Hospitals with different issues and concerns find something they like in the House-passed Helping Hospitals to Improve Patient Care Act, H.R. 5273 – and hope the Senate will make consideration of the bill a priority. But an abbreviated election-year legislative calendar could possibly push any Senate action on the bill into the fall.
Congress will recess in about a week for the presidential nominating conventions, and will be in recess during August and again in October. And lawmakers are expected to spend much of September figuring out how to fund the government through fiscal year 2017.
While September remains a possibility, it could leave a brief post-election lame duck session as hospitals’ best opportunity for getting the Senate to act on the legislation, which would, among other things, ease payment restrictions for some hospital outpatient departments, or HOPDs, adjust 30-day readmission penalties to account for socioeconomic disparities, and extend for five years the Rural Community Hospital Demonstration program.
The AHA supports those HOPD, readmissions-adjustment and rural hospital measures. “This legislation will help patients by mitigating some of the negative impact of the 2015 Budget Bill and will improve access to care,” said AHA President and CEO Rick Pollack following House passage of the bill last month. “It also will ease penalties experienced by hospitals and health systems who treat the most vulnerable patients.”
H.R. 5273 would revise Section 603 of the 2015 Bipartisan Budget Act to move the grandfather date for off-campus HOPDs under development from Nov. 2, 2015 to Dec. 31, 2016 or 60 days after enactment, whichever is later. Current law reimburses grandfathered facilities at the HOPD rate, while new facilities are capped at the lower physician fee schedule rate.
“This legislation goes a long way to create a fair and balanced solution for outpatient facilities that were under development before the [budget law] was passed late last year,” says Fred Manchur, CEO of Kettering Health Network in Dayton, Ohio. “The bill will allow us to continue fulfilling our mission to provide our communities the best possible care close to home.”
Other hospital leaders favor the bill’s proposed changes to the Hospital Readmissions Reduction Program, a part of the Affordable Care Act, which reduces Medicare reimbursements for hospitals deemed to have excess readmissions. Hospitals are slapped with a reduction in payment of up to 3% if their 30-day readmission rates exceed what was expected for heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease and hip and knee replacement.
Hospital leaders, like Steve Lipstein, CEO of BJC HealthCare System in St. Louis, Mo., contend that Medicare needs to account for socioeconomic and other social risk factors beyond hospitals’ control when measuring hospitals’ performance in the program.
Under the House-passed legislation, readmissions penalties would be adjusted by comparing hospitals with similar populations of Medicare and Medicaid patients. Those adjustments would eventually change to a “more refined” method based on federal analysis required by the Improving Medicare Post-Acute Care Transformation Act.
“It is a step in the right direction,” Lipstein says of H.R. 5273. “Passage of the bill would be an acknowledgement by Congress that socio-demographic status does indeed affect health care costs and outcomes,” he says. “The playing field is not level.”
Meanwhile, small rural hospital leaders are behind the bill’s extension of the Rural Community Hospital Demonstration program, which is set to expire at the end of this year. The program helps rural hospitals – those with between 26 and 51 beds – in sparsely-populated states that are too big to qualify for critical access status, but struggle to keep their doors open under Medicare’s prospective payment system. The program tests the feasibility of a cost-based payment model for these hospitals.
“This program provides improved reimbursement for our growing Medicare population and is a crucial factor in the hospital’s financial viability,” says Chuck Bill, CEO of Bartlett Regional Hospital in Juneau, Alaska. “It has a big impact in smaller rural communities.”
Robert Flake, Yampa Valley Medical Center’s chief financial officer in Steamboat Springs, Colo., adds that the bill “extends a lifeline to help rural hospitals continue to offer 24-hour emergency and inpatient care.”