News & Opinion from the Week of November 3 – 9, 2013

AHA and AMA to CMS Re: Two-midnight Policy Inpatient Admission and Review Criteria

November 8 Letter to CMS

November 8 Letter to CMS (yellow highlights are mine)

The AHA and the AMA issued a joint letter to CMS Administrator Marilyn Tavenner on Friday, January 8, in a rare show of combined agreement and support for hospitals in particular. The letter urges CMS to delay enforcement of the policy for a full year, until October 1, 2014.  Download the letter here (Note: the highlights are mine.)

Calling the policy “fundamentally flawed” and “overly complicated,” they insist that the policy fails to support consistent decisions from either providers or reviewers, undermines medical judgment by physicians, and disregards the safe treatment and care of patients.

Perhaps the most damning accusation in the letter is one that has been largely ignored: CMS utterly failed to educate its beneficiaries, the ones who CMS claims to be protecting with this ruling, about the significant coverage limitations (translation = higher costs) that the ruling likely creates for them, which means that the hospitals and physicians will be the ones explaining all this to the patients, at a time when the patient is least likely to want to hear such news.

The letter was quietly posted on a sidebar on the AHA website, and was oddly neither reported in AHA News Now, nor even listed on the site in any other way.

Other News from the Web

Let’s Call It “House Spin”

“Well, Madam Secretary, while you’re from Kansas, we’re not in Kansas anymore.”

– Rep. Joe Barton (R-Tex.) to HHS Secretary Kathleen Sebelius

House? What house?

House? What house?

Ten Republican senators asked President Obama in the past week to fire HHS Secretary Kathleen Sebelius, who is overseeing implementation of the Affordable Care Act and the troubled website,

Sen. Pat Roberts (R-Kan.) led nine other senators and told Obama they were concerned not only with the botched rollout of the site, but the implementation of the entire law, which they all oppose, of course. It is widely reported that dozens of House Republicans have also suggested Sebelius be dismissed.

“While assurances have been made that solutions are forthcoming, we have little confidence that immediate resolution is imminent,” the senators said in a letter to the president dated November 7. “We believe that action must be taken swiftly to protect the American people from further fallout. If a similar rollout from any other national company or private-sector business resulted in overwhelming and sustained problems, a high-profile dismissal would be expected and appropriate.”

via 10 GOP Senators Want Sebelius To Be Fired; Some Dems Press For Individual Mandate Delay

And there is more to read on the situation via the blogosphere –

via Viewpoints: Sebelius Hearing Is A ‘Grudge Spectacle;’ Obama’s ‘Politically Convenient Falsehood’ About Coverage

…And, ignore that man behind the curtain…

"There's no time to explain it to you, Mr. President..."

“There’s no time to explain it to you, Mr. President…”

U.S. Chief Technology Officer Todd Park is willing to testify in front of a House oversight committee about the shortcomings of, but–he’s still too busy trying to fix the glitch-ridden website, the White House said on Thursday, Nov. 7.

via Todd Park too busy fixing to testify on its shortcomings

 In the Wake of

There could be a switch...

There could be a switch…

CMS, despite previously proclaiming it would not conduct external ICD-10 testing, may be changing its tune in the wake of ongoing issues with

via CMS may be open to ICD-10 testing

The Official Extension of the Delay of Reviews

CMS extended a grace period regarding audits and reviews of payments related to hospital stays shorter than the “two-midnight” threshold it established earlier this year, AHA News Now reported.

via CMS extends grace period on ‘two-midnight’ billing rule

Previous Statements by the AHA on 2-Midnights

The AHA issued a statement on the 2-Midnight Policy on Wed., Sep. 25., as well as a statement on the 2014 IPPS Final Rule.

via AHA Statement on CMS Final Rule for Hospital Inpatient Services, Long-Term Care Hospitals and Re-bil

via Statement on Two-Midnight Policy

"Maybe we need a different tool?"

“Maybe we need a different tool?”

MedPAC May Kill LTCH Payments

The MedPAC discussed potential payment reforms for post-acute care, in meetings on Nov. 7. One session reviewed prior MedPAC research that would eliminate the Long-Term Care Hospital Prospective Payment System and pay LTCHs through far lower inpatient PPS payments.

via AHA News Now: MedPAC discusses post-acute issues

CMS Tells More “Reg-Time” Stories: Another Chance to Hear Them Read Regulations To You

I Dare You Not to Yawn

I Dare You Not to Yawn

CMS will answer questions about its new “two-midnight” policy for inpatient hospital admissions during a Special Open Door Forum on Tuesday, Nov. 12, at 1 p.m. ET.

via AHA News Now: CMS announces provider calls on ‘two-midnight’ policy, rural issues

In Case You Thought Those NPI Numbers Were Annoying…

CMS announced on Nov. 7 that it will begin to automatically deny certain Medicare claims for clinical laboratory tests, imaging procedures, and durable medical equipment and supplies if they do not contain a valid NPI number for the ordering clinician, as of Jan. 6, 2014.

via AHA News Now: CMS to implement ordering and referring denial edits Jan. 6

Just in Case You Missed that CAGW Story


CAGW Spokesperson

CAGW Spokesperson

CAGW Opposes Suspension of Recovery Audit Contractor’s Program

CMS issued sub-regulatory guidance suspending RAC audits until March 31, 2014. The CAGW wrote letters to Congress demanding that Congress reinstate the RAC program, immediately.  But… isn’t the RAC Program run by the Executive Branch, not the Legislative Branch? Does that mean the CAGW has no idea how our government works?

HEY WAIT — Perhaps… One wonders if the regulations are salted with special hypnotic phrases, intended to turn listeners into… oh, say, writers for the CAGW?  Could that be the true, albeit sinister purpose of the Open Door Forums?


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