Nysha Recent News

Hospital News

June 24, 2016

By Mendy Hecht, Hamaspik Gazette

Albany seeks revamp of state safety net hospital reimbursement

A bill seeking to redefine New York State’s safety net hospitals and ensure that those serving the poorest patients get a fair share of Medicaid funding has overwhelmingly passed the state Legislature.

Fifteen state Senators sponsored and co-sponsored legislation that makes straightforward changes to the supplemental reimbursement rate adjustments paid to safety net hospitals and places stricter requirements for those hospitals that receive a bigger slice of the funding pie.

The bill passed both chambers of the New York state legislature by large margins, and is now being reviewed by counsel’s office before heading to the desk of Gov. Andrew Cuomo.

According to the legislation, 50 percent of patients at an enhanced safety net hospital must be on Medicaid or medically uninsured.  Also, 40 percent of inpatient discharges at each must be covered by Medicaid—and no more than 25 percent of discharged patients can be commercially insured.  The bill also requires such hospitals to either be a public health system or federally designated as a critical access or sole community hospital.

Several unions and hospitals supported the measure, with NYC Health & Hospitals—the largest healthcare provider for these populations in the city—noting this will promote fairer distribution of Medicaid funds.

Democratic Sen. Kevin Parker, one of the 14 co-sponsors of Republican Sen. Kemp Hannon’s bill, said the proposal would be funded through next year’s budget cycle.  According to Sen. Parker, the bill reflects the shift in medical delivery from large hospitals to primary care and outpatient services.

“We have, to this point, not done an adequate job from the state perspective of managing that transition,” he said.  “This bill is intended to help that process, particularly in the low-income communities that are hit hardest by this change.”

Northeast providers form regional GPO

An alliance of health systems in the Northeast is forming its own regional group purchasing organization (GPO) to better manage procurement and sourcing of supplies.

AllSpire Health Partners, a group of seven health systems spanning New Jersey, New York, Maryland and Pennsylvania, announced at June’s end that it would be forming AllSpire Health GPO.  Members are hoping to better aggregate their purchasing volumes, streamline negotiations and find opportunities for efficiency among their networks.

Initial members of the new GPO include the Hackensack University Health Network, the Atlantic Health System, and Meridian Health, all of North Jersey; and the Lehigh Valley Health Network, WellSpan Health, Reading (Pa.) Health System, and Lancaster General Health, all of Pennsylvania.

The organization has signed an exclusive deal with HealthTrust, a national GPO based in Brentwood, Tennessee.  Each member will likewise become a member of HealthTrust.  That GPO, itself majority-owned by Hospital Corporation of America, has a strict, compliance-driven model: customers are required to use the GPO’s contracts for 80 percent of their purchases on most products.

The new AllSpire GPO will be headquartered in Pennsylvania’s Lehigh Valley region and is expected to be operational in the third quarter.

The formation of regional and niche GPOs has become an attractive strategy for health systems looking to work with area providers to find better pricing and local sourcing.  

The Greater New York Health Association’s GPO, affiliated with Charlotte, N.C.-based Premier, is one of the biggest regional GPOs in the country.

Joint Commission unveils new antimicrobial standard

Hospital-acquired infections (HAIs) have long been a thorn in the side of modern hospital-based healthcare, with widespread use of antibiotics giving rise to increasingly resistant bacteria.  Thousands of U.S. patients die each year due to infections by bacteria and other microbes.

Responding to the still-growing problem, The Joint Commission, the U.S. hospital and healthcare industry’s leading accreditor, unveiled new standards on June 29 for combating microbes in healthcare settings.

The new so-called Medication Management Standard addresses antimicrobial stewardship for hospitals, critical access hospitals and nursing care centers effective Jan. 1, 2017.

From that point on, Joint Commission-approved facilities will also be graded on such elements of performance (EPs) as making antimicrobial stewardship an organizational priority, developing an antimicrobial stewardship program, educating staff involved with administering and monitoring antimicrobial practices, and educating patients on appropriate use of antibiotics.

Hospitals more proactive about bills as ability to pay drops

According to a June 28 report by the credit rating firm TransUnion, patients’ ability to pay medical bills is declining as out-of-pocket costs under high-deductible health plans are rising.

According to TransUnion, consumers had $1,720 in revolving credit to cover every $100 in medical costs in the first quarter of 2016—down from $2,250 in revolving credit to cover those costs in the first quarter of 2015.

The report also said that nearly eight in ten patients owed over $1,000 in the first quarter, while 51 percent owed more than $1,000.  Meanwhile, patients experienced a 13 percent increase in both deductible and out-of-pocket maximum costs between 2014 and 2015, with the average annual deductible totaling $1,278 and the average annual out-of-pocket costs totaling $3,470.

With the increase in out-of-pocket costs under high-deductible plans, a growing number of hospitals are now working aggressively with patients before procedures or before they leave the hospital to work out payment.  

One large health system, Ascension Health, is waiving deductibles for patients enrolled in health plans through the Affordable Care Act exchanges who have incomes below 250 percent of the federal poverty level.  It did so because it found that many Ascension patients were drowning in debt related to their high plan deductibles, which was hurting their credit scores.

But some providers have taken a more hard-nosed collection approach, filing numerous debt collection lawsuits against patients.

Healthcare affordability under high-deductible plans has become a political issue in the presidential election.  Presumptive Democratic nominee Hillary Clinton has proposed requiring health plans to cover three sick visits to a doctor a year without applying the deductible; giving insured people a $5,000 per family refundable tax credit for out-of-pocket costs exceeding 5 percent of income; and barring providers and insurers from charging patients out-of-network bills for services received in an in-network hospital.

Donald Trump, the presumptive Republican nominee, has released a seven-point health policy agenda emphasizing market mechanisms to reduce overall healthcare costs, though it doesn’t directly address out-of-pocket costs.

At the same time, however, consumers have received some protection from having medical debts count against their credit scores. Last year, TransUnion and the two other major credit-reporting companies, Equifax and Experian, signed a settlement agreement with New York Attorney General Eric Schneiderman requiring that medical debt not be reported until after a 180-day waiting period. That allows time for any insurance payments to be applied and for consumers to have enough time to work through any disputes and pay up.

The federal Consumer Financial Protection Bureau reported in 2014 that 43 million Americans have blemishes on their credit reports because of overdue medical bills, and that medical debts comprise more than half of collection items on credit reports.