AHAWCSIT Merges with Virginia Insurance Reciprocal

In a move to strengthen the program, the board of trustees of the Arkansas Hospital Association Workers' Compensation Self-Insured Trust approved October 29 a merger with The Virginia Insurance Reciprocal (TVIR), effective January 1. TVIR is an "A" excellent rated reciprocal insurance company headquartered in Richmond, Virginia.

The new AHA workers' compensation program will function in a manner very similar to the existing program. The current board of trustees will operate with virtually the same authority and will become known as a Program Committee of TVIR.

Factoring into the decision to merge with TVIR were the company's good management; a structure which utilizes the current rating plan; a program that requires Arkansas hospital officials to continue to make decisions affecting workers' compensation; a program that provides for additional investment income while, at the same time, providing for savings on income taxes; and a program that stipulates each hospital is no longer jointly and severally liable.

The current AHAWCSIT program was begun July 1, 1985, and has returned almost $8 million in dividends to participating hospitals. AHA Services, a wholly-owned subsidiary of the Arkansas Hospital Association, looks forward to working with TVIR as its new partner in the Arkansas Hospital Association Workers' Compensation Program, administered by The Virginia Insurance Reciprocal.

Patients' Rights Bill May Pass

Proponents say the November election results may make it more likely that Congress will pass a Patients' Bill of Rights quickly. "In the last session of Congress, that bill lost by only five votes in the House and we now have five more Democrats coming to the House," said President Clinton. Rep. Greg Ganske (R-Iowa), the leading Republican sponsor of a tough managed-care regulation bill, agreed that the election results boost the bill's chances.

In early 1998, Democrats and a small number of congressional Republicans pushed for legislation that would have required managed-care health plans to guarantee access to specialists and dropped the federal ban on most patient lawsuits against managed-care plans. The bill also would have required coverage of most emergency care and required managed-care plans to offer certain consumer information. The House passed a less far-reaching version of the bill prior to November, but it failed in the Senate.

Arkansas Hospitals: Nurse Shortage Exists

An Arkansas Hospital Association survey on nursing employment in the state's hospitals shows that most believe there is a growing shortage of Registered Nurses in the state. CEOs or directors of nursing in about 55% of the 103 AHA-member hospitals responded to the survey, which was conducted in late fall. Overall findings showed a 6.2% vacancy rate among budgeted RN positions in the hospitals. Individually, the vacancy rate was reported as high as 30%, particularly in some smaller hospitals. Results of the survey also show the difficulty of retaining RNs in hospitals.

Almost 23% of the budgeted positions turn over each year, according to the respondents. Sixty-four percent of those responding said there is currently a nursing shortage in Arkansas, while 30% disagreed. More than 56% said the shortage has worsened over the past year, and 9% said the situation has improved. In spite of the perceived shortage, just 18% of the hospitals rely on agency nurses to fill their empty positions.

The AHA survey findings correspond to other studies around the country indicating an increasing RN shortage. Experts cite a number of reasons why fewer nurses are available. Among those are the declining enrollment in nursing programs; an improved economy, which makes it easier for nurses to leave the field for other opportunities; the failure to attract more males and minorities into nursing; and the increasing average age of the nurse workforce. In 1980, 25% of all nurses were under 30 years old. Today, just 9% are in that age group.

Arkansas General Assembly to Convene

The 82nd session of the Arkansas General Assembly, which convenes later this month, marks the first legislative session affected by term limits. The House has 57 new members (49 of the longest-serving House members were barred from running for re-election in 1998 because of term limits), and the Senate has 4 freshmen.

The Arkansas Hospital Association looks forward to working with newly-elected Governor Mike Huckabee and the members of the 82nd Arkansas General Assembly.

OIG Self-Disclosure Program Announced

The U.S. Department of Health and Human Services' Office of Inspector General has expanded a program for healthcare providers to voluntarily report billing mistakes affecting Medicare, Medicaid and other federal healthcare programs. Called the "Provider Self-Disclosure Protocol," it replaces a voluntary disclosure program tested by the OIG over a two-year period.

The program, which was effective October 21, provides detailed guidance to healthcare providers that decide voluntarily to disclose irregularities in their dealings with federal healthcare programs. It is posted on the OIG's Internet site at http://www.hhs.gov/progorg/org.

James A. Kopf, director of the Criminal Investigations Division, OIG, Office of Investigations, noted that the website is updated every two weeks and that providers should take advantage of the information offered there.

The new program is open to providers nationwide. While not protected from civil or criminal action under the False Claims Act, providers disclosing mistakes are advised in the protocol that the self-reporting of wrongdoing could be a mitigating factor in the OIG's recommendations to prosecuting agencies.

Healthcare providers doing business with Medicare, Medicaid or other federal healthcare programs that want to disclose violations of law are eligible for acceptance into the program. If a provider uncovers problems involving the federal healthcare programs, the provider is urged to report the discovery to the OIG. The provider will have the option of doing a self-audit in conformance with OIG guidance.

AHA, HCFA Officials Meet

Arkansas Hospital Association (AHA) executives met November 3 with administrators and staff members of the Health Care Financing Administration (HCFA) Regional Office in Dallas. The meeting was another in an ongoing series held between HCFA and state hospital association representatives from Arkansas, Louisiana, New Mexico, Oklahoma and Texas--the states located in HCFA's Region 6. The purpose of the meeting was to discuss Medicare- and Medicaid-related issues affecting, or having the potential to affect hospitals in those states.

Among the items on the agenda for the meeting was a discussion of problems related to the payment of Medicare claims in Arkansas. Regional Office staff who work with the Arkansas Medicare Fiscal Intermediary had been briefed about many of the problems that have occurred since the FI began use of the Florida Shared System (FSS) for processing Medicare claims. They said most of the country's Medicare FIs previously switched to the FSS and few reported problems when their system changeovers were made. Problems in Arkansas may be more prevalent since the Arkansas FI is having to address Year 2000 systems issues concurrent with its system changeover. The Regional Office officials offered to work closely with AHA and the FI to resolve the problems and get hospital payments back on a timely schedule.

Another issue given some attention was the new EMTALA interpretive guidelines issued by HCFA last May. While some hospital executives and health law experts around the country believe the guidelines do more than merely interpret EMTALA and its regulations--going so far as to actually expand the scope of EMTALA's application, the HCFA staff in Dallas disagrees. According to the Regional Office, the guidelines include nothing that isn't already in the regulations, which weren't changed. The HCFA staff said investigations of alleged EMTALA violations are handled on a case-by-case basis and that circumstances surrounding individual cases are important to making final determinations. One interesting point noted was that a hospital may be technically at fault if an on-call physician refuses to come to the hospital emergency room to tend to a patient's needs; however the physician is also at fault and may face stiff financial penalties for his decision not to respond.

Other items covered included HCFA's policy that all Medicare managed care patients must now be given a notice of non-coverage when inpatient care is no longer needed (the same is not true yet for Medicare fee-for-service patients); the requirement that hospitals must submit Year 2000 compliant claims beginning January 1 (all current HCFA Y2K information is available at the agency's Internet site, www.HCFA.gov.); future Medicare survey and certification delays (they're possible, but not expected); and HCFA's intent to contract with numerous groups outside their traditional fiscal intermediaries in conjunction with the Medicare Integrity Program.

Arkansans to Attend AHA Annual Meeting

Arkansas hospital CEOs, administrators and trustees will travel to Washington, D.C. for the American Hospital Association's annual meeting January 31-February 2. Attendees will hear presentations from speakers such as CNBC's Chris Matthews; former first lady Rosalynn Carter; and Scott Parker, president and CEO of Intermountain Health Care of Salt Lake City. CNN correspondent Judy Woodruff will engage key members of Congress in the annual "Congressional Crossfire," and former U.S. Senators Howard Baker, Warren Rudman and Alan Simpson will participate in a "Reliable Sources" panel moderated by Ken Bode, host of the popular PBS show "Washington Week in Review."

Hospital trustees will have three educational opportunities concerning changes in hospital ownership and control, building higher levels of trust in communities, and leadership issues. And, the annual Capitol Club luncheon for supporters of the AHAPAC will feature political satirist Al Franken.

The group will also visit with Arkansas' congressional delegation (including new Senator Blanche Lincoln) and honor the congressional aides with an appreciation/get-acquainted dinner.

HCFA Handbook Available on the Web

The Health Care Financing Administration's (HCFA) Medicare handbook, "Medicare and You," is now available on the Internet via HCFA's Medicare website: www.medicare.gov. The book will be distributed throughout the five states where HCFA is piloting its first broad-based communication effort--Arizona, Florida, Ohio, Oregon, and Washington. Seniors were mailed the handbook during November.

The handbook details, on a state or regional basis as appropriate, the most common plan design available for HMOs, as well as Medigap plans. A "Medicare and You" bulletin was mailed to the remaining 45 states, Washington, D.C., and Puerto Rico, and is also available on the website.