Skip navigation

Connection newsletter 10-31-24

Read about how Medicare Advantage plans continue to underpay hospitals, AHCCCS updating FAQs for the Covered Behavioral Health Services Guide and the approaching deadline for Healthcare Leadership Academy applications.

 

 

 

This week, read about: How Medicare Advantage plans continue to underpay hospitals. AHCCCS updating

‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌
   
Arizona Hospital and Healthcare Association (AzHHA) Banner
 

Connection Newsletter

By AzHHA Communications ● Oct. 31, 2024

Smart Brevity® count: 4.5 mins...1192 words

This week, read about:

  • How Medicare Advantage plans continue to underpay hospitals.
  • AHCCCS updating FAQs for the Covered Behavioral Health Services Guide.
  • The approaching deadline for Healthcare Leadership Academy applications.
 

Medicare Advantage plans continue to underpay hospitals

Illustration of a red cross spinning to reveal money

Despite direction from the Centers for Medicaid and Medicare Services (CMS) that Medicare Advantage plans should adhere to the two-midnight rule for covering inpatient admissions, claims admissions from Kodiak Solutions shows that little improvement has been made.

Why it matters: The CMS 2024 Medicare Advantage final rule clarified that Medicare Advantage plans must adhere to the “two-midnight rule” when reimbursing hospitals.

  • Thus, if a patient is in the hospital for two or more midnights, reimbursement should be for an inpatient stay.
  • Previously, many Medicare Advantage plans had been reimbursing a large number of visits as outpatient or observation stays and thereby not fully reimbursing hospitals for costs. Traditional Medicare had been using this definition since Oct. 30, 2015.

By the numbers: Kodiak Solutions analyzed data from more than 1,900 hospitals.

  • From July 2023 to December 2023, observation rates were 18.1% to 20.2% for Medicare Advantage plans compared to 3.7% to 5.2% for traditional Medicare.
  • Once the two-midnight rule went into effect in January 2024, if Medicare Advantage plans adhered to the two-midnight rule as required, the Medicare Advantage rates would have looked similar to traditional Medicare.
  • Instead, observation rates for Medicare Advantage ranged from 14.4% to 16.1%.
  • While this is a slight improvement, the data from Kodiak Solutions demonstrates that Medicare Advantage plans are not appropriately reimbursing hospitals and CMS needs more enforcement for Medicare Advantage plans.
 

AHCCCS updates FAQs for Covered Behavioral Health Services Guide

Illustration of Magic 8 Ball with a red cross symbol inside with a question mark on it

What’s new: The Arizona Health Care Cost Containment System (AHCCCS) recently updated its frequently asked questions (FAQs) for the Covered Behavioral Health Services Guide (CBHSG).

Why it matters: The FAQs were created in response to the numerous questions the agency received about the CBHSG.

  • The CBHSG was most recently updated Friday, Oct. 4, 2024, and provides an abundance of information on basic billing and coding information for behavioral health services.

 

 

Deadline approaching: Healthcare Leadership Academy applications - apply now

Illustration of black and white bookshelves forming a negative space cross which is colored red, to evoke healthcare

Applications are currently being accepted for the 2025 cohort of the Healthcare Leadership Academy (HLA).

  • The AzHHA Foundation partners with Creighton University to provide healthcare leadership and management education to employees of AzHHA member hospitals.
  • Seven months of virtual learning are bookended by in-person sessions beginning in March 2025 and culminating in November 2025.
  • The HLA is geared toward mid-level managers and early-stage executives to prepare them for C-suite positions.
  • Learn more about the program here.

What’s next: To apply, submit your resume, letter of support and statement of purpose in one PDF to [email protected] by 5 p.m. on Saturday, Nov. 30, 2024.

If you have any questions, please contact Laura Dickscheid, vice president of member services and 2024 HLA participant, at [email protected].

 

Don’t forget to vote!

Illustration of a Vote button with red cross symbols replacing the stars.

If you haven’t voted already, don’t forget that the 2024 General Election is on Tuesday, Nov. 5, 2024.

  • The deadline to vote early in person is tomorrow, Friday, Nov. 1, 2024.

Looking for voting information and resources? We’ve got you covered. Visit our informational page here.

 

Human resources roundtable on Thursday, Nov. 7, 2024

Conference table

Join your HR peers in a virtual discussion on hot topics in the field of human resources, including a regulatory update from a respected employment attorney.

  • Facilitated by Onvida Healthcare’s (formerly Yuma Regional Medical Center) chief human resources officer, this roundtable will take place from 2 to 3 p.m. on Thursday, Nov. 7, 2024.

What’s next: Request meeting information by emailing [email protected].

  • Agenda items are derived from member feedback and suggestions, so please share your HR headaches and best practices in advance of the meeting.
 

AzHHA releases DataGen reports

Laptop with an envelope as the screen

In relationship with DataGen, AzHHA distributes reports to hospitals based on information submitted to the Centers for Medicare and Medicaid Services. DataGen generates hospital-specific reports which are sent to AzHHA hospital members as a benefit of membership.

Why it matters: 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.

The below reports were recently sent to members:

  • FFY 2024 IPPS interim final rule analysis (sent Thursday, Oct. 24, 2024)
  • 3Q2024 Readmissions Reduction Program (sent Monday, Oct. 28, 2024)

 

 

Report: Q3 2024 healthcare labor market

Stethoscope

Get the latest Healthcare Labor Market Report from Adaptive Workforce Solutions, an affiliated partner and endorsed vendor of AzHHA.

What's inside:

  • National and regional bill rates for locum tenens, nursing, allied health and therapy
  • Insights on bill rate fluctuations and utilization trends
  • Update on Q3 legislative activity affecting the healthcare labor market
Download the report

Questions? Contact Alma Del Toro, regional director of workforce solutions, at [email protected] or Lisa Scalarone, critical access and tribal health specialist, at [email protected].

 

🏥 Arizona's top chief nursing officers recognized

An illustration of hospitals on a Monopoly board

Sherry Stotler, MSN, RN, senior vice president and chief nursing officer at Valleywise Health, has been recognized by Becker's Hospital Review as one of the "213+ CNOS to know” in 2024, one of only four in Arizona.

  • Sherry is recognized for her crucial role in ensuring the delivery of quality healthcare through effective resource management and systems implementation.
  • Under her leadership, the hospital achieved a “B” hospital safety grade from the Leapfrog Group, the highest rating in its history.
  • Sherry collaborates with statewide organizations to tackle the nursing workforce crisis and has shared her experience nationally as a member of the DNV Healthcare advisory board committee.

The big picture: The other Arizona recognitions went to:

  • Rhonda Thompson, DNP, RN, chief nursing executive and senior vice president of patient care services, Phoenix Children’s Hospital
  • Angela Wright, chief nursing officer and senior director, Banner Health - University Medicine Tucson
  • Kathy Zarubi, DNP, RN, senior vice president and chief nursing executive, HonorHealth
 

Member spotlight: Valleywise Health

Confetti flying out of a megaphone.

Valleywise Health boasts the fifth lowest psychiatric readmission rates in the U.S., according to data from the Centers for Medicare and Medicaid Services.

  • The highest readmittance rate is 35%, while Valleywise Health’s rate was only 13.4%.

The big picture: Leveraging all of Valleywise Health’s resources ensures patients receive well-rounded care prior to discharge, both from a medical and psychological standpoint.

Read more

 

 
AzHHA PAC
 

UPCOMING EVENTS

Wednesday, Nov. 20, 2024 - Social Cohesion Dialogue 2024
Join the Center for the Study of Race and Democracy director Lois Brown, PhD, and authors Jeff Goodell and Dr. Rob Gore for a riveting dialogue about health, environmental crises, violence, vulnerability, leadership and community engagement. Learn more and register.

 

IN THE NEWS

 

Share your feedback! Email [email protected]