President’s ReportWashington UpdateMedical Marijuana in the Hospital2017 NDHA PAC CampaignPhysician RecruitmentIntroducing the New AHA Region 6 ExecutiveNDHA Education Update

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Phone: 701-224-9732Fax: 701-224-9529Web Site: www.ndha.org

Jerry Jurena, PresidentTim Blasl, Vice PresidentCallen Cermak, Finance ManagerLori Schmautz, Executive AssistantPam Cook, Education DirectorMelissa Hauer, General Counsel

A portion of this publication is supported by The Center for Rural Health’s Medicare Rural Hospital Flexibility Program. Visit their site at http://rural-health.und.edu/projects/flex/.

The Informer

In This Edition:

Attachments:

NDHA Contacts

November 17, 2017

This edition of The Informer sponsored by:

2017-18 NDHA Associate Member

Presidents Report ~ Jerry Jurena Tax reform and health care: This week, Senate Republican leaders reportedly said they will consider including repeal of Obamacare’s individual mandate in their tax reform bill. This news came after an announcement by Sen. Rand Paul, R-Ky., that he will seek to repeal the individual mandate in an amendment to be added to the Senate’s bill to “provide bigger tax cuts” to middle-income earners. The issue of repealing the Affordable Care Act (ACA) is far from over. Look for changes to the tax bill that affect health care in the next few weeks.

Health Care Reform Review Committee: Representative George Keiser will chair the next Health Care Reform Review Committee meeting on Thursday, November 30 at UND in Grand Forks. The agenda is available at: http://www.legis.nd.gov/assem-bly/65-2017/interim/19-5073-02000-meeting-agenda.pdf. There will be a discussion of options to operate the state’s Medicaid program as managed care and possible changes to the North Dakota public employee health insurance plan to become self-funded. Everyone is welcome to attend.

340B Program: Early this week, H.R. 4392 was introduced in the U.S. House of Representatives, to prevent a reduction in Medicare Part B payments. CMS had sub-mitted the Hospital Outpatient Prospective Payment System (OPPS) final rule earlier this month which would reduce Medicare payments by almost 30% to certain public and non-profit hospitals for outpatient drugs purchased under the 340B program. The American Hospital Association, the Association of American Medical Colleges, and America’s Essential Hospitals also filed a federal lawsuit this week to prevent CMS from implementing these cuts to the 340B program. Stay tuned.

No Informer Next Week: Thanksgiving is next week and so there will not be an Informer. Our offices will be closed Thursday and Friday as well. If you need some-thing, you are welcome to call me on my cell phone: (701) 226-9946. Have a great Thanksgiving holiday.

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Washington Update ~ John Flink Republican plans to enact far-reaching changes in the tax code moved forward this week. The House easily passed its version of the measure, while, just hours later, the Senate Finance Committee by a 14 – 12 party line vote approved Senate Republi-cans’ proposal. Rep. Cramer voted for the House measure.

Our focus in the tax debate has been on proposals that affect the ability of non-profit hospitals to use tax exempt bonds for major capital projects. The House bill would eliminate the tax exemption for private-activity bonds for 501(c)(3) hospitals and not allow tax exempt hospitals to use new tax exempt bonds to “advance refund” existing debt. Efforts to remove these provi-sions failed in the Ways and Means and the Rules Committee.

The Senate Finance Committee bill would still allow the tax exemption for private-activity bonds, but includes the House advance funding language.

Perhaps more important, the Senate bill would remove the tax penalty on individuals who do not comply with the Affordable Care Act’s mandate that they have insurance coverage. By eliminating the tax penalty, they effectively repeal the individual mandate. The Congressional Budget Office estimates this change would save the treasury more than $300 billion but result in 13 million Americans becoming uninsured.

Lawmakers adjourned late Thursday for the Thanksgiving holiday and will reconvene November 27 when the Senate plans to begin floor debate on the Finance Committee’s tax bill.

In other news this week, several national hospital groups – including the AHA – filed a lawsuit seeking to overturn the Cen-ters for Medicare & Medicaid Services 28.5 percent cut in payments for drugs purchased through the 340B program. They hope a federal judge will prevent CMS from moving forward with implementation while the case is heard in court.

Legislation to overturn the rule also was introduced in the House of Representatives. AHA, which organized the legislative effort, says it wants to move the bill in December, ahead of the January 1 start date for the payment change.

December promises to be frenzied in Congress. In addition to the Senate tax debate, lawmakers must fund the government after December 8, when the current continuing resolution expires. Funding for the Children’s Health Insurance Program is also a high priority, as are extensions of expiring Medicare provisions.

The Medicare extenders package looks likely to address a number of issues, including rural ambulance payment add-ons, payment add-ons for rural home health services, therapy caps, continued funding for community health centers and reautho-rization of the National Health Service Corps.

As in the past, it will be important to also play defense as Congress wraps up its year. Once again, site neutral payment poli-cies and cuts to CAHs, graduate medical education and bad debt payments are potentially in play.

Members of the North Dakota delegation are likely to be around the state over the next week. If you see them, reinforce our message about the damage that would be done if the tax exemption for tax exempt bonds is eliminated, and the ACA’s individual mandate is repealed.

If you would like additional information or talking points on these or any other issues, don’t hesitate to contact me or the NDHA office.

With medical marijuana set to become available in North Dakota in the next six to 12 months, hospitals will start seeing patients who have been certified to use the drug and want to use it during a hospital stay. Marijuana remains illegal, however, under federal law as a Schedule I drug. Each hospital will need to decide for itself how it is going to handle patients bringing their medical marijuana into the hospital. Hospitals should consider their existing policies regarding patient self-administration of medications. Many hospitals already don’t allow patients to bring meds from home and self-administer them in the hos-pital, no matter what kind of medication it is. Other policies that should be reviewed include handling of personal property, alternative supplements, and hospital security practices. Hospitals should also consider CMS Conditions of Participation and accreditation standards, such as Joint Commission, if the hospital is accredited. Hospitals risk their ability to participate in Medicare and Medicaid as well as their accreditation; even if that risk is viewed by some as low, it is still a risk. In the end, the difficulty for hospitals is that marijuana is still illegal under federal law. Each hospital will need to decide how much risk it is willing to take in allowing patients to bring medical marijuana into the hospital.

Medical Marijuana in the Hospital ~ Melissa Hauer

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Physician Recruitment ~ Kevin MaleeGetting Started, What Are We Looking For......

The CV (curriculum vitae) is our introduction to the candidate. Presentation is important and the CV should be easy to read and understand. However, outside of the candidate’s history (where they have been and what they have done), what else are we looking for in this document?

Where has the candidate trained and do we know any other providers who have trained in that program? Do we know the Program Director or any of the faculty currently or formerly at the program? Are there any gaps in the candidate’s training? Has our candidate moved several times in his or her career path? Is the candidate Board Certified and, if not, why not? Look for leadership, character, community service, professionalism, honors and awards, and exemplary performance in education and training. For example, was the candidate Chief Resident, did the candidate make presentations and write publications, or participate in professional Associations and Societies (i.e., AAFP or ACP) and, finally, what are the hobbies and interests of the candidate. After reviewing a good CV, we should be excited to meet and visit with this candidate.

If we like what we are seeing on paper, move quickly to set up a phone discussion.

If I can assist you in your physician recruitment efforts, please contact me at northdakotarec@comcast.net or 701-320-2109.

Our campaign is still ongoing. The NDHA Political Action Committee (PAC) gives individuals who care about hospital issues the opportunity to speak with a strong, unified voice. The NDHA PAC makes contributions to state and federal candidates, from both political parties, who support the goals of hospitals.

• 2017 PAC Goal: $15,800 • Total Donations to Date: $10,050

Thank you to the following individuals for their leadership and support of this year’s PAC campaign.

2017 NDHA PAC Campaign

Dave Molmen Altru Health System, Grand ForksBrad Wehe Altru Health System, Grand ForksDennis Reisnour Altru Health System, Grand ForksJanice Hamscher Altru Health System, Grand ForksDr. William McKinnon Altru Health System, Grand ForksHeather Strandell Altru Health System, Grand Forks Dr. Eric Lunn Altru Health System, Grand ForksMark Waind Altru Health System, Grand ForksDwight Thompson Altru Health System, Grand ForksJerry Lepp Ashley Medical Center, AshleyJeff Drop CHI – FargoMariann Doeling CHI St. Alexius Health Carrington Keith Heuser CHI Mercy Health, Valley CityBecki Thompson CHI Oakes Hospital, OakesKurt Schley CHI St. Alexius Health, BismarckAngie Svihovec CHI St. Alexius Health, BismarckAndrew Lankowicz CHI St. Alexius Health Devils Lake Tod Graeber CHI St. Alexius Health Garrison Dan Bjerknes CHI St. Alexius Health WillistonTim Sayler Essentia Health, Fargo

Pat Branco Heart of America Medical, Rugby Theo Stoller Jacobson Memorial Hospital, ElginK.C. DeBoer Jamestown Regional Medical CenterRobert Black Linton HospitalDan Kelly McKenzie County Healthcare, Watford CityJerry Jurena NDHATim Blasl NDHAMelissa Hauer NDHAKelly Cermak NDHAKim Granfor NDHA – HSI SolutionsPete Antonson Northwood Deaconess, NorthwoodDarrold Bertsch Sakakawea Medical Center, HazenDr. Craig Lambrecht Sanford Medical Center BismarckRoger Baier Sanford Mayville Medical Center Jodi Atkinson St. Andrew’s Health Center, BottineauCody Barnhardt St. Luke’s Hospital, CrosbyBen Bucher Towner County Medical Center, Cando Alan O’Neil Unity Medical Center, GraftonBev Vilhauer Wishek Hospital

Our Club Level Contributors:

Ben Franklin Club Chairman’s Club Capitol Club Dave Molmen Jeff Drop Angie Svihovec Keith Heuser Tim Blasl Dan Kelly Andrew Lankowicz Tim Sayler Mariann Doeling Kurt Schley Melissa Hauer Darrold Bertsch Cody Barnhardt Dr. Craig Lambrecht Ben Bucher Jerry Jurena Alan O’Neil

The American Hospital Association has announced that Jeanette “Jen” A. Porter, Ed.D., will be joining their team, ef-fective January 16, 2018 and will be serving in Region 6 as an AHA regional executive based in Sioux Falls, SD. Jen most recently served as vice president for post-acute care services for the South Dakota Association of Healthcare Organiza-tions in Sioux Falls, SD. In that role, she was responsible for planning, organizing and directing activities related to long term care, home care, hospice and other aging services in the post-acute care continuum as well as oversight and direc-tion for the overall communications activities for the association. She also oversaw the quality integration activities of the association, including project oversight for the Hospital Improvement Innovation Network (HIIN).

Before joining SDAHO, she was a professor at the University of South Dakota involved in teaching/advising, research, and service within the AUPHA-certified health services administration program in the Beacom School of Business. She also worked with the Evangelical Lutheran Good Samaritan Society as a nursing home administrator, human resources consultant, and director of national operations for home health and hospice operations.

The AHA’s Region 6 team also includes Michael McCue, Director, Member Relations and Kristina Weger, Executive Director of Executive Branch Relations.

You can reach Jen on/after her start date at jporter@aha.org or 800-981-9826. Jeanette A. Porter, Ed.D., Regional Executive American Hospital Association, 3708 West Brooks Place Sioux Falls, SD 57106

NDHA Education Update Below is a listing of webinars that may be of interest to you. Registration fees for webinars are $175/NDHA member, and $300/non-member. This fee is “per facility” and you can have as many staff sit in on one connection as you’d like. All times listed below are central time.

Follow this link to register! https://www.ndha.org/education/education-events/

November 2017Telemedicine in North DakotaDate: 11/29/17 From: 10:00 AM to 11:00 AM

December 2017 Email Fail-Strategies for Reducing Risks from Electronic CommunicationDate: 12/05/2017 From: 12:30 PM to 1:30 PM

Legal Issues Concerning Employees with Psychiatric IllnessesDate: 12/07/2017 From: 12:30 PM to 1:30 PM

Retaining Millennials in Today’s WorkplaceDate: 12/07/2017 From: 12:30 PM to 2:00 PM

December continued....

Fraud and Abuse Laws - What you Don’t Know Can Hurt YouDate: 12/20/17 From: 10:00 AM to 11:00 AM

January 2018Coaching Employees for High PerformanceDate: 01/04/2018 From: 9:30 AM to 11:00 AM

Our Future Healthcare WorkforceDate: 01/04/2018 From: 12:30 PM to 1:30 PM

Medicaid Hospital Presumptive EligibilityDate: 1/24/18 From: 10:00 AM to 11:00 AM

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Introducing the New AHA Region 6 Executive