Date post: | 21-Dec-2015 |
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• 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