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					Federal Update
    June 2005
Update
vFront Burner Legislative

vPolicy Issues—IPPS; Rehab

vOther Issues on your mind
                                              ISSUE MANAGEMENT
•   Antitrust and Business Practices                •     Fraud and Abuse                              •    Quality and Patient Safety
     –    Retrospective reviews                            –   OIG pricing regulations                       –   Patient safety legislation
     –    Insurance industry consolidation
                                                    •     Health Care Liability Reform                       –   FCC medical telemetry
     –    Group purchasing organizations
                                                           –   Federal MICRA legislation                     –   8th Scope of Work
•   BCC                                                                                                      –   JCAHO legislation
                                                           –   Alternatives
     –    Billing                                                                                            –   COP revisions
                                                           –   State action center
     –    Collections                                                                                        –   Leadership Agenda
     –    Charges                                   •     Information Technology                                    Ø     Improvement
     –    Executive compensation                           –   Interoperability standards                                 * Use of Evidenced-Based
                                                                                                                             Medicine Practices
     –    Class action litigation                          –   MD integration                                             * Best Practices Clearinghouse
     –    Public Relations                                 –   Treatment of regional information networks           Ø     Accountability
     –    Membership education and tools                   –   Federal funding                                            * Hospital Quality Alliance
     –    Beyond current charges                                                                                          * Governance Dashboard
                                                    •     Mental health                                             Ø     Coordination
     –    Studies
                                                           –   Medicare psychiatric PPS                                   * Organizational redesign/
•   Coverage                                                                                                                clinical micro-systems
                                                           –   Coverage parity                                            * Chronic care coordination
     –    HCCU
     –    CTUW III                                  •     Payment                                      •    Racial and Ethnic Priorities
     –    Association health plans                         –   Federal budget                                –   Health Gap/Equality Legislation
     –    Comprehensive approach (UHPP)                           Ø   Budget resolution                      –   Data collection
•   Delivery system reform                                        Ø   Reconciliation                         –   Membership tools/leadership forum
                                                                      * Medicaid modernization         •    Regulatory Relief
     –    Limited service providers
             Ø Make moratorium permanent                   –   MD payment                                    –   HIPAA
             Ø Beyond specialty hospitals                  –   Indirect medical education adjustment         –   Model practices
             Ø Improving MD relations                      –   Rural package                                 –   EMTALA
             Ø Payment options (MEDPAC)                    –   Regular PPS rule                              –   ICD-10 approval
     –    Chronic care management                                 Ø Update factor/quality initiative   •    Tax (other)
             Ø Hospital participation in pilot projects           Ø Area wage index                          –   Pensions
             Ø (UHPP)                                             Ø Outlier thresholds                       –   Community benefit
     –    Green Bay Packer model                                  Ø Long-term care hospitals           •    Workforce
     –    Stark II/MD recruitment                                                                            –   Federal appropriations
                                                                  Ø Transfer Policy
•   Emergency Readiness and Public Health                  –   Rehabilitation 75 percent rule                –   Foreign workers
     –    Federal appropriations                                                                             –   Labor relations/organizing
                                                           –   SNF rule (RUG refinement)
     –    Flu vaccine legislation                                                                            –   MD supply
                                                           –   Pay for performance
     –    HRSA readiness grant                                                                               –   Best practices clearinghouse
                                                           –   Medicare advantage implementation
                                                                                                             –   Work design
                                                           –   Health Care as Investmentf
                Immediate Priorities
• Payment
  – Medicaid                       Organizing Themes
  – Medicare
• Public accountability           • Protecting the safety net

  – Quality and patient safety    • Increasing affordability
  – BCC                             and improving care
     Ø   Billing
     Ø   Charges                  • Expanding coverage
     Ø   Collections
     Ø   Executive compensation
     Ø   Tax-exempt status

• Liability reform
• Limited service providers
• Coverage
Budget Conference
                  Outcome
• Medicaid
  – $10 billion over five years
     Ø No cuts in first year
  – Commission (presidential appointment)
     Ø Short-term vs. long-term (15 voting; 15 non-voting; 8
      MOCs– Ds may not play)
• Medicare
  – $1 billion over five years from House Ways
    and Means Committee

• Deadline: September 16
Payment
              Challenges
• Medicare exposure
• Medicaid…holding hospitals
  harmless
  – Rx reimbursement ($5-6 billion)
• Physician payment
Limited Service Hospitals
            Challenges
qCompetition Argument
qHouse Leadership—other R
  (Barton/Coburn) Opposition
qTerry Cloth Robe Factor
(Patients like LSHs)
qPayment refinements
“Special” Coverage Project
Project
• Advisory Group                                      AARP
   –   American Hospital Association                 AAFP
   –   Association of Health Insurance Plans        AFL-CIO
   –   U.S. Chamber of Commerce                       AMA
   –   Families USA                                   ANA
                                                     APHA
   –   Federation of American Hospitals             BCBSA
   –   Heritage Foundation                            CHA
   –   Health Leadership Council                 HR Association
   –   Service Employees International Union   Johnson & Johnson
                                                     Kaiser
                                                      NGA
• “A Practical Plan for Expanding                    NCSL
   Health Care Coverage                              Pfizer
   – As Many People As Possible…As Quickly        Project Hope
     As Possible

				
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