News Briefs
Demand for beds expected to increase
Bed management likely will become an even more critical issue for access managers, with demand for hospital beds expected to increase by as much as 46% in the next 25 years.
A study published recently by Solucient, a health care business research group, says the increase of an additional 238,000 beds is expected to result from long-term demographic shifts in the U.S. population, which could drive demand for inpatient acute care through 2027.
The long-term forecasts also show that total acute care admissions are projected to increase by 13 million cases during the same time frame, a 41% jump from the current number of national admissions. The aging of the baby boom generation, increased life expectancy, rising fertility rates, and continued immigration are all likely to contribute to the 25-year growth in inpatient care, according to the study.
Regionally, the study says, inpatient demand will grow fastest in the Western and Southern states and more slowly in Midwestern and Northeastern regions. For more information, visit www.solucient.com.
Final OPPS rule increases spending
The 1,000-page final outpatient prospective payment system (OPPS) rule, which takes effect this month, provides the congressionally mandated inflationary update and increases overall spending, but still pays hospitals only
83 cents for every dollar spent on outpatient care, the Chicago-based American Hospital Association (AHA) points out.
The rule gives the mandated 3.5% increase, but the net effect of all provisions in the rule results in a 3.1% increase from last year for urban hospitals and a 6.2% increase for rural hospitals, according to a report in the on-line service AHA News Now.
The rule does not include a pro rata reduction in pass-through payments for certain new and high-cost devices, drugs, and biologicals. It lowers the outlier threshold from 3.5 to 2.75 times the ambulatory payment classifications amount, enabling hospitals to reach the outlier threshold sooner. However, outlier reimbursement will drop from 50% to 45% of costs above the threshold amount.
Emergency care crisis indicated by AZ survey
A statewide survey of recent emergency department (ED) visitors sponsored by the Arizona Hospital and Healthcare Association points to an emerging crisis in the availability of and access to emergency treatment in the state.
The public opinion poll of 925 residents shows that 82% felt nonemergency use of EDs is a problem, while 95% said many people are using hospital EDs because they have nowhere else to go for treatment.
Some 88% of those who received emergency care in an Arizona hospital in the past year reported being either very or generally satisfied with the treatment they received, regardless of whether
they were rural or urban residents, or whether
they were Hispanic. Of those who were dissatisfied, long waits were the most-cited reason.
Also, rural residents are considerably more likely (61%) than urban dwellers (44%) to see the availability of emergency care as a problem, the study showed.
To see the full report, go to www.azhha.org.
HHS issues final report on regulatory reform
The final report of the Department of Health and Human Services Advisory Committee on Regulatory Reform features 255 recommendations to improve care delivery by reducing the regulatory burden on health care providers.
The recommendations address overly burdensome, and at times unnecessary, patient assessment tools; better coordination of the release of new requirements; clarification of rules governing emergency care; and more consistency and reliability from contractors that process Medicare claims and advise hospitals.
They also urge streamlined record-keeping and reporting requirements, such as the Medicare cost report. The committee, created last year, is composed of consumers, physicians, nurses, and other health care professionals. More information is available at www.regreform.hhs.gov.
Patient violence called biggest threat to ED staff
More than 90% of emergency department (ED) managers at VHA member hospitals polled at a recent conference cited patient violence as the greatest threat to ED personnel, despite heightened awareness of bioterrorism and the recent terrorist threat to hospitals in key U.S. cities. VHA is a nationwide network of 2,200 community-owned health care systems and their physicians.
About 66% of the 74 managers polled at VHA’s Emergency Department Conference saw the risk of contracting hepatitis C as the second-biggest threat. Roughly 70% of respondents indicated their hospitals were not prepared to deal with bioterrorist-related medical emergencies, down from 80% in 2001.
Nearly a third of respondents said a lack of acute and critical care beds to which ED patients can be transferred was the primary factor for overcrowding in EDs. Other primary reasons for overcrowding included work force and staffing issues (24%) and uninsured patients using the ED for primary care (19%). For more information, go to www.vha.com.
Cash discounts surface as government concern
Cash discounts are rising on the government’s radar screen, warn health care attorneys, who point to the Department of Health and Human Services’ Office of Inspector General special advisory on inducements issued recently. "Whether and to what extent cash discounts to patients are permissible continues to be a source of frustration for physicians, ambulatory surgery centers, and other providers," says Allison Shuren of Arent Fox in Washington, DC.
Bill Sarraille, also of Arent Fox, says that list includes Medicare reimbursement limitations, state anti-kickback laws, the anti-beneficiary inducement provision of the Health Insurance Portability and Accountability Act, the Medicare exclusion provision that relates to Medicare and non-Medicare charges as well as state insurance anti-discrimination provisions.
Sarraille says the term "cash discounts" sometimes is used to incorrectly suggest an appropriate reason for improperly waiving on "out-of-network" penalties required by a patient’s managed care insurance. "Providers, in these situations, are looking for a means of eliminating the out-of-network’ penalties that would otherwise apply, without reducing the amount that the insurance company pays," he explains.
According to Shuren, another potential problem with a cash discount in connection with Medicare patients is that Medicare pays the lesser of the applicable percentage of the fee schedule allowable or the actual charge for the service. "If a cash discount is offered in connection with a Medicare covered service, the effect of this will typically be to take the actual charge below the Medicare allowable," she explains. If that fact is not reported on the claim form submitted to the Medicare program, she says the provider will receive an overpayment.
Demand for beds expected to increase; Final OPPS rule increases spending; Emergency care crisis indicated by AZ survey; HHS issues final report on regulatory reform; Patient violence called biggest threat to ED staff; Cash discounts surface as government concern.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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