Arkansas Hospital Association Ark Hosp Mag Summer 2000 Page 7

Summer,00

Distribution of Arkansas Hospitals by Hospital Type, Control, 2000

HOSPITAL TYPE
Bed Size	Community Hospitals		Psychiatric Hospitals		Rehabilitation Hospitals		Specialty Hospitals		All Hospitals
Bed Size	Number	Licensed Beds	Number	Licensed Beds	Number	Licensed Beds	Number	Licensed Beds	Number	Licensed Beds
0-49	19	673	2	83	0	0	3	107	24	863
50-99	26	1,853	4	287	2	120	0	0	32	2,260
100-199	22	2,754	1	102	1	120	0	0	24	2,976
200-299	4	941	1	315	0	0	0	0	5	1,256
300-399	5	1,694	0	0	0	0	0	0	5	1,694
400 +	6	2,490	0	0	0	0	0	0	6	2,490
HOSPITAL CONTROL
By Ownership
NOT-FOR PROFIT	49	5,615	49	5,615	2	180	1	40	54	5,975
INVESTOR-OWNED	14	1,921	14	1,921	1	60	2	67	22	2,380
GOVERNMENTAL	18	1,869	18	1,869	0	0	0	0	19	2,184
TOTAL	82	10,405	82	10,405	3	240	3	107	96	11,539

Source: American Hospital Association

Arkansas Rural Health Loan Fund
Rural Arkansas hospitals seeking alternative ways of financing capital projects might look to a recently established program, the Arkansas Rural Health Revolving Loan Fund (RLF). This fund--part of the Robert Wood Johnson's Southern Rural Access Program--provides financial expertise and capital to make healthcare improvements possible in rural areas of the state with an overall goal of increasing the viability of healthcare services in those areas.

The RLF, which was formally activated last November, is administered through the Arkansas Enterprise Group (AEG), a nonprofit organization which specializes in lending to groups located in economically distressed areas of rural Arkansas.

AEG has several key financial partners in offering loans and professional consultations through the program, including the Bank of America, the Small Business Administration, the U.S. Department of Agriculture, the Arkansas Department of Economic Development, the Arkansas Department of Health, and others.

Providers eligible for loans through the RLF include hospitals, physicians, rural health clinics, community health centers, networks, emergency medical services, and dentists. The providers must be located in medically underserved or economically depressed areas of Arkansas. One hospital in the state has already received a loan through the program and two others have applications under review.

Loan amounts will generally range between $25,000 and $750,000 and may go toward items such as start-up costs, working capital, practice management services, rent, equipment, training, transportation, or computerized information systems. For more information, contact Rodney Parks at the Arkansas Enterprise Group in Arkadelphia at (870) 246-3945.

Arkansas PEPP Studies Underway
The Arkansas Foundation for Medical Care (AFMC), the Medicare Peer Review Organization (PRO) for Arkansas, implemented its 6th Scope of Work contract last August. Under its new contract with the Health Care Financing Administration (HCFA), the AFMC is required to conduct a program designed to reduce the amount of overpayments for inpatient hospital services provided to Medicare beneficiaries.

HCFA's stated goal for this Payment Error Prevention Program (PEPP) is to reduce occurrence of those payment errors. According to AFMC officials, the Arkansas PRO intends to meet the PEPP goal through education and support for hospital coding departments.

Gary O'Neal, senior vice president for the AFMC, who also has overall responsibility for PEPP activities, met recently with the Arkansas Hospital Association board of directors to discuss the program and some of its initial findings.

For its first PEPP study, the AFMC chose to look at DRG 475, "Respiratory System Diagnosis with Ventilator Support." It is the second-highest-weighted non-surgical DRG and involves very specific coding and sequencing to ensure proper billing. Based on the study, the AFMC found three primary problem areas: errors in the selection of the principal diagnosis, inappropriate sequencing of respiratory failure, and the reporting of inappropriate procedure codes.

The AFMC began its second study, which concerns DRG 143, last November. DRG 143, for "Chest Pain," is the most frequently billed DRG for one-day hospital stays in Arkansas in 1998. In completing the study, the AFMC examined all cases billed during fiscal year 1998 under DRG 143, excluding those ending in death or transfer of the patient.

Based on a review of data that included the patient's presenting symptoms and past medical history, the physician's description of the chest pain, and the initial laboratory and EKG results, the study found that 47% of the bills were supported by chart documentation that sufficiently showed the need for inpatient care. However, 46% of the bills reviewed had no indication of symptoms that would make an admission necessary.

O'Neal informed the board that hospitals should also expect to receive requests for information relating to a random sample survey for the Clinical Data Abstraction Center (CDAC). This random survey is being carried out by a group called DyneKePRO and is meant to establish the Medicare error rate for Arkansas. Hospitals are required to respond to these requests for information and the AFMC has been instructed to make payment denials when hospitals fail to provide it.

AFMC Identifies Coding Problems
During the Arkansas Foundation for Medical Care's (AFMC) regional Payment Error Prevention Program (PEPP) meetings, a Questionnaire on Coding was conducted in an effort to identify major obstacles to correct coding in hospitals. The following obstacles were revealed:

Inadequate or incomplete physician documentation in the patient record. [A patient record with inadequate or incomplete physician documentation and missing reports may not provide the documentation needed to accurately code the record.]
Physicians not understanding the impact of the principal diagnosis on the DRG assignment
Coders often are required to code incomplete records
Lack of internal coding validation processes, written coding policies and guidelines, and continuous coding education
Physicians not knowing the UHDDS definition of principal diagnosis [Physicians tend to specify the most serious problem or the cause of death as the principal diagnosis. The principal diagnosis is "that condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care." The coder not only has the right, but also an obligation to query the physician when it is felt that the patient record does not support a diagnosis.]
Insufficient time for chart analysis before making code assignments
Not having a designated staff physician(s) to help with medical questions

White House Report Highlights Changes
The White House has released a report highlighting the growing demographic and financial changes facing Medicare. Some of the points made in the report include the following:

The number of elderly persons in the U.S. will rise from 34.7 million this year to 62 million in 2025, an increase from 13% to 19% of the total population.
The elderly will comprise 20% or more of the population in 30 states by 2025; currently, no states have a percentage of elderly people that high.
In 15 states, more than half of Medicare beneficiaries live in rural areas. The 9 million enrollees living in rural areas have little or no managed care or prescription drug coverage available.
Fewer Medicare beneficiaries are receiving prescription drug benefits.

Go to www.whitehouse.gov/WH/New/ html/Medicare2000 to view the White House report online.

Consumer Tips for Safe Medication Use
Medications can cure diseases and alleviate symptoms. They can relieve pain and make it possible for people with long-term illness to live healthier lives. Medications are also powerful chemicals and must be properly used.

As a patient or family member, you are a key part of the healthcare team. You share responsibility for safe mediation use.

Things you should know about your medicines:

Make a list of all medicines, including prescription and over-the-counter medicines, and dietary supplements such as vitamins and herbs.
Make sure your doctor knows about any allergies and adverse reactions you have had to medicines.
Make sure you understand the name of the medicine and the correct dosage.
Ask for information about your medicines in terms you can understand:
- What is the medicine for?
- How do you take it and for how long?
- What side effects are likely and what do you do if they occur?
- Is the medicine safe to take with other medicines or dietary supplements?
- What food, drink or activities should you avoid while taking this medication?
- How should the medicine be stored?

Things you should know while in the hospital:

Bring a list of all medications you are taking, including herbs.
Each time you receive your medications in the hospital, look at them and question the nurse if they look different.
If a nurse comes to replace an IV solution or administer a medication, ask what it is for. If you are given a tablet that is a different color from the one you usually take, ask the nurse about it.
When you are discharged from the hospital, ask your doctor to explain the treatment plan you will use at home.

Above all, ask questions if you are in doubt

Data Bank Now Accepting Inquiries
The Office of Inspector General has announced that the Healthcare Integrity and Protection Data Bank (HIPDB) has begun accepting requests for adverse action reports on healthcare practitioners, providers, and suppliers.

The Health Insurance Portability and Accountability Act of 1996 limits the use of the HIPDB to various state and federal agencies, private health plans, and individuals included in the database who may obtain their own reports. The HIPDB is a centralized repository of information on the following:

civil judgments-with the exception of malpractice judgments-against healthcare providers, suppliers, and practitioners in federal or state courts related to the delivery of a healthcare item or service;
federal or state criminal convictions against healthcare providers, suppliers, and practitioners related to the delivery of a healthcare item or service;
final adverse actions by federal or state agencies responsible for the licensing and certification of healthcare providers, suppliers, and practitioners; and,
exclusion of healthcare providers, suppliers, and practitioners from participation in federal or state healthcare programs.

Published in the March 3, 2000 Federal Register, rules for the program set a $4 fee for querying the HIPDB and a $10 fee for using the data bank's "Interactive Search Capability," which is only available to authorized enforcement agencies.

CEO Turnover Rate Declines
The turnover rate among hospital CEOs dropped to an all-time low last year, according to the results of a recent annual study of hospital CEO turnover by the American College of Healthcare Executives (ACHE).

The 1998-1999 turnover rate, which was calculated from March 1998 to February 1999, was 10.6%, the lowest since ACHE has kept track. This represents a decline from 16.9% for the 1997-1998 year, which was one of the highest rates on record.

Prior research by ACHE shows that only one-third of CEO turnover is involuntary; two-thirds of turnover is the result of voluntary moves such as job changes or retirement.

Several factors may have contributed to the decline in CEO turnover. Turnover rates for the 1997-1998 study were very high; CEOs who made moves during that time period were less likely to change jobs the following year, contributing to the overall decline in turnover for the 1998-1999 study.

In addition, turnover may be slowing due to an increased awareness of environmental factors that can cause problems in hospital performance. As hospital boards become more aware of the effects of outside factors such as the Balanced Budget Act and reduced reimbursements from managed care organizations, hospital CEOs are less likely to be held solely responsible for poor financial performance.

Web Sites to Watch
http://www.hcfa.gov

What's New at the Health Care Financing Administration
Special projects and initiatives; other government sites
www.hcfa.gov/medlearn.default.htm-HCFA's new Medicare Training Network pages offer tips on how to properly submit Medicare claims and get the appropriate payment for services rendered to beneficiaries.

http://www.hhs.gov/progorg/oig