Federal UpdateJune 2005

Update

Front Burner Legislative

Policy Issues—IPPS; Rehab

Other Issues on your mind

• Antitrust and Business Practices– Retrospective reviews– Insurance industry consolidation– Group purchasing organizations

• BCC– Billing– Collections– Charges– Executive compensation– Class action litigation– Public Relations– Membership education and tools– Beyond current charges– Studies

• Coverage– HCCU– CTUW III– Association health plans– Comprehensive approach (UHPP)

• Delivery system reform– Limited service providers

Make moratorium permanent Beyond specialty hospitals Improving MD relations Payment options (MEDPAC)

– Chronic care management Hospital participation in pilot projects (UHPP)

– Green Bay Packer model– Stark II/MD recruitment

• Emergency Readiness and Public Health– Federal appropriations– Flu vaccine legislation– HRSA readiness grant

• Fraud and Abuse– OIG pricing regulations

• Health Care Liability Reform– Federal MICRA legislation– Alternatives– State action center

• Information Technology– Interoperability standards– MD integration– Treatment of regional information networks– Federal funding

• Mental health– Medicare psychiatric PPS– Coverage parity

• Payment– Federal budget

Budget resolution Reconciliation

* Medicaid modernization– MD payment– Indirect medical education adjustment– Rural package– Regular PPS rule

Update factor/quality initiative Area wage index Outlier thresholds Long-term care hospitals Transfer Policy

– Rehabilitation 75 percent rule– SNF rule (RUG refinement)– Pay for performance– Medicare advantage implementation– Health Care as Investmentf

• Quality and Patient Safety– Patient safety legislation– FCC medical telemetry– 8th Scope of Work– JCAHO legislation– COP revisions– Leadership Agenda

Improvement* Use of Evidenced-Based Medicine Practices* Best Practices Clearinghouse

Accountability* Hospital Quality Alliance* Governance Dashboard

Coordination* Organizational redesign/ clinical micro-systems* Chronic care coordination

• Racial and Ethnic Priorities– Health Gap/Equality Legislation– Data collection– Membership tools/leadership forum

• Regulatory Relief– HIPAA– Model practices– EMTALA– ICD-10 approval

• Tax (other)– Pensions– Community benefit

• Workforce– Federal appropriations– Foreign workers– Labor relations/organizing– MD supply– Best practices clearinghouse– Work design

ISSUE MANAGEMENT

• Payment– Medicaid– Medicare

• Public accountability– Quality and patient safety– BCC

Billing Charges Collections Executive compensation Tax-exempt status

• Liability reform• Limited service providers• Coverage

Immediate PrioritiesImmediate Priorities

Organizing Themes

• Protecting the safety net

• Increasing affordability and improving care

• Expanding coverage

Budget Conference

• Medicaid– $10 billion over five years

No cuts in first year

– Commission (presidential appointment) 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

Outcome

• Medicare exposure

• Medicaid…holding hospitals harmless– Rx reimbursement ($5-6 billion)

• Physician payment

Payment

ChallengeChallengess

Competition Argument House Leadership—other R

(Barton/Coburn) OppositionTerry Cloth Robe Factor

(Patients like LSHs)Payment refinements

Limited Service Hospitals

ChallengeChallengess

“Special” Coverage Project Project• Advisory Group

– American Hospital Association

– Association of Health Insurance Plans

– U.S. Chamber of Commerce

– Families USA

– Federation of American Hospitals

– Heritage Foundation

– Health Leadership Council

– Service Employees International Union

• “A Practical Plan for Expanding Health Care Coverage– As Many People As Possible…As Quickly

As Possible

AARPAAFP

AFL-CIOAMAANA

APHABCBSA

CHAHR Association

Johnson & JohnsonKaiserNGANCSLPfizer

Project Hope