IHA News Update

The most recent news from the IHA is cut and pasted below. Items of particular interest to healthcare quality professionals are in red.

State Requests Potential Stimulus Project Information

Indiana is seeking information on projects that could be eligible for federal funds through both last year’s Supplemental Appropriations Disaster Relief Opportunity legislation and the American Recovery and Reinvestment Act. More information on this data collection process is available from the Center for Business and Economic Research at Ball State University: http://www.bsu.edu/cber.

The state will be launching a new Web site to receive applications for stimulus funding, but for now we suggest using the documents on this Web site as a guide for what information the state will require.

IHA continues to encourage members to prepare information on potential “shovel-ready” capital projects, disaster-related construction and repair, health information technology initiatives, and energy efficiency projects. Not all of these projects will be eligible for stimulus dollars, but it is still unclear as to how some of the programs will be implemented. IHA continues to engage the state regarding distribution of the stimulus funding, but please keep these points in mind as you prioritize your efforts:

• Most of the health IT funding will flow directly to hospitals and physicians through a specific formula of incentive payments beginning in 2010 or 2011.


• There is likely no large pool of money available that would allow hospitals to jump-start or complete capital projects, however, the bill did increase funding for certain existing programs like Community Development Block Grants and rural hospital loans/grants under the Consolidated Farm and Rural Development Act.


• Most of the dollars, if not all, for construction are going to be distributed through state and local government. IHA encourages you to contact local officials and ask for their assistance with any “shovel-ready” projects.


• Perhaps the best strategy might be to offer to assist local officials in supporting local infrastructure projects that would indirectly benefit your hospital, such as nearby local road and street improvements.

Hospital Day Approaching; Register for March 10 Event

Hospital Day at the Statehouse 2009 is less than two weeks away. The event will provide hospital leaders the opportunity for relationship building with legislators. You can make a Statehouse visit from 3-4:30 p.m. and/or invite your legislator to the Legislator Reception at the Eiteljorg Museum from 4:30-6:30 p.m. Call your legislators now to invite them to the reception.

Hospital Day will also feature a luncheon panel discussion and an issues briefing from IHA’s government relations team. Gov. Daniels is expected to address the IHA membership. Visit the Hospital Day Web page to learn more. To register, visit www.regonline.com/iha2009hospday.

Save the Date; e-Health Care Program Set for April 23

Save the date; IHA will host e-Health Care Transformation: Demystifying the Stimulus Bill HITECH Provisions on April 23 at the Montage, Indianapolis. The program will provide an overview of the economic stimulus package provisions for information technology and a practical approach to spending stimulus dollars on heath IT projects.

Dr. J. Marc Overhage, director of medical informatics at the Regenstrief Institute and CEO of the Indiana Health Information Exchange, will also discuss a strategy to expand health information technology throughout Indiana using state allocations in the stimulus package. Members will also be invited to participate in two breakout sessions of their choice. Topics include medical identity theft red flags, mandated e-prescribing, HIPAA privacy and security requirement changes, and the implementation of telehealth to address workforce shortage issues. Registration information will be available in the near future.

IHA to Host Part Two of Accreditation Webinar Series

Secure your spot for part two of IHA’s Accreditation Alternatives Series. The educational webinar is set for March 12 from 3:30-5 p.m., EDT. The program will feature Joint Commission Executive Vice President Ann Scott Blouin who will speak on hospital standards and accreditation changes for the new Joint Commission’s deemed status application. In addition, a panel of Indiana hospitals that have achieved HFAP and ISO 9001 certification will share their experiences—highlighting strengths, weaknesses, and lessons learned.

All c-level leaders, board members, quality professionals, Joint Commission liaisons, compliance officers, and hospital legal counsel are encouraged to attend. The price for the webinar is $100 per connection. If your hospital participated in the DNV Accreditation webinar on Jan. 20—part one of the series, there is no registration fee. A discount code will be provided. To register, visit http://www.regonline.com/iha2009accreditation2-web. The registration deadline is March 10.

Nursing Leaders Should Attend Retention Briefing

Indiana’s nursing leaders are encouraged to attend Engaging and Retaining Nurses: A Prescription for Redesign in Tough Economic Times. The program is set for March 18 at the Hilton Indianapolis North. Following the session, participants will have: an understanding of the role nurse retention plays in effective and efficient care; knowledge of Transforming Care at the Bedside—its principles, processes, and outcomes; an understanding of “vitality” and its contribution to nurse retention and care redesign; tools for measuring and improving vitality among nurses and other caregivers; a framework for developing nursing leadership competencies to support innovation; and techniques to engage frontline staff. To register, visit www.regonline.com/iha2009rnretention.

Three Labor Unions for Nurses to Merge

The United American Nurses, California Nurses Association, and Massachusetts Nurses Association will merge to form a new labor union for registered nurses, called the United American Nurses-National Nurses Organizing Committee. Among other priorities, the group says it is resolved to organize all non-union direct-care nurses, advocate for nurse-to-patient staffing ratios, and create a national pension for union RNs.

Red Flag Rule Enforcement to Begin in May

Enforcement of the regulations commonly known as the "red flag rules” will begin in May. Hospitals must identify patterns, practices, and specific activities that could result in a risk of identity theft. Hospitals must implement procedures that mitigate these activities.

IHA’s general counsel, Hall Render Killian Heath and Lyman, has created an implementation guide to assist members in meeting these new regulatory obligations. The cost is $500. If you have any questions regarding medical identity theft, the red flag rules, or require assistance in implementing a program consistent with these new regulatory obligations, contact Michael Batt at 317/ 977-1417 or mbatt@hallrender.com or Jeff Short at 317/977-1413 or jshort@hallrender.com.

Culture of Safety Training Sessions Set for March

The Indiana Patient Safety Center will host training sessions for hospitals interested in participating in the Culture of Safety Survey Program. More than 35,000 Indiana health professionals and physicians are participating.

The program uses a Web-based application of the Agency for Healthcare Research and Quality safety culture instrument. The AHRQ survey allows hospital leaders to gain insight into the perceptions of employees and physicians related to the culture of patient safety within each hospital. The results will provide baseline data from which to measure the impact of hospital-specific and statewide safety interventions.

To participate, each hospital must designate an on-site administrator. Designated survey administrators should participate in a one-hour, Web-based training session.

Training sessions are set for:

March 13: 10 a.m., EDT

March 17: 11 a.m., EDT

E-mail Betsy Lee, director, Indiana Patient Safety Center, at blee@ihaconnect.org, if you are interested in participating in a training session.


Registration Now Open for IHA Management Institute

Registration is now open for the IHA Management Institute set to begin June 29. Classes will be held from June 29 to Dec.14 in Indianapolis. The program provides high impact education for new and experienced hospital leaders covering a range of topics from management style to financial management. Sponsored by IHA and the Indiana University School of Public and Environmental Affairs, the institute consists of 10 classes designed to meet the needs of hospital managers. Those successfully completing nine of the 10 courses will qualify for the Certified Health Care Manager designation. A full program brochure is posted on the Management Institute Web page. To register, visit www.regonline.com/iha2009management-jun.

CMS Says Spending on Hospital Services to Slow

The Centers for Medicare & Medicaid Services reported that growth in U.S. spending on hospital services is expected to slow as use of services slows along with personal income. The recession is also expected to slow the growth in private health spending to a 15-year low. As more people lose their jobs and employer-based insurance, spending by public insurance programs is expected to rise. CMS projects Medicare’s Hospital Insurance Trust Fund could be exhausted one to three years sooner than projected by Medicare trustees last year. The CMS report was published online by Health Affairs.

IHA Bill Tracker 2-16-09

The IHA sent out an update of bills relevant to hospitals in the current session of the Indiana Legislature. You can download it here. You will need to log in.

None of the proposed bills mentioned in this blog over the past month were mentioned in the bill tracker. I guess it means that those bills are dead? (which is not a bad thing)

Quality Resources from Society of Hospital Medicine

I accidentally came across this website today from the Society of Hospital Medicine. They have posted tools, clinical pathways, and order sets for a multitude of common conditions.

The website is here.

Topics include:

• Acute Myocardial Infarction
• Anticoagulation
• COPD
• Pneumonia
• DC Planning
• Geriatric Care
• Glycemic Control
• Heart Failure
• Pre-Op evaluation
• Sickle Cell Pain Crisis
• Skin and wound care
• UTI
• VTE

While you are in the website, be sure to check out the other parts of the Quality Improvement section which includes a QI Primer PowerPoint presentation for physicians (or just click here).

Hospital of the Future

This is a link to an excellent video of a discussion at the 2007 Aspen Health Forum. Industry experts describe what they think the hospital of the future will look like given the trends we are seeing today.

http://fora.tv/2007/10/06/Hospital_of_the_Future#chapter_05

Feb 11 IHA Newsletter

The most recent IHA newsletter was released on Feb 11. The following is a cut and paste of items relevant to the Healthcare Quality Professional. The full newsletter can be found here.

IHA Board Takes Action on Issues
At its Feb. 6 meeting, the IHA Board of Directors passed a resolution encouraging hospitals to test the WHO Surgical Safety Checklist. A study published in the New England Journal of Medicine demonstrates that use of the checklist during major operations can reduce the incidence of deaths and complications by more than one-third.

More Indiana Hospitals Test Surgical Checklist
More IHA members have reported testing the WHO Surgical Safety Checklist. IHA and IHI are challenging hospitals to test the checklist in one operating room, by one surgical team, one time before April 1. Click here to view the list of IHA members who have already participated. Contact Mikell Brown at 317/423-7726 or mbrown@ihaconnect.org when your hospital has tested the checklist to have your hospital added to the IHA list.

IHA Monitors Stimulus Bill; Compile Project Lists
Congress is still hammering out a compromise between the House and Senate on the stimulus legislation. IHA is uncertain of what will be in the final version of the American Recovery and Reinvestment Act, and even its passage is not guaranteed. However, similarities between the House and Senate approaches allow us to prepare for what the President may sign into law as early as next week.

In the interest of being prepared for funds being available to Indiana’s hospitals, IHA is suggesting that you quickly compile information on projects that could be eligible for grants or other funding assistance. Much of the health care-related funding may flow directly to providers (such as Medicaid dollars and most of the health information technology funding), but state governments may be provided discretion in certain areas. For example, the Senate-passed version of the ARRA appropriates $1.6 billion for “grants to make schools and hospitals, significant users of energy, more energy efficient” (see summary available on http://appropriations.senate.gov/). It is unclear exactly how it would be allocated, but it may be prudent to prepare for some sort of competitive grant process.

Mitch Roob, CEO of the Indiana Economic Development Corporation, has been asked by Gov. Daniels to coordinate the state’s management of stimulus dollars. IHA anticipates that once the final bill is known, we will contact members again with more details on (1) what kind of projects might be eligible for funding; and (2) what information is needed by IEDC or any other grant-making entities.

Based on reviews of the stimulus legislation, the following list is provided as a guideline for you to compile projects in these areas along with supporting information that would likely be needed. IHA cannot be sure that these projects will be eligible for any funding, but we simply want to be prepared. We will follow-up with a more formal survey after passage of any stimulus legislation and additional conversations with IEDC.

NOTE: These categories of projects are listed in the order of the likelihood of available funding.

• Energy efficiency or “green building” projects: Do you have “shovel-ready” energy efficiency or “green building” capital projects in the pipeline on which work could be underway within six months after receipt of federal funding assistance? If so, what phases have been completed and what would be the level of assistance required for completion?
• Health Information Technology: Do you have projects such as electronic health records or upgraded infrastructure/servers/systems in the pipeline? If so, what phases have been completed and what would be the level of assistance required for completion?
• “Brick and mortar” capital projects: Do you have “shovel-ready” traditional capital projects in the pipeline that could be underway within six months after receipt of federal funding assistance? If so, what phases have been completed and what would be the level of assistance required for completion?

Provisions Worth Noting in Senate Stimulus Deal
The Senate Appropriations Committee has released a summary of the stimulus legislation, and there are several health-related provisions worth noting. This summary is available on the Committee's Web page here: http://appropriations.senate.gov/.

The total amount appropriated for health information technology is $3 billion. This is significantly below the $20 billion in the earlier House version. The Senate summary also reports $1.1 billion will be given to the Agency for Healthcare Research and Quality, National Institutes of Health, and the Health and Human Services Office of the Secretary to evaluate the effectiveness of health care services. The House stimulus legislation appropriated $4.1 billion for similar research. In another area of the bill, $1.6 billion would be available in energy efficiency grants for schools and hospitals. More updates will be provided.

Leaders Ask Congress to Replicate Health IT Model
Leaders in Indiana are encouraging Congress to consider replicating Indiana’s Health Information Exchange model as it looks to invest billions in health IT infrastructure as part of the American Recovery and Reinvestment Act of 2009. IHIE provides the country’s best working model of a health information exchange— securely connecting 39 hospitals, 10,000 physicians, and more than 6 million patients. The exchange delivers lab results, reports, medication histories, and treatment histories, in real-time regardless of the hospital system or location. Studies have shown that efficient exchange of medical records among doctors and hospitals in the U.S. could save billions annually. Click here to read IHIE’s letter to Congress.

RAC Rollout to Proceed; Contract Protests Resolved
The Centers for Medicare & Medicaid Services has announced it will now continue with the rollout of the permanent Medicare recovery audit contractor program. The program had been on hold as a result of contract bid protests, which have now been resolved. Details on CMS’ plans to resume the program are pending and will be shared when available. IHA plans to schedule a RAC briefing in the near future.

Registration Now Open for Nurse Retention Briefing
Registration is now open for Engaging and Retaining Nurses: A Prescription for Redesign in Tough Economic Times. It is set for March 18 at the Hilton Indianapolis North. The program will provide Indiana’s nursing leaders with practical strategies that lead to: improved staff satisfaction and retention; improved quality of patient care; more effective care teams; and greater efficiency. The program will use the tested principles and processes of Transforming Care at the Bedside, a program of the Institute for Healthcare Improvement/Robert Wood Johnson Foundation. Presenters will share the evidence base that supports practical tools, techniques, and resources for improvement. To register, visit www.regonline.com/iha2009rnretention.

ECRI Issues High Priority Alert on Bassinet Warmers
ECRI Institute, an independent, nonprofit organization that researches the best approaches to improving patient care, has issued a high priority medical device alert for several older models of infant radiant warmers. ECRI Institute recommends the removal of a series of warmer models manufactured by Borning and Hill-Rom. Complete findings and recommendations are posted for free public access on ECRI Institute's Web site in its Patient Safety Center.

Time Running Out to Register for Just Culture Program.
The registration deadline for the Just Culture Champion Training Session is Feb. 24. The program will be held March 3 at the Montage, Indianapolis. This training session will examine the Just Culture model—focusing on risk, system design, and the management of behavioral choices. The Just Culture Algorithm will also be introduced. The algorithm is a structured process for conducting an investigation of an event or near misses—identifying system contributions and assessing accountability for those involved. The session will be presented by experts from Outcome Engineering, the developers of the Just Culture Algorithm. Following the session, participating hospital teams will be ready to implement the just culture concepts learned during the session into their respective hospitals. To register, visit www.regonline.com/iha2009justculture.

Kaiser Permanente MedRite Program

The IHI recently posted a summary of the Kaiser Permanente MedRite Program. Components of this program to reduce medication errors included:

1. Step-by-step workflow of RNs to administer medications.
2. No Interruption Wear - no one should interrupt the RN wearing the NIW sash unless there is an emergency.
3. Sacred Zone - no one should cross or talk to an RN when they are in this zone marked in front of the area where medications are pulled/prepared.

The description of this program can be found at the IHI website here. The tools of this program (including overview, leadership change package, nurse change package, and project manager package) can be found here. Note that logging into the IHI website is required to access these tools. If you have not yet registered for access to the IHI webpage, you are missing out on a lot of quality improvement resources.

IHA Legislative Update - Feb 6, 2009

The most recent IHA Legislative Update is cut and pasted below (with some minor formatting changes). Items of particular interest to hospital quality professionals are colored in orange.

Deadlines Approaching; Workforce Bills Move Forward
Although conference committee work does not begin until late April, critical deadlines are approaching. Bills must be heard and pass out of committee by Feb.19. The surviving bills then must be amended and voted on by the full House and Senate by Feb. 24 and 25, respectively. Bills that don't make it through this process will be considered "dead." Of course, to keep things interesting, there are always opportunities to revive dead legislation, but these instances are limited.

Various bills addressing workforce issues are moving forward this session. Legislation includes:

Professional Licensing Matters: HB 1573, authored by Peggy Welch (D-Bloomington), addresses various professional licensing matters. The bill currently contains language that will grant physician assistants (PAs) more autonomy and somewhat expand their scope of practice. Among other changes, it would add PAs to the list of providers that can refer patients to occupational and physical therapists. It would also eliminate the current limit on the number of PAs that a physician may supervise and significantly changes the supervisory agreement. The bill is set for a hearing during next weeks' House Public Health Committee.

Home Health Care Wages and Benefits: HB 1028, authored by Rep. John Day (D-Indianapolis), would require home health care agencies to report annually wages, benefits, travel time and mileage, and other detailed information. This legislation is backed by the SEIU, which is concerned about the level of compensation for certain home health care workers. However, IHA’s government relations team has communicated to lawmakers that hospital-employed home health care workers are generally more highly-compensated than their non-hospital employed counterparts. Hospitals have been exempted from any new requirements.

Attracting Primary Care Physicians for Shortage Areas: HB 1138, authored by Rep. Scott Reske (D-Pendleton), passed out of the Public Health Committee this week. It defines primary care as family practice, obstetrics and gynecology, pediatrics, and internal medicine. The bill creates a loan forgiveness program for Indiana physicians who practice in these areas. A similar loan forgiveness program is included in HB 1210 (Public Psychiatry Development Program) authored by Rep. Charlie Brown (D-Gary). This bill is designed to increase the number of psychiatrists, psychologists, and psychiatric nurses practicing in Indiana, especially in the public sector.

Surgical Technologists and Nurse Circulators: HB 1593, authored by Rep. Chuck Moseley (D-Portage), presents some concerns for hospitals. The bill would require hospitals to employ only surgical technicians certified by a private, national accrediting agency (with some exceptions and a provision “grandfathering” those currently working as surgical technicians). This requirement would also extend to surgery centers and other health facilities.

Language in the legislation would also require nurse circulators to be present for the “duration” of surgical procedures. There are other issues that need clarification if this bill moves forward. The bill has passed out of the Public Health Committee, but Chairman Charlie Brown has asked IHA to work with the surgical technicians’ representatives to resolve other outstanding issues.

Trauma Funding Bill Passes First Test
This week, HB 1215, authored by Rep. Charlie Brown (D-Gary), was endorsed by the House Ways and Means Committee by a vote of 21-3. Before the vote, an amendment was approved that would reduce the amount of projected funding. The Legislative Services Agency had estimated that the introduced version of the bill would generate $16 million annually based on increased fees for motor vehicle violations, registrations, and driver's licenses. In its current form, the bill would only generate dollars for trauma centers through increased penalties for motor vehicle violations. HB 1215 could move to the House floor as early as next week for purposes of amendment by the full body.

FSSA Halts Welfare Modernization Rollout
FSSA Secretary Anne Murphy has halted any further rollout of the state's privatized, automated welfare intake system until agency officials are sure it can handle the additional volume. This decision comes at a time when lawmakers have introduced bills to slow down the initiative and fine-tune the new system which has met criticism. Since the rollout began 15 months ago, some have complained of lost documents, revoked benefits, lengthy hold times, and other problems.

State Revenue Falls Short; FSSA Asked to Make Cuts
The State Budget Agency has published the most recent monthly revenue report which can be viewed here: http://www.in.gov/sba/2485.htm.

Total tax collections for January were $142.2 million, well below a forecast that was made just a few weeks ago. The "Big Three"-- sales tax, individual income tax, and corporate income tax all fell below projected levels. For the first time in recent memory, this revenue report was posted along with a special commentary written by State Budget Director Chris Ruhl. His memo raises the very real possibility of additional state cost containment measures, and FSSA is specifically mentioned:

"Given the possibility of further revenue shortfalls, the Governor has directed us to assemble options for additional contingency measures. These generally include additional reductions in base spending, transferring unused balances in dedicated funds to the general fund, and renegotiating contracts and leases to generate cost savings. The Family and Social Services Administration has been asked to continue to generate other cost savings ideas in both Medicaid and other welfare programs they operate while preserving services."

RAC is Back!

Posted on the CMS Website today:

Protest Resolved: On February 4, 2009 the parties involved in the protest of the award of the Recovery Audit Contractor (RAC) contracts settled the protests. The settlement means that the stop work order has been lifted and CMS will now continue with the implementation of the RAC program.

You can find the full posting as well as additional RAC resources at: http://www.cms.hhs.gov/RAC/

Joint Commission to review NPSG 8 - Medication Reconciliation

The Joint Commission posted on their website yesterday that, due to the difficulty hospitals are having with implementation, they will be reviewing NPSG 8 - Medication Reconciliation.

Specifically:

Today, The Joint Commission Accreditation Committee determined that effective January 1, 2009, survey findings on National Patient Safety Goal 8 (Accurately and completely reconcile medications across the continuum of care) will continue to be evaluated during the on-site survey. However, given the difficulties that many organizations are having in meeting the complex requirements of NPSG 8, the Accreditation Committee agreed that The Joint Commission should evaluate and refine the expectations for accredited organizations. While this evaluation is being conducted, survey findings from NPSG 8 will not be factored into the organization’s accreditation decision. In addition, survey findings on NPSG 8 will not generate Requirements for Improvement (RFIs) and will not appear on the accreditation report.

You can read the entire posting at the Joint Commission Website here.

Comment Period for Nursing Sensitive Care Measures

The NQF today announced a comment period for the Nursing Sensitive Care Performance Measure Set. The project summary can be found here. The deadline for public comments is Feb 26, 2009.

This project summary document provides a history of the development of this measure set and how it was tested nationally. Of interest to the acute care quality professional is the last paragraph that reads:

Following a detailed discussion of each individual measure, there was consensus among the members to recommend that each of the measures move forward. The NSC measure set is due to undergo a maintenance review by the National Quality Forum in early 2009. The Hospital Quality Alliance Principals adopted the measure set in December 2008, pending NQF endorsement. The Joint
Commission is currently in the process of considering the set as an additional core measure selection option.

Remember that NQF endorsed measures have a tendency to be selected by CMS for public reporting. If you are wondering what measures make up this set, they are listed here:

1. Death among surgical inpatients with treatable serious complications (failure to rescue).
2. Pressure ulcer prevalence
3. Falls prevalence
4. Falls with injury
5. Restraint prevalence
6. Urinary catheter-associated UTI for ICU patients
7. Central line catheter-associated blood stream infection for ICU and HRN patients
8. Ventilator-associated pneumonia for ICU and HRN patients
9. Smoking cessation counseling for AMI
10. Smoking cessation counseling for HF
11. Smoking cessation counseling for PN
12. Skill Mix (RN vs LPN vs unlicensed assistive personnel, vs contract)
13. Nursing care hours per patient day
14. Practice environment scale - Nursing work index
15. Voluntary turnover

Tom Daschle Withdrawn as HHS Secretary Nominee

Apparently he felt that his tax issues and his close relationship witih the healthcare industry (speaking and consulting) will erode the confidence congress needs to have in him.

Depending on who the next nominee is, this may slow down the intended pace of Obama's healthcare reform plan.

Comparison of 2007 Indiana Hospitals HCAHPS Performance

Calendar year 2007 HCAHPS results are available from CMS along with national and state benchmarks. As you can see, no Indiana hospitals made it into the top 1% for the Likelihood to Recommend question. Nine (9) Indiana hospitals made it into the National Top 25%. Only one (1) Indiana hospital was in the national bottom 25%.

The complete list follows. If you don't find your hospital on this list, it means it either did not participate in HCAHPS during this time period or it chose to suppress the results from the public.

% of Respondents Indicating "Definitely Yes" on the HCAHPS Likelihood to Recommend Question.

94.54% National Top 1%,
92.00% ST VINCENT HEART CENTER - Indy
90.00% WOMEN'S HOSPITAL
85.04% National Top 10%,
85.00% ST FRANCIS HOSPITAL - MOORESVILLE
83.00% CLARIAN NORTH MEDICAL CENTER
82.00% CLARIAN WEST MEDICAL CENTER
81.00% DUPONT HOSPITAL
81.00% ST FRANCIS HOSPITAL - Indy
81.00% HENDRICKS REGIONAL HEALTH
81.00% ST VINCENT CARMEL HOSPITAL
80.04% National Top 25%,
80.00% MEMORIAL HOSPITAL
78.00% LAPORTE HOSPITAL
78.00% BEDFORD REGIONAL MEDICAL CENTER
77.00% ST VINCENT HOSPITAL - Indy
77.00% SAINT JOHN'S HEALTH SYSTEM, IN
77.00% ST MARY'S MEDICAL CENTER OF EVANSVILLE, IN
76.00% DUNN MEMORIAL HOSPITAL, IN
76.00% PARKVIEW NOBLE HOSPITAL, IN
76.00% TIPTON HOSPITAL, IN
75.00% DEKALB MEMORIAL HOSPITAL INC, IN
75.00% MARGARET MARY COMMUNITY HOSPITAL, INC, IN
75.00% COLUMBUS REGIONAL HOSPITAL, IN
74.00% RIVERVIEW HOSPITAL, IN
73.00% ST ANTHONY MEDICAL CENTER OF CROWN POINT, IN
73.00% DEACONESS HOSPITAL INC, IN
73.00% LUTHERAN HOSPITAL OF INDIANA, IN
73.00% PARKVIEW HOSPITAL, IN
72.00% SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND, IN
72.00% DECATUR COUNTY MEMORIAL HOSPITAL, IN
72.00% COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY, IN
71.00% CLARIAN HEALTH PARTNERS, INC D/B/A METHODIST,IU, IN
71.00% CLARK MEMORIAL HOSPITAL, IN
71.00% PARKVIEW HUNTINGTON HOSPITAL, IN
71.00% JOHNSON MEMORIAL HOSPITAL, IN
71.00% ST MARGARET MERCY HEALTHCARE CENTERS, IN
70.00% SAINT JOSEPH'S REGIONAL MEDICAL CENTER - PLYMOUTH, IN
70.00% SCOTT COUNTY MEMORIAL HOSPITAL AKA SCOTT MEMORIAL, IN
70.00% BLOOMINGTON HOSPITAL, IN
70.00% JAY COUNTY HOSPITAL, IN
70.00% SCHNECK MEDICAL CENTER, IN
70.00% ST MARY MEDICAL CENTER INC, IN
70.00% ST JOSEPH REGIONAL MEDICAL CENTER MISHAWAKA CAMPUS, IN
69.00% ST JOSEPH HOSPITAL & HEALTH CENTER, INC, IN
69.00% PARKVIEW WHITLEY HOSPITAL, IN
69.00% FLOYD MEMORIAL HOSPITAL AND HEALTH SERVICES, IN
69.00% WESTVIEW HOSPITAL, IN
69.00% Indiana State Average,
68.00% KING'S DAUGHTERS' HOSPITAL AND HEALTH SERVICES,THE, IN
68.00% National Average,
68.00% UNION HOSPITAL, INC, IN
68.00% COMMUNITY HOSPITAL, IN
67.22% National Middle 50%,
67.00% COMMUNITY HOSPITALS OF INDIANA INC (EAST), IN
66.00% WILLIAM N WISHARD MEMORIAL HOSPITAL, IN
66.00% HENRY COUNTY MEMORIAL HOSPITAL, IN
66.00% DAVIESS COMMUNITY HOSPITAL, IN
66.00% ST FRANCIS HOSPITAL AND HEALTH CENTERS, IN
66.00% COMMUNITY HOSPITAL SOUTH, IN
66.00% ST MARY'S WARRICK HOSPITAL, INC, IN
66.00% HANCOCK REGIONAL HOSPITAL, IN
65.00% MAJOR HOSPITAL, IN
65.00% LAFAYETTE HOME HOSPITAL, IN
65.00% HOWARD REGIONAL HEALTH SYSTEM, IN
65.00% ST VINCENT MERCY HOSPITAL, IN
64.00% MEMORIAL HOSPITAL, IN
64.00% ELKHART GENERAL HOSPITAL, IN
64.00% PARKVIEW LAGRANGE HOSPITAL, IN
64.00% BLUFFTON REGIONAL MEDICAL CENTER, IN
64.00% ST ELIZABETH MEDICAL CENTER, IN
63.00% ST CLARE MEDICAL CENTER, IN
63.00% SULLIVAN COUNTY COMMUNITY HOSPITAL, IN
63.00% ST VINCENT JENNINGS HOSPITAL INC, IN
63.00% WEST CENTRAL COMMUNITY HOSPITAL, IN
61.00% BALL MEMORIAL HOSPITAL INC, IN
60.00% ST JOSEPH HOSPITAL, IN
58.00% ST VINCENT FRANKFORT HOSPITAL, INC, IN
57.00% ST ANTHONY MEMORIAL HEALTH CENTERS, IN
57.00% ST MARGARET MERCY HEALTHCARE CENTERS, IN
57.00% HARRISON COUNTY HOSPITAL, IN
57.00% ST CATHERINE HOSPITAL INC, IN
56.00% MARION GENERAL HOSPITAL, IN
55.00% DUKES MEMORIAL HOSPITAL, IN
54.00% TERRE HAUTE REGIONAL HOSPITAL, IN
53.51% National Bottom 25%,
52.00% MORGAN HOSPITAL AND MEDICAL CENTER, IN

Note: It could (and has been) argued that these numbers don't mean anything because they are over a year old. However, from the perspective of the public, these are the most recently available numbers to them thus are "Real Time" for their purposes.

Rather than discounting these numbers as irrelevant and outdated, we need to look at these numbers as taking over a year to change and thus anyone wanting to change their numbers need to start immediately.

IHA Update - Jan 30, 2009

The IHA issued a legislative update on Jan 30. Of note is a proposed bill to limit insurance carriers from demanding that members accept care outside of the US as a condition of coverage. The entire IHA Legislative Update is copied below:


IHA Examines FSSA HIP Expansion Proposal
On Wednesday, FSSA Secretary Anne Murphy appeared before the House Ways and Means Committee to address the agency’s funding levels in the 2009-2011 state budget. Two elements of her presentation were of particular importance to Indiana hospitals: 1) the status of the existing Healthy Indiana Plan (HIP); and 2) a new proposal to expand HIP.

FSSA has put forth the Indiana Check-Up Plan II, which would allow more Hoosiers to be covered under the current HIP program, expand coverage for the disabled, and increase Medicaid reimbursement for hospitals closer to Medicare levels. The funding would come from a redirection of state appropriations made to replace the HCI property tax levies and a new provider tax paid by hospitals. In addition, FSSA has proposed to phase out all allotments under the Disproportionate Share Hospital (DSH) program in exchange for federal approval of covering more non-parental adults under HIP.

There are multiple reasons why FSSA is pursuing the Check-Up Plan II. For one, the majority of the 43,000 HIP enrollees are non-parental adults. Since this population is not normally covered by Medicaid, agencies that approved the HIP waiver required Indiana to give up $50 million annually in federal DSH dollars. In addition, a cap of 34,000 enrollees was placed on the number of non-parental adults that could be covered.

In her testimony, Secretary Murphy told the Committee that this cap of 34,000 will be reached early this year. FSSA says that in order for CMS and OMB to increase this limit, Indiana would likely have to forgo additional DSH funding to offset the federal government’s future costs (referred to as ‘budget neutrality’). Under the Indiana Check-Up Plan II, all remaining DSH dollars would be phased out by 2013.

BACKGROUND: The total amount of DSH dollars available to hospitals in Indiana (after the diversion of $50 million for the first HIP program) is roughly $130 million. While this number is significant, FSSA believes that the overall benefit of the Check-Up Plan II would offset this loss to Indiana’s hospitals as a whole.

Another motivator is that many disabled Hoosiers are signing up for HIP. Although they may be partially Medicaid-eligible, they are seeking to avoid the cumbersome “spend down” system imposed in Indiana. It is believed that this will drive expenses for the HIP program upward faster than expected. A chart produced by FSSA during Wednesday’s budget presentation showed annual expenses for the HIP program meeting revenues by 2011. FSSA proposes that a provider assessment levied on hospitals (in addition to the tobacco tax already dedicated for HIP) would then help stabilize funding for the entire program.

IHA is engaged with FSSA to better understand these and many other components of the Check-Up Plan II. To properly evaluate any proposed expansion of HIP, we are working with Secretary Murphy and her staff to better understand the magnitude and distribution of dollars returned to hospitals under HIP since its inception. We firmly support expanding coverage and leveraging more federal dollars back to the State of Indiana.

There are elements in the plan that generated reservations. The Federal Leveraging Task Force, convened by the IHA Board to explore the redesign of DSH and other supplemental payment programs, has been studying the proposal. Concerns have been raised about a hospital assessment that could return less than 100 percent to hospitals. In addition, members feel that the impact of the first HIP program must be better understood before Indiana surrenders its entire DSH allotment.

Legislation has been introduced to serve as a “placeholder” for FSSA’s proposal, but the bill’s author and Secretary Murphy have assured us that unless IHA supports a hospital provider tax, the major components of the Indiana Check-Up Plan II described above will not move forward this session.

This week IHA's Federal Leveraging Task Force recommended that a provider tax not be pursued at this time. This has been communicated to key policymakers. The task force did direct IHA to continue working with FSSA on many elements of the plan including: improving the current HIP program, expanding coverage for more Hoosiers, and creating a transparent and equitable supplemental payment structure.

Statewide Smoke-Free Air Bill to Be Heard Next Week
Broad smoke-free air legislation authored by Rep. Charlie Brown (D-Gary) has been scheduled for a hearing next week in the House Public Policy Committee. HB 1213 would ban smoking in public places and all enclosed workplaces. If it is successful, Indiana would join 23 other states that have enacted comprehensive smoke-free air legislation. The hearing will be held in the House Chamber on Feb. 4 at 9 a.m. and will be available online through the General Assembly's Web page.

IHA is supporting this legislation along with many other groups including the Coalition of Advanced Practice Nurses, the Indiana Academy of Family Physicians, the Indiana Minority Health Coalition, the Indiana Rural Health Association, and many more.

HB 1084: Medical Tourism Bill
A bill heard this week in the Indiana House would ban insurers from requiring health care treatment outside the U.S. as a condition of coverage. Rep. Craig Fry (D-Mishawaka), chairman of the House Insurance Committee, has authored a bill that would prevent some health insurers from forcing or encouraging customers to receive treatment overseas. HB 1084 was heard this week in the Committee, but a vote was not taken. It will be back on the agenda on Feb. 4 when the Insurance Committee meets at 10:30 a.m.

Last November, Indianapolis-based WellPoint launched a pilot program with a Wisconsin employer to cover certain elective procedures performed in India. This program was featured in an article published last month by Inside Indiana Business. Read the article.

Register Now for Hospital Day at the Statehouse
Registration is now open for Hospital Day at the Statehouse. The event is set for March 10. This year, Hospital Day will follow a new format. The luncheon will be members-only and hospital leaders should instead invite their legislators to attend an evening reception from 4:30-6:30 p.m. at the Eiteljorg Museum. To register or to view a copy of the brochure, visit www.regonline.com/iha2009hospday.