Arkansas Hospitals: Location, Classification, Beds, Special Units & Control
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Arkansas Legislators Discuss Nurse Shortage
The Arkansas House and Senate subcommittees on Health Services and their respective Committees on Public Health Welfare and Labor held a joint meeting in April to hear testimony regarding the shortage of registered nurses, registered nurse educators and pharmacists in the state.

Linda Hodges, Ph.D., Dean of the UAMS School of Nursing and representatives of other nursing education programs have studied the registered nurse educator shortage issue and have concluded that it is due in large part to the low salaries available to registered nurse educators.

Masters and doctoral prepared registered nurse educators can attract considerably higher salaries in other professions or by leaving the education field to become Registered Nurse Practitioners. Dean Hodges proposed that the legislature appropriate revenues to supplement the low salaries of registered nurse educators who staff the nursing programs offered in state colleges and universities.

AHA executive vice president Phil Matthews testified in support of the proposal by Dean Hodges. In addition, he testified that hiring and retaining nurses is a serious and worsening problem for hospitals.

He emphasized that nursing school enrollment is down due to the many career options available to those who might otherwise choose nursing as a career and that the attrition rate among hospital-employed registered nurses is high.

Tobacco Plan Impasse Ends Session
The Arkansas General Assembly ended its special session April 7 without passing legislation for spending the $1.62 billion in tobacco settlement funds that will come to the state over the next 25 years.

A bill to enact a plan developed over the previous six months by the Coalition for a Healthy Arkansas Today (CHART) was introduced and passed without opposition by the Senate a day after the legislative session began April 3. However, once the bill arrived in the House of Representatives, it didn't fare well.

Members of the House Rules Committee first amended the bill, stripping out the Senate language and replacing it with language to reflect provisions of a plan drawn up by House Speaker Bob Johnson. The House then passed the amended bill by a 60-36 vote last Thursday.

House Rules Committee Chairman Shane Broadway tried an eleventh-hour attempt for a compromise on the two bills Friday morning by convening a House-Senate conference committee. However, neither side would yield on their respective positions during the hour-long meeting. The session came to a close with a stalemate between the two chambers.

Arkansas Governor Mike Huckabee, who supports the CHART proposal, announced after the session was adjourned that he would seek to have the plan put before the state's voters during the November general election as an initiated act. Should the voters approve the CHART proposal, it would take a two-thirds majority vote of both houses of the state legislature to override the act.

CCI Edits Affect Outpatient Payments

The National Correct Coding Initiative (CCI) edits, which Medicare fiscal intermediaries will be applying to hospital outpatient claims to detect mutually exclusive procedures and unbundling, went into effect April 1, 2000. These edits may further reduce revenues already projected to shrink under the Medicare outpatient prospective payment system (PPS) that will be implemented July 1.

The CCI edits will be incorporated into the Outpatient Code Editor (OCE), which HCFA intends to modify for use with the outpatient PPS. The OCE will integrate claims data to assist the APC (ambulatory payment classification) Pricer program in determining payment amounts, calculating proper coinsurance and deductible amounts, and issuing outlier information.

According to Rita Schichiolone, author of an article published in the September 1999 Journal of American Health Information Management Association, there are six CPT codes for which the second code in each pair would not result in an additional APC because the CCI edits consider them bundled into the larger procedure.

The codes are: 29877 (chondroplasty); 29875 (synovectomy, limited) (separate procedure); 11403 (excision, benign lesion); 12002 (simple repair) (mutually exclusive procedure); 45380 (colonoscopy with biopsy); and 94760 (pulse oximetry) (clinically correlated, medically included). A copy of the CCI edits are available from the National Technical Information Service at (800) 553-NTIS or at www.ntis.gov. Rita Scichilone's article, Getting Ready for APCs, can be viewed at www.ahima.org/journal/coding/coding.9909.html.