.

FAH Supports Bipartisan Nursing WIN Act

April 04, 2019 | Chip Kahn

Category: Legislation

FAH President and CEO Chip Kahn released the following statement on the introduction of the Nursing WIN Act:

"It’s a struggle to attract critically-needed nurses to the many parts of the United States grappling with nursing shortages. The Nursing WIN Act provides loan repayment incentives to new nursing graduates while enabling them the freedom to choose from any hospital in a critical shortage community.

"FAH applauds the bipartisan leadership of Sens. Todd Young (R-IN) and Doug Jones (D-AL) to expand eligibility for this vital program. The Nursing WIN Act provides an important lifeline for patients, communities and the new nurses that choose to serve them."

Letter to Congress from FAH, AHA & AMA on Surprise Billing

April 02, 2019 | FAH Policy Blog Team

Category:

Below is a joint letter sent to leaders of several Congressional Committees today from the Federation of American Hospitals (FAH), the American Hospital Association (AHA) and the American Medical Association (AMA) on the issue of surprise billing.

The letter shows a unified front among health care providers to protect patients from surprise medical bills, but it also points out pitfalls of the complex, untested concept of hospital bundled billing to address this important issue.

The letter was sent to the leaders of the House Energy and Commerce Committee, Ways and Means Committee & Education and Labor Committee, as well as the Senate Finance and HELP Committees.

Dear Chairman Pallone and Ranking Member Walden:
 
America’s physicians, hospitals and health systems are fully committed to protecting patients from
surprise medical bills. No patient should have the added stress and financial burden of receiving a bill for
out-of-network emergency care that they could not avoid or out-of-network care that they reasonably
could have expected to be in-network. Our organizations support a federal legislative solution to protect
patients in these scenarios that limits patients’ cost-sharing obligations to the in-network amount, and
prohibits balance billing when the opportunity for health plans and providers to arrive at a fair payment
rate is ensured.

The simplicity of the solution outlined above is in stark contrast to the complexity of another, untested
idea that has been raised as part of the important dialogue about solving this issue: hospital bundled
billing. This concept may seem simple and straightforward in theory; in reality however, this approach
would be administratively complex, fundamentally change the relationship between hospitals and their
physician partners, and alone, does nothing to protect patients from surprise bills. We strongly oppose
such a model.

Bundled billing is not appropriate for many types of medical services. For example, the unique nature of
emergency care – namely uncertainty and the potential for high variation – makes it a poor candidate for
bundled payments. Several variations of bundled payments for episodes of care have been implemented
over the past decade with mixed success. Developing such an arrangement involves a complex array of
clinicians, statisticians, lawyers and others to define the services and duration of the bundle, to
appropriately price it, and to ensure that any financial relationships between the various providers adhere
to state and federal law, including the Stark law and the Anti-Kickback Statute. To-date, bundling has
been tested by the Center for Medicare & Medicaid Innovation and some commercial payers in limited
circumstances and, in general, early results indicate it could work for services for which the clinical care
pathway is well defined and little variation is expected, such as for certain planned joint replacements.
Even so, for the vast majority of these bundles, physicians and hospitals continue to negotiate their own
rates with insurers. Any individual visit to an emergency department can involve countless possible
services – from initial diagnosis and confirmatory tests to complicated trauma and surgical procedures
involving multiple physicians and other providers, depending on an array of factors. Simply put: bundled
payments are not appropriate for emergency care and have not been sufficiently tested for widespread
adoption for other types of care.

Surprise bills are a direct result of a lack of negotiated contract between the patient’s insurer and the
hospital and/or physicians that provided their care. We support solutions that focus on arriving at a fair
payment from an insurer to a provider while protecting patients from the consequences that can arise
when an insurer lacks adequate contracted providers. In contrast, bundling facility and physician
payments in these situations simply allows insurers to transfer to hospitals their responsibility for
establishing comprehensive physician networks and managing the associated financial risk.
We should remain focused on taking patients out of the middle of standard negotiations between insurers
and providers and protecting them from “surprise bills” when they have not had the opportunity to choose
who provides their care, while rejecting unproven proposals that would up-end the foundation of
relationships that hold the health care system together.

Sincerely,

Federation of American Hospitals
American Hospital Association
American Medical Association

You can also find the letter online by clicking here.

FAH Leader Reacts to Medicare X Proposal

April 02, 2019 | Chip Kahn

Category: Legislation, Medicare

FAH President and CEO Chip Kahn released the following statement on the introduction of Medicare X legislation:

“A Medicare public option may fit on a bumper sticker, but it won’t fit with the access to health care that Americans expect.

“The public option may be well-intentioned, but it will undermine the private options available for coverage not expand them. Even worse, it will make it dramatically more difficult for hospitals and caregivers to be there to serve their patients and communities.

“Instead, we urge policymakers to focus on strengthening the Affordable Care Act and achieving the universal coverage and access to care that is the law’s aim.”

FAH Files Joint Amicus Brief in Support of the ACA

April 02, 2019 | FAH Policy Blog Team

Category: Affordable Care Act

Today, FAH joined other hospital associations in filing an amicus brief in support of upholding the Affordable Care Act (ACA) in State of Texas v. USA. The lawsuit, filed by Republican Attorneys General (AGs), led by Texas, argues that Congressional action zeroing out the ACA's individual mandate penalty makes mandate unconstitutional and the entire ACA invalid. Last December, a Texas district court judge ruled in favor of the Republican AGs, striking down the entire ACA.

Democratic Attorneys General, led by California, as well as the U.S. House of Representatives, have intervened in the lawsuit to defend the ACA, and have they appealed the case to the 5th Circuit. The administration recently told the Appeals Court that the district court decision should be affirmed, and the entire ACA should be ruled invalid.

Today's amicus brief asks the Appeals Court to reverse the district court's order declaring the individual mandate unconstitutional and declaring the rest of the ACA inseverable from the mandate. It argues that striking down the ACA will harm patients that depend on the ACA, the hospitals that serve them, and the ongoing progress in health care innovation.

You can read the amicus brief here.

FAH Leader Reacts to House Leadership's Plan to Build on the ACA

March 26, 2019 | FAH Policy Blog Team

Category: Affordable Care Act, Legislation

FAH President and CEO Chip Kahn released the following statement on House leadership's plan to build on the Affordable Care Act:

"The House leadership’s efforts to strengthen the Affordable Care Act are timely and necessary. Tens of millions of Americans depend on ACA health coverage and millions more could be covered. This is why the Federation sees the new initiative as mission critical to improve and protect care for the patients we serve.

"As caregivers, our goals have been and continue to be: increase access to affordable health care coverage for all Americans – including those with pre-existing conditions – and protect and strengthen programs that take care of seniors and our most vulnerable.

The ACA framework can accomplish these objectives. We need to build on what works. The Federation is committed to working with the Congress to ensure access to high-quality, affordable coverage and care for all Americans."

FAH Leader Reacts to Administration's ACA Statement

March 26, 2019 | FAH Policy Blog Team

Category: Affordable Care Act

FAH President and CEO Chip Kahn released the following reaction to the Trump administration's ACA statement:

"The administration’s decision to sustain Texas vs. Azar and affirm the district court ruling invalidating the entire Affordable Care Act is unfortunate but not unexpected considering their long-held views on the health law.

"Millions of Americans depend on the ACA to access health care and rely on the insurance protections afforded in the law. We continue to believe the district court judge got it wrong and trust that this decision will be overturned in the appeals process."

Senate HELP Interoperability Hearing

March 26, 2019 | FAH Policy Blog Team

Category: Hearings

This morning, the Senate Health, Education, Labor, and Pensions (HELP) Committee held a hearing to examine the recent interoperability proposed rules from the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC), which are intended to implement the 21st Century Cures Act. FAH member company LifePoint Health’s Chief Medical Informatics Officer Christopher Rehm, M.D. testified before the Committee.

Making health electronic information freely available to patients, families, and health care providers has been a top priority for hospitals and health systems. In his testimony before the HELP Committee, Dr. Christopher Rehm offered a clinician’s view of some of the health IT and regulatory policies that currently hinder interoperability:

  • Complying with new regulations are time consuming and resource intensive, taking a year (or longer) for a provider organization to fully integrate into day to day work.
  • The lack of an underlying interoperability infrastructure necessary for the successful and secure sharing of medical electronic information. The security and privacy of consumers’ data could be at risk if entities with access to that data do not meet consumer expectations regarding appropriate use and safeguarding of their information.  

To address these concerns, LifePoint Health’s Dr. Rehm commended ONC’s proposals to require health IT vendors demonstrate their products are usable in a “real-world” environment, as opposed to simply a testing environment. He also highlighted the need for appropriate timelines for vendors to develop and test products and for health care providers to appropriately train and safely implement the new and/or updated technology required by the proposed regulations. Lastly, Dr. Rehm recommended an industry-backed process to independently vet and test third-party applications, particularly those entities that are not required to follow HIPAA regulations. Such vetting should ensure that these entities are meeting relevant security standards and using data appropriately (e.g., not selling it to other companies without consumers’ knowledge).

As Dr. Rehm pointed out in his testimony, interoperability is not the end goal – “it is important we all remember that deployment of health information technology, interoperability, data exchange, privacy and security are all in service of delivering the highest quality care. It is not about the technology; it is about the patients, their care and their outcomes.”

To watch the full testimony and hearing click here.

Earlier this year, FAH and AHA outlined steps towards achieving interoperability in a joint op-ed in Modern Healthcare, “Providers have made strides on interoperability; let's add urgency to finally cross the finish line.” Additionally, FAH, AHA, and other national hospital organizations released a report urging all stakeholders to unite in accelerating interoperability to fuel improved health and care, engage individuals, and promote value. The report offers pathways to improve interoperability among health information technology (IT) systems, including:

  • Security and Privacy
  • Efficient, Usable Solutions
  • Cost Effective, Enhanced Infrastructure
  • Standards that Work
  • Connecting Beyond Electronic Health Records
  • Shared Best Practices

FAH Member Facilities Named in Top 100 Hospitals of 2019

March 20, 2019 | FAH Policy Blog Team

Category: FAH News

IBM Watson Health published its 100 Top Hospitals annual study earlier this month and 21 FAH member facilities made the prestigious list.

FAH member companies represented include Ardent Health Services, Community Health Systems, HCA Healthcare, Kindred Healthcare, LifePoint Health, Prime Healthcare Services, and Tenet Healthcare.

The Watson Health study bases its list on public data, clinical quality, operational efficiency, patient satisfaction, and financial metrics. The list is then divided into groupings: teaching facilities and small, medium, and large facilities. Learn more about the IBM Watson Health study here.

FAH member hospitals in IBM Watson Health’s top 100:

  • Garden City Hospital, Garden City, MI (Prime Healthcare Systems)
  • Brandon Regional Hospital, Brandon, FL (HCA Healthcare)
  • BSA Health System, Amarillo, TX (Ardent)
  • Mercy Hospital St. Louis, St. Louis, MO (Kindred Healthcare)
  • Rose Medical Center, Denver, CO (HCA Healthcare)
  • Sky Ridge Medical Center, Lone Tree, CO (HCA Healthcare)
  • St. Mark's Hospital, Salt Lake City, UT (HCA Healthcare)
  • Mercy Hospital Oklahoma City, Oklahoma City, OK (Kindred Healthcare)
  • St. David's Medical Center, Austin, TX (HCA Healthcare)
  • Dupont Hospital, Fort Wayne, IN (Community Health Systems)
  • East Cooper Medical Center, Mt. Pleasant, SC (Tenet Healthcare)
  • East Liverpool City Hospital, East Liverpool, OH (Prime Healthcare Systems)
  • Garden Grove Hospital Medical Center, Garden Grove, CA (Prime Healthcare Systems)
  • Montclair Hospital Medical Center, Montclair, CA (Prime Healthcare Systems)
  • Mountain View Hospital, Payson, UT (HCA Healthcare)
  • West Valley Medical Center Caldwell, ID (HCA Healthcare)
  • Brigham City Community Hospital, Brigham City, UT (HCA Healthcare)
  • Lakeview Hospital, Bountiful, UT (HCA Healthcare)
  • Lone Peak Hospital, Draper, UT (HCA Healthcare)
  • San Dimas Community Hospital, San Dimas, CA (Prime Healthcare Systems)
  • Southern Tennessee Regional Health System, Lawrenceburg, TN (LifePoint Health)

For a full list of the recognized hospitals click here.

How a Medicare Public Option Could Affect Access to Care in Your State

March 18, 2019 | FAH Policy Blog Team

Category:

FAH and AHA’s newly released joint study highlights the impacts a Medicare Public Option proposal could have on the ability of hospitals and health systems to continue to provide access to the high-quality care patients and communities need and deserve. Among the effects, the proposal would inflict the largest ever cut to hospitals – nearly $800 billion – and be particularly disruptive to the employer-sponsored health insurance market. State by state, the Medicare Public Option proposal would be equally as devastating, with cuts as high as $130.6 Billion. 

The executive summary and full analysis can be found here.

Here’s how the proposal could impact your state:

State Hospital Spending Cuts 2024-2033 

AK

$ 1.8 B

AL

$ 10.9 B

AR

$ 2.6 B

AZ

$ 12.9 B

CA

$130.6 B

CO

$ 14.6

CT

$ 6.0 B

DC

$ 1.4 B

DE

$ 1.6 B

FL

$ 80.1 B

GA

$ 21.0 B

HI

$ 4.3 B

IA

$ 3.8 B

ID

$ 7.3 B

IL

$ 26.5 B

IN

$ 16.9 B

KS

$ 6.4 B

KY

$ 6.4 B

LA

$ 5.7 B

MA

$ 10.5 B

MD

$ 5.1 B

ME

$ 3.1 B

MI

$ 15.3 B

MN

$ 9.4 B

MO

$ 13.8 B

MS

$ 7.2 B

MT

$ 3.9 B

NC

$ 30.9 B

ND

$ 1.3 B

NE

$ 4.8 B
NH

$ 2.5 B

NJ

$ 21.9 B

NM

$ 4.7 B

NV

$ 5.4 B

NY

$ 38.3 B

OH

$ 21.0 B

OK

$ 5.5 B
OR

$ 12.8 B

PA

$ 32.3 B

RI

$ 1.1 B

SC

$ 11.6 B

SD

$ 2.5 B

TN

$ 13.9 B

TX

$ 71.7 B

UT

$ 9.5 B

VA

$ 21.9 B

VT

$ 0.7 B

WA

$ 17.8 B

WI

$ 9.3 B

WV

$ 1.5 B

WY

$ 1.2 B

Joint Statement from FAH & AHA: Hospitals Seek Common Sense Solutions to Surprise Bills

March 18, 2019 | FAH Policy Blog Team

Category: FAH News

FAH President and CEO Chip Kahn and AHA President and CEO Rick Pollack issued the following joint statement reacting to a letter from insurer and business groups on surprise bills:

"Our patients come first and the hospital community has proposed a plan to protect them from surprise bills. Consumers, health insurers, employers, and hospitals all agree and should seek a common solution.

"That solution is simple: patients should not be balance billed, and they should have certainty regarding their cost-sharing obligations based on an in-network amount.

"Beyond protecting patients and ensuring adequate health plan provider networks, it is essential that insurers and providers of care retain the ability to negotiate appropriate payment rates. Not only is it a dangerous precedent for the government to start setting rates in the private sector, but it could also create unintended consequences for patients by disrupting incentives for health plans to create comprehensive networks.

"The hospital community is actively engaged in finding solutions to this issue for our patients. We want to ensure that patients are protected from surprise gaps in coverage that result in surprise bills, and we look forward to working with policymakers to achieve this goal."

 

Navigant Study Shows “One Size Fits All” Health Care Proposals Correlates with Hospital Cuts

March 18, 2019 | FAH Policy Blog Team

Category: Legislation, Medicare

Today, the consulting firm Navigant released a study showing that government-run health care proposals, like Medicare for All, would directly result in financial stress on hospitals. This comes on the heels of a study from FAH and AHA that found a Medicare public option could have a significant impact on patient access to care by leading to the largest ever cut to hospital funding – nearly $800 billion.

Navigant found that Medicare for All-style proposals could force hospitals to limit the care they provide, drive significant “layoffs” and “potentially force the closure of essential hospitals.” Navigant projected the impact on hospitals by using a hypothetical mid-sized regional hospital as the base for comparison. This sample hospital has 1,000 beds, a $1.2 billion annual revenue, and an operating margin of 2.3%.

Using that as a baseline, Navigant found that Medicare as a single-payer, also known as Medicare for All, has the most dramatic negative impact on hospitals, cutting operating margins to -22.1% and reducing revenues by approximately $330 million. The study found that a Medicare public option would cut the hospital’s revenues by approximately $157 million and reduce operating margins to -6.3%.

Additionally, Navigant asserted that continuing the status quo does not leave hospitals unharmed. The continued migration of baby boomers from the employer-based market into Medicare, along with other contributing factors, would also result in financial stress to hospitals. Navigant estimates that this would result in a reduction of $94 million in operating margin over a “period of years.”

MedPac reports hospital Medicare margins are already at a historic low of -11%. Navigant’s Jeff Leibach says any expansion of the program "would potentially accelerate those headwinds significantly.”

Navigant’s study comes just one week after FAH and AHA released a joint study that showed the devastating impact a Medicare public option proposal would have on hospitals and the health care system. FAH and AHA’s study found that the proposal would be the biggest cut to hospitals ever – an unprecedented $774 billion.

To see the full Navigant study click here. For FAH/AHA’s study click here.

New Report Outlines Negative Impact of Medicare Public Option Proposal on Hospitals and Patients

March 12, 2019 | FAH Policy Blog Team

Category: Financing, Legislation, Medicare

The American Hospital Association (AHA) and the Federation of American Hospitals (FAH) today released a new report that details the impact that a Medicare public option proposal could have on the ability of hospitals and health systems to continue to provide access to high-quality care to their patients and communities. The study finds that such a proposal, which would create a government-run Medicare-like health plan on the individual exchange, could have a significant impact on patient access to care. It would create the largest ever cut to hospitals - nearly $800 billion - and be particularly disruptive to the employer-sponsored health insurance market. The study further finds these significant disruptions would result in only a modest drop in the number of uninsured compared to how many people would gain coverage through expanding the existing coverage framework. The report was prepared by KNG Health Consulting on behalf of the AHA and FAH.

“This buy-in to a Medicare-like public option may fit on a bumper sticker, but it is no solution for health care coverage. This ill-conceived program would undermine access to care and threaten the ability of providers and clinicians to meet the needs of their patients,” said FAH President and CEO Chip Kahn. “Moreover, this study highlights the disruption proposals like this would have on the private coverage Americans are satisfied with today.”

“It is not practical to disrupt coverage provided through employer-sponsored plans that already cover more than 150 million Americans. America’s hospitals and health systems remain committed to working together with policymakers to help expand coverage and reduce costs for all Americans. However, a ‘Medicare for All’ approach would impede, not advance, our shared goals,” said Tom Nickels, AHA executive vice president.

The analysis specifically examined the Medicare-X Choice Act, a proposal which would compound the stresses already faced by many of the nation’s hospitals. Providers would be reimbursed at Medicare rates under this proposal. Public programs such as Medicare and Medicaid historically reimburse providers at less than the cost of delivering services. In 2017, combined Medicare and Medicaid underpayments totaled $76.8 billion. The dramatic shift of tens of millions of Americans from private coverage to Medicare-like public coverage would destabilize commercial insurance markets and hospital finances alike, jeopardizing access to care.

Specifically, the findings in the report show that the proposal could:

  • Result in only a modest drop in the number of uninsured compared to the 9 million Americans that would gain insurance by taking advantage of the existing public/private coverage framework.
  • Lead to a significant disruption to the employer-sponsored insurance market, which provides coverage to more than 150 million Americans.
  • Lead to a cut of nearly $800 billion for hospital-based services over a 10-year period from 2024-2033, while utilization (and therefore, costs) will grow as a result of increased coverage.
  • Impact the ability of providers, many of which are already absorbing more than $200 billion in Medicare cuts, to continue to care for patients under new public plans.
  • Stifle hospitals’ ability to keep pace with new life-sustaining advances in medicine, to continue to invest in new payment and delivery models and to manage rapidly escalating drug prices.
  • Continue to put pressure on other commercial plan rates, further undermining coverage for Americans not on Medicare, as well as other unintended consequences.

A copy of the executive summary and full analysis can be found here.

FAH Leader Reacts to White House's FY2020 Budget

March 11, 2019 | Chip Kahn

Category: FAH News, Financing, Medicare

The new White House budget imposes arbitrary and blunt Medicare cuts to hospitals who care for the nation’s most vulnerable. The impact on care for seniors would be devastating. Not to mention that massive reductions would drastically reduce resources critical to care for low-income Americans and cripple efforts to stave off the looming physician shortage.

Hospitals are less and less able to cover the cost of care for Medicare patients, it is no time to gut Medicare.

Milton Johnson Receives FAH’s Mike Bromberg Lifetime Achievement Award

March 04, 2019 | FAH Policy Blog Team

Category: FAH News

The Federation of American Hospitals was honored to give its Mike Bromberg Lifetime Achievement Award to HCA’s Milton Johnson Monday morning during the FAH Annual Meeting in Washington, D.C.

Presenter Ron Rittenmeyer, Chairman of the Federation of American Hospitals gave the award to Mr. Johnson.

Milton retired as HCA’s CEO at the end of 2018, and still serves on the company’s board. He started at HCA back in 1982 and served as the Federation’s Chairman in 2017. His dynamic leadership of FAH has enabled a seamless transition to the all CEO Board that the Federation has today.

During Milton’s long and distinguished career, he came to be recognized as one of the most influential figures in the health care sector.  Johnson devoted his professional life to the nation’s health care delivery system. 

Among his notable achievements - leading HCA’s efforts to advance clinical quality throughout its hospitals. By using data from its tens of millions of patient encounters annually, HCA has identified leading clinical practices, which help to continually improve care and save lives.

Johnson has always represented the investor-owned hospital community with distinction, and there is no doubt that Milton has earned the great respect of his colleagues. He is a wise voice who has made our industry better through his knowledge, experience and understanding of the intersection of the health care, policy and politics. Health care and the very lives of millions of rural Americans have been improved by Milton’s leadership and vision.

Milton is also a valued member of his community, giving generous amounts of time and support to various charitable causes. The Nashville area and health care in America today are better for the contributions that Milton has made.

FAH President and CEO Chip Kahn offered his personal congratulations to Milton, saying “he brought leadership and wisdom to his time at the helm of HCA. I want to add to his legacy the unique role he played for the Federation in the last few years. We owe so much to him because his guidance was key to achieving our new governance structure.”

Please join us in sincerely congratulating Milton Johnson on receiving this much-deserved award.

FAH Presents Annual Corris Boyd Leadership Award to Deborah Williams

March 04, 2019 | FAH Policy Blog Team

Category: FAH News

This week the Federation of American Hospitals presented Deborah Williams, Senior Director of Program Management at Premier Inc., with the 13th annual Corris Boyd Leadership Award.  Williams was honored March 4th during the FAH Annual Meeting in Washington, D.C.

Presenter Ken Kuiper, Chairman of the FAH Exposition Advisory Committee, was joined on stage by a special guest – Corris Boyd’s wife, Vanessa.

“This award is given annually in memory of our late friend. Corris Boyd was an exceptional person and an outstanding leader in workplace diversity. This award is our way of keeping his legacy of excellence going and we are so happy to have Vanessa here to take part,” Kuiper said.

It has become a tradition to surprise the winner and this year was no different. Ms. Williams was unaware of the honor until her name was called.

Nominators used words like diligence, coach, mentor, positive drive and instrumental to describe Ms. Williams. As one wrote, Ms. Williams has “propelled positive and measurable changes” in her industry. She has been “instrumental in working with diverse suppliers and our members to help contribute to the overall economic growth and well-being of the communities in which we live and work.”

But if you talk to those who know her best, they will highlight not only her professional accolades but her personal attributes. Her passion for coaching and mentoring, her desire to see others succeed, and her dedication to diversity.

Deborah Williams has served the health care industry for nearly 40 years – specializing in supplier diversity, ensuring minority, women - and veteran-owned suppliers and small businesses receive the resources they need.

Deborah Williams is an amazing example of what our industry strives to achieve.

The Corris Boyd Leadership Award honors an individual or company that has made an outstanding contribution in fostering leadership in the health care industry.   The FAH established the Corris Boyd Leadership in 2007 to honor the late Corris Boyd, who spent his career working with hospital management companies and group purchasing organizations.  Corris Boyd committed his life to diversity and excellence in health care. He believed that leadership development is crucial to success and was devoted to the success of minority- and women-owned business enterprises.

FAH is honored to present Deborah Williams as the 2019 Corris Boyd Award winner and extends its thanks for her outstanding work which embodies the ideals the award represents.

HCA Healthcare Named a 2019 World’s Most Ethical Company

March 01, 2019 | FAH Policy Blog Team

Category:

HCA Healthcare has been recognized for the 10th consecutive year as one of The World’s Most Ethical Companies by The Ethisphere Institute, a global leader in defining and advancing the standards of ethical business practices.

Sam Hazen, Chief Executive Officer of HCA Healthcare, said that being recognized for the 10th year in a row “reflects the culture we have built here at HCA Healthcare. We have 265,000 colleagues who share a strong sense of purpose to improve the lives of our patients and to enrich the communities we serve.”

The World’s Most Ethical Companies assessment follows the Ethisphere Institute’s Ethics Quotient framework, evaluating the following criteria:

  • corporate citizenship and responsibility
  • ethics and compliance program
  • corporate governance leadership
  • innovation and reputation
  • culture of ethics

Please join FAH in congratulating HCA Healthcare on this honor.

To learn more about how HCA earned this recognition, visit their website at HCA Today Blog.

FAH Leader Speaks at Nashville Health Care Council

February 27, 2019 | FAH Policy Blog Team

Category:

Today, the Nashville Health Care Council hosted a discussion about the future of health care featuring FAH’s Chip Kahn and Matt Eyles, president and CEO of America’s Health Insurance Plans (AHIP). Kahn and Eyles spoke to a crowd of 250 Council members in a conversation moderated by Melinda Buntin, professor and Mike Curb Chair, Department of Health Policy, Vanderbilt University Medical Center.

The discussion ranged from topics like House Democrats’ introduction of Medicare for All legislation, the Partnership for America’s Health Care Future, rising drug costs, surprise billing and more.

When addressing Medicare for All, Kahn stated that, “Once President Trump was elected and Bernie Sanders continued to tout Medicare for All, I thought that we in the industry really needed to take the momentum for it seriously. We are for having everyone covered, but we already have a structure for how to do this—the ACA. As an industry, we needed to have some counter-messaging around why Medicare For All is not the way to go.” 

Read Nashville Health Care Council’s full coverage of the event here.

FAH Leader Reacts to Medicare for All Bill

February 27, 2019 | Chip Kahn

Category: Legislation, Medicare

"Hospitals oppose legislation that would needlessly upend coverage for hundreds of millions of Americans. We have long been committed to assuring that everyone has access to high quality, affordable health coverage. This legislation eliminates private health insurance and would lead to a massive disruption in care for patients."

Before the Finger Pointing Begins – Here are the Facts about Drug Costs

February 26, 2019 | FAH Policy Blog Team

Category: Hearings, Pharmaceuticals

This morning the leaders of seven major pharmaceutical companies are going to testify before the Senate Finance Committee. It is widely expected that they will downplay their role in the out-of-control price increases for lifesaving drugs needed by American families.

But the truth – skyrocketing drug costs and shortages are causing a crisis across the health care system,

Just last month, a joint study released by the Federation of American Hospitals (FAH), the American Hospital Association (AHA), and the American Society of Health-System Pharmacists (ASHP) found that continued rising drug prices, as well as shortages for many critical medications, are impacting patient care and putting strains on hospital budgets and operations.

Key findings include:

  • Average total drug spending per hospital admission increased by 18.5% between FY2015 and FY2017.
  • Outpatient drug spending per admission increased by 28.7% while inpatient drug spending per admission increased by 9.6% between FY2015 and FY2017. This 9.6% increase was on top of the 38% increase in inpatient drug spending between FY2013 and FY2015 included in the previous report.
  • Very large percentage increases (over 80%) of unit price were seen across different classes of drugs, including those for anesthetics, parenteral solutions, and chemotherapy.
  • Over 90% of surveyed hospitals reported having to identify alternative therapies to manage spending.
  • One in four hospitals had to cut staff to mitigate budget pressures.
  • Almost 80% of hospitals found it extremely challenging to obtain drugs experiencing shortages, while almost 80% also said that drug shortages resulted in increased spending on drugs to a moderate or large extent.

The full report can be found HERE. You can view a short video explaining the issue HERE and find an infographic HERE.

The report was prepared based on analysis conducted by NORC at the University of Chicago, an independent research institution.

FAH, Major Hospital Groups Outline Surprise Billing Solutions in Letter to Congress

February 20, 2019 | FAH Policy Blog Team

Category: Financing

This afternoon, the Federation of American Hospitals, along with five major hospital groups, sent a letter laying out principles for Congress to consider as it develops solutions to address surprise billing.

“No patient should be surprised by a medical bill. We are fully committed to working with Congress to protect our patients from the stress and financial burden of surprise bills,” said Chip Kahn, FAH President and CEO.

Joining the Federation on the letter were the American Hospital Association, America’s Essential Hospitals, Association of American Medical Colleges, Catholic Health Association of the United States and the Children’s Hospital Association.

You can find the complete letter here

Hospital Mergers & Quality

February 15, 2019 | FAH Policy Blog Team

Category: Quality

The funny thing about studies is that no matter the topic you can almost always find “evidence” to prove what you have already decided to be true – whether it is based in fact or not.

This is the case with the recent opinion piece in the New York Times written by Austin Frakt entitled “Hospital Mergers Improve Health? Evidence Shows the Opposite.”

The issues begin with his title when he uses the word evidence. Frakt’s attack on the quality of care in consolidated U.S. hospitals is based largely on a mix of studies none of which allow one to make that claim. Most of the studies he mentions examine health care in the United Kingdom or outcomes at physician practices. As the old adage says – this is comparing apples to oranges.

The truth is that the studies he mentions have serious limitations that prevent us from making broad generalizations; some of the studies look at single year time frames, some look at specific conditions. Others only find marginal results in very small sub-populations. Few have a comparison group. Most only look at mortality in a single procedure.

There are studies published by the Robert Wood Johnson Foundation and the Journal of the American Medical Association that point to the positive effect on quality associated with hospital mergers. Positives like improvements in quality and reductions in mortality. Conveniently, these are not mentioned in the article.

Among the benefits of hospital consolidation is a way to reduce care fragmentation and improve outcomes and efficiencies through economies of scale.

Hospitals are facing increasing cost pressures as well as payments from government programs like Medicare and Medicaid that fall far below the cost of care.  Consolidation can save hospitals from closure and ensure communities have access to needed care.

Before jumping to conclusions we need to make sure we are comparing apples to apples and using current, complete, and meaningful data. At this point the literature looking into the association of competition and quality is nascent, riddled with limitations, non-generalizable and as a whole inconclusive. The jury is still out – more rigorous and longitudinal research is needed. In the meantime, we need to refrain from misleading conclusions that consolidation does not improve, or even worsens quality.

ICYMI: FAH Statement on Medicare Buy-in Legislation

February 14, 2019 | FAH Policy Blog Team

Category: Legislation, Media

FAH President and CEO Chip Kahn released a statement yesterday following the introduction of legislation that would allow people over 50 to buy into Medicare.

 

National media took note of FAH’s comment, stating the Federation “came out swinging” against the one size fits all plan.

 

In Case You Missed It…

 

Washington Examiner’s article “Democrats seeking Obamacare fix before ‘Medicare for all’ roll out 'Medicare at 50’” highlighted Kahn’s statement emphasizing the importance of Medicare, saying it “works for seniors and others who depend on it. But expanding the program with hospitals facing the lowest Medicare margins in history will make it more difficult to provide the critical care that all Americans expect and deserve."


Politico Pulse, a daily newsletter, said the Federation “came out swinging” against the Medicare buy-in bill. The article “Push for Medicare buy-in picks up with '50 and over' bill” published on Politico’s website said FAH warned against the financial pressure on hospitals that serve large Medicare populations.

 

Modern Healthcare highlighted Kahn’s statement in “Medicare buy-in at 50 leads way for Democratic public-option proposals,” focusing on his plan for next steps, saying Congress should work to "sustain and expand affordable private coverage."

 

Bloomberg Government included FAH President and CEO’s statement in “‘Medicare for More’ Campaign Kicks Off With Buy-In Legislation.” Bloomberg’s coverage included that expansion would hurt those currently in Medicare. “Instead of focusing on Medicare buy-ins and other variations of single-payer proposals, Congress should work to sustain and expand affordable private coverage,” Chip Kahn, president and chief executive officer of the Federation of American Hospitals, said in a statement. “Medicare should be left alone to continue its successful mission of making sure seniors have access to care.”

 

Yahoo Finance’s article “Senators introduce bill to allow people to buy into Medicare at age 50” also called attention to FAH’s opposition by acknowledging that it would weaken coverage for Americans already enrolled in Medicare.

 

FAH Leader Chip Kahn’s statement was also included in:

 

ThinkProgress: Major hospital lobbying group comes out against 'Medicare at 50' bill

 

Splint: A Preview of the Bloody Uphill Battle for Single-Payer

 

Money and Markets: Moderate Dems Shift Gear From Far Left’s Single-Payer to ‘Medicare for More’

 

WPRI: Reed, Whitehouse want Medicare coverage offered to 50-year-olds

FAH Leader Comments on Medicaid Buy-In Bill

February 14, 2019 | Chip Kahn

Category: Legislation, Medicaid

The FAH is unwavering in its strong support for expanding coverage to Americans who lack insurance. However, we shouldn’t waive the white flag on Medicaid expansion and leave millions of Americans in the coverage gap.  Any legislation to expand coverage must avoid disrupting the insurance millions of Americans already depend on. Instead, we should focus on encouraging more states to expand Medicaid to their low-income residents.

FAH Leader Reacts to Medicare Buy-In Bill

February 13, 2019 | Chip Kahn

Category: Affordable Care Act, FAH News, Legislation, Medicare

The so-called Medicare buy-in for those over 50 would harm more Americans than it would help. That is why we strongly oppose this legislation.

Allowing more people into Medicare actually weakens the coverage options of people who currently depend on the individual insurance market, leaving them with fewer choices.

There is no question that Medicare works for seniors and others who depend on it. But expanding the program with hospitals facing the lowest Medicare margins in history will make it more difficult to provide the critical care that all Americans expect and deserve.

Instead of focusing on Medicare buy-ins and other variations of single-payer proposals, Congress should work to sustain and expand affordable private coverage. Medicare should be left alone to continue its successful mission of making sure seniors have access to care.

HCA Healthcare Ranked in Top Health Systems for Quality Care by Advisory Board

February 12, 2019 | FAH Policy Blog Team

Category: FAH News

In a recent survey published by Reaction Data, FAH member HCA Healthcare of was ranked a top eight health system for delivering high quality care at a sustainable cost.

The survey polled over 300 hospital and health system leaders to identify the leading national organizations for various achievements.

When respondents were asked, "What health care system comes to mind as a model for delivering high quality care at a sustainable cost?", the eight most-cited hospitals were:

Kaiser Permanente;
Cleveland Clinic;
Mayo Clinic;
Intermountain Healthcare;
Geisinger Health;
Johns Hopkins;
Advocate Health; and
HCA Healthcare (Nashville, Tennessee).

Please join FAH in congratulating HCA on this honor.

For more information regarding the top ranked health care systems, including the full survey, can be found on Advisory.

FAH, AHA Leaders Outline Steps to Interoperability in Modern Healthcare

February 11, 2019 | FAH Policy Blog Team

Category: Publications

FAH CEO and President Chip Kahn and AHA CEO and President Rick Pollack wrote a joint op-ed in the most recent edition of Modern Healthcare discussing the importance of interoperability to the health care system and the six pathways to achieve full interoperability.

The op-ed, entitled “Providers have made strides on interoperability; let's add urgency to finally cross the finish line,” details the current state of interoperability and the progress that has been made in recent years toward achieving full, secure transferring of health information between patients, families, and providers.

This builds upon a report released last month by FAH, AHA and several other national hospital associations.

Kahn and Pollack explain that despite “commendable progress, our system of sharing, securing and transferring complete patient health data is still limited in many cases by differing vendor platforms, geographic region, inconsistent use of standards and other factors.”

The FAH and AHA leaders recommend six pathways to advance a system that works for everyone:

Security and privacy. Stakeholders must be able to trust that shared data is accurate, secure and used in accordance with best practices and patient expectations.
Efficient, usable solutions. Data must be available where and when it is needed and in a useful format.
Enhanced infrastructure. The infrastructure to connect information-sharing networks will require consistent use of standards, semantics and a common set of “rules of the road” for exchange.
Standards that work. Connected systems require standards implemented to minimize proprietary solutions and gatekeeping.
Beyond EHRs. Interoperable systems must expand to include population health, the social determinants of health and patient-generated data.
Best practices. All stakeholders should exchange best practices so we can continue to build on what works.

Full interoperability will benefit patients, families, and the entire health care system, meaning improved quality, safety, and efficiency. Tremendous progress has been made thus far, but Kahn and Pollack leave readers with a call to action: “we’ve come far and the finish line is in sight. Let’s cross over it.”

FAH, AHA Briefing Drug Prices Draws Full House on Capitol Hill

February 08, 2019 | FAH Policy Blog Team

Category: Pharmaceuticals, Research

The Federation of American Hospitals along with the American Hospital Association (AHA) and the American Society of Health-System Pharmacists (ASHP) held a briefing on Capitol Hill this week to present the findings from a recent joint study on drug pricing.

Presenting to a room packed with Congressional staffers and media members, the expert panel detailed the burden of skyrocketing drug prices on hospitals and outlined market-based solutions to ensure patients receive quality and affordable medicines.

The panel included Martin VanTrieste, president and CEO of Civica Rx; Jack Hoadley, research professor emeritus at Georgetown University's Health Policy Institute; Molly Smith, AHA vice president for coverage and state issues; and Erik Rasmussen, AHA vice president of federal relations. 

Panelists used real-world examples to illustrate how relentless drug price increases and frequent shortages are eroding hospitals' ability to care for patients. They also highlighted these main findings from the study, including:

  • Average total drug spending per hospital admission increased by 18.5% between FY2015 and FY2017.
  • Outpatient drug spending per admission increased by 28.7% while inpatient drug spending per admission increased by 9.6% between FY2015 and FY2017. This 9.6% increase was on top of the 38% increase in inpatient drug spending between FY2013 and FY2015 included in the previous report.
  • Very large percentage increases (over 80%) of unit price were seen across different classes of drugs, including those for anaesthetics, parenteral solutions, and chemotherapy.
  • Over 90% of surveyed hospitals reported having to identify alternative therapies to manage spending.
  • One in four hospitals had to cut staff to mitigate budget pressures.
  • Almost 80% of hospitals found it extremely challenging to obtain drugs experiencing shortages, while almost 80% also said that drug shortages resulted in increased spending on drugs to a moderate or large extent.

The full report can be found HERE. You can view a short video explaining the issue HERE and find an infographic HERE.

FAH Strengthens Public Affairs Team

February 07, 2019 | Chip Kahn

Category: FAH News

Welcomes Caitlin Gallagher, New Director of Media and Communications, Paige Mihalik Promoted to Director, Digital and Political Affairs

The Federation of American Hospitals is pleased to announce two moves that will strengthen our public affairs team further enhancing our efforts to advocate for the patients and communities served by our hospitals.

Paige Mihalik is being promoted to Director, Digital and Political Affairs.

Paige has been with the Federation for more than three years and during that time she has been responsible for the FAH’s political action committee and grassroots programs.  She has also grown the Federation’s social media footprint and played an integral role in the successful launch of our podcast series – Hospitals In Focus.

Paige will continue her leadership role in political affairs and will take an enhanced role in the association’s public affairs’ digital efforts.  Before joining FAH, she was active in the political affairs field working on compliance issues.

Paige is a graduate of Florida Gulf Coast University.

Caitlin Gallagher is joining FAH as our new Director, Media and Communications.

Caitlin’s experience both on political campaigns and on Capitol Hill will bring tremendous value to our public affairs team.

She most recently served as Press Secretary for the National Republican Senatorial Committee. She also worked in the Washington office of Senator John Cornyn (R-TX) and on the presidential campaign of Jeb Bush.

Caitlin will play a key role in the FAH media outreach strategy, which includes telling compelling stories from our member companies and promoting patient-centered messages across our social media channels. 

Caitlin is an alum of Baylor University.

FAH Announced New Board Chair, New Member

February 06, 2019 | FAH Policy Blog Team

Category: FAH News

The Federation of American Hospitals (FAH) announced its Board of Directors and Chairman for 2019. We are also excited to welcome a new member – Prime Healthcare.

The FAH board is comprised of the leaders of member companies. The 2019 Chair will be Ron Rittenmeyer, Executive Chairman and CEO of Tenet Healthcare.

“Health care will continue to be at the forefront of political and policy debates in the upcoming year. The FAH Board, with Ron as our leader, is well positioned to advocate for common sense solutions that will protect our ability to care for patients and meet the challenges that threaten the ability of hospitals to serve their communities.” said Chip Kahn, President and CEO of FAH.

“I am pleased to become Chair of the Federation for what is shaping up to be a pivotal year for health care policy. FAH members will continue building a strong advocacy platform that gives a clear voice to patients and their healthcare needs. We remain steadfast in our commitment to provide important perspectives to policymakers and drive solutions that we believe will improve the delivery of care in the communities we serve,” said Rittenmeyer. 

Prime Healthcare is also joining FAH in 2019.

Prime Healthcare is a leading health system dedicated to its mission of "Saving Hospitals, Saving Jobs, Saving Lives." It has 45 hospitals in 14 states and employs more than 40,000 people. Prem Reddy, MD, Prime Healthcare’s Chairman, President and CEO, has joined the FAH Board.

“The Federation welcomes Prime Healthcare to our membership. Since its founding, Prime Healthcare has been committed to assuring patients access to high-quality hospital care in their own communities. Dr. Reddy has been extremely successful as an entrepreneur, physician, and philanthropist. We look forward to him bringing his leadership and experience to the Federation,” added Kahn.

“Prime Healthcare shares the Federation’s focus on making sure America’s hospitals provide the best treatment possible for the patients who depend on us,” said Dr. Reddy.

Adding, “For more than 50 years the Federation has built a reputation in Washington of being an organization that focuses on constructive, patient-centered policy and political solutions to the issues facing our nation’s health care system. I look forward to working with Chip and the leadership at FAH and sharing our experience in revitalizing community hospitals as we deliver on our shared mission to provide quality care to the patients and families we serve.”

Members of the FAH Board of Directors for 2019 include:

CHAIR

Ronald A. Rittenmeyer
Executive Chairman and CEO
Tenet Healthcare

DIRECTORS

Benjamin Breier
President and CEO
Kindred Healthcare, Inc.                                                                

David Dill
President and CEO
LifePoint Health

Ralph de la Torre, MD
Chairman and CEO
Steward Health Care System LLC

Samuel N. Hazen
Chief Executive Officer
HCA

Alan B. Miller
Chairman and CEO
Universal Health Services, Inc.

Prem Reddy, MD
Chairman, President and CEO
Prime Healthcare

Wayne T. Smith
Chairman and CEO
Community Health Systems

Mark J. Tarr
President and CEO
Encompass Health

David T. Vandewater
President & CEO
Ardent Health Services

New Study on Hospital Prices Uses Limited Data to Draw Flawed Conclusions

February 05, 2019 | FAH Policy Blog Team

Category: FAH News, Financing

FACT: Hospital Price Growth Across All Payers Averages Just 1.8% Over Last Three Years

A study published by Health Affairs on Monday evening uses limited, old data to draw flawed conclusions about hospital prices.

The groups of six researchers based their study on the Health Care Cost Institute's (HCCI) limited claims data for people with employer-sponsored insurance from Aetna, Humana and United Healthcare Group (which recently announced it was dropping out of HCCI). It is noteworthy that this data base is not comprehensive – covering only 27.6% of individuals who have employer-sponsored coverage.

The researchers also focused on data going back 12 years - from 2007 to 2014 - completely ignoring recent trends of slowing hospital price and spending growth.

The January 2019 report from the Altarum Center for Value in Health Care shows that hospital price growth across all payers averaged just 1.8 percent over the last three years (2016 through 2018). Altarum also found that hospital year over year spending growth through November 2018 was lower than all other categories of services, including physician and clinical services and prescription drugs.

In comparing differential price growth between hospitals and physicians, the researchers also didn’t take into account the significant costs borne by hospitals that do not apply to physicians.

According to data from the American Hospital Association, it is estimated that nationally hospitals, health systems and post-acute providers spend nearly $39 billion annually on the administrative aspects of regulatory compliance. And an average-sized community hospital spends $7.6 million per year, or $1,200 per admission, to support compliance with regulations from just four federal agencies.

The report in Health Affairs also ignores other consequential costs that hospitals bear in order to provide lifesaving care to anyone who comes through their doors 24/7 – costs like purchasing drugs and medical devices.

A recent study conducted for FAH and AHA found that the average total drug spending by hospitals per admission increased 18.5% between fiscal years 2015 and 2017 – the main driver was price increases from pharmaceutical companies.

It is estimated that during the period that the researchers studied, 2007 to 2014, hospitals invested more than $300 billion in health information technology operating and capital expenses.

Clearly these researchers were looking in the rearview mirror and didn’t dig deep enough into current data and trends - while ignoring cost pressures hospitals face providing care for the patients and communities they serve. We hope this isn’t overlooked in the future.     

New Report From National Hospital Associations Outlines Agenda for Interoperability

January 22, 2019 | FAH Policy Blog Team

Category: FAH News, Health Care Delivery

Seven leading national hospital associations released a report urging all stakeholders to unite in accelerating interoperability to fuel improved health and care, engage individuals, and promote value.

The report, Sharing Data, Saving Lives: The Hospital Agenda for Interoperability, sets forth pathways to improve interoperability among health information technology (IT) systems—a goal that holds great promise for lasting improvement in patient care.

“We see interoperability in action all around us. Mobile phones can call each other regardless of make, model, or operating system. The hospital field has made good headway, but it’s time to complete the job. We are united in calling for a truly interoperable system that allows all providers and patients to benefit from shared health records and data, leading to fully informed care decisions,” said AHA President and CEO Rick Pollack.

“For the best care today, it’s the data stupid. Quality care depends on having the right information at the right time so our patient’s records need to be available in the hospital or wherever our patients receive care. Hospitals are joining together to support improving interoperability because it is the key to assuring the best for our patients,” said Federation of American Hospitals President and CEO Chip Kahn.

Hospitals and health systems are making progress in sharing health information, with 93 percent making records available to patients online and 88 percent sharing records with ambulatory care providers outside their system. They have worked to create the most interoperable systems possible given the tools available to them, but at great cost and effort. Working with policymakers and other stakeholders, hospitals and health systems believe the following elements are the pathway to advance interoperability:

  1. Security and Privacy
  2. Efficient, Usable Solutions
  3. Cost Effective, Enhanced Infrastructure
  4. Standards that Work
  5. Connecting Beyond Electronic Health Records
  6. Shared Best Practices

The report further discusses the benefits of fully interoperable data for patients and providers, outlines current challenges, and provides suggestions for how all stakeholders can work together to achieve the goal of the best possible health for each individual.

The contributors to this report include: America’s Essential Hospitals, American Hospital Association, Association of American Medical Colleges, Catholic Health Association of the United States, Children’s Hospital Association, Federation of American Hospitals and the National Association for Behavioral Healthcare. Click here to view the report and click here to view the infographic.

New Report Shows Impact of Rising Drug Prices and Drug Shortages on Patients and Hospitals

January 15, 2019 | FAH Policy Blog Team

Category: Pharmaceuticals, Research

Today, the Federation of American Hospitals (FAH), the American Hospital Association (AHA), and the American Society of Health-System Pharmacists (ASHP) released a new report finding that continued rising drug prices, as well as shortages for many critical medications, are impacting patient care and putting strains on hospital budgets and operations. The report was prepared based on analysis conducted by NORC at the University of Chicago, an independent research institution.

“We see a developing crisis. Relentless drug price increases and all too frequent shortages of critical medications are eroding the capacity of hospitals to provide our patients needed care,” said FAH president and CEO Chip Kahn. “We believe policymakers should act now to protect patients.”

“This report confirms that we are in the midst of a prescription drug spending crisis that threatens patient access to care and hospitals’ and health systems’ ability to provide the highest quality of care,” said AHA president and CEO Rick Pollack. “Solutions must be worked on to rein in out-of-control drug prices and ease the drug shortages that are putting a strain on patient care.”

“ASHP is at the forefront of efforts to combat the systemic impact of ongoing drug shortages and rapidly rising drug prices,” said ASHP CEO Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP. “By working with government agencies and partners such as AHA and FAH, we will continue to offer policy solutions and a roadmap for the changes necessary to ensure optimal care for patients.”

This report updates and expands on a previous AHA/FAH report from 2016 on skyrocketing inpatient hospital drug cost increases by also analyzing outpatient drug costs and the impact of drug shortages. The report found that hospital budget pressures resulting from the continued dramatic increases in drug prices have negative impacts on patient care, with hospitals being forced to delay infrastructure investments, reduce staffing, and identify alternative therapies. Hospitals also struggle with drug shortages, which can disrupt typical work patterns and patient care, and often require significant staff time to address. 

Specifically, the report showed that:

  • Average total drug spending per hospital admission increased by 18.5% between FY2015 and FY2017.
  • Outpatient drug spending per admission increased by 28.7% while inpatient drug spending per admission increased by 9.6% between FY2015 and FY2017. This 9.6% increase was on top of the 38% increase in inpatient drug spending between FY2013 and FY2015 included in the previous report.
  • Very large percentage increases (over 80%) of unit price were seen across different classes of drugs, including those for anesthetics, parenteral solutions, and chemotherapy.
  • Over 90% of surveyed hospitals reported having to identify alternative therapies to manage spending.
  • One in four hospitals had to cut staff to mitigate budget pressures.
  • Almost 80% of hospitals found it extremely challenging to obtain drugs experiencing shortages, while almost 80% also said that drug shortages resulted in increased spending on drugs to a moderate or large extent.

The full report can be found HERE. You can view a short video explaining the issue HERE and find an infographic HERE.

FAH Leader Expresses Opposition to Ruling that Overturns 340B Medicare Regulation

January 02, 2019 | Chip Kahn

Category: Financing, Medicare, Pharmaceuticals

The DC Federal District Court’s ruling to stop reforms to Medicare payment for drugs acquired under the 340B drug discount program is unfortunate because it undermines HHS efforts to cut drug costs and promote fairer payments.

The current HHS policy will ultimately lower drug costs for patients. It also benefits the vast majority of hospitals, including some 80 percent of rural facilities. 

This ruling puts all those benefits at risk

We look forward to an appeals process that will recognize HHS authority to advance these program improvements.

FAH, AHA Send Joint Letter to Congress on Surprise Billing

December 21, 2018 | FAH Policy Blog Team

Category: Financing, Health Care Delivery

This afternoon FAH President and CEO Chip Kahn and AHA President and CEO Rick Pollack sent a joint letter to leaders in Congress addressing the issue of surprise billing highlighting the need to find a solution that first and foremost protects patients.

The letter states in part:
 
“We strongly believe that any public policy solution to resolve surprise bills must protect patients by prohibiting balance billing and by limiting patients’ cost-sharing to an in-network amount.
 
“The AHA and the FAH are working together and with our respective memberships to develop specific solutions to these challenges. We are evaluating issues including, but not limited to:

  • How we protect the broadest range of patients, including those in self-insured plans;
  • How cost-sharing should be determined for out-of-network care so that patients have certainty about their financial obligations;
  • The role of network adequacy requirements and enforcement in ensuring patients have sufficient access to in-network care; and
  • Once the patient is protected, whether policy interventions are needed to determine fair provider payment.

“We appreciate that this is a high priority issue for Congress, as it is for us, and we intend to provide more specific feedback to policymakers early in the new Congress.”

You can find a complete copy of the letter here.

FAH Comments on Proposed Rule Expanding Use of HRAs

December 21, 2018 | FAH Policy Blog Team

Category: Financing

Today, the FAH commented on the Administration’s proposal to expand the use of health reimbursement arrangements (HRAs).  Under the proposal, employers would be allowed to reimburse their employees through the use of a HRA for purchase of individual coverage.

In its letter, the FAH noted its support for actions that would help more employers offer and contribute to comprehensive health coverage for their employees; increase health coverage among the U.S. population overall; and increase the viability, stability, and sustainability of coverage in the individual market for insurance.

FAH also noted the importance of understanding the impact the proposed policies may have on the important and robust employer sponsored insurance market and cautioned the Departments to ensure that any final policy does not create incentives to draw individuals out of the medium- and large- group employer markets for insurance.

The FAH’s comment letter can be viewed here

FAH Comments on CMS’s New 1332 Guidance

December 21, 2018 | FAH Policy Blog Team

Category: Affordable Care Act

Today, the FAH commented on the Administration’s action, replacing existing guidance for Section 1332 waivers that give states an opportunity to opt out of certain requirements set forth by the Affordable Care Act (ACA).  The newly named State Relief and Empowerment Waivers will apply to waivers for plan years 2020 and later.

The October guidance issued by the Department of Health and Human Services and the Department of the Treasury (“the Departments”) loosens the application of the existing statutory standards so that states can more easily receive approval for implementing waivers under the new guidance.

In its comments, the FAH acknowledged the need for a support of state flexibility and innovation while at the same time, affirming that the Departments have an obligation to ensure that the statutory stanrdards are met and that individuals seeking coverage in those markets are protected. “Unfortunately,” the FAH wrote, “the revisions described in the October notice are incongruent with the statute and as such, we oppose them.”

The FAH goes on to argue that the new guidance would likely result in the loss of comprehensive coverage in states that choose to pursue waivers under the guidance.  Additionally, the letter notes that undermining comprehensive coverage will have a negative impact on the health of the individual market. 

The FAH’s comment letter can be viewed here.

FAH Submits Comments in Response to MA Proposed Rule

December 21, 2018 | FAH Policy Blog Team

Category: Medicare

Today, FAH submitted comments in response to a Proposed Rule from the Centers for Medicare & Medicaid Services (CMS) making changes to the Medicare Advantage (MA) program. The FAH letter addressed support for the following policies:

  • CMS’ implementation of provisions of the Bipartisan Budget Act of 2018 allowing MA plans to offer additional telehealth benefits as basic benefits while urging expanded access to telehealth services fee-for-service Medicare beneficiaries; and
  • CMS’ adoption of the modified Plan All-Cause Readmission measure, which includes observation stays in the calculation of the measure.  

The letter also recommended future regulatory action to address issues not included in the Proposed Rule:  

  • Ensuring that MA organizations (MAOs) reimburse contracted providers for their enrollees’ bad debt;
  • Addressing concerns with inaccurate provider directories and inadequate networks;
  • Ensuring providers and enrollees can rely on MAO prior authorizations;
  • Requiring MAOs to use the Medicare fee-for-service Two-Midnight Rule when reviewing inpatient admissions vs. observation stays; and
  • Requiring MAOs to follow the Medicare Inpatient-Only list to determine procedures that must be performed in an inpatient setting.

You can find the letter here.

FAH Comments on International Pricing Index Model ANPRM

December 21, 2018 | FAH Policy Blog Team

Category: Pharmaceuticals

Today, the FAH commented on the Administration’s International Pricing Index Model for Medicare Part B Drugs Advance Notice of Proposed Rulemaking (ANPRM).  The ANPRM signaled the Administration’s interest in testing an Innovation Center model which would dramatically change the manner in which Part B drugs are priced, acquired and paid for in the Medicare program.

Under current regulation, separately payable Part B drugs are reimbursed at Average Sales Price (ASP) plus a six percent add-on.  Under the current framework, hospitals and physicians acquire the drugs and then bill Medicare for payment.  As described in the ANPRM, HHS is considering a mandatory demonstration in certain unspecified geographic areas where HHS would contract with certain vendors to supply these Part B drugs to hospitals and physicians.  Under the model, the vendors, instead of hospitals and physicians, would acquire and bill for the specified Part B drugs.  HHS contemplates single source drugs and biologicals being tested first.  Vendor payment would no longer be calculated as ASP plus six percent but rather would be set through a calculation that, relying on a benchmark of international pricing for those drugs, would move payment closer to the lower, international payments. 

In responding to the proposal, the FAH stated its support for CMS’s goals of reducing Part B drug costs for Medicare beneficiaries, maintaining financial stability and reducing burden for physicians and hospitals, and addressing the disparity in drug prices between the U.S. and other countries. However, the FAH conveyed its concern that the system CMS is planning to implement will be highly disruptive to the current Part B drug distribution system and will be more burdensome, rather than less burdensome, to the hospitals and physicians that will be mandated to participate in the model. Further, the FAH noted its concern that the model may increase international prices rather than lower U.S. drug prices and potentially increase US prices for physicians and hospitals not within the bundle.

Should the Administration proceed with the model, it will likely issue a Proposed Rule some time next year at which point the FAH will evaluate it and submit comments.

The FAH’s comment letter can be viewed here

FAH Leader Comments on Ruling by Federal Judge Striking Down the ACA

December 15, 2018 | Chip Kahn

Category: Affordable Care Act, FAH News

The judge got it wrong. FAH believes this ruling would have a devastating impact on the patients we serve and the nation’s health care system as a whole.

Americans deserve access to affordable coverage so they can get the care they need, including consumer protections such as pre-existing conditions. Millions have gained coverage since the passage of the ACA, and this ruling could reverse that progress. 

Having this decision come in the closing hours of open enrollment also sows seeds of unnecessary confusion.

We strongly believe this should be overturned in the appeals process.

Joint Statement from FAH & AHA: Hospitals Seek Common Sense Solutions to Surprise Bills

December 10, 2018 | Chip Kahn and Rick Pollack

Category: FAH News, Insurance

Hospitals and health systems want to protect their patients from surprise bills. Consumers, health insurers, employers, and hospitals all agree on that and need to find a common ground solution.

Inadequate health plan provider networks that limit patient access to emergency care is one of the root causes of surprise bills. Patients should be confident that they can seek immediate lifesaving care at any hospital.

The hospital community wants to ensure that patients are protected from surprise gaps in coverage that result in surprise bills, and we look forward to working with policymakers to achieve this goal.

FAH Leader Comments on Trump Administration’s Health Care Competition Report

December 03, 2018 | Chip Kahn

Category: Health Care Delivery, Realignment

Too many elements of the Administration’s report resort to the same old bromides that got us here in the first place, and would reverse the progress hospitals and others are hard at work on. 

The FAH shares the Administration’s goal to improve choice and competition for patients.  We support several specific recommendations regarding the benefits of telehealth and streamlining quality measurement programs.  And we agree that a more engaged consumer is key to driving value.

However, physician-owned hospitals are part of the problem, not the solution, as reports from GAO, OIG, and MedPAC have well documented.

Further, the report ignores that a key to patient access is to ensure community hospitals have the resources they need to provide lifesaving care for anyone who walks through our doors 24/7.  Hospitals are struggling to maintain critical service lines with hundreds of billions of dollars in Medicare cuts and negative 11 percent operating margins.  

Hospital realignment helps preserve access to care, and promotes needed clinical integration and coordination of care for patients.

Finally, patients need to know that they will be covered for the care that they require. Standards for network adequacy need to be strengthened, not relaxed, so consumers won’t be caught by surprise if their neighborhood hospitals are suddenly out-of-network or off limits.

We stand ready to work with the Administration and Congress on reforms that advance higher value health care and access for American families.

FAH Supports Bipartisan Nurse WIN Act

November 30, 2018 | Chip Kahn

Category: Legislation

“Loan repayment incentives can provide new nursing graduates the freedom to choose the communities they think they can serve best. In many areas grappling with staffing shortages, it’s a struggle to attract critically needed nurses. It is essential that nurses have a level playing field to take advantage of much deserved federal loan repayment incentives to serve any qualified critical shortage facility.

“The Federation applauds the bipartisan leadership of Sens. Todd Young (R-IN) and Doug Jones (D-AL) to expand eligibility for this vital program to assure that all nurses have a fair shot at serving patients in the communities with critical nursing shortages.  The Nurse WIN Act will provide an important lifeline for patients, communities and the new nurses that choose to serve them.”

You can find FAH’s letter supporting the Nurse WIN Act by clicking here.

Bipartisan Group of Lawmakers Honor Rural Hospitals During Rural Hospital Week

November 27, 2018 | FAH Policy Blog Team

Category: General, Rural

Reps. Cheri Bustos (IL-17), Tom Reed (NY-23), and Glenn Thompson (PA-05) recently submitted statements to the Congressional Record recognizing the importance of our country’s rural hospitals from coast to coast.

As Rep. Thompson makes clear in his statement, “It is a time to promote awareness of the full range of issues that impact approximately 60 million rural Americans.” He continues, “For those in rural regions, the need is great and services are scarce.”

Rep. Bustos highlights the important role rural hospitals play in the lives of Americans who live in rural areas and rely on their services. “Our doctors, nurses, and other rural hospital employees work tirelessly to help patients overcome many of the health care challenges they face on a daily basis, including limited access to primary care providers and specialists.”

Seeking to help overcome these challenges, Congresswoman Bustos introduced legislation to expand broadband access and remove barriers to telehealth. The Special Registration for Telemedicine Clarification Act was signed into law on October 24th, 2018.

But rural hospitals aren’t just healing patients, they are contributing to the success of small towns across the United States. Rep. Reed explains that “hospitals account for 14 percent of total rural employment nationwide. In this way, rural hospitals keep not just their patients healthy, but the economies of their local communities as well.”

You can read the entirety of Rep. Bustos’ letter here, Rep. Reed’s letter here, and Rep. Thompson’s letter here.

The Federation of American Hospitals thanks Reps. Bustos, Reed, and Thompson for standing up for rural hospitals and the patients they serve during Rural Hospital Week.

Groups Urge Congress to Protect Seniors from Rising Drug Prices

November 13, 2018 | FAH Policy Blog Team

Category: Medicare, Pharmaceuticals

The Federation of American Hospitals joined 16 other groups in sending a letter to Congressional leaders today urging them to preserve the actions taken in the Bipartisan Budget Act (BBA) of 2018 to protect seniors and taxpayers from out-of-control drug prices during the upcoming lame duck session of Congress.

As Bloomberg News reported, drug manufacturers are already lobbying Congress to undo these important, cost-saving protections. 

The letter states, “It is critical that Congress keep in place the important policies enacted in the BBA that help lower high out-of-pocket prescription drug costs, particularly for those facing the highest cost burdens. As such, we urge you to stand with Medicare beneficiaries and taxpayers to resist any attempts from the pharmaceutical industry to undo these critical reforms during the lame duck session.”

It continues, “Prescription drug prices will continue to increase at unsustainable rates unless Congress holds the pharmaceutical industry accountable for putting profits before people. Conversely, agreeing to a bailout for the pharmaceutical industry – at the expense of patients and taxpayers – during the lame duck session will send the exact opposite message, particularly at a time when drug prices remain needlessly high and unaffordable for too many patients.”

You can find the complete letter here.

Groups signing the letter included FAH, AHA, the Campaign for Sustain Rx Pricing, Families USA, the Medicare Rights Center and a number of health insurer and physician associations.

FAH Celebrates Impact of Rural Hospitals

November 12, 2018 | FAH Policy Blog Team

Category: Rural

When you hear rural community you think small town, but add up the population of these areas across the country and it equals nearly 60 million people, or one in five Americans.

At the heart of many of those communities is the local hospital. The most obvious benefit – they provide timely, quality care, but these facilities are also often the financial backbone in the areas they serve. And speaking of service, hospital employees not only save lives, they improve them. Their reach extends past the four walls of the hospitals as they act as coaches, volunteers, and leaders in community organizations.

The Federation of American Hospitals wants to recognize everything these folks do, so from November 12th to November 16th we are celebrating Rural Hospital Week.

It all starts with care. Whether you need emergency treatment or have a scheduled routine procedure, the presence of a hospital in these communities saves lives. When seconds matter most, having essential health care minutes away, instead of hours, can mean the difference between life and death.   

But the impact to a community extends far beyond medical capabilities. In many rural areas the hospital is the largest or second largest employer in the area. It also contributes to job creation throughout a community. A recent study by the American Medical Association found that “each physician supports almost 14 jobs and adds more than $2 million in economic output, on average.” Those aren’t just jobs in the hospital or doctor’s office, they include restaurants, dry cleaners and day cares. You would be hard pressed to find a business in a rural area that isn’t touched in some way by those who work for or get treatment at one of these facilities.

Hospital employees also make an indelible mark in the rural areas where they work and live. This week the Federation is highlighting the civic contributions of hospital heroes. You can read about them here and look for their stories on Facebook, Twitter, Instagram and LinkedIn.

We are also debuting a new episode of our podcast – Hospitals In Focus with Chip Kahn – focusing on rural hospital care. LifePoint Health’s Chairman and CEO Bill Carpenter talks with Chip about the creative ways their hospitals are advancing care and some of the challenges they face in non-urban areas. You can listen here.

The goal of Rural Hospital Week is to raise awareness of their importance nationwide and you can help by joining the conversation on social media. Share your stories of how rural hospitals have impacted your life using #StandUp4RuralHospitals.

Thank you to the dedicated employees that make rural hospitals and the communities they serve so great!

Working in Health Care, Serving their Community

November 12, 2018 | FAH Policy Blog Team

Category: Rural

From helping in the halls of the hospital to making contributions in their community, rural areas depend on hospital heroes every day.

These folks are nurses, techs and CEOs, but they are also volunteers, coaches and even quilters. They don’t ask for attention, but we think they deserve our gratitude.

This Rural Hospital Week the FAH is shining a light on people who work in health care and continue to serve their community once they leave the hospital.

There are thousands upon thousands of stories from coast to coast – we want to share these four with you:

David Asherbraner – Hickory, North Carolina

David works at Frye Regional Medical Center as a Manager, Assent Management/Transport. He is great at his job, but his co-workers say it is what he does outside the hospital that makes him even more special.

Hospital COO Chris Fensterle says that, for David, “The world is not about him. It is about what he can do to serve others for a greater good.”

For nearly 20 years, David has volunteered at the Hickory Soup Kitchen, serving lunch to the less fortunate. But he doesn’t stop there. He also coordinates a monthly Frye Volunteer Day, inviting hospital employees to sign up to work at the soup kitchen. He even delivers food to the homeless on the weekend when the kitchen is closed.

Shaina Musselman – Roaring Springs, Pennsylvania

Shaina works at Conemaugh Nason Medical Center as a CT Technologist in the Radiology Department, but her lifesaving work doesn’t end when she leaves the hospital. In 2015, Shaina became a volunteer firefighter and she is really good at it. She was recently named the department’s member of the year, while her husband received the firefighter of the year award.

Shaina is also a mentor at the local YMCA and collects Easter baskets and gift cards for hospitalized children in the area.

Jan Bryan – Fort Morgan, Colorado

Jan is a Registered Nurse who work in Surgical Services. In her more than 31 years as a nurse, Jan has built a reputation for delivering compassionate care and enriching the lives of her patients and their families.

Fort Morgan’s city manager notes that Jan refers to her patients as “my people,” and treats them as if they are her own family. Her superior skills are also known outside the community; she received the prestigious Nightingale Luminary award for clinical leadership and nursing excellence.

A gifted seamstress, Jan sews colorful quilts and gives them to patients and co-workers, and donates them to support charitable causes.

“Her quilts are symbols of comfort,” says hospital CEO Gene O’Hara. “They have benefitted non-profit organizations like Relay for Life, the Wounded Veteran’s Foundation and more.”

Robb Williams – Princeton, West Virginia

Robb Williams is the CEO at HealthSouth Southern Hills Rehabilitation Hospital. However, when he leaves the hospital his focus turns to the hardwood and city hall. Robb has coached at the largest high school in his county for several years and also serves on the Board of Directors for Bluefield, West Virginia.

Robb has long been active in the community. He coached seven seasons of Bluefield Boys Soccer, and led them to the state semi-finals in 2015. He currently serves as the assistant coach for the Princeton High School Boys Basketball team.

Robb was also elected to the Bluefield, WV Board of Directors in 2017. He currently represents District III and is focused on making the community a place where families will put down roots, telling the local paper, “As I get older, and my kids get older and grandchildren are born, I want them to stay in Bluefield.”

Please help us say thank you by sharing their stories using #StandUp4RuralHospitals and if you have a hospital hero in your area – share their story with us!

Honoring Your Service, Supporting Your Future

November 11, 2018 | FAH Policy Blog Team

Category: FAH News, General

This weekend we honor the many veterans who have served our country in war or peace. FAH appreciates the sacrifices made by members of our nation’s military and their families to preserve our freedoms.

Hospitals have partnered with the Veterans Administration for many years to ensure all of our veterans have access to quality health care close to home. We are proud to work with the VA to provide support for our nation’s heroes.

FAH member companies are committed to supporting and hiring veterans as they return home from service and transition into 21st century jobs. The companies appreciate the unique skills and values instilled by military service and in turn are able to provide meaningful work caring for their communities.

Hospitals are proud to hire heroes from all branches of the military because we know what a difference they can make in every aspect of patient care.

Veterans, thank you for your service and your sacrifices. Happy Veterans Day!

FAH Leader Reacts to Midterm Election Results

November 07, 2018 | Chip Kahn

Category: FAH News

Once again health care was a clear game changer. Concerns about losing pre-existing conditions protections and the availability of affordable health coverage moved American voters. There is a real desire for a ‘let’s fix it’ approach to ensuring consumer protections and access to quality care. Now is the time to focus on the commonsense health care solutions people supported at the ballot box.

FAH’s Chip Kahn Joins Health Care Leaders at Global Summit on Future of Hospitals

October 26, 2018 | FAH Policy Blog Team

Category: FAH News, Quality

This past week FAH President and CEO Chip Kahn served as co-chairman at a first of its kind summit in Israel centered around the theme - “The Future Hospital: Setting Strategies for 2030 and Beyond.”

The event was hosted by Sheba Medical Center, Tel HaShomer where Chip was joined by leading health care executives from the US, Canada, Europe and Israel.

Participants took part in in multiple workshops that addressed developing medical professions, the evolving role of hospital systems and how hospitals can expand community-based patient care. Participants also had the chance to experience cutting-edge technologies currently being developed in Israel that will shape the future of the health and medical industry.

Kahn said after the summit that the discussions were a good first step.

"We all agree we can't predict the future but we know digitalization and medical science is advancing very quickly. And while digitalization and Artificial Intelligence (AI) are going to change the way we address patient care, we cannot lose sight of the fact that the essence of healthcare is compassion with a human touch. Digitalization will transform patient care for physicians and health care professionals, as they will become translators of data for their patients as well as caregivers.”

Adding, “We also agreed that the hospital of the future will have to go beyond the 4 walls and become a virtual caregiver to patients and communities alike. Additionally, hospitals, in order to meet the demands of care in the future, will have to be flexible.  The sharing of these challenging ideas at the Sheba International Summit will now serve as a powerful foundation for on-going discussions between us going forward."

The roster of those in attendance included:

  • Prof. Robert Bell, CEO, Royal Brompton & Harefield Hospitals Chair, Association of UK University Hospitals, UK, London
  • Dr. Fabrice Brunet, President and CEO, University Hospital of Montreal (CHUM) and CHU Sainte-Justine, Canada, Montreal, Quebec
  • Nigel Edwards, Chief Executive, The Nuffield Trust, UK, London
  • David Entwistle, President and CEO, Stanford Health Care, Stanford, CA
  • Hans Erik Henriksen, CEO, Healthcare Denmark, Denmark, Odense
  • Gary Kaplan, Chairman and CEO, Virginia Mason Medical Center, Seattle, MA
  • Dr. Daniel Kraft, Faculty Chair for Medicine & Neuroscience and Chair of Exponential Medicine, Singularity University, US, Moffet Field, CA
  • Prof. Ernst J. Kuipers, Chairman of the Board of Directors, Erasmus Medical Center, Netherlands, Rotterdam
  • Wright Lassiter, CEO, Henry Ford Health System, Detroit, MI
  • Prof. Christoph A. Meier, Chief Medical Officer, University Hospital Basel, Switzerland, Basel
  • Sir Jonathan Michael, Healthcare Consultant, Former Chief Executive, Oxford University Hospitals NHS Foundation Trust, UK, Godalming, Surrey
  • Mr. Ralph W. Muller, CEO, University of Pennsylvania Health System, Philadelphia, PA
  • Dr. Paul Rothman, Dean of the Medical Faculty and CEO, Johns Hopkins Medicine, Baltimore, MD

You can click here to read more about the summit. Photos of the event can be found here.

FAH Leader Comments on the Trump Administration’s Proposal To Change Medicare Drug Prices

October 25, 2018 | Chip Kahn

Category: Financing, Medicare, Pharmaceuticals

We agree with the President that it is time to reduce the drug tab for Americans, and actions need to be focused on the real culprit - manufacturers’ prices - not the frontline hospitals and physicians who administer and prescribe those medicines.  We look forward to examining the details and fine print of the Administration’s proposals. 

It is important that the plan aim at protecting patients and does not impede the freedom of physicians to prescribe the precise drug therapies their patients need.

FAH Responds to Request for Information on the Electronic Health Record (EHR) Reporting Program

October 17, 2018 | FAH Policy Blog Team

Category: HIT

FAH Responds to Request for Information on the Electronic Health Record (EHR) Reporting Program

The FAH submitted comments to the Office of the National Coordinator for Health Information Technology (ONC) in response to the Request for Information on the Electronic Health Record (EHR) Reporting Program. The FAH expressed appreciate for the agency’s efforts to improve interoperability and offered suggestions for ONC’s implementation of the EHR Reporting Program, including revising the focus of the Program and improving the Certified Health IT Products List (CHPL) website.

Rather than a comparative, “consumer reports” model, the FAH recommended that the Program would be most impactful by focusing on a robust, collaborative post-acquisition/post-implementation health IT surveillance and improvement model. The FAH also noted that ONC could reduce the burdens of a health IT surveillance program by ensuring it is voluntary for health care providers, that providers are offered incentives to participate, and utilizing data that can be generated and reported automatically by health IT systems.

The FAH also offered improvements to the CHPL website for health IT consumers, such as: requiring health IT vendors to list the geographic locations and provider types where they have already integrated around health information exchanges (HIEs) so that those acquiring, upgrading, or customizing health IT can leverage work that has already been done; and requiring vendors to provide information on the costs associated with health IT upgrades and interfaces so that consumers have some insight into the costs associated with maintenance and use of their health IT tools. The FAH encouraged ONC to conduct listening sessions with providers for additional ides to improve the CHPL website.

The complete letter can be found here.

FAH Comments on MSSP, ACO Pathways to Success Proposed Rule

October 17, 2018 | FAH Policy Blog team

Category: Financing, Medicare

FAH Comments on MSSP, ACO Pathways to Success Proposed Rule

FAH submitted comments Tuesday to CMS’ Medicare Shared Savings Program (MSSP); Accountable Care Organizations (ACOs) ― Pathways to Success Proposed Rule.

FAH said in the letter that it appreciates the agency’s efforts to improve the MSSP, but expressed concern that a number of aspects of the proposed rule could undermine the ability of ACO participants to achieve long term success in the program.

One of the main areas addressed in the letter is the FAH’s strong opposition to the low and high revenue distinction for determining participation options.

CMS proposes to define participation options by making a distinction between low revenue ACOs (proxy for physician group ACOs) and high revenue ACOs (typically associated with hospital ACOs). 

The FAH believes that this proposed policy would severely limit participation options for high revenue ACOs.

The letter states, “This low/high revenue distinction serves no purpose, other than punitive, given the steep structure of the glide path CMS proposes that would sharply limit time in the one-sided risk model options. This arbitrary distinction also discourages participation by the type of ACOs CMS most wants to attract; those, we believe, that can best coordinate acute and ambulatory care and are more likely to generate substantial savings to the Medicare program over the long-term.”

FAH also outlines several additional topical areas that CMS needs to address, including:

  • Revising definitions of experience and inexperience with Medicare ACO initiatives
  • Providing adequate and timely data
  • Using regional factors when establishing and resetting ACO’s benchmarks
  • Monitoring for financial performance
  • Supporting consistent data-sharing transparency for beneficiaries
  • Improving the processes for voluntary alignment
  • Incorporating stability and/or flexibility where appropriate, and
  • Addressing interactions between the MSSP and other CMS models

For more information on each issue – you can find the complete letter here.

FAH Launches New Podcast – Hospitals In Focus with Chip Kahn

October 11, 2018 | FAH Policy Blog Team

Category: FAH News, Media

Chip Kahn, President and CEO of the Federation of American Hospitals brings more than 40 years of experience in the health care field to his new podcast, Hospitals In Focus with Chip Kahn.

The podcast shines a light on what’s happening in community hospitals across the country as he explores the latest in advancements in patient care with our nation’s leading health experts.

Chip speaks with Stuart Altman, health care economist and professor at Brandeis University, for the first two episodes launching October 15th and 22nd. In episode one, they discuss the origins of the modern hospital – from past to present. Part two of their discussion looks forward to the future of hospitals and the role they will play in an ever changing health care system. 

He then dives in to how hospitals are using big data to improve patient care by utilizing algorithms and artificial intelligence. Dr. Jonathan Perlin from HCA Healthcare talks about how this technology is driving advances in childbirth, sepsis, and MRSA on the episode premiering October 29th.

Health care, and hospitals specifically, have a part in responding to every disaster both natural and man made. Mike Wargo from HCA Healthcare speaks with Chip about how hospitals are preparing for everything from electrical grid failures to hurricanes on the episode premiering November 5th.

Your health care shouldn’t depend on what zip code you live in. Chip talks to Bill Carpenter of LifePoint Health about how they are bringing high quality care to rural communities across the country. Listen to Chip’s conversation with Bill on November 12th.

Look for new episodes to launch on Mondays on Apple PodcastsGoogle Play and fah.org.

Bill Carpenter Receives FAH’s Mike Bromberg Lifetime Achievement Award

October 09, 2018 | Chip Kahn

Category: FAH News, Quality, Rural

The Federation of American Hospitals was honored to give its Mike Bromberg Lifetime Achievement Award to LifePoint Health’s Bill Carpenter Tuesday morning.

Health care and the very lives of millions of rural Americans have been improved by Bill’s leadership and vision.

Bill has been at LifePoint since its inception nearly 20 years ago and took over as CEO in 2006. During that time, he has been the driving force behind the company’s mission of Making Communities Healthier and his leadership has ensured that patients in rural areas have access to high quality health care close to home, no matter where that home is.

To achieve this, Bill led LifePoint’s efforts to advance lifesaving innovations and forge meaningful partnerships between hospitals and the communities they serve.

All those significant achievements were recognized earlier this year when LifePoint won what many consider the Oscar of health care awards – the Eisenberg Award for Innovation in Patient Safety recognizing the company’s National Quality Program.

Bill reflects many qualities with the namesake of the award he is being given today. Mike Bromberg, who led the Federation for 25 years, stood for a commitment to quality health care and access to hospitals for all Americans.

We in the FAH community sincerely congratulate Bill on receiving this much deserved award.

FAH Comments on FCC Telehealth Pilot Program

October 05, 2018 | FAH Policy Blog team

Category: Health Care Delivery, HIT

FAH Comments on FCC Telehealth Pilot Program

FAH sent a comment letter to the Federal Communications Commission (FCC) this week supporting the Connected Care Pilot Program, which earmarks $100 million to support telehealth for low-income Americans, especially those living in rural areas and veterans.

However, FAH asked that the agency to expand eligibility to include investor owned hospitals.

“Telehealth and other medical technologies are transforming the delivery of health care throughout the United States. Such innovation in treatment modalities have the potential to both improve health care outcomes and reduce costs. The FAH applauds the FCC for developing the Connected Care Pilot Program, which will help expand access to care via telehealth, especially in rural and underserved communities,” the letter states.

It continues, “Unfortunately, under current guidance, investor-owned hospitals are not eligible to participate in the RHCP based on their tax filing status. The FAH membership includes nearly 300 tax-paying rural hospitals, which traditionally serve older, low-income populations. This lack of parity unjustly penalizes patients living in rural communities across the United States that are served by an investor-owned hospital. As such, we encourage the FCC to think more broadly when considering the eligibility criteria for the Connected Care Pilot Program in order to support the most robust implementation of the pilot.”

You can find the complete letter here.

FAH Comments on 2019 OPPS Proposed Rule

September 24, 2018 | FAH Policy Blog Team

Category: Financing, Pharmaceuticals, Quality

FAH Comments on 2019 OPPS Proposed Rule

This afternoon FAH filed comments with CMS regarding the 2019 Hospital Outpatient Prospective Payment System (OPPS) proposed rule.

Key policy recommendations in the letter include:

Proposal and Comment Solicitation on Method to Control Unnecessary Increases in the Volume of Outpatient Services

FAH strongly opposes a proposed adjustment to the payment rate for clinic services “because it is not a method for controlling unnecessary increases in volume, it addresses a purported volume increase that Congress has already addressed under section 603 of the Bipartisan Budget Act of 2015 (“Section 603”), it fails to provide any deference to physician’s judgment as to the clinical necessity of the hospital outpatient setting, and the payment reduction may have unintended and counterproductive effects, including volume increases and decreased beneficiary access.”

Expansion of Clinical Families of Services at Excepted Off-Campus Departments of a Provider

FAH wrote that we “strongly oppose CMS’s renewed proposal to restrict the expansion of clinical families of services at excepted PBDs (off-site departments), reiterating our prior objections to the proposal and noting the absence of any information indicating that this burdensome policy is now warranted or appropriate.”

Also reiterating concerns that limiting the types of services furnished by excepted PBDs and reimbursable under OPPS would run contrary to Congress’ direction, is unworkable, and would be administratively burdensome.

Proposed Adjustment for Rural Sole Community Hospitals and Essential Access Community Hospitals

“FAH supports CMS’s proposal to provide this important payment adjustment. These hospitals are typically the chief, if not sole, source of community outpatient care for rural residents and this adjustment is vital to ensuring continued access to the care they need.”

Proposed OPPS Payment for Drugs Acquired Through the 340B Program

FAH reiterated our support for CMS’s proposed 340B payment policy and agrees that it is an appropriate action by the Secretary.

Requirements for the Hospital Outpatient Quality Reporting (OQR) Program

“FAH commends CMS for its proposed application of the Meaningful Measures initiative to the hospital outpatient quality reporting program. Prioritizing and reducing the number of quality measures addresses our previously expressed concerns about the burden of managing many measures. FAH supports a focus on measures designed specifically for improving patient care and working towards meaningful patient outcomes.”

Proposed Additional Hospital Inpatient Quality Reporting (IQR) Program Policies

FAH supports CMS’s proposal to remove three “Communication About Pain” questions from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) measures, but urged the agency to find another way to measure a patient’s pain level.

FAH also expressed a desire to overhaul the entire HCAHPS system, writing, “it is vitally important that CMS take this opportunity to develop an updated HCAHPS system rather than to continually edit the existing one. The data on which the HCAHPS survey was built is now dated and the patient experience and healthcare landscapes have vastly changed. Consideration of the opioid epidemic is only one of the necessary changes. It is time for CMS to re-evaluate all the domains and questions currently in the HCAHPS.”

Requests for Information

FAH also responded to CMS’s Requests for Information on Promoting Interoperability and Electronic Health Care Information, Price Transparency, and Leveraging Authority for the Competitive Acquisition Program for Part B Drugs and Biologicals for a Potential CMS Innovation Center Model. Comments on each of these proposals reiterated points FAH has made in the past on these topics.

Click here to find the complete letter.

FAH Comments on CY 2019 Physician Fee Schedule Proposed Rule

September 11, 2018 | FAH Policy Team

Category: Financing, Health Care Delivery

The Federation of American Hospitals (FAH) submitted comments late today on CMS’ Physician Fee Schedule proposed rule.

In a letter to CMS Administrator Seem Verma, FAH wrote, “It is imperative that providers focus on the care and well-being of their patients without unnecessary regulatory burden getting in the way…we appreciate CMS identifying a number of areas where policies can be updated, and burden reduced.  However, we do have significant concerns with a number of CMS’s proposed policies including the proposal to collapse the payment rates for E/M visit codes.”

Key recommendations in the letter include:

Evaluation and Management (E/M) Visit Codes

FAH enthusiastically supports CMS’s proposals to reduce administrative burdens by targeting extra or redundant E/M documentation requirements, as well as CMS’s overall focus on reducing administrative burden while improving care coordination, health outcomes, and patient autonomy. However, we strongly urge CMS not to adopt the proposed coding and payment changes for office and other outpatient E/M visits.This code collapse would have a destabilizing effect, violate Congressional direction that work relative value units (RVUs) be based on physician time and intensity, and not meaningfully reduce documentation burdens.

Payment Rates under the Medicare PFS for Nonexcepted Items and Services Furnished by Nonexcepted Off-Campus Provider-Based Departments of a Hospital

FAH believes that the lack of transparency in the proposed rule prevents stakeholders from meaningfully commenting on the proposed PFS Relativity Adjuster.  Based on prior analyses, we urge CMS to adopt a PFS Relativity Adjuster of at least 60 percent, which better captures the actual non-facility practice expenses associated with the services and the impact of packaging.

In addition, FAH’s letter urges CMS to use all items and services billed with either a “PN” or “PO” modifier when calculating the PFS Relativity Adjuster so that the calculation accounts for a more representative sample of the range of items and services furnished in off-campus PBDs.

Communication Technology-Based Services/Telehealth

FAH expressed support for CMS’s proposal to expand payment for communication technology-based services while encouraging the agency to reform the coverage and payment rules for telehealth and remote monitoring technologies.  We believe that additional reforms will lead to improved access for beneficiaries in both rural and urban areas to primary as well as specialty and subspecialty care.

Quality Payment Program

FAH appreciates CMS’s continued gradual implementation of the QPP, such as the gradual increase in the Merit-Based Incentive Payment System (MIPS) performance threshold to 30 points, as well as CMS’s proposal to permit facility-based reporting for hospital-based clinicians and groups. However, we also urge the agency to make improvements to the program, such as adjusting the low-volume threshold to include more clinicians, as the current exclusion of a significant number of clinicians from MIPS participation has resulted in extremely low positive payment adjustments for those clinicians and groups that do successfully participate. FAH wrote that we appreciate CMS’s proposal not to increase the financial risk parameters for Advanced Alternative Payment Models (Advanced APMs) through performance year 2024 and encourages CMS to focus on boosting participation in Advanced APMs.

Clinical Laboratory Fee Schedule

FAH said it agrees with CMS’s reasoning that Congress intended to “effectively exclude hospital laboratories as applicable laboratories…” and opposes the suggested alternative approaches to defining applicable laboratory.  The letter says that use of the CLIA certificate or bill type 14x would be administratively burdensome for hospitals and would likely require many hospital laboratories to report data, which is clearly inconsistent with Congressional intent.

Appropriate Use Criteria

FAH expressed continued concerns about the ability of providers to implement the changed required under the current timeline, the continued complexity of AUC implementation, and its potential impact on patient care.  For example, we believe that AUC consultation information should only be reported on the furnishing professional’s claim, not the facility claim and that CMS should exclude Emergency Departments from the AUC program entirely.

You can read the entire letter by clicking here.

FAH Comments on Senators Grassley and Durbin Drug Pricing Amendment

August 21, 2018 | FAH Policy Blog Team

Category: FAH News, Legislation, Pharmaceuticals

Rising and excessive drug prices threaten patient access to the drugs they need and can undermine the care physicians see as necessary for patients. The Grassley-Durbin amendment (#3787) would take a great leap forward in providing consumers useful information on drug prices that could help them buy smart. And, the public display of prices could put a spotlight on those high prices and bring them down. 

We agree with the Campaign for Sustainable Rx Pricing’s letter that requiring disclosure of drug pricing in DTC advertising would “provide useful information for consumers as they engage in discussions with their providers about the best treatment options…”  The FAH urges the Senate to approve this amendment.

Modern Healthcare Honors FAH’s Chip Kahn, Several Members on Annual “100 Most Influential” List

August 20, 2018 | FAH Policy Blog Team

Category: FAH News

FAH and its company leaders are strongly represented on the just released 2018 “100 Most Influential People in Healthcare” list from Modern Healthcare. The annual ranking is a collaboration between the magazine’s senior editors and readers. After a nomination process, readers pick their favorites from a preliminary ballot of 300. The final rankings take into account vote totals and input from the senior editors.

Modern Healthcare has selected six FAH leaders for their 2018 list:

  • #14 – Milton Johnson, Chairman and CEO, HCA, Nashville, TN
  • #33 – Chip Kahn, President and CEO, Federation of American Hospitals, Washington, DC
  • #38 – William Carpenter, Chairman and CEO, LifePoint Health, Brentwood, TN
  • #63 – Alan Miller, Chairman and CEO, Universal Health Services, King of Prussia, PA
  • #73 – Wayne Smith, Chairman and CEO, Community Health Systems, Franklin, TN
  • #89 – Mark Tarr, President and CEO, Encompass Health, Birmingham, AL

Chip Kahn is one of only three people who have appeared on the list since its inception in 2003. Modern Healthcare said he “continues to be one of the hospital industry’s most prominent advocates in Washington, D.C.”

You can see the 2018 list in its entirety here.

Congratulations to all of the leaders honored this year.

LifePoint Health’s National Quality Program Featured in Peer Reviewed Journal

July 25, 2018 | FAH Policy Blog Team

Category: FAH News, Quality, Research

LifePoint Health’s National Quality Program (NQP) was featured in the July 2018 issue of The Joint Commission Journal on Quality and Patient Safety, a nationally recognized peer-reviewed journal publication.

The NQP is a collaboration between LifePoint Health, a member of the Federation of American Hospitals (FAH), and Duke University Health System. The program has led to significant patient safety improvements across the LifePoint network, including a greater than 60 percent reduction in aggregate patient harm.

It all starts when hospitals enroll in the program and begin working with Duke and LifePoint quality coaches to evaluate and strengthen their quality programs and processes. Following an initial evaluation, the hospital creates a plan and begins to deploy changes that will help it achieve quality improvement benchmarks and establish long-term solutions to sustain its results.

So far this initiative has helped create a highly reliable culture of safety and drive enhancements across the LifePoint system, which includes a decrease in hospital-acquired infections by 78 percent for urinary tract infections, 58 percent for sepsis infections, and 73 percent for pneumonia from 2010 to 2017.

The Joint Commission Journal on Quality and Patient Safety is a peer-reviewed publication dedicated to providing health professionals with the information they need to promote the quality and safety of health care. You can read the article about the NQP by clicking here.

FAH Leader: Boehler is a Real World Innovator, Well Suited for New Role

July 18, 2018 | Chip Kahn

Category: Health Care Delivery, Medicaid, Medicare

“A fresh take on health care is certainly called for and Adam brings that to this new and important position. He has been an actual innovator in health care, working in the real world, looking for new ways to serve patients and their families better as well as making caregiving more efficient and effective.

“During his tenure at CMMI, Adam has displayed a bold vision for the future of the nation’s health care system. I believe he is well suited for his new role as Senior Advisor for Value-Based Transformation and Innovation.

“Secretary Azar has assembled an impressive team to help him advance his health care transformation agenda. We look forward to working with each of them as we confront the health care challenges and opportunities facing our patients, families and caregivers.”

FAH Comments on HHS Blueprint to Lower Drug Prices

July 17, 2018 | FAH Policy Blog Team

Category: Pharmaceuticals, Transparency

The Federation of American Hospitals (FAH) sent a letter Monday to HHS Secretary Alex Azar commenting on the agency’s recently released Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs.

One of the most noteworthy parts of the Blueprint involved the possibility of moving some drugs from Medicare Part B to Part D.

FAH wrote that it “opposes the move of any non-self-administered drugs provided in the hospital outpatient setting from Medicare Part B to Medicare Part D in light of patient safety and access risks, the risk of increased Part D premiums, and beneficiary financial burdens, and administrative and operational burdens.”

HHS also asked about the effects of a site neutral payment policy for physician-administered drugs.

“FAH opposes site neutral payment for drug administration procedures because it is inappropriate and unworkable, is inconsistent with the principles of a prospective payment system, and would negatively impact patient access and quality of care,” the comment letter states.

Another topic addressed by FAH was site neutrality between inpatient and outpatient settings. FAH noted the fundamental differences in the IPPS and OPPS that warrant disparate payment for drugs but also emphasized the importance of relying on a physician’s professional judgement to determine whether a patient should be treated in the inpatient or outpatient setting.  As such, the Federation argued, it would be fundamentally unfair to reduce hospitals’ payments given a hospital’s limited involvement with that determination.

The FAH comment letter also discussed possible “unintended consequences” when and if HHS attempts to regulate Pharmacy Benefit Managers (PBMs), especially if the agency is considering making changes to the Anti-Kickback Statute (AKS) discount safe harbor and the group purchasing (GPO) safe harbor.

“We caution that HHS should consider that various stakeholders across the health care supply chain, not simply PBMs, rely on these safe harbors to provide legal certainty for certain business arrangements that achieve lower costs for providers and Medicare beneficiaries.”

FAH also outlined for HHS changes that could be made to increase competition and pricing transparency.

You can read the complete comment letter by clicking here.

FAH, Coalition Write CMS in Support of Risk Adjustment Program

July 16, 2018 | FAH Policy Blog Team

Category: Affordable Care Act, Insurance

The Federation of American Hospitals along with 27 other provider and patient groups sent a letter to CMS Administrator Seema Verma today expressing apprehension about the suspension of the Affordable Care Act risk adjustment program.

“We are very concerned that this move will create further uncertainty in the marketplace, negatively impacting patients’ access to affordable and comprehensive coverage, and lead to higher premium increases next year,” the groups wrote.

On July 7th CMS announced it was suspending billions of dollars in payments related to the risk adjustment program. It protects insurers from unanticipated costs in the event that their enrollees are less healthy, as well as minimizes any incentives for insurers to target healthier individuals only for enrollment.

The groups urged the agency to reconsider the decision and possibly issue an expedited rule that would reinstate the payments.

You can click here to read the complete letter and find the list of groups who signed it.

FAH Welcomes Patrick Velliky, New Vice President of Legislation

June 29, 2018 | Chip Kahn

Category: FAH News

The Federation of American Hospitals is pleased to welcome Patrick Velliky to our team. Patrick will join FAH as Vice President, Legislation on July 2nd.

Patrick is a great addition to our advocacy staff. Having held leadership roles on Capitol Hill and in the private sector, he has gained a unique knowledge of health care issues and the legislative process – qualities that will bring tremendous value to our members.

Patrick got his start on Capitol Hill with Senator Arlen Specter. He went on to work in various capacities for Rep. Jim Renacci, including serving as his Legislative Director.

Patrick has also held positions at Humana, Inc. and most recently at Anthem, Inc., where he was the Director, Congressional Affairs.

Patrick is an alum of Bloomsburg University of Pennsylvania.

FAH Comments on FY2019 IRF and IPF Proposed Payment Rules

June 27, 2018 | FAH Policy Blog team

Category: HIT, Quality

Today, the Federation of American Hospitals (FAH) submitted comments to the Centers for Medicare & Medicaid Services (CMS) in response to the FY 2019 Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) proposed rule and the FY 2019 Inpatient Psychiatric Facilities (IPF) PPS proposed rule. 

IRF Proposed Rule

The FAH's comments on the IRF PPS proposed rule were highlighted by responses to CMS's proposal to remove the FIM™ Instrument from the IRF-PAI and undertake refinements to the Case-Mix Classification System in FY 2020. The FAH opposed CMS’s proposal due to data quality issues and lack of clinical validation and transparency in the process of refining the Case-Mix Classification System. These changes would introduce instability into the IRF payment system and could threaten access to IRF care for patients. The FAH recommended that CMS not move forward with the proposed changes in FY 2020 and instead examine and address the data quality issues reported. The FAH also recommended that CMS work with the provider community to ensure common understanding of the clinical measurement approach and solicit and address any concerns regarding the proposed system.

In addition, the FAH also provided comments in response to proposals affecting coverage requirements, high-cost outliers, wage adjustment, and the IRF Quality Reporting Program, as well as in response to CMS’s Request for Information on Promoting Interoperability and Electronic Healthcare Information Exchange. The FAH’s full comment letter can be viewed here.

IPF Proposed Rule

The FAH’s comments on the IPF PPS proposed rule were highlighted by responses to CMS’s proposals regarding wage index adjustments, IPF cost reporting, the IPF Quality Reporting Program, as well as in response to CMS’s Request for Information on Promoting Interoperability and Electronic Healthcare Information Exchange. The FAH’s full comment letter can be viewed here.

FAH Submits Comments to CMS on Proposed FY2019 IPPS & LTCH Payment Rule

June 25, 2018 | FAH Policy Blog Team

Category: Financing, HIT, Medicaid, Medicare, Quality, Rural, Transparency

Today, the Federation of American Hospitals (FAH) submitted comments to the Centers for Medicare & Medicaid Services’ (CMS) FY 2019 Inpatient Prospective Payment System (IPPS) proposed rule.  The FAH’s comments were highlighted by responses to CMS’s proposals on Medicare Disproportionate Share Hospital (DSH) payments, payments for new and costly CAR T-Cell therapy, CMS’s quality and payment reporting programs, interoperability, long-term care hospital policies, and price transparency.

Medicare Disproportionate Share Hospital (DSH) Payments

The FAH noted its support for CMS’s proposed policies and commended the Agency for its efforts over the past year to better define the costs of uncompensated care (UC) by including the cost of uninsured patient discounts into the definition of charity care while taking a number of administrative steps that will result in improving both the processes and data for UC-DSH disbursements.  The comments also note that while CMS has done much in the last year to cause the data to be more usable to distribute UC-DSH payments, CMS still needs to take steps to cause hospitals to more accurately report that data.  This includes further educating providers about the correct way to report and actually auditing the data rather than just preparing edits to identify gross aberrations in reported data. 

CAR T-Cell Therapy

The FAH recommended to CMS that the Agency provide for the applicable MS–DRG payment plus the blended average sales price (ASP) for substantially similar CAR T-cell therapies.  CAR T-cell therapy represents a significant medical advancement for beneficiaries who previously had limited to no treatment alternatives.  But, the FAH noted, because of the extraordinary drug costs, CAR T-cell therapy also threatens to disrupt IPPS reimbursement through underpayment of CAR T-cell therapy cases (particularly in rural markets) and/or the redistribution of payment from basic hospital services to CAR T-cell therapy drugs unless an adequate add-on payment is provided.  In order to preserve access to care while also maximizing price-based competition among CAR T-cell therapy drug manufacturers, the FAH recommended adoption of an alternative new-technology add-on payment that is set based on the blended ASP for substantially similar CAR T-cell therapy drugs.  Applying this add-on payment in FY 2019 will provide an opportunity for competition to reduce current prices, for CMS to develop experience with CAR T-cell therapy claims, and for Congress to explore any appropriate legislative approaches to CAR T-cell therapy payment, if appropriate and necessary.

Quality Payment and Reporting Programs

The FAH commended CMS for its proposed application of the Meaningful Measures initiative to the hospital inpatient quality reporting and pay-for-performance programs.  The FAH noted that prioritizing and reducing the number of quality measures across these programs addresses FAH’s previously expressed concerns about the burden of managing many measures and the unnecessary duplication of measures across programs.  The FAH also commented that, in its review of the hospital quality programs, it is appropriate that CMS takes a holistic approach to evaluate each of the pay-for-performance program measures in the context of all three programs (readmissions reduction, hospital-acquired conditions reduction, and value-based purchasing).

Promoting Interoperability Programs and Request for Information

The FAH expressed appreciation that the proposed modifications to the requirements that eligible hospitals and critical access hospitals (CAHs) must meet to demonstrate meaningful use of certified electronic health record technology (CEHRT) address concerns about the feasibility of operationalizing current requirements.  The FAH also expressed support for CMS’s desire to provide additional flexibility for eligible hospitals and CAHs and the focus on interoperability.  However, the FAH commented that while the proposed scoring changes are an improvement over retaining the current Stage 3 scoring requirements, it will take time to implement.  Thus, the FAH requested more flexibility to select measures, and asked that the points required for meeting meaningful use be adjusted to reflect these implementation issues.  Additionally, while noting its functionality, the FAH highlighted the concerns across stakeholders about API readiness, as well as the security of Application Programming Interfaces (APIs) and third-party applications.  The FAH urged CMS to work with the Office of the National Coordinator for Health Information Technology (ONC) to establish a trust framework for third party applications, including security standards, terms of use, and an overall validation process.

In response to the Proposed Rule’s Request for Information on promoting interoperability, the FAH noted its long support for efforts to achieve comprehensive interoperability and data liquidity.  However, the FAH commented that it does not support the proposed revision of the Conditions of Participation (CoPs), Conditions for Coverage (CfCs), and Requirements for Participation (RfPs) related to interoperability and the exchange of health information.  The FAH cautioned that the ecosystem is simply not mature enough to facilitate the movement of this information, as evidenced by the obstacles that currently prevent seamless information exchange and would make it exceedingly difficult for hospitals and other providers to comply with the requirements.  For example, post-acute providers and behavioral health providers have not been able to adopt Health IT to the extent of hospitals and CAHs because they were ineligible for the Electronic Health Record (EHR) Incentive Programs under the Health Information Technology for Economic and Clinical Health (HITECH) Act.  As an alternative, the FAH recommended that CMS permit the numerous public and private initiatives in this area, some of which are nascent, time to mature and advance our shared goals.

Long-Term Care Hospitals (LTCHs)

The FAH expressed support for CMS’s proposal to eliminate the 25% Rule, noting that the 25% Rule deters the admission of patients who are otherwise appropriate for the LTCH level of care, arbitrarily caps the number of patients an LTCH can admit from any hospital yet still receive a full payment, and thus interferes with the normal LTCH admissions process.  While expressing support for the elimination of the 25% rule, the FAH expressed its strong opposition to the application of a 0.9% permanent budget neutrality adjustment.  The FAH noted that the LTCH patient criteria and site neutral payment rate already serve as a true functional replacement for the 25% Rule, and CMS has not previously applied such an adjustment in connection with multiple statutory and regulatory moratoria on the rule.

Additionally, the FAH expressed strong disagreement with CMS's proposal to apply a budget neutrality factor to LTCH site neutral cases that qualify for high cost outlier payments.  As the FAH explained in previous years’ comments, this budget neutrality adjustment is duplicative and unwarranted because CMS has already applied budget neutrality adjustments to reduce the operating and capital portions of the IPPS standard Federal payment rate before using that rate to determine the IPPS comparable per diem amount for site neutral payment cases.

Price Transparency

The FAH expressed support for CMS’s efforts to require hospitals to make available a list of their current standard charges via the internet in a machine-readable format and to update this information at least annually, or more often as appropriate, noting that many hospitals already comply with this requirement, either voluntarily or because it is required under state law. 

While the FAH offered its support for efforts to ensure that consumers have clear, accessible, and actionable information concerning their cost-sharing obligations, the FAH also expressed concern that CMS is considering avenues for providing this information that focus exclusively on hospitals when payers—insurers, group health plans, Medicare, Medicare Advantage organizations, and others—are best suited to provide actionable coverage and cost-sharing information for all providers and suppliers involved in an episode of care.  The FAH commented that payers understand the full range of benefits under a patient’s applicable health coverage and cost-sharing obligations (including out-of-pocket spending limits, deductibles, coinsurances, and any reference-based pricing strategies used by the plan) and, because an episode of care typically involves multiple providers and suppliers, the payer is the only entity that is capable of providing a patient with an accurate and actionable estimate of their potential financial exposure for the entire episode of care.  As such, the FAH expressed that hospitals are simply not the appropriate entity to be tasked with interpreting and explaining a patient’s cost-sharing obligations under a particular plan. 

In addition, the FAH continued to recommend that CMS adopt the “surprise billing” section of the National Association of Insurance Commissioners’ (NAIC) Health Benefit Plan Network Access and Adequacy Model Act (Model Act) as a robust way to address the issue of surprise billing.  The FAH commented that this policy provides real protection for patients and strikes the right balance between the roles and responsibilities of hospitals, providers, and plans in situations in which a patient seeks care at an in-network hospital and may be treated by a provider who is not covered by the patient’s plan.

The FAH’s full comment letter can be viewed here.

Hospital Funding Study Sponsored by FAH, AHA Grabs Headlines

June 21, 2018 | FAH Policy Blog Team

Category: FAH News, Financing

A new analysis showing that the cumulative reductions in federal payments to hospitals since 2010 will top $218 billion by 2028 continues to grab headlines in leading healthcare publications.

The study from the health economics consulting firm Dobson | DaVanzo and Associates examined how eleven pieces of legislation combined with numerous regulatory changes would affect hospital funding from 2010 through 2028. It was commissioned by the Federation of American Hospitals (FAH) and the American Hospital Association (AHA).

Publications from across the health care sector covered the study’s release.

Politico’s influential Morning Pulse e-newsletter wrote about the report and shared a link to the related infographic.

Healthcare Dive gave unique context to the study’s findings:

“Despite millions of newly insured Americans since the Affordable Care Act (ACA), which helped reduce uncompensated care, other actions from Washington, D.C., have taken money from hospitals. These cuts haven’t been isolated to healthcare legislation. Hospitals have seen reimbursements hit in federal budget bills and legislation that focused on other areas, such as military retirees, tax relief and jobs.”

Becker’s Hospital Review focused on the areas being cut the most:

“The study investigated how new healthcare legislation and regulatory changes have changed hospital funding over time. The study found the three biggest contributors to the payment reductions were $79.3 billion from changes with MS-DRG documentation and coding; $73.1 billion due to federal budget sequestration; and $25.9 billion from lower Medicaid disproportionate share hospital payments.”

Inside Health Policy highlighted the quote from FAH President and CEO Chip Kahn:

“$218 billion is not just a number; the funding reductions it reflects have real world consequences for patients. Losses of this significance simply cannot be sustained and will affect the ability of hospitals to meet the expectations of the patients and communities we serve.”

You can view the entire report by clicking here.

Federation Leaders Named on “Most Influential Physician Executives” List

June 18, 2018 | FAH Policy Blog Team

Category: FAH News

Modern Healthcare Magazine’s most recent edition recognized the 50 most influential Physician Executives and Leaders 2018 and included on the list are two leaders at FAH member companies.

Jonathan Perlin, President of clinical services and chief medical officer at HCA Healthcare, and Anthony Tedeschi, CEO of Tenet Healthcare’s Detroit Medical Center, were honored by the magazine.

Modern Healthcare says it aims to recognize “physicians working in all sectors of the healthcare industry who are steering their organizations and the healthcare delivery system through dynamic, challenging times. These physicians stand out for the scope of their executive responsibilities, personal achievements, innovation and commitment to their communities.”

Editors pointed out Perlin’s work on fighting infections, as well as his efforts to expand the use of big data:

“Among Perlin's recent achievements was a landmark study that resulted in a 44% improvement in bloodstream infections. It's a continued recognition of the work Perlin does with the clinical services team to pursue best practices across HCA. He also led a project to boost HCA's use of data analytics. Perlin this fall will join the influential Medicare Payment Advisory Commission.”

The magazine touted Tedeschi’s leadership in revitalizing Detroit Medical Center:

Tedeschi took over as CEO in January 2017 and has been embarking on a reorganization. Detroit Medical Center has allocated $50 million in capital investments with an eye toward improving access to care and services for the community. He's also called on the organization to try and achieve zero preventable harm events in 2018.”

You can view Modern Healthcare’s 50 most influential Physician Executives and Leaders 2018 list here. Congratulations to all of this year’s honorees.

New Report Shows Cumulative Hospital Cuts Top $218 Billion

June 14, 2018 | FAH Policy Blog Team

Category: Affordable Care Act, Financing, Medicaid, Medicare

The cumulative reductions in federal payments to hospitals since 2010 will reach $218.2 billion by 2028, according to a report released today by the health economics consulting firm Dobson | DaVanzo and Associates.

The study, which was commissioned by the Federation of American Hospitals (FAH) and the American Hospital Association (AHA), examined how eleven pieces of legislation combined with numerous regulatory changes would affect hospital funding from 2010 through 2028.

The leaders of FAH and AHA reacted to the results.

“$218 billion is not just a number; the funding reductions it reflects have real world consequences for patients. Losses of this significance simply cannot be sustained and will affect the ability of hospitals to meet the expectations of the patients and communities we serve. It is critical that going forward policymakers recognize this fact and work with hospitals so we can continue to deliver the 24/7 care Americans deserve,” said Chip Kahn, FAH President and CEO.

AHA President and CEO Rick Pollack added, “Continued cuts of this magnitude represent a troubling trend for hospitals and health systems as many struggle with declining reimbursements for services provided in and out of the hospital. As noted in other recent reports, Medicare margins have hit a ten-year low and almost a third of hospitals now have negative aggregate margins across all payer types. Additional reductions will create challenging and potentially unsustainable financial circumstances that could adversely impact patients’ access to care and the ability of hospitals to provide services.”

A complete copy of the Dobson | DaVanzo study can be found on here. You can also view a newly updated infographic here.

HCA’s Dr. Jon Perlin Receives Prestigious National Health Care Award

June 14, 2018 | FAH Policy Blog Team

Category: FAH News

Dr. Jonathan Perlin, president, clinical services and chief medical officer at HCA Healthcare received B’nai B’rith International’s 2018 National Healthcare Award on Thursday for a career of service to the medical community and patients in the United States and around the globe.

For more than three decades, B’nai B’rith has given out this award to recognize exceptional trailblazers in the health care industry.  

“Dr. Jonathan Perlin has been instrumental in advancing health care, as he advocated for implementing electronic health records to connect and improve patient care across the nation. B’nai B’rith and I are very proud to honor Jonathan with this award,” B’nai B’rith International President Gary P. Saltzman said.

Dr. Perlin has served as the president, clinical services and chief medical officer of Nashville-based HCA Healthcare, Inc. since 2006. He provides leadership for clinical services and improving performance at 178 hospitals and approximately 1,800 sites of care, including surgery centers, freestanding ERs, urgent care centers and physician clinics, in 20 states and the United Kingdom.

Dr. Perlin also works closely with the Federation of American Hospitals (FAH), taking what he has learned in the field to policy makers in DC. Ultimately, this leads to the creation of guidelines that helps patients nationwide.

FAH President and CEO Chip Kahn, a past winner of the B’nai B’rith National Healthcare Award, has gotten to know Dr. Perlin professionally and personally, as the two have worked on several important civic projects together.

“Dr. Perlin has had a magnificent, storied career and has left a mark that he can be proud of, that has made a difference in the life and health care of so many, and exemplifies why he deserve this high honor.

Before joining HCA, Dr. Perlin served as Under Secretary for Health in the U.S. Department of Veterans Affairs.

Other important roles include, 2015 chairman of the American Hospital Association and inaugural chair of the U.S. Department of Health and Human Services Health IT Standards Committee.

“Between his time at HCA Healthcare and his work with the Veterans Health Administration, it’s quite an honor to bestow this prestigious award upon Jonathan. His work with our nation’s veterans is incredible, and his dedication and passion for the health care industry is inspiring,” B’nai B’rith International CEO Daniel S. Mariaschin said.

​According to the organization, recipients of the B’nai B’rith National Healthcare Award have shown a history of dedicated leadership and outstanding civic involvement in the health care field and in the broader community. Award winners support philanthropic causes benefiting health, youth, seniors and education programs.
 
For more information on Dr. Perlin’s career and the National Healthcare Award – click here.

Hospitals Improving Patient Safety, but Quality Program Needs Overhaul

June 11, 2018 | FAH Policy Blog team

Category: Quality

Hospitals are dedicated to providing safe care to the communities they serve.  They have been working tirelessly to make patients safer by reducing hospital-acquired infections and it is paying off. But despite the success, some hospitals are still being penalized by a system that doesn’t recognize recent trends in improvement.

A recent report from the Agency for Healthcare Research and Quality (AHRQ) indicates that between 2014 and 2016, hospital acquired conditions were reduced nationwide by 8 percent.  AHRQ calculated that this reduction of 350,000 hospital-acquired conditions helped prevent an estimated 8,000 deaths and saved $2.9 billion over a period of two years.  This is a testament to the efforts of community hospitals in making care safer.

Much of the improvement can be attributed to the Partnership for Patients, which was launched in 2011 as a public-private partnership with a shared goal to help improve the quality, safety and affordability of health care of Americans.  The Federation of American Hospitals along with other hospital groups, and associations joined with CMS to form this alliance and one of the main goals is a 20% reduction in all-cause patient harm through the prevention of HACs. 

Our progress is evident, but in an odd twist, the Partnership’s success has highlighted the need for CMS to overhaul its HAC Reduction Program.

Currently, the HAC Reduction Program bases penalties on what is called a “tournament” model.  This “tournament” model, ranks hospitals relative to each other and penalizes those in the bottom ranks.  When it comes to HACs, facilities in the bottom 25th percentile receive a penalty of 1% of their IPPS payments.  Comparing hospitals to each other with no performance target means that even if a hospital is performing at a high level and has zero harm events, it could still be penalized.

This system simply isn’t fair. By not rewarding or fostering collaboration among hospitals, it goes against everything the Partnership stands for.

Hospitals are holding up their end of the deal. Our cooperation is leading to sustained improvement nation-wide. That is why it is time for policymakers to seriously consider shifting away from the competitive approach of tournament models and instead transition into a program that prospectively sets performance targets.  Let’s not risk penalizing high performers whose dedication to patient safety and commitment to the Partnership continues to help save lives.

FAH, 45 Other Groups Urge Senators to Pass CREATES Act

June 07, 2018 | FAH Policy Blog Team

Category: FAH News, Legislation, Medicare, Pharmaceuticals

A wide ranging coalition of 46 groups, that include FAH, from across the health care spectrum sent a letter today to leaders of the Senate Judiciary Committee urging swift action on the Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act (S. 974).

The legislation is a bipartisan, market-based reform that will speed the introduction of generic and biosimilar competition for brand-name drugs.

The letter lays out the case for the bill saying, “It is a highly-targeted remedy that will end the anticompetitive abuses utilized by some brand-name manufacturers, help restore the balance between innovation and affordability that Congress intended, and achieve the goal of more affordable prescription drugs. The Congressional Budget Office has estimated that enacting the CREATES Act would save $3.8 billion over ten years.”

You can read the entire letter by clicking here.

FAH Submits to CMMI's Direct Provider Contracting Model Request for Information

May 30, 2018 | FAH Policy Blog Team

Category: FAH News, Medicaid, Medicare

Late last week, the FAH submitted comments to the Center for Medicare and Medicaid Innovation (CMMI) on a Request for Information (RFI) it issued on a Direct Provider Contracting (DPC) model it is considering.  The DPC RFI outlines a new type of model where CMS suggests it could contract directly with participating physician practices to establish those practices as the main source of care for primary care or other services for beneficiaries that voluntarily enroll. CMS considers the use of a fixed per beneficiary per month payment to cover the cost of these services with the expectation that the contracted physician practice would provide those services in a manner agreeable to both CMS and the physician practice.

The FAH urged caution with regard to implementing these types of arrangements, especially due to the potential for significant adverse impact on existing accountable care organizations (ACO) and other CMMI models. The FAH noted that given the time and resources that CMS, providers, and patients have devoted to improving and implementing CMS's existing models, it is imperative that CMS not only continue to devote energy and resources to these models but to also examine how they would be affected by the launch of a new model, in particular whether this new model would disrupt their operations and diminish their performance and potential. As such, prior to implementation of a new model, CMS should consider:

  • How would model overlap, hierarchy, and attribution issues be managed? These are areas that have required considerable collaboration between CMS and providers, and the introduction of a new model such as the DPC model could compound them significantly.
  • How would the DPC model and similar type models impact participation in existing models? How could patient attribution to new models undermine the success of existing models? For example, it is clear from recent public statements that CMS is interested in pushing the pace of ACOs taking greater levels of financial risk. How will CMS assure providers interested in greater risk that new models will not undermine their investment, by for example, cherry-picking patients?
  • How does CMS plan to allocate finite resources to manage existing and new models? CMS's administrative resources are not limitless, and the obligations associated with deploying a new model could result in additional issues with data timeliness, responsiveness, and priority updates for current models.

Given these considerations, the FAH believes CMS is better served in the short-term by devoting its energy and resources to existing models, incorporating a number of the proposals in the DPC RFI into its existing models, and determining how it can build off of the existing models to further reform care delivery.

The FAH's comment letter can be viewed here.

Rural Health Center Stage at Senate Hearing

May 25, 2018 | FAH Policy Blog Team

Category: Financing, Rural

At a Senate Finance Committee hearing held today, witnesses and legislators examined the issues surrounding access to health care in rural communities.

Before the hearing started, FAH President and CEO issued a statement emphasizing the importance of rural care:

"Hospitals are the foundation of health care in small communities from coast to coast. With a hospital close by rural Americans have access to timely, quality care and frequently depend on that hospital as their sole source of care.

"We appreciate the Senate Finance Committee convening today's hearing not just to draw attention to the many challenges rural health care faces, such as hospital closures - but to explore opportunities that can improve people's lives, like expanding the implementation of telehealth.

"This hearing is an important first step. We look forward to working with the Congress to ensure rural families have access to care close to home, when and where they need it most."

One topic that was brought up by Senators and witnesses - free-standing emergency rooms.  

In his opening remarks, Chairman Orrin Hatch (R-UT) cited an April recommendation from the Medicare Payment Advisory Commission to pay free-standing EDs more than 35 miles from other hospitals an annual fee to aid fixed overhead costs on top of their standard reimbursement rate.

Legislation from Sen. Chuck Grassley (R-IA), meanwhile, would create a new Rural Emergency Hospital classification, doing away with hospitals' need to maintain costly inpatient beds to be paid under Medicare.

You can read witness testimony and watch video of the hearing by clicking here.

 

FAH Leader Calls Senate Hearing On Rural Health Care “Important Step”

May 24, 2018 | Chip Kahn

Category: Rural

“Hospitals are the foundation of health care in small communities from coast to coast. With a hospital close by rural Americans have access to timely, quality care and frequently depend on that hospital as their sole source of care.

“We appreciate the Senate Finance Committee convening today’s hearing not just to draw attention to the many challenges rural health care faces, such as hospital closures – but to explore opportunities that can improve people’s lives, like expanding the implementation of telehealth.

“This hearing is an important first step. We look forward to working with the Congress to ensure rural families have access to care close to home, when and where they need it most.”

To learn more about the hearing, click here

FAH Leader Supports Passage of VA MISSION Act

May 23, 2018 | Chip Kahn

Category: FAH News, Legislation

“As we prepare to remember on Memorial Day those who gave the ultimate sacrifice, it is important to take care of the veterans who made it home. This legislation does that by making it easier for the medical community to serve those who have served us.

“The VA MISSION Act expands the health care network for our veterans by eliminating confusing eligibility rules and opening greater access to telehealth services. These and several other components of the legislation will give veterans greater access to care outside of the VA’s traditional medical network.

“Our hospitals are honored to serve veterans, and we look forward to a continued and invigorated partnership with the VA to ensure America’s heroes receive the care they deserve.”

You can find a summary of the legislation from the House Committee on Veterans’ Affairs here.

FAH Outlines Issues with Proposed Medicaid Access Rule

May 23, 2018 | FAH Policy Blog Team

Category: Health Care Delivery, Medicaid

In a letter sent today to CMS Administrator Seem Verma, the FAH outlines several concerns with policies contained in the Medicaid Access Proposed Rule.  Under current Medicaid law, states are required to assure that Medicaid payments are "consistent with efficiency, economy, and quality of care are sufficient to enlist enough providers so that care and services are available....."  In November 2015, CMS finalized regulations requiring states to use a process to document compliance with the legal standard for demonstrating sufficient payment.  The Proposed Rule issued by CMS and which the FAH commented on today, would inappropriately loosen those requirements.  

Areas highlighted in the letter include:

Disproportionate Impact on Vulnerable Beneficiaries

As many as 18 states would be exempt from current access monitoring requirements because at least 85% of their Medicaid enrollees are enrolled in comprehensive Medicaid managed care plans.

The letter states, "In FAH's view, current regulations are the minimum requirements in assuring states carefully consider the impact of states' policies on access. They require data, comparisons across different types of insurers and geographic areas, ongoing monitoring of rate changes and public feedback. Those activities continue to be critical for enrollees who receive their care through fee for service (FFS). We urge CMS to not finalize the exemptions for states with high managed care enrollment."

"Nominal" Rate Reductions

Under the Proposed Rule, states implementing rate reductions below 4% in one year and 6% over two years would be exempt from access monitoring requirements and they would not need to seek public input on those rate reductions. In the Proposed Rule's preamble, CMS calls these "nominal" changes.

"If finalized, this threshold would allow a state to implement a 12% rate reduction over a period of 4 years or a 16% rate reduction over a period of 5 years without requirements for ongoing monitoring of the impact of the rate changes on access services. We believe that the imposition of rate reductions of those magnitudes is far from 'nominal' and the results of such reductions could be devastating for ensuring beneficiaries in the FFS delivery system have access to Medicaid services."

Loss of Information

Under the Proposed Rule, states meeting the high managed care enrollment thresholds would no longer have to provide to CMS certain types of information, data or assumptions regarding its evaluation of access, including comparisons of rates among payers, analyses of access within geographic areas, and projections of the impact of rate reductions on access.

"The new rules would represent a major loss of information that may otherwise be used by CMS for overseeing the Medicaid program and assuring the programs are operated consistent with statutory requirements to assure access."

You can find the complete letter here.

May is Mental Health Awareness Month

May 23, 2018 | FAH Policy Blog Team

Category: FAH News, General, Media

Everyone is going through something. SNL actor Pete Davidson, singer Mariah Carey, and NBA star Kevin Love are just three of the 43.7 million Americans who experience a mental health condition each year, according to Mental Health America.

However, statistics show only 1 in 5 people living with mental illness will receive treatment. It’s time to end the stigma surrounding a mental illness diagnosis. 

FAH and its member companies are joining other health care industry leaders to bring awareness to the numerous treatment options available to help those suffering from depression, anxiety, schizophrenia, bipolar disorder, Post Traumatic Stress (PTSD) and other disorders.

The theme this year “Fitness #4Mind4Body” is shining a light on the mind-body connection which recognizes that our thoughts, feelings, and emotions have an effect on our biological functions. The theme is encouraging healthy habits like exercising regularly, reducing screen time throughout the day, and taking time to breathe intentionally. Most importantly, it’s highlighting the importance of getting help when you or a loved one needs it.

May is the month to get involved. Check in on your mental wellness using this screening tool from Mental Health America and pledge to start a new healthy habit. Tell us what it is and join the conversation using #MHAM #MHS2018 and #4Mind4Body.

FAH Leaders Nominated for Modern Healthcare’s “100 Most Influential” List – Vote Now!

May 22, 2018 | FAH Policy Blog Team

Category: FAH News

Every year, Modern Healthcare magazine honors industry leaders in its “100 Most Influential People In Healthcare” list. This annual ranking is based upon input from Modern Healthcare readers and the magazine’s senior editors.

This year, the FAH is proud to announce that Modern Healthcare’s list of 300 nominees includes 10 leaders from our membership, as well as FAH President & CEO Chip Kahn.  Voting is underway and will continue through June 12th.  We encourage everyone to place their vote by clicking here so we can acknowledge the great work of our industry’s leaders.

FAH leaders nominated for the 2018 “100 Most Influential People In Healthcare” list are:

  • Benjamin Breier, President and CEO, Kindred Healthcare
  • William Carpenter , Chairman and CEO, LifePoint Health
  • Dr. Ralph de la Torre, Chairman and CEO, Steward Health Care
  • R. Milton Johnson, Chairman and CEO, HCA Healthcare
  • Chip Kahn, President and CEO, Federation of American Hospitals
  • Alan Miller, Chairman and CEO, Universal Health Services
  • Dr. Jonathan Perlin, President, clinical services and chief medical officer, HCA Healthcare
  • Ronald Rittenmeyer, Executive chairman and CEO, Tenet Healthcare Corp.
  • Wayne Smith, Chairman and CEO, Community Health Systems
  • Mark Tarr, President and CEO, Encompass Health Corp.
  • Dr. Tony Tedeschi, CEO, Detroit Medical Center

You can learn more about Modern Healthcare’s awards on its recognition page.  Voters are required to vote for exactly five nominees.  Don’t forget to vote now!

FAH Members Included on Becker’s 100 Great Leaders in Healthcare List

May 16, 2018 | FAH Policy Blog Tean

Category: FAH News, General, Media

Becker’s Healthcare released its 100 Great Leaders in Healthcare list this week and it includes three people from FAH member companies.

Bill Carpenter, Chairman and CEO of Lifepoint Health, Milton Johnson, Chairman and CEO of HCA, and Marsha Powers, Senior Vice President and Chief Strategy Officer of Tenet Healthcare, were each honored by Becker’s.

The story about the list states, “By working to improve the quality of care and solve the toughest problems in healthcare today, the following leaders have clearly made their mark.”

In describing Bill Carpenter, the article says:

“Mr. Carpenter has been a force in the healthcare arena for more than 30 years. After serving as a healthcare attorney, he left his practice in 1999 to become one of the founding employees of LifePoint Health. He was named CEO in 2006 and system chairman in 2010. Today, under his tutelage, LifePoint boasts a portfolio of 71 hospital campuses, physician practices, outpatient centers and post-acute care facilities across 22 states. To recognize his contributions to the Nashville community, Operation Andrew Group awarded him the 2017 Joe and Honey Rodgers Christian Civic Leadership Award.”

Becker’s highlighted, not only Milton Johnson’s work at HCA, but his efforts in the community and with industry groups, like FAH:

“Mr. Johnson leads the $41.5 billion Hospital Corporation of America, which provides about 5 percent of hospital services in the U.S. The organization encompasses 179 hospitals, 120 freestanding surgery centers and 240,000 employees. HCA estimates its cash taxes were reduced about $500 million for 2018 as a result of the Tax Cuts and Jobs Act, and Mr. Johnson plans to reinvest the expected savings into HCA's markets and workforce development. He also serves as chairman of the Federation of American Hospitals, the Nashville Chamber of Commerce and The HCA Foundation, and serves on the boards of the Center for Medical Interoperability, the Nashville Health Care Council and the United Way of Metropolitan Nashville.”

The article touted Marsha Powers’ work on the state and local level and mentioned her being honored with FAH’s Corris Boyd Leadership Award in 2016:

“A veteran healthcare executive with more than 30 years of experience, Ms. Powers joined Tenet in 2007 and has served as CEO of both its Florida Region and Eastern Region-Coastal Division, where she oversaw the direction, strategy and operations for 17 hospitals. In her current position, Ms. Powers exhibits a talent for developing high-quality, niche healthcare programs while focusing on market share growth, physician recruitment and quality patient care. For her valuable leadership, she was awarded the 2016 Federation of American Hospitals Corris Boyd Leadership Award and recognized as a Power Leader by South Florida Business Journal.”

You can view Becker’s Healthcare’s 100 Great Leaders in Healthcare list here. Congratulations to all of this years honorees.

Coalition Asks Key Committee to Support Limited Repeal of IMD Exclusion

May 16, 2018 | FAH Policy Blog Team

Category: General, Medicaid

FAH joined a coalition of other care providers in asking leaders of the House Energy and Commerce Committee to include in their legislative effort to combat the opioid epidemic a bill entitled “The Limited Repeal of the IMD Exclusion for Adult Medicaid Beneficiaries with Substance Use Disorder Act.”

This bill would improve access to needed substance use disorder (SUD) treatment services for millions of Americans.

Since 1965, the Institutions for Mental Diseases (IMD) exclusion has prohibited federal payments to states for services for adult Medicaid beneficiaries between the ages of 21 and 64 who are treated in facilities that have more than 16 beds, and that provide inpatient or residential behavioral health – SUD and mental illness – treatment. The discriminatory IMD policy was established at a time when SUDs were not considered medical conditions on the same level as physical health conditions. Today, we know that SUD is a brain disease and that successful treatment requires access to the full continuum of care – namely, inpatient care, partial hospitalization, residential treatment and outpatient services.

The coalition sent a letter to E&C leaders that states, “Different types of patients require different clinical services from across the care continuum. The IMD exclusion currently excludes critical elements of that care continuum…Investing only in outpatient care and failing to provide states with relief from the IMD exclusion would continue to deny many of these patients access to the most clinically appropriate care.”

The letter, which can be found here, was signed by FAH, AHA, America’s Essential Hospitals, Association of American Medical Colleges, Catholic Health Association of the United States, National Association for Behavioral Healthcare, Premier healthcare alliance and Vizient, Inc.

Federation Leaders Named to Top COOs List

May 10, 2018 | FAH Policy Blog Team

Category: FAH News

Modern Healthcare’s most recent edition recognized the Top 25 COOs in Health Care 2018 and included on the list are two leaders at FAH member companies.

Sam Hazen, the President and Chief Operating Officer at HCA Healthcare, and Kent Wallace, Executive Vice President and Chief Operating Officer at Kindred Healthcare, were honored by the magazine.

As the article about the list states, “the COO needs a diverse set of skills that encompasses clinical, operating, financial and logistical know-how. And as vertical integration becomes increasingly popular, the COO carries the heavy load of centralizing operations and standardizing practices while maintaining work culture and philosophy.”

Editors adding that the 25 leaders on the list “deftly maneuvered their organizations through the frenetic pace of change facing the industry.”

In describing Hazen Modern Healthcare wrote:

“Hazen serves as a president and COO of HCA Healthcare. He oversees operations that include 171 hospitals, 118 ambulatory surgery centers, and numerous outpatient facilities and physician practices across 42 domestic markets and in the United Kingdom. A 35-year veteran of HCA, Hazen has served in various senior positions such as president of operations from 2011 to 2015. He also served as president of HCA's Western Group, which included all operations west of the Mississippi River and represented about half of the company's revenue. He was named COO in 2015 and added the president title a year later. HCA in March signed a letter of intent to acquire six-hospital Mission Health, based in Asheville, N.C.”

The magazine touted Kent Wallace’s varied experiences:

“Wallace has served as executive vice president and COO at Kindred since February 2015. Kindred reported $6 billion in revenue in 2017. The post-acute provider operates nearly 2,700 facilities--long-term care, rehabilitation, home health and more--in 46 states. Previously, Wallace was CEO of RegionalCare Hospital Partners, a Brentwood, Tenn.-based operator of community hospitals, for almost eight years. He also served as president and COO of Vanguard Health Systems, where he helped develop the company's integrated-care market strategy, and held leadership roles at Province Healthcare Co., Tenet Healthcare Corp. and HCA Holdings. Humana and private equity firms TPG Capital and Welsh, Carson, Anderson & Stow have proposed a $4.1 billion acquisition of Kindred.”

You can view Modern Healthcare’s Top 25 COOs list here. Congratulations to all of this years honorees.

FAH Leader Comments on CMS’ New Rural Health Strategy

May 08, 2018 | Chip Kahn

Category: Medicaid, Medicare, Rural

Providing health care for rural Americans comes with unique challenges. It frequently will require unique solutions.

FAH and our members have long advocated for assuring the more than 60 million people who live in rural areas have access to timely, quality care. Advancing the use of telehealth, tailoring Medicare and Medicaid programs to better serve small communities and the other objectives laid out by CMS today will ultimately help patients and those hospitals that serve them.

We are pleased that CMS is embarking on this new initiative and look forward to partnering with the agency to achieve these important goals which are so critical to the health of rural Americans.

You can view the CMS Rural Health Strategy Fact Sheet by clicking here.

FAH Celebrates 2018 National Hospital Week

May 07, 2018 | FAH Policy Blog Team

Category: FAH News, General, Media

This week, FAH and its member companies are joining other health care industry leaders to celebrate hospital week.  A time when we express our appreciation for the more than 5,000 community hospitals across our country. 

Each year, we take this week to show our gratitude to the dedicated physicians, nurses, therapists, clinicians, engineers, custodial workers, food service workers, volunteers, and administrators who keep hospitals operating all day, every day to care for anyone who walks through their doors. 

In line with this year’s theme, “Caring is our Calling” we are highlighting many of the different types of hospitals that exist in our communities.  We are celebrating the hospitals and caregivers who are healing our veterans as they return home from service, teaching our next generation of providers, and assisting those of us recovering from serious illness thrive at home.

These hospitals are not just filling a vital role in the wellbeing of our communities, they are economic pillars providing jobs to our friends and neighbors and millions of people across the country.

This year’s celebration began on May 6th and will last through May 12th, Florence Nightingale’s birthday.  The FAH extends its gratitude to the dedicated and compassionate professionals who care for millions of patients each day.  Please join us this week by using #HospitalWeek to join in on the conversation.

FAH Leader Supportive of IPPS Proposed Rule

April 25, 2018 | Chip Kahn

Category: Financing, Medicare, Transparency

The newly released IPPS Proposed Rule goes a long way to putting patients first.

We appreciate CMS’s efforts to empower patients with information about their medical records and costs of care. The proposed increase in critically needed funds to treat the uninsured as well as the reduction in regulatory burden will also help enhance access to quality care for all patients.

FAH Submits Comments on Short Term Insurance Proposed Rule

April 24, 2018 | FAH Policy Blog Team

Category: Affordable Care Act, Insurance

The Federation of American Hospitals submitted comments today on CMS’s proposed rule changing the definition of short-term, limited duration (STLD) insurance outlining how the changes would harm consumers and destabilize insurance markets.     

Under the proposed rule, the definition of a STLD plan would be changed from a plan with an expiration date that is less than 90 days to one with an expiration date that is less than 12 months after the original effective date – meaning a short-term plan could last as long as 364 days.

In the letter FAH wrote, “Consequently, under the proposed rule, it is likely that many consumers may be attracted to the lower costs offered by STLD plans and/or misunderstand their limitations, only to find that their coverage is ridden with gaps, leaving them without coverage for needed services and exposed to significant out-of-pocket costs. Moreover, FAH members and the health care providers that care for these individuals are concerned that the result will be increased uncompensated care, particularly for patients who need uncovered services or treatment for pre-existing conditions.”

FAH also highlighted the negative effects the proposed rule would have on insurance markets.

“By allowing the STLD plans to be available for the same duration as ACA-regulated products, more people are expected to enroll in such plans. Those who enroll, however, would likely be only those with the lowest likelihood of health needs and expensive treatment. Older adults and people with preexisting conditions would remain in the ACA-regulated individual health insurance market, creating additional instability in that market. Coverage of hospital services could be greatly compromised, leading to increasing numbers of underinsured individuals and rising hospital bad debt.”

You can read the entire comment letter by clicking here.

FAH, Member Company Participate in Red Tape Relief Roundtable

April 13, 2018 | FAH Policy Blog Team

Category: FAH News, Health Care Delivery, Medicare

The House Ways and Means Health Subcommittee held a Red Tape Relief Initiative roundtable earlier this week focused reducing regulatory burdens on hospitals.

Committee leaders framed this as a unique chance for Members to hear from industry professionals about how Congress can improve Medicare so that it works more effectively for both patients and medical providers.

FAH President and CEO Chip Kahn was there alongside Dr. Christopher Ott, HCA Physician Services Group’s chief medical officer.

Dr. Ott addressed the bipartisan group of Committee Members highlighting two main Medicare issues – the redesign of the programs hospital value-based programs and MedPAC’s recent recommendations regarding standalone emergency department (ED) services.

In regard to hospital value-base programs, Dr. Ott pointed out that FAH general supports efforts to reduce the number of measures, eliminate burden and focus on measures that are meaningful to patients and providers. However, he pointed out that many quality measures are behind the times.

When discussing MedPAC’s recent stand-alone ED policy recommendations, Dr. Ott supported the flexibility given to rural facilities, but outlined serious concerns with the possible rules for urban EDs. He told legislators that the proposed changes could lead to diminished access points and treatment options for patients.

Many of the points highlighted by Dr. Ott are echoed in a letter FAH sent to Ways and Means Committee leaders last year on the topic of red tape relief. You can read that complete letter here.

The roundtable is part of the three part process outlined by the committee that is supposed to ultimately culminate with Congressional action.

FAH Affiliated Hospital Named to “Top Places to Work in Healthcare” List

April 13, 2018 | FAH Policy Blog Team

Category: FAH News, Health Care Delivery

Becker’s Hospital Review recently released its 2018 list recognizing the top places to work in healthcare.  Ardent Health Services' Bailey Medical Center  in Owasso, Oklahoma was included in the list which “highlights hospitals, health systems and healthcare companies that promote diversity within the workforce, employee engagement and professional growth.” As a 73-bed acute care hospital, Bailey Medical Center was recognized with Ardent Healthcare's Ardent Cup as an outstanding facility four times from 2012 to 2017, and it earned a five-star CMS rating in 2017. Some of the hospital's unique employee benefits include up to $2,500 in coverage of weight loss surgery, an annual free health screening that helps participants receive discounts on their premiums, and a health advocate program to help employees and their families navigate medical claims issues, negotiate fees for noncovered services and find elder care services.  You can view the entire list here.

FAH Responds to Senate Request about Health Care Price and Information Transparency

March 23, 2018 | FAH Policy Blog Team

Category: Transparency

Today, FAH submitted a letter in response to a request from Senators Cassidy, Bennet, Grassley, Carper, Young, and McCaskill. The Senators recently launched a bipartisan effort to increase health care price and information transparency to empower patients, improve quality, and lower costs. The letter notes FAH members’ support of efforts to promote transparency and provide information to enhance consumer choice and offered principles for Congress to consider regarding the release of such information. This information is not only important for consumers prior to receiving medical services, but also is important when they are selecting their health insurance coverage; and it should be clear, accessible, and actionable and focus on what patients want and need to know – their out-of-pocket costs and their provider networks. It should also be coupled with quality information so consumers can make informed decisions based on both the cost and quality of care. The letter makes numerous recommendations for improving quality measurement and public reporting, including with regard to the Star Ratings Program and the use of electronic health records (EHRs).

For insured patients, insurers are in the best position to provide pricing information to their enrollees as they have access to information about the entire episode of care. Additionally, FAH recommends adoption of the “surprise billing” section of the National Association of Insurance Commissioners’ (NAIC) Model Act. The NAIC model protects insured patients from surprise bills when they receive services in an in-network hospital but some of those services are delivered by an out-of-network physician. For uninsured consumers, health care providers and state databases are sources of pricing information, recognizing that there are limitations to this information due to the involvement of multiple providers in an episode of care and the uniqueness of each patient. The letter also cautions against the release of negotiated rates between insurers and providers, as such information is not useful or actionable for patients and could have anticompetitive effects.  

Lastly, the letter notes the extraordinary number of regulatory requirements with which hospitals must comply and recommends actions Congress and the Administration could take to lessen these requirements and improve health outcomes and efficiencies.

You can find a complete copy of the letter here.

Axios Vitals’ Report on Medicare Margins Misses Key Data Point from MedPAC Report

March 22, 2018 | FAH Policy Blog Team

Category: FAH News, Medicare

In a good report full of facts and figures, it is tempting to pick out one or two and claim they prove your point. Unfortunately, this morning’s (March 22nd) Axios Vitals selectively used data from MedPAC’s March Report to Congress to suggest that hospitals lose money on Medicare because they are inefficient. The blurb entitled “Let’s talk about hospitals’ Medicare margins” misses what is arguably MedPAC’s most compelling data point:  331 “relatively efficient” hospitals experienced a negative Medicare margin in 2016.  It’s on page 86 – just two pages past the points highlighted by Axios.

It’s always a good idea to read the whole story. 

Here are some additional facts to consider from the March report. Medicare hospital margins have been negative since 2003.  More recently, since 2013, margins will have fallen a stunning 116 percent by 2018 based on MedPAC’s projection that Medicare hospital margins will fall to an historic low of negative 11 percent.  This should come as no surprise because the average net increase in Medicare’s hospital payment rate over that time – 1.1 percent -- is less than half the average rate of increase – 2.6 percent -- in the market basket of goods and services used to determine the annual hospital inflation update. 

That wide gulf is due largely to cuts imposed on hospitals through legislation and regulation.  And frankly, it is not sustainable, especially as public payments – especially Medicare and Medicaid, which typically pays less than Medicare – are nearly half of total hospital operating revenue.

The pressure to lower costs is constant, and hospitals are doing their part keeping the increase “roughly equivalent to underlying price inflation,” notwithstanding what MedPAC notes are increasing drug and device costs, which together accounted for 26 percent of the 2016 growth in costs per Medicare discharge. 

Yet the actual fixed Medicare (and Medicaid) payment rate is not keeping up with inflation.  And that, along with the $38.3 billion in uncompensated care costs that hospitals provided in 2016, goes a long way towards explaining why hospitals must seek higher payments from private insurers, through arms-length marketplace negotiation, to meet the community mission hospitals commit to, and which our seniors expect and deserve. 

This commonly referred to cost-shift is not some mere “theory,” but a stubborn fact, something policymakers should keep in mind as they contemplate cutting hospital payments even further.

Coalition Asks Congress to Act Now on Vital Health Care Issues

March 19, 2018 | FAH Policy Blog Team

Category: Insurance, Legislation

A coalition of prominent health care and business associations, including the Federation of American Hospitals, sent a letter today to Congressional leaders asking that they take action to lower health care premiums.

The group sent a similar message to Capitol Hill earlier this month, but the message is more urgent now because as they wrote – “Time is running out.”

Congress is working on an omnibus appropriations bill that it must act on by Friday, March 23rd. The coalition is urging leaders to make sure the legislation includes elements that that will reduce premiums, improve affordability, and improve the individual market for 2019 and beyond, such as:

  • Establishing a premium reduction/reinsurance program to help cover the costs of people with significant health care needs.
  • Providing multi-year funding for cost-sharing reduction (CSR) benefits.

The letter highlights recent analysis that shows taking these actions could lower premiums by up to 21% in 2019 and increase enrollment and expand coverage to over 1.5 million Americans.

You can find a complete copy of the letter here.

It was signed by FAH, AHA, America’s Health Insurance Plans, American Academy of Family Physicians, American Benefits Council, American Medical Association, Blue Cross Blue Shield Association, and U.S. Chamber of Commerce.

The letter was sent to Senate Majority Leader Mitch McConnell (R-KY), Senate Minority Leader Chuck Schumer (D-NY), Speaker Paul Ryan (R-WI) and House Minority Leader Nancy Pelosi (D-CA).

FAH Highlights to Congress Effective Ways to Combat Opioid Epidemic

March 16, 2018 | FAH Policy Blog Team

Category: Legislation, Pharmaceuticals

FAH sent a letter today to leaders on the House Ways and Means Committee highlighting policy changes that would help in battling the opioid epidemic.

Reps. Kevin Brady (R-TX), Richard Neal (D-MA), Peter Roskam (R-IL) and Sander Levin (D-MI) recently asked stakeholders to share their thoughts on ways to fight the crisis.

"We appreciate the opportunity to offer our insight on the role hospitals are playing in meeting the challenges of the crisis and on what additional tools and policies are likely to be helpful in both preventing and treating opioid addiction and the acute and long-term medical needs that stem from their misuse," FAH President and CEO Chip Kahn wrote.

The letter begins by pointing out that hospitals are on the frontlines of the crisis - partnering with community groups to address the crisis and also looking for alternative approaches to treating pain.

FAH also draws attention to policy changes that could address the issue, including:

Health Insurance Coverage Fundamental to Addressing Crisis  

Data shows that sustaining and growing the gains in health insurance coverage is essential to connecting those in need with critical services. It is important that the Essential Health Benefits requirements remain in place and cover benefits for addiction treatment. FAH also recommended removing Medicaid restrictions on Institutions for Mental Disease (IMD), which would increase the availability of appropriate care.

Expanded Data Sharing Among Prescription Drug Monitoring Programs (PDMPs) Needed

FAH outlined its reasons for supporting expanding data sharing among PDMPs, including with CMS and other health care entities.

"Consistent, real-time, standardized PDMP's, accessible to health systems in addition to providers or pharmacists, can lead to increased monitoring and reporting that effects changes in opioid-related outcomes such as opioid prescribing behavior, opioid diversion and supply, opioid misuse, and opioid-related morbidity and mortality."

The letter also lays out solutions to the potential barriers to expanded sharing among PDMPs.

Medication Assisted Treatment (MAT) Important

"Broader integration of MAT in the primary care setting in conjunction with increases in the number of SUD treatment facilities expands access to treatment and reduces stigma.  Recent legislation has vastly increased coverage of SUD treatment in primary care, raising the importance of identifying best practices."

Telehealth Offers Pathway to Services

"By breaking down barriers to treatment (e.g., distance), telehealth can assist in connecting patients to qualified providers.  Given the breadth of the crisis, it is important that we use all available pathways to treatment."

Allow Treating Providers to Access Their Patients' Substance Use Disorder Records

Legislators should consider steps needed to "align the 42 CFR Part 2 requirements with the Health Insurance Portability and Accountability Act (HIPAA) requirements to allow the use and disclosure of SUD records from a federally assisted program for "treatment, payment, and health care operations" without prior written authorization... Using the HIPAA requirements would improve patient care by enabling providers with a patient relationship to access their patient's entire medical record."

The letter concludes by expressing FAH's desire to work with Members of Congress on ways to address the opioid epidemic.

You can find the complete letter here.

LifePoint Health Receives Prestigious John M. Eisenberg Award for Innovation in Patient Safety

March 14, 2018 | FAH Policy Blog Team

Category: FAH News, Quality

LifePoint Health received the John M. Eisenberg Award for Innovation in Patient Safety at the Local Level on Tuesday at the National Quality Forum (NQF) Annual Conference in Washington, DC.

The company received the honor for its National Quality Program, which was created in partnership with Duke University Health System. The program has led to significant enhancements across the LifePoint network, including a more than 60 percent improvement in aggregate patient safety.

LifePoint Health, a member of the Federation of American Hospitals (FAH), is the first investor-owned health system to earn an Eisenberg Award.

“Receiving the John M. Eisenberg Award is an honor and one of the proudest moments of our company,” said Bill Carpenter, chairman and chief executive officer of LifePoint Health. “Since our company was founded, we committed ourselves to always putting quality and patient safety first. We, along with our partners at Duke, created the LifePoint National Quality Program as a way to institutionalize and ensure this undisputed top priority and way of life across our system. This recognition is a testament to the hard work and commitment of our dedicated employees, physicians and leaders across the nation.”

“I want to applaud Bill Carpenter and the team at LifePoint Health for earning this honor and being leaders in area of patient safety. The National Quality Program they created is proof of what can happen when a company brings its resources to bear to focus on what matters most – quality, patient-centered care,” said Chip Kahn, President and CEO of the Federation of American Hospitals.

The LifePoint National Quality Program is a data-driven program implemented in LifePoint’s facilities across the nation. Rooted in patient-centeredness, the program is focused on leadership that empowers people, proven systems of performance improvement, and a culture of safety. This initiative has helped create a highly reliable culture of safety and drive enhancements across the LifePoint system, including a 62 percent improvement in aggregate patient safety compared to the company’s 2010 baseline and 12 months of zero central-line infections at 73 percent of its hospitals. Additionally, from 2010 to 2017, hospital-acquired infections at LifePoint hospitals’ decreased by 78 percent for urinary tract infections, 58 percent for sepsis infection, and 73 percent for pneumonia.

“The LifePoint National Quality Program has established at the hospital and system level an ongoing, measurable approach to driving sustainable improvements in patient safety, quality and patient experience,” said Rusty Holman, MD, chief medical officer for LifePoint Health. “Because of the diverse hospitals within the LifePoint system, this program offers many lessons for how healthcare facilities of all types and sizes serving a variety of patient populations can operationalize quality, create a national learning laboratory, and engineer a sustainable culture of safety.” 

The Eisenberg Awards, launched in 2002, honor the late John M. Eisenberg, MD, MBA, former administrator of the Agency for Healthcare Research and Quality (AHRQ). An impassioned advocate for healthcare quality improvement, Eisenberg was a member of NQF’s founding board of directors, chaired the federal government’s Quality Interagency Coordination Task Force and personally led AHRQ’s grant program to support patient safety research. Each year, Eisenberg Awards honor those making strides in innovating patient safety and quality at the individual level, local level and national level.

For more information, including reaction to LifePoint’s honor from other leaders in the medical community, please click here.

Coalition Asks Congress to Pass Market Stabilization Legislation

March 12, 2018 | FAH Policy Blog Team

Category: Insurance, Legislation

FAH joined a coalition in asking Congress to pass bipartisan market stabilization legislation. The group is made up of organizations that either provide health care or coverage to hundreds of millions of Americans

“We are writing to urge you to move forward with bipartisan legislation to reduce premiums, improve affordability, and improve the individual health insurance market. We ask that you include this legislation in the omnibus appropriations bill that Congress needs to act upon by March 23.”

The letter points out that Americans would most benefit from two critical elements:

• Establishing a premium reduction/reinsurance program to help cover the costs of people with significant health care needs.

• Providing multi-year funding for cost-sharing reduction (CSR) benefits.

The letter, which can be found here, was signed by FAH, AHA, America’s Health Insurance Plans, American Academy of Family Physicians, American Benefits Council, American Medical Association, Blue Cross Blue Shield Association, and U.S. Chamber of Commerce.

FAH Comments on CMS 2019 MA Draft Call Letter

March 12, 2018 | FAH Policy Blog Team

Category: Media, Medicare

FAH recently submitted a comment letter to CMS on the 2019 Medicare Advantage (MA) and Part D Advance Notice and Draft Call Letter. FAH urged CMS to use caution when allowing MA organizations (MAOs) greater flexibility regarding cost-sharing and benefit design (e.g., tiered cost-sharing, increased cost-sharing to manage utilization, and new interpretation of the uniformity requirements), as these changes could limit transparency and increase beneficiary costs and confusion.

 

The letter also expressed continued concern that MAOs inappropriately reclassify inpatient hospital stays as outpatient "observation" stays, as well as disappointment that CMS has not addressed network adequacy deficiencies, particularly with regard to sub-networks and post-acute care. Additionally, the letter urges CMS to: continue enforcement actions against MAOs for inaccurate provider directories; require MAOs to honor prior authorizations at the time of payment; require MA plans to inform providers about an enrollee's participation in the Qualified Medicare Beneficiary (QMB) Program; and undertake updates to the Star Ratings Program.


You can read the letter here.