join us in washington · lion to rehab units and $17.7 million to freestanding facilities. • the...

A M A G A Z I N E F O R A R K A N S A S H E A LT H C A R E P R O F E S S I O N A L SA M A G A Z I N E F O R A R K A N S A S H E A LT H C A R E P R O F E S S I O N A L S

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CEO PROFILE: Gary Bebow

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Spring 2006 I Arkansas Hospitals 3

is published by

Arkansas Hospital Association419 Natural Resources Drive • Little Rock, AR 72205

501-224-7878 / FAX 501-224-0519www.arkhospitals.org

Beth H. Ingram, Editor

BOARD OF DIRECTORSRobert Atkinson, Pine Bluff / Chairman

Ray Montgomery, Searcy / Chairman-Elect

Luther Lewis, El Dorado / Treasurer

Timothy E. Hill, Harrison / Past-Chairman

Robert R. Bash, Warren / At-Large

David Cicero, Camden

Ann Cloud, Siloam Springs

David Dennis, Berryville

Dan Gathright, Arkadelphia

Michael D. Helm, Fort Smith

Ed Lacy, Heber Springs

James Magee, Piggott

Larry Morse, Clarksville

John Neal, Stuttgart

Richard Pierson, Little Rock

John N. Robbins, Conway

Steve Smart, El Dorado

Russ Sword, Crossett

EXECUTIVE TEAMPhil E. Matthews / President and CEO

Robert “Bo” Ryall / Executive Vice President

W. Paul Cunningham / Senior Vice President

Beth H. Ingram / Vice President

Don Adams / Vice President

DISTRIBUTIONArkansas Hospitals is distributed quarterly to hospital executives, managers, and trusteesthroughout the United States; to physicians,

state legislators, the congressional delegation, and other friends of the hospitals of Arkansas.

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Edition 54

Arkansas Hospitals

PAGE 14

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A M A G A Z I N E F O R A R K A N S A S H E A LT H C A R E P R O F E S S I O N A L SA M A G A Z I N E F O R A R K A N S A S H E A LT H C A R E P R O F E S S I O N A L S

SPRING 2006 www.arkhospitals.orgSPRING 2006 www.arkhospitals.org





Cover Photo Spring in theArkansas Ozarks

Photo by ArkansasDepartment of Parks and Tourism

PAGE 35

Departments4 From the President6 Education Calendar7 Arkansas Newsmakers and Newcomers

CEO Profile8 Gary Bebow of White River Medical Center

Features27 Guidelines for CAH Relocations28 CAHPS Survey (HCAHPS) Fact Sheet29 Court Upholds Assisted-Suicide Law30 Study on Increasing Hospital Nurse Staff30 Effects of Reducing Public Health Coverage 30 Impact of Methamphetamine Abuse

Medicare/Medicaid35 Medicaid Recovering Excess Payments35 Inpatient Psychiatric Facility Rate Increase36 OIG Reports FY 2005 Medicaid Savings36 HHPPS Utilizes Revised MSA Designations36 AFMC Compliance Workbook Available37 Medicare Long Term Care Proposed Rule37 Medicare Contractor Reorganization38 CMS Redesigns Web Site38 CMS: P4P Improves Quality39 P4P Should Bolster “Effective Care”39 Arkansas Retains High Medicaid FMAP39 Telehealth Payment Amount Explained40 Apply for Your National Provider Identifier40 Guidance For NPI Use Offered by CMS40 Ambulance Inflation Factor Announced

NewsSTAT7 Arkansas Health Summit 12 AHA Testifies About Medicaid Losses13 HIPAA Administrative Simplification 14 $2 Million in FEMA Reimbursement14 Ambulance Diversion Rate One per Minute14 Crowding Factor in Ambulance Diversions15 Need for State Trauma Network 15 Trauma is Leading Medical Expenditure16 Leadership Conference, June 14-1616 Middle Management Certificate Series 17 Investment Program Now Available17 AAHT: Helping Hospital Trustees18 Arkansas Children’s Hospital’s EMMY19 Information Technology Forum April 2619 CMS Projects $4 Trillion Health Bill20 Learning Facility Capacity Constraints20 “Prior Approval” Policy Concerns21 Nurses and Medical Screening Exams22 SWOT Provides Help for Hospitals24 U.S. Healthcare Spending Holds Steady 24 $36 Billion Medicare Reduction Proposed34 Mental Health Parity Act Extension

Emergency Preparedness25 JCAHO “Surge Hospital” Guide Available25 Video on Children and Bioterrorism26 Grant to Aid States in Flu Preparedness

Quality41 JCAHO Allows Hospital Data Review 41 JCAHO Patient Safety Goals42 Quality Measurement Oversight Board42 Antibiotic Resistant Bacteria Guidelines42 Latest Hospital Quality Data Posted 43 Surgical Care Improvement Project43 NIH Models Infectious Disease Outbreaks

JCAHO44 JCAHO Won’t Sell Performance Data44 JCAHO Survey Price Hike Announced44 JCAHO Unannounced Survey Exceptions45 JCAHO and Medication Reconciliation

Electronic Health Records46 Report Pushes EHR Funding46 AHRQ Releases Learning Resources

32 Join Us in Washington, April 30 – May 3

33 2006-2008 American Hospital Association Strategy Map

34 Arkansas PAC Contributions Recognized

4 Spring 2006 I Arkansas Hospitals

To all of us involved in healthcare, President Bush’s pro-posed 2007 budget, specifically its $36 billion in Medicarecuts over five years through 2011, is a trumpet call for

action. It is time for all of usinvolved with Arkansashealthcare to make our unit-ed voices heard on this issue,and to let our Congressionaldelegation know in no uncer-tain terms how devastatingthese cuts, if enacted, will beto the patients and hospitalsof Arkansas.

To see what devastationthe cuts will cause right hereat home in Arkansas, consid-er these figures (based oninformation regarding theproposed Medicare cuts pro-vided by the Centers for

Medicare & Medicaid Services):

• The proposed reduction in the market basket updatefor inpatient and outpatient care of 0.45% in FY2007, of 0.4% in FY 2008, and of 0.4% in FY 2009will amount to $8.1 billion nationally. And here athome in Arkansas? Our best estimate is that theinpatient loss will be $59.3 million, and the outpa-tient loss $14 million.

• The proposed freeze in the payment update for inpa-tient rehabilitation facilities for 2007 and an updateof market basket minus 0.4% in 2008 and 2009 willresult in a loss of $1.6 billion nationally. Here athome in Arkansas, it will mean a loss of $18.3 mil-lion to rehab units and $17.7 million to freestandingfacilities.

• The proposed four-year phase out of reimbursementfor Medicare bad debt will mean a loss of $6.2 billionnationally. $43.8 million will be cut from ArkansasPPS hospitals, and an additional $3.9 million fromour critical access hospitals.

Other proposed cuts in the Bush budget, both toMedicare and Medicaid, will also have a severely negativeaffect on healthcare, both nationally and right here athome in Arkansas.

We all know that cutting healthcare funds is NOT theway to a healthier America, nor to a healthier Arkansas. Ifthese cuts go through, it will be a setback for our citizens,who deserve protected healthcare access.

2006 is definitely a year when hospitals need to speakup. Action is needed by each of us. We cannot wait for“the other guy” to do all of the talking!

It is important that each of our members let our con-gressional delegation know how these cuts will affectthem at the grassroots level, in their own hospitals and intheir own communities. When we speak to our electedofficials in very specific ways about how their constituentswill be affected by the proposed budget cuts, it truly makesan impact and can avert disaster for the nation’s healthcaresystem!

I urge each of you to consider joining us April 30-May 3at the annual meeting of the American HospitalAssociation in Washington, D.C. We will visit withSenators Lincoln and Pryor, Representatives Berry,Boozman, Ross and Snyder and their staff members to letthem know how the proposed Medicare and Medicaidcuts will affect Arkansans and Arkansas hospitals.

If you cannot go to Washington with us, please consid-er sitting down with these officials when they are at homein your district. Take members of your governing board,auxilians, even those who have been patients in your hos-pitals. Let them tell the story of what these cuts will meanto the hospitals of Arkansas. Their presence will make theproposed impacts a reality.

The most important thing is to speak up, to act, and notto wait for someone else to carry the message. We mustact together, we must speak with a united voice, we mustrealize that this is a marathon race and not a sprint, andwe must take action, now – TOGETHER!

Speaking Clearly, with a United Voice

Phil E. MatthewsPresident and CEO Arkansas Hospital Association

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April 19, Little RockLeaping from Staff to Management:

You’re a Manager…Now What?Mid-Management CertificateSeries

April 20, Little RockLeaping from Staff to Management:

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April 26, Little RockInformation Technology Forum

April 27, Little RockArkansas Organization of Nurse

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April 28, Little RockArkansas Healthcare Human

Resources Association SpringConference

April 30-May 3, Washington, D.C.American Hospital Association

Annual Meeting

May 3-5, Hot SpringsSociety for Arkansas Hospital

Purchasing and MaterialsManagement Annual Meeting

May 4, Little RockArkansas Foundation for Medical

Care Annual Quality Conference

May 10-12, Hot SpringsArkansas Association for Hospital

Engineering Annual Meeting

May 24, Little RockBuilding a Culture of Commitment.

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June 14-16, Branson, MOArkansas Hospital Administrators

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ARKANSAS NEWSMAKERSandNEWCOMERS

Robert L. Kerr, MD, has succeeded Steve Erixon aspresident and CEO of Baxter Regional Medical Center(BRMC) in Mountain Home as of March 13 while thehospital board of directors conducts a search for theposition. Kerr, a retired physician and longtime mem-ber of the Mountain Home medical community, wasmost recently medical director for Arkansas Blue CrossBlue Shield

Board chairman Clark Fletcher said, “Steve[Erixon], his team, the medical staff and our board ofdirectors have created a hospital with the highest-qual-ity patient care. BRMC is known throughout our stateand nation as a state-of-the-art hospital with outstand-ing doctors, nurses and support staff. We look forwardto continuing to provide our region with the best inhealthcare.”

Surgical Hospital of Jonesboro was approved for mem-bership by the AHA board of directors at its January13 meeting. Nate Miller is CEO of the facility. Millerwas previously administrator of HealthSouth RehabHospital in Jonesboro prior to joining the SurgicalHospital in February 2004. He has a master’s degree inphysical therapy from the University of CentralArkansas and was named to Arkansas Business’ “Fortyunder Forty” for 2005.

Jay Bunyard, chairman of the board of directors ofDeQueen Regional Medical Center, has announced thesale of the hospital to JCE Healthcare, Inc. ofDeQuincy, Louisiana. Amy Vines is administrator ofthe facility. Hospital expansion and upgrade plans for2006 include the opening of a 10-bed rehabilitationunit, as well as replacing obsolete equipment with thelatest technology, including 4-D ultrasound.

Kurt Meyer, CEO of Rebsamen Medical Center, Inc. ofJacksonville, has been named chairman of the AHAWorker’s Compensation Self Insured Trust. Meyer suc-ceeds Ron Rooney, president of Arkansas MethodistHospital in Paragould, who has served as chairman forthe past 13 years. Mark Deal, president and CEO ofDelta Memorial Hospital in Dumas, was elected vicechairman.

Lee Simpson has joined The Bridgeway Hospital inNorth Little Rock as CEO/Managing Director, suc-ceeding Joel Klein. Simpson is the former VicePresident/Behavioral Health of St. Bernards BehavioralHealth in Jonesboro. Prior to that, he worked inadministration in hospitals and healthcare organiza-tions in Memphis, Oklahoma City, San Antonio andAustin. •

Arkansas Health Summit Will Help Educate Leaders on Health Issues Facing Our State

The Arkansas HospitalAssociation will co-host anArkansas Health Summit with theArkansas Medical Society, theUniversity of Arkansas for MedicalSciences, the Arkansas Center forHealth Improvement and theArkansas Division of Health. Theevent was scheduled to take placein mid-April, but postponed to alater date due to the special legisla-tive session called by GovernorHuckabee. The Summit’s objective

is to gather state legislators andeducate them on health issuesexpected before the 2007 legisla-tive session.

Arkansas Governor MikeHuckabee will speak regarding thehealth of those living in Arkansasand his Healthy ArkansasInitiatives, and Dr. Joe Thompson,Arkansas’ Surgeon General, willdiscuss the health status of the stateand specific areas where improve-ments can be made. Attorney

General Mike Beebe also hasagreed to appear on the program.

Other speakers will cover topicssuch as Medicaid funding andreforms, evidence-based medicine,health promotion and disease pre-vention, flu pandemic, and tobaccosettlement funds.

For more information about theSummit, please contact ArkansasHospital Association ExecutiveVice President Bo Ryall at 501-224-7878. •


C E O P R O F I L E

As you enter the main entrance ofthe White River Medical Center inBatesville, to the right of the informa-tion desk is a large window with aclear view into someone’s office.Looking inside, you see Gary Bebow,administrator and CEO of the WhiteRiver Health System, standing as heworks at his computer. He turns witha smile and a wave.

During his 15 years in Batesville,the White River Health System hasgrown from a community hospital toserving as a regional health network.Part of the reason may be Bebow’sintense commitment to being accessi-ble to the community. “The window

in my office lets peo-ple see me workingfor them, lets themknow they can comein and visit. I can’ttell you how manytimes a day membersof the medical staff,members of the com-munity, and hospitalemployees stop andwave. They havelearned that I’mavailable, and thathas formed an all-important founda-tion for clear communication.

“Hospital administration is a 24/7career,” he says. “People ask ques-tions when you’re at the grocery store,in line at the movies, everywhere.Being accessible to people is what it’sall about.”

Bebow’s commitment to accessibili-ty spreads throughout the several-county region served by the health sys-tem. “When I first came to WhiteRiver Medical Center, we were essen-tially serving Batesville and the imme-diate surrounding area. Now, we havea broader service area and see our-selves as a truly regional health system.That is probably the most importantchange that has occurred in my 15years here. We have shifted our focusfrom community to regional.”

That shift in focus has come, large-ly, because the community, hospitalboard, administrators, medical staff,and employees work together for thegreater good. “We have continued toreach out to our region with morehealthcare access points and services as

each year passes,” hesays. “Much of thisgrowth is due tocommunity influ-ence. An importantmessage for adminis-trators everywhere isthat we can’t losetouch with our com-munities. We mustgrow and makechanges that thecommunity sees asboth relevant andneeded.”

To make certainhe has the ear of the region and under-stands its needs, Bebow has an unusu-ally large health system board of 24members. In addition, 24 people serveon a White River Medical Center advi-sory board, more than 30 on thewomen’s health advisory council, 11on the Stone County Medical Centeradvisory board, 17 on the health sys-tem foundation board and more than120 in the hospital volunteer organiza-tion. “Members of our administrativeteam are active throughout the area,”he says. “I guess you could say ourhospital is very sensitive to our region,and does all it can to maintain anopen, active, ongoing relationship withthe public we serve.”

As head of the White River HealthSystem, Bebow oversees both the 199-bed White River Medical Center inBatesville and the 25-bed StoneCounty Medical Center, a criticalaccess hospital in Mountain View. Inaddition, he guides operation of thesystem’s three nursing homes inMountain View, Horseshoe Bend and

Gary Bebow Brings a Commitment to Accessibility to the White River Medical Center

by Nancy Robertson Cook

White River Health System Administrator/CEOGary Bebow speaking with employees inthe newly-completed Josephine RayeRogers Center for Women and Imaging inBatesville. The bronze art piece behindthem depicts a joyful mother with hernewborn infant.


Marshall, the two residentialcare centers in MountainView and Horseshoe Bend,eight rural health clinics/pri-mary care physician establish-ments, outpatient care facili-ties in Mountain View,Cherokee Village andBatesville, and the system’shome health services, durablemedical equipment supplyand hospice care operations.

He has served as leader ofthe White River HealthSystem for the past 15 years,coming to Batesville in 1991from his former position asChief Operating Officer for ahospital in Venice, Florida.

“I grew up in Alma,Michigan, a farming community ofabout 12,000,” Bebow says. “When Iwas growing up, I knew that farmingwas not going to be my career of

choice, and I always had strength inmathematics and analytical skills.Accounting was a good choice for me.”

He graduated from Michigan State

University with an undergrad-uate degree in accounting,then accepted his first jobwith the accounting firm ofErnst and Ernst, where heobtained his certified publicaccountant license and forthree and one-half yearsworked on hospital account-ing and audits.

“I admired my uncle, whohad been the CFO of a hospi-tal, then started his own CPAfirm in Lansing, Michigan,”Bebow says. “I had long beeninterested in his work withhospitals, and that led to myworking with hospitals in myyears as an accountant. Inthose years, I began to devel-

op a desire to have a more expandedview of the hospital setting.” In 1975,one of the hospitals for which he per-formed audits asked him to join its

Gary and Verona Brown-Bebow, MD

Gary Bebow, Les Frensley (WRHS Board President), Doyle Rogers, Josephine Raye Rogers and Dick Bernard (WRHS Foundation BoardPresident), at ground breaking of the Josephine Raye Rogers Center for Women and Imaging.


C E O P R O F I L E

staff, and his true career path began.That hospital was W.A. Foote

Hospital in Jackson, Michigan. At thetime, Foote, a major inner city publichospital, had just merged with a hospi-tal owned by the Sisters of Mercyhealth system. “I was asked to comeon board to help with financial transi-tions related to the merger,” he says.“The two cultures were, understand-ably, very different. I learned a lotabout compromise in those first yearsas a hospital financial officer.”

It was during his time at Footethat he began to take a keen interestin hospital management, specificallystrategic planning. He began takingcourses at the University of Michigantoward a degree in hospital adminis-tration, graduating in 1981 with amaster’s in Health ServicesAdministration.

“I knew that I would definitely beseeking an administrative position inthe warmer South,” Bebow smiles.“I was really getting tired ofMichigan’s cold winter weather!”

Bebow joined the Venice(Florida) Hospital soon thereafter.He spent his first five years as VicePresident, Finance (CFO) of the hos-pital, and his last five years there asits Chief Operating Officer. “I waslucky to move from hospital financeto operations,” he says. “It was agreat opportunity to become more

well-rounded as anadministrator.

“There was a lotto learn in Venice,”he says. “We wentfrom a summertimepopulation of 35,000to a winter popula-tion of 70,000. Thatteaches you a lotabout how to balanceresources, employees,operations.” Histenure there was from1981-1990.

He credits his back-ground in hospitalfinance as a reason theinterviewing team forthe White RiverHealth System foundhim an attractive can-didate. “A main issuethen was the financialside of the operation,”he says. “I have nowlived in Arkansas for15 years, and I love ithere. Every day, I amcommitted to provid-ing accessible healthcare for patients inthis part of the state. We look at it asproviding the best care and servicespossible for the least cost possible.”

He says that too often, hospitalsbegin thinking of themselves primari-

ly as big businesses, rather than pri-marily as service providers. “I thinkthat today, the shift in healthcare isdefinitely back to the service side,”he says. “That is one of the majorcycle changes I have seen in my yearsin healthcare. Today, we focus wherewe should, on customer service.Improved patient outcomes, moreattention to safety and buildingstrong community relationships areall a part of that emphasis on excel-lent customer service.”

2005 marked the opening of one ofthe health system’s greatest responsesto regional needs – the new JosephineRaye Rogers Center for Women andImaging. “The community believed inthe mission, and trusted us to carry itout,” Bebow says. Though fundingcame from many sources includingpersonal gifts and grants, the commu-nity at large raised more than $5 mil-lion toward construction of the newfacility. It is a state-of-the-art unit

Mr. Bebow speaking to the crowd at the 11th Annual WhiteRiver Health System Foundation Golf Classic benefiting theJosephine Raye Rogers Center for Women and Imaging.

“We would all like limitlessnumbers of nurses, medical

staff and technologies inorder to provide the highest

possible level of quality, but in today’s reality, that is not financially feasible.”


offering the latest in OB/GYN servic-es, both outpatient and inpatient, aswell as imaging services, communityeducation and a research library acces-sible to the public.

Today, Bebow and his team arehard at work on another majorimprovement project — renovatingthe Stone County Medical Center inMountain View. The communityhas already raised $250,000 for theproject, underlining its belief in thehospital’s importance to the region.The project includes expansion toinclude additional med/surg bedsand surgical suites, an enhancedemergency room and general updat-ing of the entire facility. It is sched-uled for completion later this year.“The renovation and expansion issomething everyone in the communi-

ty responds to, and can be proudof,” Bebow says.

Though there is little down time inhis career, Bebow says he enjoys spend-ing time with his family, especially hiswife, Verona Brown-Bebow, MD, hisstep-children, Clare, 15, and Tice, 18,and his grown children, Ella and herhusband, Wes (who live in Memphis),and son Andy, his wife, Erika and theirtwo-and-a-half-year-old son Graham(who live in North Carolina). He alsoenjoys playing golf.

He sees limited financialresources, federal cutbacks and thegrowth of the numbers of uninsuredas real challenges for healthcare’sfuture. “We would all like limitlessnumbers of nurses, medical staff andtechnologies in order to provide thehighest possible level of quality,” he

says, “but in today’s reality, that isnot financially feasible.” He addsthat he believes challenges can be metand answers found if people are cre-ative and work together.

That is one place the ArkansasHospital Association really helps, hesays. “The AHA represents hospitals’views in enacting change, and is thecatalyst for hospitals in the state toshare ideas and provide consensus.”

As the future unfolds, he willremain accessible, will continue tobuild relationships with the manygroups in his region, and will seekanswers to the tough questions.“How many people can actually saythey are working in the best job forthem?” he asks. “I could not be in abetter place or have a better career. Ilove this work.” •

Jim Wann (Owner, Wann Office Supply and Treasurer, WRHS Foundation), Tony Rushing, Gerald Meacham (WRHS board member) andGary Bebow (CEO/Administrator, WRHS) – team at the 11th Annual White River Health System Foundation Golf Classic benefiting theJosephine Raye Rogers Center for Women and Imaging.


In September 2005, ArkansasHospital Association (AHA) execu-tive vice president Bo Ryall toldmembers of the Arkansas LegislativeCouncil’s Hospital and MedicaidStudy Subcommittee that a lawpassed earlier that year was a goodfirst step, but it wouldn’t generateenough new state revenues to allow amuch needed Medicaid paymentincrease for hospitals. Act 2222 of2005 provided for limited newMedicaid revenues that could gotoward increasing the program’slong-standing hospital inpatient perdiem cap, but only if insurance pre-mium taxes paid to the state came inabove forecasted levels.

Ryall based his comments on thefindings of a study showing that hos-pitals lost about $33 million in 2002taking care of Medicaid patients. Hesaid that the losses were growing andwould get worse with every passingyear. The subcommittee reviewed thefindings of that study and asked

Ryall to address the issue again, oncethe AHA completed a plannedupdate of its study to show morerecent numbers.

On February 23, the subcommit-tee again turned its eyes and ears toRyall and Susan Miller, a consultantwith BKD Healthcare Group, asthey reviewed the findings of thenewly completed update. The law-makers learned that the combinedhospital losses had shot up to $64million by 2004. While the newstudy included more hospitals —inpatient data was taken from 63hospitals and outpatient data from58, versus 46 facilities for the earli-er study — a direct comparison oflosses for the hospitals that partici-pated in both studies shows theirlosses increased 36%, from $33 mil-lion to $45 million, over the two-year period.

According to Miller, who directedthe study and authored the report,inpatient losses for the year could be

as much as $26 million more thanreported, since the data do not reflectamounts related to care for inpatientswho exhaust their 24-day per yearbenefit limit. She also said that inpa-tient losses for 2006 could be doublethose recorded in 2004, consideringchanges in the state’s Medicaid upperpayment limit program mandated bythe federal Centers for Medicare &Medicaid Services that were effectiveJuly 1, 2005.

Ryall’s testimony was intended toprovide further evidence thatMedicaid must increase its hospitalper diem cap, which has remainedunchanged at $675 per day since1996. The AHA has been workingclosely with Medicaid officials, legis-lators and the governor’s office tofind additional state dollars to makethat increase possible. The AHA willdistribute copies of the report to allmember hospitals for use in advocat-ing for the increase with their locallegislators. •

AHA Testifies About Medicaid Losses

Highlights of the new findings are shown below:Total Costs, Reporting Period Ending in 2004 ($277,026,112)

Inpatient $205,367,546

Outpatient $71,658,566

Add: Medicaid Payments $171,598,016



Losses Due to Inadequate Payments ($105,428,096)



Less: Medicaid UPL Payments * $41,362,807

Net Losses for Hospitals ($64,065,289)

Percentage Inpatient Costs Paid w/o UPL 68.1%

Percentage Inpatient Costs Paid w/UPL 88.3%

Percentage Outpatient Costs Paid 44.3%

Percentage Overall Costs Paid w/o UPL 61.9%

Percentage Overall Costs Paid w/UPL 76.9%

*UPL payments offset inpatient losses, bringing that total to $24,129,334


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C O N C E P T S

The Department of Health andHuman Services published a February16 final rule detailing the enforcementprocess for the Health InsurancePortability and Accountability Act’s(HIPAA) administrative simplifica-tion standards.

The rule extends the existing regu-lations for investigating noncompli-ance with the privacy standard to allof the administrative simplificationstandards, and elaborates on the rulesfor imposing civil monetary penaltieson entities that violate the administra-tive simplification provisions.

The American Hospital Associa-tion is reviewing the rule and willissue a set of highlights to memberssoon.

In a related move, the Centers forMedicare & Medicaid Servicesrecently posted answers to two newfrequently asked questions regardingHIPAA’s administrative simplificationstandards.

The first question (ID# 6595)relates primarily to the use of the pro-posed transaction standard for claimsattachments, and whether healthcareproviders can use the proposed stan-dard ahead of a final rule. The answeris yes.

The second question (ID# 6594)addresses which business structuresare considered “organizations”under the final rule for NationalProvider Identifiers.

Go to http://a257.g.akamaitech.net/7 / 2 5 7 / 2 4 2 2 / 0 1 j a n 2 0 0 6 1 8 0 0 /edocket.access.gpo.gov/2006/pdf/06-1376.pdf to see the new rule. The FAQs are located at http://ques-tions.cms.hhs.gov/. •

DHS Publishes Final Rule for HIPAAAdministrative Simplification Standards


According to FEMA contractors,Arkansas hospitals will receiveapproximately $2 million in reim-bursement for the treatment of unin-sured evacuees from HurricanesKatrina and Rita.

The reimbursement money wasrelatively easy to apply for but hospi-

tals had a very limited time to applyfor the funds. At press time, 98% ofthe claims had been processed.

At two February meetings in LittleRock, Jeff Cox, FEMA project offi-cer, and several FEMA public assis-tance coordinators, answered ques-tions about FEMA reimbursement

posed by representatives of nearly 40Arkansas hospitals. At both meet-ings, Cox explained he had beenbrought in specifically to work withhospitals to help them receive reim-bursements due them for the careand treatment of uninsured hurri-cane evacuees. •

A recent study in the Annals ofEmergency Medicine said about oneambulance in the U.S. is diverted everyminute from its intended emergencydepartment because it was overcrowd-ed and could not care safely for anoth-er sick or injured patient.

Using research from the 2003National Hospital AmbulatoryMedical Care Survey, the Centers forDisease Control and Prevention foundthat hospital emergency departmentsdiverted ambulances when they wereovercrowded, citing a lack of appro-

priate inpatient beds (51%), a highnumber of emergency department vis-its (50%), and complexity of emer-gency department cases (18%).

Also, about 16.2 million patientsarrived by ambulance at emergencydepartments in 2003, representing14% of the total emergency depart-ment visits made that year, accordingto the CDC. Of those visits, seniorsaccounted for 40%, the largest grouptransported by ambulances to emer-gency departments.

“Considering the biggest users of

ambulance services are people over age65, and the number of seniors isexpected to substantially increase overthe next decade, ambulance diversioncould disproportionately affect this agegroup,” Catharine Burt, the study’slead author, said in a news release.

A separate study by UCLAresearchers, published with the CDC’sfindings online in the Annals ofEmergency Medicine, found thatambulance diversions at Los AngelesCounty hospitals more than tripledbetween 1998 and 2004. •

ER Crowding is a Factor in AmbulanceDiversions, Study Shows

An average one ambulance perminute was diverted in 2003 becausehospital emergency departments couldnot receive additional ambulancepatients, according to a new study byresearchers at the Centers for DiseaseControl and Prevention. (2003 is thelatest date for which data is available.)

Patients arrived by ambulance for16.2 million ED visits in 2003, withabout 31 ambulances arriving at aU.S. ED every minute, the study ofNational Hospital Ambulatory

Medical Care Survey data found. An estimated 501,000 ambulances

were diverted during the year, and anestimated 45% of U.S. emergencydepartments reported diverting ambu-

lances at some point during the year. “This study again illustrates the

incredible pressures facing hospitals intrying to meet the growing demand foremergency care,” said CarolineSteinberg, vice president of healthtrends analysis for the AmericanHospital Association.

An abstract of the study can befound at the Annals of EmergencyMedicine Web site. Go tohttp://www.annemergmed.com/article/PIIS019606440501989X/abstract. •

Ambulance Diversion Rate Reaches Oneper Minute, According to New Study

Approximately $2 Million in FEMA Reimbursement for Arkansas Hospitals


In January, the American Collegeof Emergency Physicians released itsreport showing Arkansas’ emergencycare system graded as the worstamong all states. Coincidentally, thereport came at a time when theArkansas Trauma Care Advisory

Council is actively ramping uprenewed efforts to address needs fora statewide trauma care network.

With those two actions serving asa catalyst, the Arkansas HospitalAssociation (AHA) convened aFebruary 16 meeting of representa-

tives from a half dozen hospitalsacross the state and staff members ofthe state Department of Health andHuman Services’ Section ofEmergency Medical Services andTrauma Systems (EMSTS) within theDivision of Health, who are responsi-ble for emergency services issues. Thediscussion centered on the lack ofany designated trauma centers in thestate and the steps that must be takenin order to establish an effective trau-ma care network for Arkansas.

The Arkansas Board of Healthadopted a set of Rules andRegulations for Trauma Systems in2002, but no hospitals have volun-teered to meet those standards yet,for several good reasons. Theseinclude the added costs (for whichthere is no extra reimbursement) andthe difficulty in getting cooperationof needed specialists who must beavailable in the facilities or on call tocare for trauma-related cases.

Other issues involve the type oftrauma registry that the EMSTS isusing, the cumbersome requirementsfor case data that must be reported tothe registry, liability concerns thathinder voluntary participation bymany specialty physicians, andsquabbles among insurers aboutwhich group is the primary payer onmany trauma cases.

Participants agreed that legisla-tion will be required to clear many ofthese hurdles. In the meantime, theEMSTS office will continue to inves-tigate how a statewide trauma sys-tem can best be attained. The mostimmediate task will be to collectinformation that can be used to sup-port a request during a future legisla-tive session for laws that will betterenable and help to finance a truetrauma care network for Arkansas.

The AHA workgroup will contin-ue to meet as necessary to reviewnew information as it becomesavailable. •

AHA Advisory Group Discusses Need for State Trauma Network

Trauma Spending SurpassesHeart Disease, Cancer as LeadingMedical Expenditure by Condition

The Agency for HealthcareResearch and Quality reportedJanuary 16 that U.S. spending to treattrauma-related disorders nearly dou-bled between 1996 and 2003 to sur-pass heart disease as the leading med-ical expenditure by condition.

Over the same period, spending forheart conditions increased nearly 17%to surpass cancer as the second leading

medical expenditure by condition. The number of Americans with

medical expenditures for heart condi-tions and cancer increased over theperiod, while the number ofAmericans with medical expendituresfor trauma was roughly unchanged.

Go to http://meps.ahrq.gov/Com-pendiumTables/TC_TOC.htm toview the data for the report. •

Arkansas Hospitals Middle ManagementCertificate Series Planned

As a leader in yourhealthcare facility,how are you progress-ing? Have you select-ed the right people tobe on your team? Areyour leaders and man-agers properly trained?

Supervising may bea bit unnerving forsome, especially thosewho have been movedinto management posi-tions without assis-tance in developing skills and compe-tencies necessary for the job. Thoseindividuals want to succeed in theirnew positions, and you want them tosucceed. But they cannot learn to beexcellent supervisors just by receivinga new title.

To help hospital leaders assist man-agers in expanding their skills, theArkansas Hospital Association hasdeveloped a “Mid-ManagementCertificate Series” of common senseworkshops teaching the skills vital tonew managers’— and ultimately your

program’s — success.The series will help

improve the quality ofyour facility’s manage-ment by developing andenhancing coreleadership skillsand managerialabilities in yourmid-managementteam. The overar-ching objective isincreasing reten-tion of managers

and frontline staff by helpingyour managers learn to relatewith those working for themeffectively.

Studies of employee turnovershow that the direct relationshipwith the supervisor is theNumber 1 reason staff leave theircurrent position. If you can help yourmanagers become effective communi-cators, good leaders, excellent organiz-ers and positive influences, youremployee turnover rate should dimin-ish and your hospital’s efficiency

should increase. You enable your man-agers to achieve success when you signthem up for this certificate series.

The series will offer the followingone-day workshops:

Series and workshop information isavailable on the AHA Web site atwww.arkhospitals.org/calendar. Formore information on this exciting newprogram, please contact Beth Ingramat 501-224-7878. •


Summer Leadership Conference, June 14-16Hospital executives

from around the stateshould mark your calen-dars to attend the annualArkansas Hospital Admin-istrators Forum/ArkansasHealth Executives ForumSummer Leadership Con-ference to be held June 14-16 at the Chateau on theLake in Branson, Missouri.

The faculty for this year’s meeting ishighlighted by healthcare consultantRichard Hoerl, who will discuss medi-ation, negotiation, and conflict resolu-tion for hospital leaders; and KarolynBroussard, senior vice president for

consulting services, QHR,who will focus on improv-ing hospitals’ bottom linethrough revenue cycleimprovements. Also on theprogram, Dr. Sidney Hayes,the medical director forMedicare Parts A and B atPinnacle Business Solu-tions, Arkansas’ Medicarecontractor, will discuss the

Contractor Error Rate Testing (CERT)program and areas within that reviewprograms where Arkansas hospitalsneed improvement.

Along with the planned educa-tional activities, Branson offers many

opportunities for family entertain-ment — golfing, outlet malls, fishing,boating, swimming, tennis, a fullrange of musical entertainment forall ages and tastes, and much, muchmore — which make the trip toBranson memorable.

Registration information will bemailed in a few weeks, but you areencouraged to make hotel reserva-tions now by calling 1-888-333-5253. Mention the ArkansasHospital Association or ArkansasHospital Administrators Forum forspecial room rates. Contact BethIngram at (501) 224-7878 for addi-tional information. •

April 19 Leaping from Staff to Management:You’re a Manager…Now What?

April 20 Leaping from Staff to Management:You’re a Manager…the Next Steps

May 24 Building a Culture of Commitment(recruiting and reducing turnover)

August 24 Financial Skills for Managers

August 25 Financial Skills for Managers II: TheBusiness Side of Healthcare forNon-Financial Managers

September 13 Presenting Like a Pro

October 26 Dealing with Conflict

November 16 Government Relations Workshop


Arkansas Hospital Investment ProgramNow Available Through AHA Services, Inc.

Short-term and ultra short-terminvestment services are now availableto AHA members through theArkansas Hospital Association (AHA)subsidiary, AHA Services, Inc.(AHASI). AHASI has endorsedBancorp South Investment Services,Inc. (BISI), a wholly owned subsidiaryof Bancorp South Bank, as investmentadviser to AHA member hospitals.

A letter announcing this endorse-ment was recently sent to all Arkansashospital CEOs and CFOs. BISI began

marketing the new program, called theArkansas Hospital Investment Pool(AHIP) early in January 2006.

BISI provides ultra short-term andshort-term fixed income investmentservices to participating hospitalsthat have excess reserves or operatingcapital needing to be put to work inthe short term. The investment prod-ucts BISI offers are designed to pre-serve capital, enhance returns andmaintain liquidity.

BISI has a long and successful track

record of providing fixed incomeinvestment instruments to hospitalassociation members in Mississippiand Louisiana. In addition, they are inthe process of finalizing an agreementwith the Alabama HospitalAssociation service corporation to pro-vide similar investment services totheir member hospitals.

Questions about the program maybe directed to Don Adams at the AHAby calling 501- 224-7878 or [email protected]. •

AAHT: Helping Hospital Trustees Better Understand and Become More Effective in Their Role

How can you educateyour hospital’s governingboard to be better-informedtrustees of your organiza-tion? How can you providenetworking opportunitiesfor them with access toother trustees around thestate? How can you offerinformation with a broadperspective on healthcarepolicy and issues, alongwith new insights and infor-mation on a trustee’s specif-ic role within the hospital?

The answer? Join the ArkansasAssociation of Hospital Trustees(AAHT), an affiliate of the ArkansasHospital Association (AHA). TheAAHT was formed in 1993 to helphospital trustees become moreinformed and effective board mem-bers through education and commu-nication. Now, in its 12th year, theAssociation membership has grownto more than 560 trustees, represent-ing 47 Arkansas hospitals. Dr. Steve

Smart of El Dorado serves as theAAHT’s current president.

“Interaction with directors fromother hospitals throughout the statehas been invaluable for me, and thisbenefit is available for your directorsas well,” Smart says. “The AAHToffers the opportunity to be asinvolved and informed as a directorcould possibly desire. If there is nointerest in new commitments of time,there are the options of simply utilizingthe literature provided by AHA to stay

abreast of trends and direc-tor responsibilities or toattend excellent continuingeducation programs spon-sored by the AAHT fortrustees. In addition, my per-sonal exposure to the AHA isheightened by my represent-ing the AAHT on the AHABoard of Directors.”

Membership in the organ-ization is only $250 per hos-pital, and that entitles everyone of your board members

to all AAHT benefits. A brochuredetailing those benefits and a member-ship application were recently mailedto all hospitals.

There truly is strength in numbersand there is value in linking to thosewith common needs, concerns, andgoals. Please consider joining theArkansas Association of HospitalTrustees and strengthening the voice ofArkansas hospitals. Contact BethIngram at 501-224-7878 for informa-tion about AAHT. •


Arkansas Children’s Hospital Brings Home an EMMY Award

Arkansas Children’s Hospital(ACH) and Litzwire Sound &Vision were recently awarded aprestigious Emmy Award for theirall-terrain vehicle (ATV) safety tel-evision spotsentitled “ATVsare Not Toys.”The award waspresented at theMid-Amer i caRegional EmmyAwards ceremo-ny held late last fall at the HyattRegency in St. Louis, Missouri.

The Mid-America Chapter ofthe National Academy ofTelevision Arts & Sciencesincludes markets in Illinois,Missouri, Iowa, Kansas,Kentucky, Louisiana andArkansas. In each award category,three finalists are selected as hav-ing the honor of being “EmmyNominated” and one nomineewins the Emmy Award.

“The Emmy Award is certainlywell known and highly presti-gious,” said Scott Allen, directorof Community Outreach atArkansas Children’s Hospital. “Itis a great honor for ArkansasChildren’s Hospital and LitzwireSound & Vision to be recognizedfor our work on these public serv-ice announcements promotingATV safety. We believe thesevideo spots will help raise aware-ness of ATV-related dangers, illus-trate consequences of poor choicesand cause families to give carefulconsideration before allowing ayoung person on an ATV.”

Arkansas Children’s Hospitaldeveloped the ATV safety cam-paign with the tagline “ATVs areNot Toys” and Litzwire Sound &Vision produced the two thirty-

second public service announce-ments. This theme was used forthe Emmy-winning video spotsand for the entire ATV safety cam-paign at ACH.

“ U n l i k ebikes or scoot-ers, ATVs arep o w e r f u l ,motorized vehi-cles that canweigh as muchas 600 pounds

and reach speeds of 60 mph orgreater,” says Allen. “The mes-sages conveyed in the two Emmy-winning video spots are designedto help young people and adultsalike understand that criticalthinking skills, strength, coordina-tion and mature judgment are allimportant considerations beforeallowing anyone on an ATV.”

Arkansas has seen a continuedrise in injuries to children resultingfrom ATV crashes. In 2004, ACHadmitted 65 patients with ATV-related injuries. More than half ofthose injured were under age 12,most were riding adult-sized ATVsand very few were wearing hel-mets. National statistics indicatethat children constitute only 14percent of ATV drivers, butaccount for nearly 40 percent ofATV-related injuries.

The ATV safety spots areshown on cable systems origi-nating in central, northeast andnorthwest Arkansas to help raiseawareness of the need for ATVsafety.

To view the Emmy-winningpublic service announcements goto www.archildrens.org and clickon the link under ACH Spotlighton the right-hand side of thehome page. •

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Are you preparing for the wave ofinformation technology that issweeping healthcare today? Surelyyou wouldn’t spendhundreds of thou-sands or even mil-lions of dollars onnew equipment, newtechnology or newservices withoutinvesting in appro-priate education ofyour informationtechnology depart-ment, would you?

In order to pro-vide answers for hos-pitals to meet that

challenge, the Arkansas HospitalAssociation in cooperation with theArkansas Chapter, Health Informa-

tion and Manage-ment Systems Society(HIMSS) will presentan Information Tech-nology Forum onWednesday, April 26 atthe Holiday Inn Selectin Little Rock.

Forum presenta-tions include: Develop-ing practical informa-tion security policies;IT best practices forusing technology toimprove patient care,

including the development of a new“eICU,” a self-developed PACS(Picture Archival and Communi-cation System) and what telemedi-cine can mean to your hospital; theemerging RHIO (Regional HealthInformation Organization) move-ment; a discussion of the NationalHealth Information Network; howto achieve CPHIMS designation;and an update from the ArkansasChapter, HIMSS.

Program and registration infor-mation are available by clicking onwww.arkhospitals.org/calendare-ducworkshops.htm, or by contact-ing Beth Ingram at 501-224-7878 [email protected]. •

According to numbers publishedby the Centers for Medicare &Medicaid Services (CMS), it took 30years for the nation’s healthcarespending to top $1 trillion followingthe 1965 law that set up theMedicare program. The milestoneoccurred in 1995. CMS recentlyreleased its newest national health-care expenditure projections whichcover the next ten years. Those esti-mates show that the U.S. health billwill climb to $4 trillion by 2015. Ifthat happens, the total will haveincreased 300% in just 20 years.

According to CMS, annualhealthcare spending growth will con-tinue to slow through 2007 and aver-age 7.2% through 2015. That wouldbe slower than in recent years, butstill 2.1% faster than the annualgrowth in Gross Domestic Product(GDP). Hospital spending growthfor 2005 is projected at 7.9%, whichreflects a projected slowdown ininflation and in Medicaid spending

growth. Nevertheless, it marks thesecond consecutive year that growthin the sector is expected to outpacegrowth in total personal healthcareexpenditures.

If CMS’ projections are correct,by 2015, public payer spending,including federal and state dollars,will account for 47.5% of the coun-try’s total healthcare spending, andwill consume 20% of GDP.

The study also forecast the fol-lowing significant projections:

• Medicare spending will spike by25% in 2006 due to the newprescription drug benefit, thenaverage 7.5% growth between2008 and 2015.

• Medicaid spending should aver-age 8.6% growth annually from2008 through 2015 when spend-ing reaches $670 billion.Medicaid is a joint federal-stateprogram for poor Americans.

• Private health insurance premi-ums slowed for a third consecu-tive year and grew by 6.8% in2005. However, an upturn in theunderwriting cycle in 2007means that premiums will growby a forecast 8.3% in 2009.

• Out-of-pocket spending is pre-dicted to decline by 1% in 2006after remaining stable at 5.6%growth in 2005. Consumers areexpected to spend $421 billionout of pocket on healthcare by2015, up from $248.8 billion in2005.

For more details, visithttp://www.cms.hhs.gov/NationalHealthExpendData/03_NationalHealthAccountsProjected.asp. •

Information Technology Forum Scheduled for April 26

CMS Projects $4 Trillion Health Bill


An ad hoc committee composed ofArkansas hospital representatives metFebruary 3 with Arkansas Blue Crossofficials to discuss the insurer’s recentpolicy change requiring prior approval(PA) for certain “high-tech” outpatientimaging services.

Effective February 1, Blue Crossstarted requiring the PA for ComputedTomography, Magnetic ResonanceImaging, Positron EmissionTomography and Nuclear Cardiologyprocedures in an effort to better man-age the utilization of those services.

During the meeting, Blue Cross rep-resentatives Mike Brown, Dr. ClementFox and Dr. Pete Marvin reviewed thereasons why the insurer has imple-mented the policy, saying that it is anattempt not only to curtail over-utiliza-tion, but also to provide a mechanismfor identifying physicians who areordering the procedures and thosedelivering them. Currently, Blue Crossdoesn’t have an information systemcapable of identifying physicians who

may be over- or under-utilizing imag-ing services.

The three also responded to issuesand concerns raised by the committeemembers. Primary among those con-cerns are physicians’ complaints relat-ed to the added workload and time-consuming process for obtaining thePAs. Dr. Fox shared data from the firstweek of operation (the call line for thePA went “live” on January 23) show-ing that the average response time tothe calls ranged from four minutes and20 seconds to seven minutes and 15seconds (including answer time).However, since the process may ofteninvolve callbacks, there is no data toindicate how long it takes to get thefinal PA approved. Blue Cross will beworking with its contractor, NationalImaging Associates (NIA), to reducethose times where possible.

Hospitals are also concerned thatphysician reluctance to fully accept theprocess and obtain PAs for patientsthey refer will put hospitals at risk of

losing reimbursements for those proce-dures, especially when the referringphysician has no payment at stake forproviding the imaging service or read-ing it. Blue Cross will deny paymentfor the technical and professional com-ponent related to the affected servicesabsent a prior authorization, and hos-pitals can’t balance-bill patients for theunpaid amounts.

Dr. Fox noted that there is an incen-tive for referring physicians to abide bythe new policy. Any physician who hassigned a Blue Cross contract has anobligation to comply with the termsand conditions that govern the organi-zation’s utilization management pro-gram. The PA policy is part of thatprogram. Failure to comply may resultin the physician being excluded fromBlue Cross’ provider network.

During the first week of operations,NIA handled 312 calls requesting PAs.Of those, 238 were approved and 40were disapproved for administrative(i.e. eligibility) reasons and four

AHA, Blue Cross Meet to Discuss “Prior Approval” Policy Concerns

Nursing Enrollments Up, But Learning FacilityCapacity Constraints Now Causing Difficulty

The American Association of Colleges ofNursing (AACN) reported in December2005 that enrollment in entry-level bac-calaureate nursing programs increased 13%for the 2005-2006 nursing school classes,but nursing colleges and universities wereforced to turn away 32,617 qualified appli-cants due to capacity constraints.

“Despite the successful efforts of schoolsnationwide to expand student capacity, ournation’s nursing schools are falling far shortof meeting the current and projecteddemand for RNs,” said AACN presidentJean Bartels.

The federal government projects a short-fall of 800,000 registered nurses by the year

2020. Pamela Thompson, CEO of theAmerican Organization of NurseExecutives (AONE), said, “This datafrom AACN is troubling for all of us.We desperately need to increase thenumber of students graduating frombaccalaureate programs, but the con-straints on schools to accomplish thisseem to be increasing. The shortage offaculty and limits to capacity could crip-ple our ability to graduate enough nurs-es to meet our future needs. We mustcontinue to search for multiple solutionsto this growing problem.”

AONE is an American HospitalAssociation subsidiary. •


Nurses May Conduct Some Medical Screening Exams, but Must Follow All Rules

During the Arkansas HospitalAssociation’s (AHA) “Day with theLawyers” seminar on January 25,there was discussion as to whether reg-istered nurses are able to conduct“medical screening examinations”(MSEs) as defined under the federalEmergency Medical Treatment andActive Labor Act (EMTALA).

AHA Legal Counsel Elisa Whitehas learned that there is confusionabout this issue traceable to ArkansasState Board of Nursing (ASBN) inter-pretations. White believes the confu-sion is related to the differences in fac-tual scenarios presented to the ASBNand not to any inconsistency in theboard’s policies.

The Rules and Regulations forHospitals and Related Institutions inArkansas addresses this EMTALAissue under Section 36(F)(1), whichstates, “Each patient presenting to theEmergency Department shall have amedical screening examination by a

qualified medical personnel (QMP).” According to the Arkansas

Department of Health and HumanServices, qualified medical personnel,including RNs, who have been for-mally designated by the hospital’smedical staff and governing authori-ty may provide those medical screen-ing exams. However, the Rules andRegulations further states, “Theexamination shall be completely doc-umented. If a physician is not pres-ent, the qualified medical personnelshall contact the physician requestedby the patient or the physician oncall to discuss the assessment find-ings and determine the patient’s con-dition [emphasis added].

In response to a request from theAHA, the ASBN has clarified that aregistered nurse may perform a med-ical screening examination (MSE), aslong as that examination is consistentwith the RN’s scope of practice. Thehospital must evaluate whether and to

what extent an RN should be perform-ing MSEs, and the specific require-ments for the performance of MSEs byvarious personnel (RNs, APNs, etc.)should be set out in the hospital’sbylaws and rules and regulations.

Hospitals will want to ensure thatappropriate personnel perform MSEsdepending upon the overall complexi-ty of the patient’s healthcare problemand that, if there is no physician pres-ent, the RN or other QMP must con-sult with a physician, who will deter-mine if an emergency medical condi-tion exists. In general, it is recom-mended that hospitals allowing RNsto perform screening exams provideclear protocols governing these evalua-tions and provide the nurses withprompt access to physician support asneeded for patient care.

Hospitals that continue to havequestions about this matter should feelfree to contact the AHA at 501-224-7878 for additional information. •

requests were withdrawn by therequesting physicians.

PAs for another 30 requests weregiven with an “alternative clinical rec-ommendation,” an educational quali-fication. In short, those requestswould not meet the guidelines for a PAif submitted for the same reasons as ofMay 1, 2006.

The discussions also covered theseitems: • Although the policy went into

effect February 1, Blue Cross willnot deny payment for the failure toobtain a PA for procedures previ-ously allowed under its coveragepolicy until May 1, 2006.

• Blue Cross is currently using NIAguidelines to cover reviews of pro-cedures for which there are no BlueCross guidelines. See the NIA guide-lines at http://healthadvantage-

hmo.com/providers/AuthInf.asp orat http://www.radmd.com.

• A set of “Frequently AskedQuestions” about the prior author-ization policy on outpatient diag-nostic imaging procedures is avail-able via Blue Cross’ secure AHINWeb site that providers can accessthrough http://www.healthadvan-tage-hmo.com.

• While hospitals can’t obtain a PAfor a physician, they may initiatethe process by contacting NIA andproviding initial demographicinformation on the patient.

• For now, physicians must contactNIA via telephone to request a PA.But, those physicians registeredwith the radmd.com Web site mayretrieve a PA number via thataddress by logging on with theirassigned user ID and password.

• Blue Cross is working with NIA tomake the full PA process, from theinitial request through actuallyobtaining the PA number, availableonline. Hopefully, that can beaccomplished by May 1, 2006.

• Blue Cross is requiring the PAapproval in cases where it is thesecondary payer, but does notrequire it for Medi-PAK policies. According to Blue Cross, the NIA

review process is conducted at threelevels. A non-clinician answers allcalls and may grant a PA number forprocedures that unquestionablymeet the guidelines. If there arequestions, the request is forwardedto a clinical nurse or a radiologicaltechnologist. If the matter remainsunresolved, a physician handles therequest. Denials are given only at thephysician level. •


Based upon the big changes in the2006 OPPS (Outpatient ProspectivePayment System) final rule and theCPT code updates, I recommend hos-pitals follow a “SWOT” plan of attackin this top 10 list. Use it to implement,manage, and respond to APC revenueimpact, code changes, and new billingrequirements in your facility.

What is SWOT? It’s an acronymthat stands for Strengths, Weaknesses,Opportunities and Threats. Your hos-pital should plot out strategies basedupon the “hot spots” listed below.Outlining your “SWOT” list with theappropriate team members will assistin designing your facility’s executionplan. (Note: This list is not in order ofimportance; facilities should order itbased on the services they provide.)

1. Medicare’s commitment to newtechnology APC revenue. Based uponthe refinement of payment bands,updated surgical/implantation crite-ria, and movement of APC revenuefrom new technology to establishedAPC groups, hospitals should moni-tor their new technology APCs care-fully in the coming year. Compareyour facility’s specific 2005 to 2006APC payments to yield insightful rev-enue analysis.

2. Large amount of CPT/HCPCScode, status indicator, and APCchanges. Based upon previous years,2006 brings a number of new APCrevenue opportunities; however,direct careful attention to the follow-ing areas – packaged status indicators(SI) changed to a payable APC, cate-

gory III code(s), deleted CPT code(s),and deleted temporary HCPCScode(s) with conversion to permanentHCPCS code(s).

It’s important to use Addendum Bfinal 2006 APC payments and condi-tion codes (CC) – CH, NI, NF. Workwith the deleted CPT/HCPCS code(s)first; and replace with new code ifapplicable. This is extremely impor-tant with deleted HCPCS codes, asMedicare has replaced them with per-manent codes. Be sure to exposeHIM coders to Category III andHCPCS codes under OPPS along with2006 CPT.

3. New outlier formula for bothhospitals and community mentalhealth services (CMHS). For hospi-tals, the formula changes so that out-lier payments are triggered when thecost of furnishing a service or proce-dure by a hospital exceeds 1.75 timesthe APC payment amount, andexceeds the APC payment rate plus$1,250. The outlier payment will con-tinue to be calculated as 50% of theamount by which the cost exceeds.

For CMHS, the formula changeswhen cost of furnishing a service orprocedure exceeds 3.40 times theAPC payment rate and the outlierpayment is calculated as 50% of theamount by which the cost exceeds 3.4times the APC payment rate.

4. APC payment changes for vas-cular access procedures. With newCPT codes introduced in 2004,Medicare had enough data to createnew APCs 621, 622 and 623 with

APC national payments of $489.85,$1,264.39 and $1,615.56. This is amajor increase from 2005 – in somecases up to 55%. Due to the varyingservice sites in which these procedurescan be performed (interventional radi-ology, special procedures, treatmentrooms, cardiology, and the operatingroom) and different application ofCPT codes – HIM v. CDM – remem-ber to re-validate the accuracy of yourCPT code reporting to ensure APCrevenue integrity.

5. Update your pharmacy CDMfrom the inside out. Medicare final-ized outpatient drug payments usingAverage Sale Price (ASP) + 6%, whichhas integrated payment for bothacquisition and overhead costs inaggregate. This means no extra Ccodes for 2006 (whew!), but it alsomeans your pharmacy CDM needsimmediate and continued attention.

A slew of status indicator changesalong with HCPCS updates will keepthe APC reimbursement analyst busy.Medicare will continue to pay fortransitional pass through drugs (sta-tus indicator [SI] G), separatelypayable drugs without pass throughpayments (SI K), vaccines (SI L, F),and orphan drugs (G).

Use 2006 Addendum B and sortthrough the above status indicators inorder to assist with your CDMupdate. Remember, pharmacy sys-tems typically have “sub-basements”that must be mapped to your CDMtediously in order for the HCPCS totransfer to the UB-92 claim form.

Help for Hospitals: Use SWOT to Attack Top 10Changes in OPPS Final Rule

by Andrea Clark, RHIA, CCS, CPC-H, President, Health Revenue Assurance Associates, Plantation, Florida


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Recheck your revenue codes and donot forget to validate each quarter anumber of claims to ensure APC rev-enue integrity to include HCPCScode(s) and units.

6. Radiopharmaceuticals (RP) andnuclear medicine. Medicare adoptedstatus indicator H along with moreHCPCS codes to identify separatelypayable RP’s based on the hospital’scharge adjust to cost for CY 2006.CMS will continue to collect data andask for your input in anticipation ofthe 2007 updates. Again, with theadded APC revenue opportunities, itis imperative to re-validate yournuclear medicine CDM for updatedRP HCPCS codes.

7. Wound care updates, includingCPT and HCPCS. There are majorchanges within the CPT manual alongwith major HCPCS updates andchanges for the products (Intregra,Apligraf, Dermagraf, Trancyte, andOrcel) used during these procedures.There’s a whole new skin section inthe 2006 CPT Manual under integu-mentary to implement. CMS will alsoseparately pay for 97602 (nonselec-tive wound care debridement). Thisrequires immediate education for theHIM outpatient coders, CDMupdates, and department involve-ment.

8. Stick it to me—injections andinfusions. For the second year, majorupdates to drug administrationrequire education in a variety of dif-ferent departments, including ED,urgent care, ambulatory care,chemotherapy, and IV therapy units

in which injections, infusions andchemotherapy are provided. Not onlydo we have to contend with the 2006updates, facilities will have to mixboth CPT (20 codes) and HCPCS(eight C codes) in order to get thisright. Even Medicare says that thiswill be a difficult task for hospitals toimplement!

To help educate staff, rememberyour 4 Ds:• Distribute information, including

2006 CPT updates, November2005 CPT Assistant, CPT 2006overview, and transmittals fromMedicare to the appropriatedepartments including coding,clinical, compliance and billing.

• Detail. Review the detail andinstructions for both 2006 CPTand HCPCS with appropriatedepartments.

• Documentation. Although distrib-uting and poring over the detail iscritical, reviewing documentationrequirements with specific clinicalpersonnel is the key to the entirepuzzle. Develop forms to help easethis burden using input from thespecific departments. Good docu-mentation will allow you to choosethe right codes in a straightfor-ward manner. Consider a revenuecycle specialist in the ED who com-bines clinical and financial knowl-edge to charge injections and infu-sions, since nurses may be over-whelmed with the changes.

• Dedication. This is not a one-shotimplementation project; you mustmonitor and assess injections and

infusions’ coding and billing viadocumentation and back-endclaims submission. Provide ongo-ing feedback to specific depart-ments to assist with complianceand APC revenue integrity results.9. Observation services a chronic

offender. Once again, CMS issuedupdated HCPCS codes for observa-tion services. It’s important to notethat while observation is simplified,this does not negate the continuedneed for appropriate physician ordersthat state why the patient is receivingobservation and reliable charge cap-ture to include units and additionalservices provided during observation.Hospitals need to continue to monitordocumentation versus claims submis-sion in this area.

10. Device-dependent APC pay-ments. With device-dependent APCpayments fluctuating from year toyear, it is critical that hospitals take thetime to review their generated APCsand perform a revenue comparisonfrom 2005 to 2006. This is a greatopportunity to look at your most fre-quently reported device-dependentAPCs and perform a comprehensivecoding review, data transference assur-ance, charge capture reliability, and FIAPC payment reconciliation.

Review Table 16 in the final rulefor the complete list of APCs and thenrun this against your own internaldata. Pull a selective sample of claimsto perform your internal audit, com-pile results, provide education andfeedback where necessary, and repeatto show your improvement. •


Practically on the heels of congres-sional action to approve a federalbudget bill for fiscal year 2006 thatwill take about $11 billion from theMedicare and Medicaid programsbetween now and 2010, PresidentBush in early February released hisbudget recommendations for FY 2007that would take another $36 billion incuts from the Medicare program overfive years projected out through 2011.This time, the reductions would have amore direct hit on hospitals throughthe following means: • A reduction in the market basket

update for inpatient and outpatientcare of 0.45% in FY 2007; of 0.4%in FY 2008, and of 0.4% in FY2009. ($8.1 billion)

• A freeze in the payment update forinpatient rehabilitation facilities for2007 and an update of market bas-ket minus 0.4% in 2008 and 2009.($1.6 billion)

• A freeze in the payment update forskilled nursing facilities for 2007and an update of market basketminus 0.4% in 2008 and 2009.($5.1 billion)

• A freeze in the payment update forhome health care for 2007, and anupdate of market basket minus0.4% in 2008 and 2009. ($3.5 bil-lion)

• A four-year phase-out of reim-bursement for Medicare bad debt.($6.2 billion)

• An adjustment of payment for hipand knee replacements in post-acute settings. ($2.4 billion)

• The administration also proposedan overall Medicare spending cap,which, if exceeded, would requireautomatic across-the-board cutsto all provider payment. Thiscould be significant. The administration also proposes

to wring out another $5.9 billion inother cuts to Medicaid through adraw down of public providers’ pay-ments with the use of inter-govern-mental transfers, instituting furtherrestrictions on Medicaid upper pay-ment limits and reducing the allow-able Medicaid provider tax that somestates rely on to generate Medicaidmatching funds.

In addition to the Medicare and

Medicaid cuts, the president’s pro-posed budget for fiscal year 2007contains about $133 million in pro-posed cuts to rural health programsadministered by the Department ofHealth and Human Services’ HealthResources and Services Adminis-tration. Among those proposedcuts, funding for rural flexibilitygrants would be eliminated, downfrom $64 million in funding thisyear; and rural health outreachfunding would decline to $10 mil-lion from $39 million this year.

“Hospitals already are stretchingscarce resources to respond to thedaily challenges of providing care toall who come through our doors,”said American Hospital AssociationPresident Dick Davidson. “…Weshare the Administration’s goal toimprove health in America andexpand access and coverage for theuninsured, and will continue towork toward health coverage for all.But the budget put forward byPresident Bush is a step backward inprotecting access to care for allAmericans.” •

Additional $36 Billion Medicare ReductionProposed in President’s 2007 Budget

U.S. spending on healthcareincreased 7.9% in 2004 to $1.88 tril-lion, holding steady at about 16% ofgross domestic product, according to anew report from the Centers forMedicare & Medicaid Services (CMS).Spending on hospital care grew 8.6%,largely due to the rising costs of provid-

ing care but was less than the increasein spending on physician services(9.0%) and home health care (13.3%).

Public spending for hospital careincreased 7.9%, led by a 9.9% increasein Medicaid spending, while spendingby private payers remained stable atroughly 9.5%. CMS attributed the

Medicaid increase largely to anenhanced federal matching rate andincreased payments to providers thattreat a disproportionate share of low-income, uninsured patients.

The data is reported in theJanuary/February issue of HealthAffairs. •

U.S. Healthcare Spending Holds Steady

U.S. healthcare spending grew7.4% in 2005 to surpass $2 trillionand is expected to grow 7.3% in2006, the CMS said in an annualreport. That’s down from a recent

peak of 9.1% growth in 2002. Theincrease in spending on hospital serv-ices, 7.9%, outpaced overall health-care spending growth for the secondyear in a row. The CMS said

Medicare spending will exceed $790billion in 2015, up from $309 billionin 2004. Medicaid spending, mean-while, will hit $670 billion in 2015,up from $293 billion in 2004. •

U.S. healthcare spending rose 7.4% last year


New Video Shows CliniciansHow to Treat Children Exposed to Chemicals Used in Bioterrorism Attacks

Now available is the Departmentof Health and Human Services’Agency for Healthcare Research andQuality (AHRQ) video TheDecontamination of Children:Preparedness and Response forHospital Emergency Departments.This is a 27-minute video that trainsemergency responders and hospitalemergency department staff on howto decontaminate children who havebeen exposed to hazardous chemicalsduring a bioterrorism attack or otherdisaster.

Produced for AHRQ’s Bioter-rorism Preparedness ResearchProgram by Michael Shannon, M.D.,M.P.H., Chief of the Division ofEmergency Medicine at Children’sHospital, Boston, the video outlineskey differences between decontami-nating children and adults; providesan overview for constructingportable and permanent decontami-nation showers and designating hot

and cold zones; and provides steps toestablishing and maintaining pedi-atric decontamination capacity in ahospital emergency department.

This video provides a step-by-stepdemonstration of the decontamina-tion process in real time and trainsclinicians about the nuances of treat-ing infants and children, who requirespecial attention during decontami-nation procedures. For example, chil-dren may be frightened not only bythe emergency situation itself, butalso may be afraid to undergo decon-tamination without their parents;children also take longer to gothrough the decontamination processthan adults.

“The Decontamination of Childrenvideo provides a valuable andstraightforward overview for firstresponders and hospital emergencypersonnel on decontaminatinginfants, children, and parents whohave been exposed to dangerous

chemical agents,” said AHRQDirector Carolyn M. Clancy, M.D. “Ihope this will be a valuable tool forthose taking care of children, whowill be one of our most vulnerablepopulations during a bioterrorismattack or other emergency.”

A short clip from “TheDecontamination of Children” canbe found online at http://www.ahrq.gov/research/decontam.htm. A free,single copy of the video – available inDVD or VHS format – may beordered by calling 1-800-358-9295or by sending an e-mail [email protected].

AHRQ has funded more than 50emergency preparedness-relatedstudies, workshops, and conferencesto help hospitals and healthcare sys-tems prepare for medical emergen-cies. More information about theseprojects can be found online athttp://www.ahrq.gov/browse/bioterbr.htm. •

JCAHO “Surge Hospital”Guide Now Available

The Joint Commission on Accreditation of Healthcare Organizations(JCAHO) recently issued a guide describing how community, state andfederal healthcare planners can establish temporary facilities called “surgehospitals” to supplement existing hospitals in an emergency.

The guide examines the various types of surge hospitals, and how toplan for, establish and operate them and how surge hospitals were estab-lished during the recent hurricanes in the Gulf Coast.

“Hurricanes Katrina and Rita have shown us that having plans to‘surge in place,’ meaning expanding a functional facility to treat a largenumber of patients after a mass casualty incident, is not always sufficientin disasters because the healthcare organization itself may be too damagedto operate,” the JCAHO notes.

Access the Guide at http://www.jointcommission.org/PublicPolicy/surge_hospitals.htm. •

E M E R G E N C Y P R E P A R E D N E S S

E M E R G E N C Y P R E P A R E D N E S S


The Departmentof Health andHuman Services(HHS) on January12 announced that$100 million infunding is beingmade available toU.S. states, territo-ries and regions as part of the admin-istration’s plan to prepare the nationfor a potential flu pandemic. Thefunding is part of $350 million includ-ed in the recent emergency appropria-tion for combating pandemic influen-za passed by Congress in December.

These initial grants will be awardedto all 50 states, seven territories, theCommonwealth of Puerto Rico andthe District of Columbia. Each state

will receive a mini-mum of $500,000,with additionalallocation of fundsby population. Inaddition to thestate grants, fundsare being awardedto New York City,

Chicago and Los Angeles County.The remaining $250 million fromthe appropriation will be awardedlater this year in accord with guid-ance that will require progress andperformance.

States and municipalities are to usethese funds to accelerate and intensifycurrent planning efforts for pandemicinfluenza and to exercise their plans.The focus is on practical, community-

based procedures that could preventor delay the spread of pandemicinfluenza and help to reduce the bur-den of illness communities would con-tend with during an outbreak.

In December, HHS SecretaryMichael Leavitt met with seniorofficials from all 50 states andlaunched a series of preparednesssummits to be held in every stateover the next several months. Thegoal of the summits is to enhancestate and local preparedness. Inaddition to this new funding and thestate summits, HHS has sought tofoster planning by developingchecklists for individuals and fami-lies, businesses and state and localhealth departments to aid their pan-demic preparedness efforts. •

HHS Offers Grant Funding to Aid States in Pandemic Flu Preparedness

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In a November 14 letter to StateSurvey Agency directors, the Centersfor Medicare & Medicaid Services(CMS) provided guidance for theimplementation of new regula-tions regarding the location andrelocation of Critical AccessHospitals (CAH).

The Medicare PrescriptionDrug, Improvement andModernization Act of 2003(MMA), enacted in December2003, contained a number ofmodifications to the CAH statu-tory requirements. Includedwas a new provision that elimi-nated the use of state-issuednecessary provider designa-tions, which allow participationof CAHs that do not meet therequirement to be located 35miles from a hospital or anoth-er CAH or, in the case of moun-tainous terrain or in areas withonly secondary roads available,a 15-mile drive.

The MMA stipulates that thenecessary provider designationswould no longer be issued on orafter January 1, 2006. TheMMA allows grandfathering forCAHs that were already certifiedvia a necessary provider designa-tion prior to January 1, 2006,but the Act raised questionsabout the grandfathering ofthose medically necessaryproviders that build replacementfacilities in new locations.

The interpretive guidelinesaddress the criteria used by aCMS Regional Office to deter-mine if a CAH that relocatescontinues to be essentially thesame provider serving the samecommunity so that the same

provider agreement would continueto apply to the CAH or medicallynecessary provider at the new loca-

tion. The guidelines are available athttp://www.cms.hhs.gov/medicaid/sur-vey-cert/letters.asp.

Critical Access Hospitals: Guidelines for CAH Relocations


CAHPS Hospital Survey (HCAHPS) F A C T S H E E T

From the Centers for Medicare & Medicaid Services and Agency for Healthcare Research and Quality

Overview The intent of the CAHPS®

1 Hospital Survey (also knownas Hospital CAHPS or HCAHPS) initiative is to provide astandardized survey instrument and data collection method-ology for measuring patients’ perspectives on hospital care.

While many hospitals collect information on patient sat-isfaction, there is no national standard for collecting or pub-licly reporting this information that would enable valid com-parisons to be made across all hospitals. In order to make“apples to apples” comparisons to support consumer choice,it is necessary to introduce a standard measurementapproach.

HCAHPS can be viewed as a core set of questions thatcan be combined with a customized set of hospital-specificitems. HCAHPS is meant to complement the data hospitalscurrently collect to support improvements in internal cus-tomer services and quality related activities.

Three broad goals have shaped the HCAHPS survey.First, the survey is designed to produce comparable data onthe patient’s perspective on care that allows objective andmeaningful comparisons between hospitals on domains thatare important to consumers. Second, public reporting of thesurvey results is designed to create incentives for hospitals toimprove their quality of care. Third, public reporting willserve to enhance public accountability in healthcare byincreasing the transparency of the quality of hospital careprovided in return for the public investment.

With these goals in mind, the HCAHPS project has takensubstantial steps to assure that the survey will be credible,useful, and practical. This methodology and the informa-tion it generates will be made available to the public.

HCAHPS Development The Centers for Medicare & Medicaid Services (CMS)

has partnered with the Agency for Healthcare Research andQuality (AHRQ), another agency in the Department ofHealth and Human Services, to develop HCAHPS. AHRQhas carried out a rigorous, scientific process to develop andtest the HCAHPS instrument. This process has entailed mul-tiple steps, including a public call for measures; review ofexisting literature; cognitive interviews; consumer focusgroups; stakeholder input; public response to several FederalRegister notices; a three-state pilot test; consumer testing;and small-scale field tests.

The HCAHPS survey is composed of 27 items: 18 sub-stantive items that encompass critical aspects of the hospitalexperience (communication with doctors, communicationwith nurses, responsiveness of hospital staff, cleanliness and

quietness of the hospital, pain control, communicationabout medicines, and discharge information); four items toscreen patients to appropriate items; three items to adjust forthe mix of patients across hospitals; and two items to sup-port congressionally-mandated reports.

In May 2005, the 27-item HCAHPS survey was formallyendorsed by the National Quality Forum (NQF), a volun-tary consensus standard-setting organization established tostandardize healthcare quality measurement and reporting.The NQF endorsement represents the consensus of manyhealthcare providers, consumer groups, professional associ-ations, purchasers, federal agencies, and research and quali-ty organizations.

Acting upon an NQF recommendation, CMS commis-sioned an independent research firm, Abt Associates, Inc., toconduct an analysis of the benefits and costs of HCAHPS.The Abt report, which includes detailed cost estimates forhospitals, can be found at http://www.cms.hhs.gov/hospi-talqualityinits/30_hospitalHCAHPS.asp.

On November 7, 2005, CMS published the final publiccall for comments on the HCAHPS survey, with a 30-daypublic comment period.

Mode Experiment

Following OMB approval of the survey, CMS will initiatea large-scale study to investigate whether the four approvedmodes of survey administration (mail, telephone, mail withtelephone follow-up, and active IVR), as well as the mix ofpatients a hospital serves, systematically affect survey results.A representative sample of hospitals will be invited to partic-ipate in this experiment.

Training for HCAHPS

Training for administering the Hospital CAHPS surveywas held in February 2006. All survey vendors that intendto administer the survey, as well as hospitals that plan toconduct the survey for themselves, were required to attend.

Dry Run

A short “dry run” of the survey will be implemented fol-lowing training. This dry run will give hospitals and surveyvendors the opportunity to gain first-hand experience collect-ing and transmitting HCAHPS data — without the publicreporting of results. Using the official survey instrument andthe approved modes of implementation and data collectionprotocols, hospitals and survey vendors will collect HCAHPSdata for one or two months and report it to CMS. All hos-pitals that intend to participate in HCAHPS must take part in


the dry run for one or both months. The data collected dur-ing the dry-run phase will not be publicly reported.

National Implementation

Collection of HCAHPS data intended for the publicreporting of results will commence shortly after the conclu-sion of the dry run. Hospitals will voluntarily implementHCAHPS under the auspices of the Hospital QualityAlliance, a private/public partnership that includes the majorhospital associations, government, consumer groups, meas-urement and accrediting bodies, and other stakeholders whoshare a common interest in improving hospital quality.

This first full national implementation of HCAHPS isplanned for late 2006, with the first public reporting ofHCAHPS results slated for late 2007. HCAHPS results willbe posted on the Hospital Compare Web site, found atwww.hospitalcompare.hhs.gov, or through a link onwww.medicare.gov.

Quick Facts about HCAHPS• HCAHPS will result in the first truly national, standard-

ized, publicly reported benchmark of hospital patients’perspectives of their care.

• Participation in HCAHPS is voluntary; there are nofinancial incentives or disincentives tied to the survey.

• All short-term, acute care, non-specialty hospitals areinvited to participate.

• Hospitals may use an approved survey vendor, or collecttheir own HCAHPS data.

• Hospitals may either integrate the HCAHPS items withintheir own patient satisfaction survey, or implementHCAHPS as a separate survey.

• The survey can be conducted by mail, telephone, mailwith telephone follow-up, or active IVR; CMS will adjust

the results prior to public reporting for mode of adminis-tration and patient-mix effects.

• Hospitals will survey a random sample of their live dis-charges who were 18 and older at admission, had anovernight stay, and had a non-psychiatric diagnosis.

• Hospitals should survey patients on a monthly basis andsubmit data to CMS on a monthly or quarterly basis.

• Hospitals are asked to provide 300 completed surveys peryear; for smaller hospitals, as few as 100 completed sur-veys are needed for public reporting.

• Hospitals will own their raw HCAHPS data and are freeto analyze it as they wish.

• Hospitals may preview their HCAHPS results prior topublic reporting.

For More InformationTo learn more about HCAHPS, please visit the following

Web sites: • For general information: http://www.cms.hhs.gov/hospi-

talqualityinits/30_hospitalHCAHPS.asp orwww.ahrq.gov

• For information about training: www.hcahpsonline.org

To Provide Comments or Ask Questions:• To communicate with CMS staff about implementation

issues: [email protected]• To communicate with AHRQ staff on survey develop-

ment issues: [email protected]• For technical assistance, contact the Arizona QIO: hcah-

[email protected] or 1-888-884-4007 •

1CAHPS® is a registered trademark of the Agency for HealthcareResearch and Quality, a U.S. Government agency.

Supreme Court Upholds Assisted-Suicide LawThe Supreme Court, in mid-January,

upheld Oregon’s unique physician-assisted suicide law. With this ruling,the Court held that the Bush adminis-tration improperly tried to use a druglaw to prosecute Oregon doctors whoprescribe overdoses to help terminallyill patients end their lives.

In a 6-3 vote, the justices heldthat federal authority to regulatedoctors does not override the 1997Oregon law.

The ruling is seen as a reprimand toformer Attorney General JohnAshcroft, who claimed in 2001 thatdoctor-assisted suicide is not a “legiti-

mate medical purpose” and warnedthat Oregon physicians would be pun-ished for helping people end their livesunder the state law.

In the majority opinion written byJustice Anthony Kennedy, he said the“authority claimed by the attorneygeneral is both beyond his expertiseand incongruous with the statutorypurposes and design,” adding that“Congress did not have this far-reach-ing intent to alter the federal-state bal-ance.” Kennedy wrote for himself,now-retired Justice Sandra DayO’Connor and Justices John PaulStevens, David Souter, Ruth Bader

Ginsburg and Stephen Breyer.Writing for himself, Chief Justice

John Roberts and Justice ClarenceThomas, Justice Antonin Scalia saidfederal officials have the power to reg-ulate the doling out of medicine. “Ifthe term ‘legitimate medical purpose’has any meaning, it surely excludes theprescription of drugs to producedeath,” he wrote.

The Oregon law was written tocover only extremely sick individualswith incurable diseases, and whom atleast two doctors agree have sixmonths or less to live and are ofsound mind. •


A study in theJanuary/February issueof Health Affairs esti-mates the national costof increasing hospitalnurse staffing and theresulting improvementsin patient outcomes.

It concludes thatincreasing the proportion of nursinghours that are provided by registerednurses, without increasing total nurs-ing hours, would avoid nearly

60,000 potential adverseoutcomes for patientsand reduce hospitalexpenses by an estimat-ed 0.1%.

Kathy Sanford, presi-dent of the AmericanOrganization of NurseExecutives, told AHA

News Now she has no argumentwith the research. However, she saidthe nation’s growing shortage ofnurses is central to the discussion,

noting there aren’t enough nursesgraduating from nursing school toreplace those retiring and meetfuture demand.

“Nurse training is expensive,”Sanford said, which is why AONE isworking with the AHA and others tolobby for increased funding for nursefaculty and education. AONE is asubsidiary of AHA. For more infor-mation and to view the study, go tohttp://content.healthaffairs.org/cgi/content/abstract/25/1/204 •

The National Association ofCounties has released a surveyexploring the impact of metham-phetamine abuse on hospital emer-gency departments.

The vast majority of the 200 hos-pitals surveyed (in 39 states) werecounty-owned or operated. Nearlythree-quarters reported increases inmethamphetamine-related ED visits

in the past five years, and nearly halfsaid visits related to methampheta-mine exceeded those for any otherillicit drug.

A majority of respondents saidmethamphetamine-related visitswere driving up their hospital’s costsand that such patients were oftenuninsured.

A full copy of the NACo survey

“The Meth Epidemic in America: TheEffect of Meth Abuse of HospitalEmergency Rooms” can be found athttp://www.naco.org/Template.cfm?Section=Special_Surveys&Template=/ContentManagement/ContentDisplay.cfm&ContentID=18837. The reportalso includes an accompanying surveytitled “The Challenges of TreatingMeth Abuse.” •

Survey Examines Impact of Meth Abuse on County EDs

Only 9% of low-income adultswith public health insurance wouldhave access to an alternative source ofinsurance in the absence of public cov-erage, a new study from the KaiserCommission on Medicaid and theUninsured estimates. The analysis of anational survey of families byresearchers at the Urban Institute

found the vast majority of enrolleesaffected by cutbacks in eligibility forpublic programs would likely be leftuninsured. (More information on thisstudy is available at www.kff.org/med-icaid/7449.cfm)

Another new study, in theJanuary/February issue of HealthAffairs, suggests that savings achieved

by reducing eligibility and enrollmentin public health insurance programslargely shifts those costs to safety-netproviders and other state or local pro-grams that care for the uninsured.More on this study is available athttp://content.healthaffairs.org/cgi/content/full/25/1/237?ijkey=Bzunw9Sr22Wlo&keytype=ref&siteid=healthaff •

Studies Estimate Potential Impact of Reducing Public Health Coverage

Study Estimates Costs, Benefits of Increasing Hospital Nurse Staffing

A D V O C A C Y


Your Presence is Requested in Washington, DCAmerican Hospital Association Annual Meeting, April 30 – May 3

“The Women and Men of America’sHospitals: First in Hope, First in Care,Always There” is the theme for theAmerican Hospital Association’s annu-al membership meeting April 30-May3 in Washington, DC. During theevent, Arkansas hospital CEOs, admin-istrators, and trustees will visit withArkansas’ congressional delegation onWednesday, May 3, and join the StateChamber of Commerce in honoringthe delegation with a dinner Monday,May 1.

The annual meeting format hasmuch to offer. Participants have theopportunity to attain AmericanCollege of Healthcare ExecutivesCategory I credit through a workshopon the Baldrige Award. Hospitaltrustees will have several educationalopportunities to discuss issues such asboardroom disorder, trends in health-care and their implications for effectivegovernance, and making the most ofthe board-CEO partnership.

Several executive briefings will beheld on topics such as making the casefor information technology, improvingcare through management diversityand surviving Hurricanes Katrina andRita. Other session leaders will discussquality improvement strategies for dis-parities in care, connecting with com-munities and changing the debate onthe value of healthcare.

Attendees also will hear presenta-tions from Newt Gingrich, formerSpeaker of the House, and a federalrelations forum with leaders fromCongress and the Administration.

Meeting and registration informa-tion has been mailed to AmericanHospital Association members or youmay register online at www.aha.org.Please fax a copy of your meeting reg-istration form to Beth Ingram at theArkansas Hospital Association (501-224-0519) to receive special mailings

detailing Arkansas events. You mayalso email attendance plans to [email protected].

What are the AmericanHospital Association’s StrategicGoals, 2006-2008?

The American Hospital Associa-tion’s Strategic Plan for 2006-2008 isour roadmap to a better future for hos-pital leaders and the people and com-munities they serve. It is designed tofix a course for the association to be thestrongest advocate for the needs of hos-pitals and health systems and animportant source of ideas that can helpmembers create the kind of communi-ty-based healthcare that assures everyAmerican the right care, at the righttime, in the right place.

The plan provides an overview ofthe AHA’s strategic direction andfinances, highlights the specific goalsthat will guide the association along theway, and illustrates how the strategiesaddress the planning assumptions thatAHA developed last year. For ourmembers, it can give them a useful win-dow on the national issues that affecttheir futures as well. The plan can befound at www.aha.org. Click on the“Members Only Access” section andthen select “2006 - 2008 AHAStrategic Plan.” Do you have questionsor feedback? Contact Gene O’Dell,AHA’s vice president of strategic plan-ning, at [email protected].

A Member-Driver OrganizationWhen we say the American

Hospital Association is a member-driv-en organization, what do we mean? Weare articulating one of the basic tenetsof this association: the hospital leaderswe represent are the compasses thatdetermine the direction of this organi-zation.

Our job is to help you do your job

… to make your organizations the bestthey can be for the patients and com-munities you serve. As the AHA sets acourse for its future, its Strategic Planmust reflect the challenges and priori-ties facing the women and men at thefront lines of care, such as:

■ Building a stronger foundation forhealthcare. Millions of children andadults go without proper healthcarebecause their families cannot affordhealth insurance premiums.Chronically ill Americans are often leftalone to manage their complicated,sometimes debilitating illnesses. TheAHA stands for a unified healthcarepolicy that expands coverage, createsfairer payment systems, and providesbetter management of care.

■ Enhancing community trust andaccountability. Every hospital leadershould be prepared to talk to his or hercommunity about the work theirorganization has done on quality andpatient safety. To this end, the AHAwill continue our key role in theHospital Quality Alliance, which ishelping the public get useful informa-tion about hospital quality. We also arehelping to lead the Surgical CareImprovement Project (SCIP), a collabo-rative quality effort aimed at improvingsurgical care in the nation’s hospitals.America’s hospitals are committed toproviding the highest quality of carepossible to their patients and commu-nities. Your participation in initiativeslike the Hospital Quality Alliance andSCIP offer a powerful reminder to yourcommunity of what makes your hospi-tal the special place it is.

■ Strengthening the hospital-commu-nity bond. Hospitals have a powerfulstory to tell about what they mean tothe people and communities they serve.At a time when hospitals face signifi-

A D V O C A C Y


cant challenges, it’s never been moreimportant for you to make sure yourcommunity understands the manyways in which your commitment tomission makes life better for those youserve. Renew your hospital’s partner-ship with your community, and helpcreate in it a sense of ownership in thehospital … the community hospital.Our task is to remind people that hos-pitals are places where people take careof people with dignity and compassion,inside and outside the four walls, frombedside to billing office.

■ Demonstrating your hospital’s con-tribution to a healthier, strongerAmerica. Healthcare spending is a wor-thy investment in people’s lives. Everydollar invested in healthcare servicesproduces a return of between $2.40and $3.00 – a return that comes in the

form of fewer deaths, increasedlongevity, and improved outcomes inseveral important areas of care. Andhospitals not only play a critical role inthe health of Americans, they also con-tribute more than $1.3 trillion to thenation’s economy. They remain a stablesource of employment even duringtimes of economic stress, and supportother businesses when they purchasethe goods and services needed to pro-vide care. Help the public understandthat the health benefits we receive as anation far outweigh the dollars spent,and that spending on healthcare is aninvestment in the economy, people anda healthier society.

The AHA’s Strategic Plan providesan overview of the AHA’s three-yearstrategic direction, highlighting specificgoals that will guide us along the way,

and it illustrates how the goals addressthe planning assumptions that wedeveloped earlier this year.

Behind every goal and every com-mitment of resources is a direct connec-tion to the vital work hospitals andhealth systems must accomplish for thepeople who rely on them. And as youtake a look at the 2006-2008 StrategicPlan (available online at the addressabove) and the accompanying StrategyMap (below on this page), keep inmind the vision that you and your col-leagues across America created whenthis organization was formed: thevision of a society of healthy communi-ties, where all individuals reach theirhighest potential for health. •— Dick DavidsonPresident, American Hospital Association


A D V O C A C Y

Arkansas PAC Contributions Recognized During 2005, the Arkansas

Hospital Association Political ActionCommittee (AHAPAC) received$27,895.35 in contributions, prima-rily from hospital executives andemployees throughout the state.These donations, which are sharedbetween the Arkansas HospitalAssociation and the AmericanHospital Association, make possiblethe financial support those organiza-

tions are able to provide to politicalcandidates seeking state or federalelective offices.

Contributions of any amount fromall contributors to the AHAPAC areseriously needed and deeply appreciat-ed. However, special acknowledge-ment is given individuals who con-tribute at certain threshold levels.Those individuals qualify for recogni-tion as members of the American

Hospital Association’s Capitol Clubor its Chairman’s Circle.

Capitol Club membership isawarded for individuals who con-tributed $250 or more to AHAPACduring the year, while theChairman’s Circle membership isearned with a $500 donation. Wethank the individuals from Arkansaswho qualified for membership ineach of these clubs.

Don Adams, Arkansas Hospital Association Robert Bash, Bradley County Medical Center Roger Busfield, Arkansas Hospital Association, Retired David Cicero, Ouachita County Medical Center Paul Cunningham, Arkansas Hospital AssociationDean Davenport, BKD, LLP Stephen Erixon, Baxter Regional Medical Center Dan Gathright, Baptist Health Medical

Center-Arkadelphia Russell D. Harrington, Jr., Baptist Health

Michael D. Helm, Sparks Health System Tim Hill, North Arkansas Regional Medical Center Beth Ingram, Arkansas Hospital Association Luther Lewis, Medical Center of South Arkansas Phil Matthews, Arkansas Hospital Association John Neal, Stuttgart Regional Medical Center James E. Newman, St. Edward Mercy Medical CenterScott Peek, Chambers Memorial Hospital Ron Rooney, Arkansas Methodist Medical Center Bo Ryall, Arkansas Hospital Association

Robert P. Atkinson, Jefferson Regional Medical Center Chris Barber, St. Bernards Medical Center Gary Bebow, White River Health System JoAnn Butler, Arkansas Hospital Association Tina Creel, AHA Services, Inc. Harrison Dean, Baptist Health Medical Center-NLR David Dennis, St. John’s Hospital-Berryville Nancy Fodi, Southwest Regional Medical Center Joel Klein, The BridgeWay Ray Kordsmeier, Conway Edward Lacy, Baptist Health Medical

Center-Heber Springs

Jimmy Leopard, Medical Park Hospital Mike McCoy, Saint Mary’s Regional Medical Center Ray Montgomery, White County Medical Center Larry Morse, Johnson Regional Medical Center Kristy Noble, St. John’s Hospital-Berryville Ben Owens, St. Bernards Healthcare Kirk Reamey, Ozark Health Medical Center John Robbins, Conway Regional Medical Center Allen Smith, Baptist Health Russ Sword, Ashley County Medical Center James Teeter, Arkansas Hospital Association, Retired Doug Weeks, Baptist Health Medical Center-Little Rock

Members with minimum contributions of $250 who qualify for membership in the 2005 Capitol Club are:

Arkansans who contributed at least $500, becoming members of the AHAPAC’s 2005 Chairman’s Circle are:

Mental Health Parity Act Extension The House and Senate in early

January approved a one-year exten-sion of the Mental Health Parity Actof 1996, which has been extendedeach year since its original expirationin 2002.

While this congressional actionmaintains the protections affordedby the bill as passed in 1996, it fallsshort of broader parity legislationcalled for by the American Hospital

Association (AHA) and some 250other health organizations.

In an October 2005 letterprompted by Hurricane Katrina,these groups warned Senate andHouse leadership that loopholes inthe 1996 statute, which requiresgroup health plans to fund mentalhealth benefits at the same level asmedical and surgical benefits, allowfor higher co-payments, deductibles

and co-insurance payments for men-tal health services.

The groups said a mere extensionof the law “is no remedy and wouldfurther perpetuate the discriminationfaced by those with mental healthneeds.” The AHA has long advocat-ed parity for hospital days, outpa-tient visits, co-pays, deductibles andmaximum out-of-pocket costs for in-network services. •


Representatives of theArkansas Medicaid programreport once again that they areclose to beginning the processto recover overpayments relat-ed to emergency room claimsdating back to September 1,2003 when Medicaid changedthe way it reviews and paysthose claims.

Prior to that date, theArkansas Foundation forMedical Care (AFMC), the med-ical review contractor, reviewed100% of Medicaid emergency room(ER) claims, approving or denyingthem for payment. Since then, the ERclaims are paid as submitted to EDS,Medicaid’s intermediary, and AFMCdoes post-payment reviews on a sam-ple set of claims from each hospital.

Although AFMC has beenreviewing ER claims under the newprocess for more than two years,and denying some, Medicaid hasnot attempted to recover any pay-ments related to those deniedclaims. Plans were in place to sendout recovery letters early in 2005,

but they were halted whenMedicaid had to develop regu-lations pursuant to theMedicare Fairness Act of 2005,which impacts denied claims.

Medicaid’s most recent tallyshows that the total amount tobe recovered is about $1.4 mil-lion for claims denied duringthe span of more than twoyears. The hospital-specificrange runs from about $300 tomore than $170,000, depend-

ing on the volume of claims submit-ted by the hospital.

Medicaid started the recoveryprocess March 1. The amounts tobe repaid do not include paymentsthat hospitals received for lab andx-ray charges billed in conjunctionwith the denied ER visit. •

Inpatient psychiatric facilitieswould receive an average 4.2%increase in their Medicare paymentrates for discharges occurring on orafter July 1, 2006 under a January 13proposed rule by the Centers forMedicare & Medicaid Services (CMS).

Under the proposed rule, thenation’s freestanding governmentalpsychiatric hospitals receive thelargest share of the aggregate increase.

The payment increase wouldaffect approximately 1,800 inpa-tient psychiatric facilities (IPFs),including freestanding psychiatrichospitals as well as certified psychi-atric units in general acute care hos-pitals and critical access hospitalsthat are paid under Medicare’sInpatient Psychiatric FacilityProspective Payment System (IPF

PPS), which was mandated by theMedicare, Medicaid, and SCHIPBalanced Budget Refinement Act(BBRA) of 1999 and made effectiveJanuary 1, 2005.

The IPF PPS bases payments on asingle federal per diem rate thatincludes both inpatient operating andcapital-related costs, including routineand ancillary services. The proposedper diem rate for Rate Year (RY) 2007is $594.66, up from $575.95 in RY2006. The base rate is adjusted toaccount for patient and individualfacility characteristics.

Plus, the IPF PPS provides a higherpayment for each electroconvulsivetherapy (ECT) treatment furnishedduring the IPF stay. Medicare alsocontinues to pay separately for certaincosts, including the costs of physician

and non-physician practitioner servic-es, bad debt and direct graduate med-ical education costs.

During a three-year period fortransitioning from cost-based reim-bursement to the PPS, inpatient psy-chiatric facilities will be paid a blendof costs and the federal payment rate.For cost reporting periods beginningin calendar year 2006, IPF paymentrates will be based 50% on the cost-based methodology and 50% on thefederal PPS rate.

A final rule will be published thisspring. The new payment rates andpolicies will become effective for dis-charges occurring on or after July 1,2006.

For detailed information, seehttp://www.cms.hhs.gov/InpatientPsychFacilPPS/01_overview.asp. •

Medicare Proposes Inpatient Psychiatric Facility Rate Increase

M E D I C A R E / M E D I C A I D

Arkansas Medicaid Recovering Excess Payments


For the six-month reporting periodof fiscal year (FY) 2005 that endedSeptember 30, 2005, the Office ofInspector General (OIG) focused onaccounting for Medicaid funds andpayment for Medicaid prescriptiondrugs. Because the federal share ofMedicaid spending is expected toexceed $192 billion in FY 2006, theOIG is anticipating that its work in thisarea will increase in importance.

The OIG examined state financingmechanisms used to maximizeMedicaid payments, documented how

the Medicaid program pays too muchfor prescription drugs compared withprices available in the marketplace andtestified before the Senate FinanceCommittee on its Medicaid work.

Other areas that the OIG focusedon in the six-month period in FY2005 included: (1) the publication oftwo audits of Medicaid claims forschool-based services; (2) identifyingvulnerabilities in the NationalInstitutes for Health (NIH) reviewprocess; and (3) increasing adminis-trative enforcement through the impo-

sition of civil monetary penalties.The OIG reported $35.4 billion in

savings and recoveries during FY 2005,made up of $32.6 billion in implement-ed recommendations to put funds tobetter use, $1.2 billion in audit receiv-ables and $1.6 billion in investigativereceivables. The OIG doubled savingsand recoveries since FY 2000.

The OIG identified that its biggestchallenge in FY 2006 will be the imple-mentation of the Part D program,which will be the largest expansion ofthe program since its creation. •

OIG Reports FY 2005 Medicaid Savings;Shows Funds Put to “Better Use”

Under new instructions from theCenters for Medicare & MedicaidServices (CMS), Medicare’s homehealth prospective payment system(HHPPS) annual update for calen-dar year 2006 is the first that usesthe Office of Management andBudget’s revised area labor marketMetropolitan Statistical Area

(MSA) designations. CMS Pub. 100-04, Transmittal

No. 764, established a one-yeartransition period to implement thenew area labor market designations.The transition index consists of ablend of 50% of the new area labormarket designations’ wage indexand 50% of the old area labor mar-

ket designations’ wage index. The fixed dollar loss ratio, used in

the determination of outlier pay-ments, has been re-estimated to 0.65,and the loss-sharing ratio of 0.80remains unchanged. A new tablereflecting the transitional 2006 wageindex changes will be installed in theHome Health Pricer software. •

HHPPS Utilizes Revised MSA Designations

The Arkansas Foundation forMedical Care’s (AFMC) HospitalPayment Monitoring Program(HPMP) is making available thelatest edition of the HPMPCompliance Workbook.

This workbook is an updatedversion of the PEPP ComplianceWorkbook, which AFMC distrib-uted to all Inpatient ProspectivePayment System (IPPS) hospitalsunder the Payment ErrorPrevention Program (PEPP) in2000.

The workbook focuses on therole of compliance officers regard-ing payment error monitoring andprevention in acute care hospitals.It was designed to give practicalguidance and provide helpful toolsfor hospitals that are seeking todevelop, update, or strengthen theircompliance efforts.

Information contained in theworkbook can help hospitals iden-tify and improve their complianceprogram structures and processesthat contribute to payment errors,

with emphasis on areas currentlybeing monitored by the Centers forMedicare & Medicaid Services(CMS).

The workbook and related mate-rials may be downloaded and print-ed from AFMC’s Web site athttp://afmc.org/HTML/programs/hpmp_pepp/workbook.aspx.

To request a hard copy of theworkbook (only one per hospital,please), contact Tori Gammill,HPMP administrative assistant, at479-649-8501, ext 248. •

AFMC Compliance Workbook Available




The Centers for Medicare &Medicaid Services (CMS) issued aJanuary 19 proposed rule forMedicare’s long term care hospitalprospective payment system (LTCHPPS) that keeps the federal paymentfor those facilities at $38,086.04 forthe 2007 rate year.

CMS said that the proposal isbased on an analysis of the LTCHcase-mix index and margins beforeand after implementation of theLTCH PPS program and the latestavailable LTCH cost reports, whichindicate that LTCH Medicare mar-gins were 8.8% for FY 2003 and11.7% for FY 2004.

The proposed federal rate is con-sistent with MedPAC’s recent updaterecommendation for the LTCH PPS.Long-term care hospitals, in general,are defined as hospitals that have an

average Medicare inpatient length ofstay greater than 25 days.

These hospitals typically provideextended medical and rehabilitativecare for patients who are clinicallycomplex and may suffer from multi-ple acute or chronic conditions.Services usually include comprehen-sive rehabilitation, respiratory thera-py, head trauma treatment and painmanagement.

There are now approximately 375long-term care hospitals in the U.S., anumber which is up about 32% sincethe implementation of the LTCH PPSin FY 2003.

The final rule, which will beeffective for discharges occurring onor after July 1, 2006 through June30, 2007, will be published later thisspring.

Go to http://www.cms.hhs.gov/LongTermCareHospitalPPS/ formore information. •

Medicare Long Term Care Hospital Proposed RuleWould Maintain Current Federal Payment

The Centers for Medicare &Medicaid Services (CMS) announcedJanuary 6 that it has awarded con-tracts for four specialty groups thatwill be responsible for handling theadministration of Medicare claimsfrom suppliers of durable medicalequipment, prosthetics and orthotics.

The new contracts are the first of23 that will be awarded by 2011 tofulfill requirements of the contractingreform provisions of the MedicareModernization Act of 2003.

CMS selected the four newDurable Medical EquipmentMedicare Administrative Contractors(DME MACs) through a competitivebidding process, replacing the currentDurable Medical Equipment RegionalCarriers (DMERCs).

Geographic jurisdictions are slight-

ly realigned from those formerly serv-iced by the DMERCs in an attempt toimprove service to beneficiaries andproviders, support the delivery ofcoordinated and quality care, and pro-vide greater administrative efficiencyand effectiveness for the traditionalfee-for-service Medicare program.

The new DME MAC forArkansas is Palmetto GovernmentBenefits Administrators located inSouth Carolina.

Under the current Medicare con-tractor system, fiscal intermediariesprocess claims for Part A providerssuch as hospitals, skilled nursingfacilities and other institutionalproviders. Carriers process claims forphysicians, laboratories and othersuppliers under Medicare Part B.

When contracting reform is fully

implemented, the current fiscal inter-mediary and carrier system will bereplaced by MACs responsible forboth Part A and Part B claims. Thenew structure will mean beneficiariesand providers will have a single pointof contact with the Medicare program.

The DME MACs will immediatelybegin transition activities and willassume full responsibilities for theclaims processing work currently per-formed by the DMERCs on July 1,2006. Once operational, the DMEMACs will serve as the point of con-tact for all Medicare suppliers, where-as beneficiaries will pose their claims-related questions to BeneficiaryContact Centers.

Go to http://www.cms.hhs.gov/MedicareContractingReform formore information. •

Medicare Contractor Reorganization Underway


Anyone who has visited the Centersfor Medicare & Medicaid Services’(CMS) Web site in the past wouldprobably agree that finding specificinformation there is often like lookingfor the proverbial needle in a haystack.

It seems that all those howls offrustration finally made their pointwith the agency’s powers-that-be,because CMS recently launched itsredesigned Web site, which is sup-posed to be more “user-friendly.”

CMS says that its new Web site,which went live December 15, fea-tures consistent organization and nav-igation, timely, relevant and accuratecontent, an improved Google searchfeature and much more.

The new Web site is organized infour levels: Top-Level Subject Area(such as Medicare), Category (i.e. hos-pitals), Section (i.e. PPS Rule) andPage Number. At any time during avisit, it’s possible to navigate back tothe Top-Level Subject Area that dis-plays all categories in that area.

The new Web site has one-stop-shopping areas called “Centers” thatare targeted to specific professionalneeds. For example, Providers or

Partners have the option to browsethe Web site by their area of interest inspecific “Provider and PartnerCenters,” where help finding andobtaining the most up-to-date infor-mation can be found.

CMS also plans to continue evalu-ating the new Web site in order to pro-vide the best organization and naviga-tion – to help users continue to retrieve

the information they are looking for inthe most efficient way possible.

CMS urges people to check out thenew Web site at http://www.cms.hhs.gov.Find out more by going to the bannerentitled “Launch of the Agency’sRedesigned Website.” •— Paul CunninghamArkansas Hospital Association

CMS Redesigns Web Site to be More “User-Friendly”

The Centers for Medicare &Medicaid Services (CMS) says that ademonstration project on pay-for-per-formance (P4P) has yielded statisticalevidence showing the payment modelimproves the quality of healthcare forpatients. The conclusion was based onthe findings of the Hospital QualityIncentive demonstration in whichimprovements in care were tied to anaward of monetary bonuses in CMS’Medicare payments to hospitals.

The demonstration, in whichmore than 260 hospitals voluntarilyparticipated, began in

October 2003 and included 36

hospitals with fewer than 100 beds,as well as smaller hospitals. Five clin-ical areas were measured: (1) heartattack, (2) heart failure, (3) pneumo-nia, (4) coronary artery bypass graft,and (5) hip and knee replacement.Composite quality scores were calcu-lated for each demonstration hospitalby combining individual clinical areameasures into an overall qualityscore for each clinical condition.

Medicare will distribute $8.85million in bonuses to hospitals thatdemonstrated measurable improve-ments in care during the first year ofthe project, including $1,756,000

distributed to 49 hospitals for heartattack care; $1,818,000 to 52 hospi-tals for heart failure care; $1,139,000to 52 hospitals for pneumonia care;$2,078,000 to 27 hospitals for heartbypass; and $2,061,000 to 43 hospi-tals for hip and knee replacement.

The largest bonus awarded,$326,000, will be to a medical centerfor heart bypass patient care. The sec-ond largest bonus was $249,000.

The demonstration began inOctober 2003 with more than 260hospitals agreeing to participate. Itis scheduled to end in September ofthis year. •

CMS: P4P Improves Quality, and Improved Quality Yields Bonuses




The Department of Health andHuman Services has published theFederal Medical Assistance Percentages(FMAP) for U.S. states and territoriesin fiscal year 2007, which beginsOctober 1, 2006. Published annually,the percentages are used to determinethe federal matching shares for theMedicaid and State Children’s

Health Insurance Program. The state FMAP rates are derived

from a legislatively set formula thatcompares the average income for astate to that average income of theU.S. Under the formula, Arkansas’FMAP for fiscal year 2007 will be73.37%, which is the highest rate ofany state except Mississippi.

It means that the federal govern-ment will continue to fund about $3for each $1 in state matching fundsthat are allocated and paid forMedicaid programs.

The rates can be viewed athttp://a257.g.akamaitech.net/7/257/2422/01jan20051800/edocket.access.gpo.gov/2005/pdf/05-23392.pdf. •

Arkansas Retains High Medicaid FMAP at 73.37%

Pay-for-performance, also calledP4P, has the potential to increase theuse and quality of “effective care”but is unlikely to help bring down therising costs of healthcare, accordingto a new study sponsored by theCommonwealth Fund. Effective careis therapy that is viewed as medicallynecessary based on clinical-outcomeevidence, for example the use of beta-blockers after a heart attack.

John E. Wennberg of theDartmouth Medical School, whoauthored the study, said that effec-tive care is underused and influ-ences only a relatively small propor-tion of the healthcare dollar. As aresult, he said, it won’t influencehealthcare costs to the same extentas “preference-sensitive care,”which involves significant tradeoffsbased on a patient’s values, and

“supply-sensitive care,” in whichthe supply of resources dictates thefrequency of their use.

Wennberg said preference-sensi-tive care is misused and supply-sen-sitive care is overused, but he pre-dicted pay-for-performance strate-gies, along with efforts to rewardefficient providers and pay forchronic-illness-management infra-structure, could promote reform. •

New Study Says P4P Should Bolster “Effective Care”

Section 1834(m) of the SocialSecurity Act established the amountMedicare paid as the telehealth origi-nating site facility fee for services pro-vided from October 1, 2001, throughDecember 31, 2002.

The amount was set at $20. Forsuch services provided on or afterJanuary 1 of each subsequent calendaryear, the telehealth originating sitefacility fee was increased as of the firstday of the year by the percentage

increase in the Medicare EconomicIndex (MEI).

The 2006 MEI increase is 2.8%.Thus, for calendar year 2006, the pay-ment amount for HCPCS code Q3014(telehealth originating site facility fee)

is 80% of the lesser of the actualcharge or $22.47, which is 102.8%of the 2005 fee. The beneficiary isresponsible for any unmetdeductible amount or co-insurance.

Find more information aboutthe telehealth originating site facili-ty fee payment amount by going tohttp://new.cms.hhs.gov/transmit-tals/downloads/R41BP.pdf on theCMS Web site. •

2006 Telehealth Payment Amount Explained



Arkansas hospitals that haven’t yetdone so should submit their applica-tion for a National Provider Identifier(NPI). The NPI will replace healthcareprovider identifiers in use today instandard healthcare transactions.

All Health Insurance Portabilityand Accountability Act (HIPAA) cov-ered entities, except small healthplans, must begin using the NPI onMay 23, 2007; small health planshave until May 23, 2008.

Medicare systems began acceptingclaims including an existing legacyMedicare number or an NPI as longas it was accompanied by an existinglegacy Medicare number on January3, 2006, and will accept the claimscontaining both numbers throughOctober 1, 2006.

Beginning October 2, 2006, andthrough May 22, 2007, the Centersfor Medicare & Medicaid Services’

(CMS) systems will accept an existinglegacy Medicare number and/or anNPI. This will allow for 6-7 months ofprovider testing before Medicareclaims including an NPI only areaccepted as of May 23, 2007.

After that date, Medicare claimsthat don’t have an NPI will not bepaid. More explicit instructions ontime frames and implementation ofthe NPI for Medicare billing will beissued later this year.

While the NPI is automaticallyentered for Medicare purposes uponcompletion of the application process,healthcare providers are responsible forinforming other payers of their NPI,when it is assigned. Other health planswith whom providers do business willgive instructions as to when healthcareproviders may begin using the NPI instandard transactions.

An instructional Web tool, called the

NPI Viewlet, is available for viewing athttp://www.cms.hhs.gov/medlearn/npi/npiviewlet.asp and under “HIPAALatest News” at http://www.cms.hhs.gov/hipaa/hipaa2 on the CMS Website. This tool provides an overview ofthe NPI, a walk-through of the applica-tion, and live links to the National Planand Provider Enumeration System’s(NPPES) Web site where the learnercan apply for an NPI. It is designed forall healthcare providers.

To apply for an NPI, visit:https://nppes.cms.hhs.gov on the CMSWeb site. To request a paper applica-tion, call 1-800-465-3203.

In addition, the Centers forMedicare & Medicaid Services hasissued a new “fact sheet” explainingthe NPI. The fact sheet may be viewedby going to http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/NPIFactSheet_010906.pdf. •

Reminder: It’s Time to Apply for Your Hospital’s National Provider Identifier

The Centers for Medicare &Medicaid Services has posted guidanceto help Medicare enrolled healthcareproviders determine how they shouldhandle “subparts” and whether thesewill need a separate National Provider

Identifier for use in standard electron-ic transactions under the HealthInsurance Portability andAccountability Act (HIPAA). The Actrequires the reporting of a standardunique identifier on electronic claims

and other standard electronic transac-tions by May 23, 2007.

Visit http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/Medsubparts01252006.pdf for theguidance •

Guidance For NPI Use Now Offered by CMS

Medicare’s Ambulance InflationFactor (AIF) for calendar year (CY)2006, has been released to contrac-tors. Prior to January 1, 2006, dur-ing the transition period, the AIFwas applied to both the fee scheduleportion of the blended paymentamount (both national and region-al) and to the reasonable cost or

charge portion of the blended pay-ment amount separately, respective-ly, for each ambulance provider andsupplier.

As of January 1, 2006, the totalpayment amount for air ambulanceproviders and suppliers will bebased on 100% of the nationalambulance fee schedule, while the

total payment amount for groundambulance providers and supplierswill be based on either 100% of thenational ambulance fee schedule or60% of the national ambulance feeschedule and 40% of the regionalambulance fee schedule.Additionally, the AIF for CY 2006has been set at 2.5%. •

Ambulance Inflation Factor for 2006 is Announced


Q U A L I T Y

Dr. Dennis O’Leary, president ofthe Joint Commission onAccreditation of HealthcareOrganizations (JCAHO), sent aDecember 13, 2005 letter to accredit-ed hospitals advising that they will beprovided access to their hospital-spe-cific data before the reports arereleased to the BlueCross BlueShieldAssociation (BCBSA).

Under a highly controversial pilotproject, the JCAHO is creating andissuing reports to the BCBSA basedon hospital performance measure-ment data submitted to the accredit-ing organization. The scheduledDecember release of the next groupof reports has been delayed to allowhospitals to review their data, whichwere made available on the hospital’spassword-protected JCAHO extranetsite no later than mid-January.

The files posted on the hospital’sextranet site will not include thepatient safety indicator data or plan-specific rates that are included in theBCBSA reports. They will include hos-pital-specific data compared to stateand national averages for the timeperiod covering the second quarter of

2004 through the first quarter of2005. Most of these data are alreadypublicly available on the JointCommission’s Quality Check Web site;however, that Web site currently doesnot portray quarterly measure rates.

The data being posted to the

selected hospital secure JCAHOextranet sites, and to be included inthe BCBSA reports, are based on datathat the affected hospitals have previ-ously transmitted to the JointCommission through their measure-ment system vendors. •

JCAHO Allows Hospital Data Review

As part of its 2007 National PatientSafety Goals, the Joint Commission onAccreditation of HealthcareOrganizations (JCAHO) has proposednew goals for JCAHO-accredited hos-pitals covering safety of medications,identification of safety risks inherent inthe organization’s patient population,disruptive behavior among the organi-zation’s staff, orientation for tempo-rary workers, improved recognitionand response to changes in patientconditions and harm associated withhealthcare worker fatigue.

The JCAHO is concerned with thecomplexity of dosing and monitoring

requirements, patient compliance anddrug or dietary interactions that canresult in adverse drug events. Implemen-tation expectations address the use ofstandardized practices in monitoring.

The 2007 proposed goals wouldalso require that the organization iden-tify safety risks inherent in its patientpopulation through risk assessmentsand continuous reassessments. In par-ticular, the JCAHO lists identifyingpatients at risk for falls, which is arequirement from past years, as well asidentifying patients at risk for suicideand preventing decubitus ulcers.

In response to a study that conclud-

ed that 88% of respondents haveencountered some form of disruptivebehavior among staff members, thenew goals would require accreditedhospitals to develop guidelines foracceptable behavior as well as identify,report and manage disruptive behavior.

Finally, the 2007 proposed goalswould require the organization to iden-tify conditions and practices that con-tribute to healthcare worker fatigueand take action to minimize thoserisks. Implementation would involvebetter management of work hours andinstituting schedules that reflect knowneffects of sleep physiology. •

JCAHO Patient Safety Goals


Q U A L I T Y

New hospital infection control guidelinesdesigned to slow the spread of antibiotic-resistant bacteria are expected from theCenters for Disease Control and Preventionwithin the next few months, according to areport from Bloomberg News. The new rulesare expected to intensify sterilization require-ments for healthcare workers, increase testingof patients who may harbor dangerous germsand may call for hospitals to create specialquarantine wards.

CDC researchers say they are especially con-cerned about antibiotic resistant bacterialinfections that arise in hospitals and spread tohomes and crowded workplaces.

To learn more, visit the CDC Web site athttp://www.cdc.gov. •

New Infection Control Guidelines on Antibiotic Resistant Bacteria Expected Soon

The Institute of Medicine (IOM)has recommended that Congressestablish an independent board with-in the Department of Health andHuman Services to coordinate anational system for healthcare per-formance measurement and report-ing that builds on the work of key

public and private organizations,including the Hospital QualityAlliance.

The IOM suggested that Congressauthorize $100 to $200 million inannual funding for the board, developmeasurement and reporting tools andissue an annual report to Congress

reviewing its activities and progress. The IOM panel also recommend-

ed Congress fund research to addresscurrent gaps in quality measurementand reporting, test reporting formatsand evaluate the cost and care conse-quences of quality measurement andreporting, among other issues. •

Possible Quality Measurement Oversight Board

The Hospital Quality Alliance(HQA) updated its HospitalCompare Web site December 15with the latest data from participat-ing hospitals. The site enablespatients and families to compare theperformance of the nation’s acutecare hospitals on 20 quality meas-ures for care provided to adultpatients in 2004 and 2005 for heartattack, heart failure, pneumonia and

the prevention of surgical infections. About three-quarters of the

roughly 4,000 reporting hospitalsprovided information on the 18measures for heart attack, heart fail-ure and pneumonia. In addition,many hospitals provided data on twomeasures for surgical infection pre-vention added to the site inSeptember.

This year, HQA participants plan

to begin collecting and sharing datafrom a new national survey onpatients’ perceptions of hospital care,known as HCAHPS, pending finalapproval by the federal Office ofManagement and Budget.

HQA partners include theAmerican Hospital Association andother hospital groups, Centers forMedicare & Medicaid Services, AFL-CIO, AARP and others. •

Latest Hospital Quality Data Posted


Q U A L I T Y

More than 42 million operationsare performed each year in U.S. hos-pitals to protect, enhance and savelives. But too often, post-operativecomplications can prolong a patient’ssuffering, disrupt their families andadd to the cost of care for everyone.The Surgical Care ImprovementProject (SCIP) is a new patient safetyinitiative intended to reduce thosedangerous and costly complicationsand to improve surgical care for hos-pital patients.

The SCIP involves the entire careteam – doctors, nurses, anesthesiolo-gists and quality improvement staff –in preventing four of the most com-mon surgical complications: surgicalsite infections, blood clots, heartattacks and ventilator-associatedpneumonia. The goal is to reducethese complications by 25% withinfive years. Hospitals across the coun-try are committing to participate inthe SCIP because they see real bene-fits to their patients – better care andless chance of developing seriouscomplications that can affect apatient’s health.

Improving quality of care contin-ues to be a top priority for hospitals,and participating in SCIP is an excel-lent way to continue and extend qual-ity improvements. While the project iscurrently being launched as a quality

improvement program, in 2007 theHospital Quality Alliance will ask allhospitals to consider collecting datafor public reporting. More informa-tion will be available next year.Arkansas hospitals that have notjoined the project can sign up and startmaking a difference in surgical care fortheir patients now.

For more information, go to theAmerican Hospital Association’s (AHA)

Web site – http://www.aha.org – andclick on the SCIP icon. Print outAHA’s SCIP Quality Advisory andcommit to being part of SCIP bycompleting and sending back thesign-up sheet.

The advisory also includes tips andstrategies to prepare for participatingin SCIP. If you have additional ques-tions, please call AHA MemberRelations at 1-800-424-4301. •

Surgical Care Improvement Project: Is Your Hospital On Board?

Four new teams have joined aninternational research network devel-oping computer-based simulations ofpandemic flu and other infectious dis-ease outbreaks, the National Institutesof Health reports.

One team including Brigham &

Women’s Hospital in Boston willdevelop ways to identify new clustersof emerging infectious diseases andtrack antimicrobial resistance in hospi-tals and emergency settings, NIH said.

It also will optimize strategiesfor using patient care data from

large health systems in infectiousdisease models.

The four research teams willreceive about $7.8 million over thenext five years, and collaborate withfour existing network teams estab-lished in 2004. •

NIH Expands Network Modeling Infectious Disease Outbreaks


J C A H O

The Board of Commissioners ofthe Joint Commission onAccreditation of HealthcareOrganizations (JCAHO) voted atits November 18-19 meeting not tosell performance measurement dataanalyses to private third-party pay-ers.

In a statement on the matter, theJCAHO said that accreditationcontract language consistent withthis intent will be drafted and madeavailable to any accredited organi-zation that wishes to incorporate itinto its JCAHO contract.

At the same time, the commission-ers affirmed the Joint Commission’sneed to secure access to patient-levelperformance data to support its ongo-ing accreditation-related measurementactivities. In so doing, the Board agreedthat there is need for resolving a series

of outstanding issues involving thiseffort that have been raised by theAmerican Hospital Association (AHA),especially those involving compliancewith the Health Insurance Portabilityand Accountability Act. The JCAHOsaid it would work in collaborationwith the AHA to resolve these issues.

It appears clear that the commit-

ment in the Joint Commission’sNovember 21 statement “not tosell performance measurementdata analyses to private third partypayors” applies to any new plansfor data-sharing going forward.

However, in order to avoid anymisunderstandings, ArkansasHospital Association legal counselElisa White further clarified thatthe Joint Commission does have acontractual obligation to fulfill itsresponsibilities to the current BlueCross Blue Shield Association pilot

project. As specified by this contract,the third set of data reports have beenissued, and the final set of reports wasto be issued during the first week ofMarch 2006.

The Joint Commission’s involve-ment in the pilot project will then beconcluded. •

JCAHO Won’t Sell Performance Data

The Joint Commission onAccreditation of HealthcareOrganizations (JCAHO) will increaseits fees for full on-site accreditationand certification surveys by 5% aspart of a 2006 operating plan andbudget recently approved by itsBoard of Commissioners.

The average estimated on-sitesurvey fee increase for hospitalswould be $465, or $155 for criticalaccess hospitals. There will be noincrease in the annual base rate feesor for any of the other types of on-site surveys.

At its recent meeting, the board

also reappointed Fred Brown as itschair for an additional one-yearterm. Founding president and CEOof BJC Healthcare in St. Louis and aformer chair of the AmericanHospital Association (AHA) Boardof Trustees, Brown was appointed tothe JCAHO Board by the AHA. •

JCAHO Survey Price Hike Announced

As of January 1, 2006, the JointCommission on Accreditation ofHealthcare Organizations (JCAHO)began conducting all regular accred-itation surveys on an unannouncedbasis, with a few exceptions.

During the field engagementprocess, the JCAHO determined thatit is not appropriate or feasible to con-duct unannounced surveys in certain

“small” healthcare organizations.Therefore, between 2006 and

2008, the unannounced surveyswill occur in the year that theorganization is due for survey.Subsequent surveys will occur with-in 18-39 months of the organiza-tion’s first unannounced survey,based on pre-established criteriagenerated from Priority Focus

Process data and other factors. Accredited organizations can

identify up to 10 days each year inwhich an unannounced surveyshould be avoided (i.e., black-outdates).

Go to http://www.jcaho.org/accredited+organizations/svnp/qa_unannounced.htm to see theUnannounced Survey Q&A. •

JCAHO Unannounced Survey Exceptions


J C A H O

On January 25, theJoint Commission onAccreditation of Health-care Organizations(JCAHO) issued aSentinel Event Alertencouraging healthcareorganizations to recon-cile a patient’s medica-tions as the patient tran-sitions from one caresetting or practitioner toanother to help avoidmedication errors suchas omissions, duplica-tions, dosing errors, ordrug interactions.

Medication reconcili-ation is also the subject of a preexist-ing JCAHO National Patient SafetyGoal, but unlike the requirements ofthe Goal, which are mandatory,implementation of the tactics in thenew Alert is not required.

In order to comply with the cur-rent National Patient Safety Goalrelated to medication reconciliation(Goal 8), JCAHO requires hospitalsto: (1) obtain and document a com-plete list of the patient’s medicationsupon admission; and (2) to commu-nicate a complete list of the patient’smedications, including new medica-tions that are being ordered and oldmedications that are being resumed,to the next provider whenever thepatient is “referred or transferred toanother setting, service, practitioner,or level of care within or outside theorganization.” The broad require-ments of Goal 8 provide hospitalswith considerable flexibility indesigning medication reconciliationprocesses.

The Alert is more detailed thanGoal 8 and recommends that hospi-tals consider three specific opera-tional tactics related to medicationreconciliation. The tactics, which arenot mandatory, are summarizedbelow with a description of how they

differ from mandatory JCAHOrequirements.

Tactic 1: Placing the reconciled med-ication list in a highly visible locationin the chart and including other spe-cific information on the list (dosage,drug schedules, immunizations, aller-gies and drug intolerances).

JCAHO already requires hospi-tals to create a reconciled med-ication list and defines medica-tion broadly to include vaccines.JCAHO does not require hospi-tals to have a separate form forthe list, to place the list in a spe-cific location in the chart, or toinclude allergies and drug intol-erances on the list.

Tactic 2: Creating a process for rec-onciling medications at all “inter-faces of care” (admission, transfer,discharge), determining “reasonable”time frames for the reconciliationprocess and involving patients, doc-tors, nurses, and pharmacists in theprocess.

JCAHO already requires hospi-tals to have processes for rec-onciling medications uponadmission, discharge, andtransfer, and specifies that

patients should beinvolved in the cre-ation of the medicationlist on admission.JCAHO does notrequire that the med-ication reconciliationprocess identify time-frames for reconcilia-tion or specify whattype of hospital per-sonnel should beinvolved in the process.

Tactic 3: Providing thepatient with a com-plete list of all medica-tions upon discharge

and encouraging the patient to carrythe list and share it with all of thepatient’s healthcare providers.

JCAHO requires hospitals toprovide the next healthcareprovider with a reconciled listof medications but does notrequire that hospitals providepatients with a reconciled listof medications and encouragethe patient to carry the list andshare it with others.

Again, the Alert recommends thatthe reconciliations be done at everytransition of care in which new med-ications are ordered or existingorders are rewritten. Transitions incare include changes in setting, serv-ice, practitioner or level of care.

As outlined above, this processcomprises five steps: 1) develop alist of current medications; 2) devel-op a list of medications to be pre-scribed; 3) compare the medicationson the two lists; 4) make clinicaldecisions based on the comparison;and 5) communicate the new list toappropriate caregivers and to thepatient.

Go to http://www.jcaho.org/about+us/news+letters/sentinel+event+alert/sea_35.htm to read the Alert. •

JCAHO Alert Encourages Medication Reconciliation, but Causes Confusion


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E L E C T R O N I C H E A LT H R E C O R D S

A new report by the Center forHealth Transformation outlines rec-ommendations for spurring theadoption of electronic healthrecords based on the successfulpractices of health dataexchanges known as regionalhealth information organiza-tions (RHIOs).

The report calls onCongress to pass “comprehen-sive” health information tech-nology (IT) legislation this yearthat includes grants or loans tocreate and develop RHIOs andremoves regulatory barriers tohealth IT progress.

The Center advocates dedicating1% of federal discretionary spend-ing, or roughly $7 billion a year, to

health IT, which it calls vital toreducing medical errors andincreasing disaster preparedness.

Former House Speaker NewtGingrich, who founded theCenter, said, “There are com-munities around the countrythat are already realizing thepower of health informationnetworks. Their strategies,expertise and technology areconnecting caregivers in waysthat are saving lives and sav-ing money. We now need toput these tools in the handsof providers and peoplenationwide.” •

Report Pushes EHR Funding; Seeks Dedicated Annual Amount

The Health and Human Services’Agency for Healthcare Researchand Quality (AHRQ) has launcheda new suite of learning resources tohelp healthcare providers adopthealth information technologies.

Part of the agency’s NationalResource Center for HealthInformation Technology, the toolsinclude descriptions of AHRQ-

funded research projects and emerg-ing lessons from the field, a knowl-edge library with links to more than5,000 health IT informationresources, and an evaluation toolkitto help those implementing healthIT projects.

The agency’s $166 million healthIT initiative funds more than 100projects in various healthcare set-

tings, including hospitals. “This shared learning tool brings

the lessons of experience together inone place, so we can help providersavoid problems and achieve greaterbenefits when they make their moveto health IT,” said AHRQ DirectorCarolyn Clancy, M.D.

To access the materials, go tohttp://www.healthit.ahrq.gov. •

AHRQ Releases Learning Resources to Help Providers Adopt Health IT

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