Check out information about the proposed remedy for 340B payment cuts, AHCCCS disenrollments and survey results about the impact of some commercial insurer practices.
Proposed remedy for 340B payment cuts
The Department of Health and Human Services (HHS) has released its proposed remedy for unlawful payment cuts to certain hospitals that participate in the 340B Drug Pricing Program.
The proposed rule has two main components:
- HHS would repay the approximately 1,600 affected 340B covered entity hospitals that were unlawfully underpaid from 2018 to 2022 in a single lump sum payment, and the calculations of the amounts owed to these hospitals are contained in the proposed rule.
- HHS proposes to recoup funds from those hospitals that received increased rates for non-drug services from 2018 to 2022. CMS plans to recoup these funds by adjusting the outpatient prospective payment system conversion factor by minus 0.5% starting in calendar year 2025 until the full amount is offset, which CMS estimates to be 16 years.
Notwithstanding their efforts to protect hospitals through a lengthy transition, AzHHA remains concerned that the proposal to take back five years of payments sets a dangerous precedent. It runs counter to the principles of finality and predictability that are foundational to the Medicare outpatient prospective payment system.
AHCCCS continues disenrollments
Last month, AHCCCS disenrolled 51,000 Medicaid recipients, bringing the total up to 221,000 since disenrollments began on Saturday, April 1, 2023. During the public health emergency, states were prohibited from disenrolling individuals from Medicaid who no longer met income eligibility requirements. AHCCCS anticipates that up to 650,000 individuals could lose AHCCCS coverage over a 12-month period.
AHCCCS has developed messaging toolkits and supporting materials to assist health plans, providers, community partners and tribal communities to build awareness of the regular renewal process.
New survey results about the impact of some commercial insurer practices
On Tuesday, July 11, the American Hospital Association released findings of three recent surveys which show robust concerns among patients and providers regarding healthcare practices that increase administrative burden and make it more challenging for patients to receive the healthcare they need.
Key findings from the surveys:
- In the past two years, the majority (62%) of patients have had delayed medical care because of insurance. Of those, 43% said that this resulted in a worsening of their health.
- More than four out of five (84%) of patients want policymakers to focus on insurance practices which make it more challenging for them to receive care.
- Most patients (83%) want their healthcare provider, rather than their insurance company, to determine the care they receive.
- Four out of five physicians said that insurance practices and policies impact their ability to practice medicine.
- Three out of four nurses (74%) said that insurance administrative policies reduce the quality of patient care.
- More than half of nurses (56%) said that job satisfaction has decreased due to insurance administrative requirements.
Don’t delay! Apply today for an AzHHA Quality Award
The inaugural AzHHA Quality Awards are now open to outstanding applicants.
What you need to know:
- Hospitals must be able to highlight a recent project in Quality and Patient Safety, Community Engagement or Emergency Management.
- Winners will be presented with their AzHHA Quality Award at the 2023 Arizona Hospital Leadership Conference in October.
- Details on how to apply.
Submission deadline: 12 p.m. on Monday, July 31, 2023
Looking for more information about the awards? Learn more.
UPCOMING EVENTS
Friday, July 21 – 2023 Summer State of the State, Flagstaff Medical Center’s McGee Auditorium
Register and receive $15 off registration with code azhha2023 at checkout.
Thursday, Aug. 31 - Introduction to POLST
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 of the workshops 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.
- Learn the process of submitting healthcare planning documents to the Arizona Healthcare Directive Registry.
Register now.
Friday, Sept. 15 – AIM Collaborative Conference
Register now for our second annual event focusing on AIM’s obstetric hemorrhage maternal health bundle. Hear from engaging speakers from around the state presenting on maternal health initiatives and integrating health equity into patient care. Attendees will include clinicians and executives from hospitals and birthing facilities, leaders from state agencies, community partners, not-for-profits, tribal healthcare and students. Sponsorship opportunities are available; contact [email protected].
IN THE NEWS
Proposed Medicare cuts jeopardize access to care for patients and communities (thehill.com)
COVID-19 vaccine compliance no longer required: Joint Commission (beckershospitalreview.com)
Nurse staffing laws: 3 updates from across the US (beckershospitalreview.com)
4 ways hospitals can alleviate ‘supply shocks’: McKinsey (beckershospitalreview.com)