AHA DATABANK Program Rollout
The Arkansas Hospital Association (AHA) officially rolled out its new DATABANK program for member hospitals with three September regional information and training programs for the on-line survey. 

The DATABANK program is a system for collecting utilization and financial information from individual hospitals and generating back to them reports that contain numerous operational indicators for the participating facility and for peer groups of similar hospitals. The reports can augment the hospital’s own financial information and be useful for internal management purposes.

Developed by the Colorado Health and Hospital Association (CHHA) and in use for more than 15 years, the on-line survey is simple to complete, requiring less than one hour per month to input the data. The system’s edit/review feature ensures accuracy of the hospital input data, detailed instructions result in uniform reporting, and Web technology provides for a quick conversion of data into online reports.

CHHA licenses the on-line DATABANK survey to state hospital associations in more than 35 states across the country. Participation is voluntary, and in most states, as in Arkansas, it is offered at no charge to member hospitals. Hospitals that will participate in an ongoing manner will find DATABANK to be a valuable tool and will demonstrate their commitment to supporting hospital advocacy efforts through helping to build a useful national hospital database of timely information.

HIPAA Provisions Expected by Year End
During a recent meeting of the National Uniform Billing Committee and National Uniform Claim Committee meeting in Baltimore, Stanley Nachimson, senior technical advisor for information systems at the Centers for Medicare and Medicaid Services (CMS) said that a number of important HIPAA provisions will soon be ready for CMS Administrator Tom Scully to sign.  These include final rules creating unique identifiers for providers and employers and the proposed rule establishing a unique identifier for health plans.

CMS is working on administrative issues relating to the rules, such as how it will pay for collecting information and implementing these databases.  It also is preparing a proposed rule for electronic claims attachments, Nachimson said, which should be out by the end of the year. Such attachments are expected to be a vital part of the new HIPAA regulations for physicians, streamlining a burdensome, paper-based task.

On a positive note for physicians, Nachimson said health plans that are not ready to accept the new HIPAA claim format – and that demand that medical practices send their claims to a clearinghouse to reformat them to meet the health plan requirements – cannot charge providers for the cost of reformatting.  CMS expects to include this information in its “frequently asked questions” section of its HIPAA Web site, http://aspe.os.dhhs.gov/admnsimp/. 

The security standards for personal health information are in final form and should be published by the end of 2001.

Nachimson said the October 16, 2002 implementation date for the electronic data transactions standards and other provisions has not changed.  But two proposed rules are expected to be released by February 2002 that will make some revisions to those standards.  They include:

• A proposed rule to change the batch standard for pharmacy claims.  This rule will also propose the retraction of the NDC code usage for everyone other than retail pharmacists.
• The changes to the electronic standards and corresponding implementation guides recommended by the Designated Standards Maintenance Organizations (i.e., NUBC, NUCC, and others) would be the culmination of a process that allowed anyone to suggest additions, deletions, or modifications to any HIPAA electronic transaction standard.

Another issue yet undecided is what agency will enforce these standards.  Experts say it is unlikely that CMS will be the enforcement agency because Medicare is one of the payers.  As with privacy regulations, which are being enforced by the Office for Civil Rights within HHS, another agency – possibly the OIG – could be the enforcement agency.  CMS expects to release the enforcement rule before the implementation deadline for the transaction standards in October 2002.

Arkansas Initiated Act 1 Implementation Plans
Two provisions of Arkansas Initiated Act 1 of 2000 that should most benefit hospitals are scheduled to go into effect November 1, 2001. The Act, a blueprint for spending Arkansas’ share of the national tobacco settlement fund, was developed by members of the Coalition for a Healthier Arkansas Today (CHART). Voters passed it in November 2000.

The Arkansas Division of Medical Services, the arm of the Department of Human Services that administers the Medicaid program, is preparing a proposed policy change that will reduce the Medicaid recipient co-pay for inpatient hospital services from 22% of a hospital’s per diem on the first Medicaid covered day of an admission down to 10%. An Official Notice of the change has been mailed. 

Another Official Notice will increase the inpatient Medicaid benefit limit from 20 Medicaid-covered days per year to 24 days. Current policies will be in effect through October 31, 2001.

In addition, Medicaid coverage of pregnant women is scheduled to be expanded. Currently, pregnant women who have annual incomes up to 133% of the federal poverty level qualify for Medicaid coverage. 

The expected November 1 change will increase the eligibility level to 200% of the poverty level. The increased eligibility limit will ensure coverage for many moms and newborns who otherwise have no source of payment for the hospital services they receive. Together, implementation of the two Initiated Act 1 provisions should add between $7 million and $9 million annually to Medicaid hospital payments.

Trustee Orientation Workshop November 7 – Little Rock
In response to numerous requests from trustees and Arkansas hospital CEOs, the Arkansas Association of Hospital Trustees will host a Trustee Orientation Workshop Wednesday, November 7 at the Holiday Inn Select in Little Rock.  

The workshop is designed not only for trustees new to their governance position, but also for those who've been "in the trenches" for quite some time.  It's never too late to learn and share new ideas and techniques, concerns, and strategies.

Larry Walker, governance consultant and facilitator, will be the featured speaker presenting topics recommended by Arkansas hospital CEOs.

Topics will include the challenge of healthcare governance and why excellence in trustee leadership is more critical than ever; lessons from the trenches; preparations for the future; boardroom basics (medical staff development, credentialing, QA, finance, accreditation, payment systems, CEO performance, etc.); the ideal strategic board; effective board meetings; and error-proofing hospital governance.

In addition, participants will receive an extensive notebook with supporting materials, including executive briefings on issues, trends, governance processes; the language of healthcare; Trustee KnowledgePLACE (which includes websites and reports useful to trustees), and other relevant tools and resources developed by The Walker Company.

Call Beth Ingram at 501-224-7878 for a copy of the registration brochure.

Arkansas Medical Board Service Certified
The Arkansas State Medical Board’s Centralized Credentials Verification Service (CCVS) has reached a milestone in its goal to implement the requirement that all credentialing organizations use a single source for obtaining credentialing information on physicians. 

In August, the National Committee for Quality Assurance (NCQA) issued certification in each of the eight areas for which the CCVS applied. NCQA certification is one of two requirements to trigger the mandate.

The other requirement is that the price for the service must be no higher than other statewide credentialing services. After conducting a price survey, the CCVS has proposed a pricing structure of $60 for initial applications and $40 for re-credentialing. Credentialing organizations are prohibited from passing these costs on to physicians. In addition, the $100 medical licensing fee in place for the last two years to fund the start-up of the program will be reduced to $25.

Beginning in January 2002, any organization that credentials Arkansas physicians such as hospitals, HMOs, insurance carriers, PPOs, and IPAs, will be required to utilize the services.

UAMS Plans Myeloma Research Center
University of Arkansas for Medical Sciences (UAMS) officials announced August 22 their plans to form the world’s first institute dedicated to research on multiple myeloma. The proposed Myeloma Institute for Research and Treatment would be built and operated with the goal of becoming the worldwide authority on the disease, which affects blood cells and bone marrow. It would be founded on the myeloma work underway at UAMS’ Arkansas Cancer Research Center (ACRC) since 1989. 

A day following the announcement, UAMS received word that two myeloma patients at the center ¾ one from New York and the other from Miami ¾ would donate a combined $1.5 million to help implement the new program. Dr. Bart Barlogie, ACRC director, is heading fundraising efforts for the new myeloma center and hopes to raise at least $50 million for construction and $10 million for a maintenance endowment fund.

CMS Proposes “Pass-Through” Cutbacks
The Centers for Medicare and Medicaid Services (CMS) released a proposed rule August 20 covering services provided under the Medicare outpatient prospective payment system (OPPS) in 2002. The rule allows hospitals an average 2.3% payment hike effective January 1. It also includes deep reductions in extra “pass-through” payments that cover about 1,100 high-tech medical devices, drugs, and biologicals used in outpatient procedures.

Congress required Medicare to make the pass-through payments temporarily under the 1999 Balanced Budget Refinement Act and capped them at 2.5% of the estimated overall amount paid under OPPS. The cost of the items is now running at an estimated 10% of all OPPS payments, forcing the proposed cutbacks.

CMS administrator Tom Scully said the proposed rule would achieve the goal of making appropriate payments to hospitals, given the ongoing shift of services from the inpatient to outpatient setting. But, some groups disagree, saying the cuts lined up for advanced outpatient technologies could force many Medicare beneficiaries back into the inpatient setting, driving up Medicare spending and placing hospitals at risk for added revenue losses. 

The American Hospital Association and key health lawmakers have called for CMS to delay the final publication of the rule until it is ready to implement alternatives to the proposed cuts. Read the proposed rule at www.hcfa.gov/regs/propcy2002.htm.

Six Sigma Quality and Healthcare Quality Outcomes

There is a new term being mentioned when discussing various levels of quality – Six Sigma Quality.  The term sigma is taken from a letter in the Greek alphabet and is used in statistics as a measure of variation. Six Sigma Quality is a term used generally to indicate that a process is well controlled, i.e., ±6 sigma from the centerline in a control chart. The term is usually associated with Motorola, which named one of its key operational initiatives "Six Sigma Quality."

Many airline, publishing, and manufacturing companies have adopted the Six Sigma approach to quality assessment and improvement and have achieved high levels of quality (4 to 6 sigma) by significantly reducing defects and errors in their systems and processes.  For instance, the airlines have reached quality levels above 6 sigma, with 0.43 deaths per million passengers.  By comparison, most of the health care quality outcomes that have been measured fall in the 2 to 4 sigma range.

According to James E. Orlikoff and Mary Totten, authors of Trustee Workbook, healthcare quality has lagged behind other industries in quality levels for several reasons.  They say healthcare continues to “perpetuate, through training and in practice, a largely physician-driven, insular culture of individualism and autonomy in decision-making, rather than a multidisciplinary, team-oriented culture that values and draws on the best skills and experience available within and outside of healthcare.”

In addition, many healthcare organizations lack necessary information systems and infrastructure necessary to produce the kinds of data essential to understanding quality, which would provide the framework for ongoing monitoring and improvement.

For more information about Six Sigma Quality, go to www.asq.org, the Web site for the American Society for Quality.