AHA addresses commercial health plan challenges, RSV cases are significantly increasing and the CDC offers resources for healthcare providers during C. diff awareness month.
CMS Releases OPPS Final Rule
The Centers for Medicare and Medicaid Services (CMS) Tuesday released the final Medicare Outpatient Prospective Payment System (OPPS) rates rule. CMS will increase its rates by 3.8% for 2023, using a market basket update of 4.1% offset by a 0.3 percentage point productivity cut. While the 3.8% increase is above their proposed 2.7% rate, AzHHA still believes this rate is inadequate to deal with the significant increases in costs that hospitals are experiencing. As reported in the 2022 Q2 AzHHA Quarterly Financial Analysis, Arizona hospitals averaged a 15% increase for staff and wages from 2020 to 2021 which constitutes a significant portion of a hospital’s budget.
CMS also finalized its policy for hospitals that participate in the 340B Drug Pricing Program. As proposed earlier this year, CMS will restore the Medicare outpatient payment to average sales price plus 6% for 2023, given the recent Supreme Court decision. In addition, CMS is exempting rural sole community hospitals from the site-neutral clinic visit cuts and will instead pay for clinic visits furnished in excepted off-campus provider-based departments of these hospitals at the full OPPS rate.
Addressing Commercial Health Plan Challenges to Ensure Fair Coverage for Patients and Providers
The American Hospital Association (AHA) released a report on commercial health insurers and recommendations on Tuesday. Among its findings:
- Policies and practices from some commercial insurers appear to be designed to create barriers for hospitals and health systems to receive appropriate payments.
- There is increasing evidence that barriers to appropriate payment are increasing. Based on a survey of its members, 78% of hospitals and health systems report their experience working with commercial insurers is getting worse while less than 1% report that it is getting better.
- Inappropriate delays and denials have serious implications for the financial stability of hospitals and health systems and increase administrative costs. Moreover, they can lead to emotional stress on enrollees and can even lead to adverse outcomes for patients.
In order to ensure that patients get appropriate care, AHA recommends: 1) Standardize prior authorization and process and 2) Ensure necessary oversight to stop inappropriate prior authorization, payment delays and denials.
RSV on the rise; 4.5 times higher compared to a five-year average
The Arizona Department of Health Services (ADHS) reports a sharp rise in respiratory disease within the state. The ADHS Director’s blog states Arizona is “seeing a higher rate of influenza and respiratory syncytial virus (RSV) activity than usual. So far, three times more influenza and 4.5 times more RSV cases have been reported when compared to the five-season average for this week.”
Spread the Word, Not C. diff
The Centers for Disease Control and Prevention (CDC) encourages you to “Spread the Word, Not C. diff” throughout the month of November. The CDC reports Clostridioides difficile (C. diff) is a germ that causes severe diarrhea, which can be life-threatening. It can affect anyone and is usually associated with recent antibiotic use. CDC estimates that C. diff causes almost half a million infections in the United States each year and contributes to about 29,300 deaths.
The CDC offers the following resources to healthcare providers:
- The latest C. diff prevention guidance and resources for clinicians
- NEW and UPDATED C. diff materials for patients and clinicians
- FREE print materials (search “C. diff” under “Programs”)
- Answers to frequently asked questions about C. diff
AzHHA releases DataGen reports
In relationship with DataGen, AzHHA distributes reports to hospitals based on information submitted to the Centers for Medicare and Medicaid Services. This data helps hospitals understand the financial impact of proposed changes and annual updates. The reports can also assist in preparing budgets or benchmarking results with other similar organizations. DataGen generates hospital-specific reports which are sent to AzHHA hospital members as part of their membership. Below is the list of reports recently sent to members:
- Critical Access and Small Rural Hospital Prospective Payment System (PPS) Utilization Analysis - Sent 9/13/2022
- Cost Report Model - Sent 10/25/2022
Vote for the Health of it!
Election Day is just a few short days away, but there is still time to make your voice heard! We are all eager for election season to be over (and to have the fundraising texts and calls stop!), but we can’t forget that the outcome of the election will have a significant impact on healthcare policy in Arizona and at the federal level. As healthcare leaders, our work is to improve the health and well-being of our communities. Keep that perspective in mind when you cast your ballot!
If you vote by mail and haven’t returned your ballot yet, you must take your ballot to a ballot drop-off location or voting location in your county by 7 p.m. on Election Day Tuesday, Nov. 8, 2022. If you vote in person, you may find information about your polling place on the Arizona Voter Information Portal.
It’s unlikely we will have results in the days or maybe weeks following Election Day, but AzHHA will be hosting a member-only call on Friday, Nov. 11 to review the election results for federal, statewide and legislative candidates—at least what we know at that point. If you need information on this call, please email AzHHA’s Director of Government Relations Meghan McCabe.
2022 United Against the Flu Campaign
AzHHA works with the American Hospital Association (AHA) and the HHS in their national vaccine initiatives. The United Against the Flu campaign, by the AHA, delivers the importance of influenza and COVID-19 vaccinations. Visit United Against the Flu Campaign for materials and additional information. Additionally, the HHS COVID-19 public education campaign centers around increasing public confidence and administering vaccinations against COVID-19. Visit WECANDOTHIS.HHS.GOV to learn more about this campaign.
November 10-13 – 19th Annual Amigos Trail Ride and Drive
Attend the Wickenburg Community Hospital Foundation 19th Annual Amigos Trail Ride and Drive Nov. 10-13, 2022, at Boyd Ranch, Wickenburg. The event offers four days of guided trails, gymkhana, trail-trial challenge and trail ride options. Email [email protected] or call 928-668-1812 for more information. Registration may be found here.
December 6 – AzCHER Cybersecurity Tabletop (TTX) Exercise
Join us for a Tabletop exercise (virtual delivery) to Examine the coordination, collaboration, information sharing, and response capabilities of Hospitals and Healthcare Organizations in response to a cyber incident. Learn more about this, and other emergency preparedness events, here.
December 13 – Introduction to POLST workshops
Join physician orders for life-sustaining treatment paradigm (POLST) for their one-hour virtual workshops equipping healthcare professionals with knowledge and resources to begin using POLST in Arizona. The objectives are to describe what POLST is at the state and national level, explain why POLST is important, define the population for POLST, when to begin the conversation and who completes POLST, describe the process for completing, reviewing and updating POLST, and learn the process of submitting healthcare planning documents to the Arizona Healthcare Directive Registry.
Register for these virtual workshops below:
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