Session #1: Eight is Enough: 8 Big Problems Facing Hospitals

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1 Session #1: Eight is Enough: 8 Big Problems Facing Hospitals Speaker: Ben Peltier Date: Saturday, Jan. 10 Time: 9:45 10:45 a.m.

2 Ben Peltier Ben Peltier is the vice president of legal services for the Minnesota Hospital Association. Ben is an experienced hospital attorney with time served in the law department of a large Minnesota health system and representing hospitals and physicians at a Washington, DC law firm. Early in his career, Ben managed health care policy issues for U.S. Representative John Boehner of Ohio. During his time on Boehner s staff, Ben worked on a variety of health reform topics including Medicare reform, HIPAA, and health insurance regulation. Ben went to law school at George Mason University in Virginia and studied economics as an undergrad at the University of St. Thomas in St. Paul.

3 Eight is Enough: 8 Big Problems Facing Hospitals Place picture here Ben Peltier, Vice President, Legal Services January 2015 Topics Is Eight Enough? 1. Employee Safety and Mental Health 2. Penalties for Hospital Acquired Conditions 3. Medical Cannabis in the Hospital 4. DOJ and OIG Medical Necessity Investigations 5. The Data Practices Act 6. Nurse Staffing Reporting/Ratios 7. Cybersecurity and Big Data Breaches 8. Managed Care Litigation 1

4 Employee Safety, Mental Health Background: Horror stories from the ED Causes: Lack of treatment options Lack of Capacity Incremental approaches to mental health reform Ideas and Resources to reduce violence Hospital-acquired Conditions Medicare Penalties Just completed first year of a federal penalty program aimed at reducing preventable harm and improving patient safety 724 hospitals in bottom-scoring range These hospitals will see their total Medicare payments docked by 1% in fiscal 2015 as part of the 2

5 Hospital-acquired Conditions Medicare Penalties (cont.) Based on measures of adverse events occurring during hospital stays: pressure ulcers, pulmonary embolisms and certain types of healthcare-associated conditions Concerns about the measurement system? Note there will always be one-quarter of hospitals in that bottom quartile. Medical Cannabis New Medical Cannabis law adopted in 2014 How will hospitals handle issues associated with patients who come to the hospital with prescriptions for medical marijuana Clean Indoor Air Act Security of product and patients Limitations on prescribing, filling prescriptions 3

6 Medical Cannabis (cont.) MDH has been open/collaborative about trying to manage medical cannabis in a reasonable way MDH has issued rules for providers What are the risks of federal enforcement actions DOJ and OIG Investigations that Focus on Medical Necessity Key criminal and civil cases that involve medical necessity issues The importance of in-patient admission, observation status, and the two-midnight rule in 2015 Hospital Policies and procedures that can reduce risk 4

7 Data Practices Act Requests The Minnesota Data Practices Act Background Prior application to health care 2013 Minnesota Supreme Court Decision TimberjayNewspapers v. Johnson Controls, Inc. Data Practices Act Requests (cont.) In response to the Timberjaydecision, Legislature enacted legislation that explicitly requires public disclosure of certain government contractor contracts Final legislation provided a one-year exception for health plans and health care providers participating in state health care programs Required DHS to study the potential impact of broader disclosure of contractor and subcontractor data with respect to government health care costs What can hospitals expect after (or if) the exemption expires? 5

8 Nurse Staffing Reporting, Ratios Current reporting requirements Challenges and criticisms of current staffing Continue pressure for more The Massachusetts model Will the Nurse Union go for half a loaf? What are Minnesota hospitals doing to respond? The Campaign to Protect Minnesota Health Care Cybersecurity Challenges/ Big Data Breaches Many hospitals are creating data warehouses and other big data resources to utilize for research, quality improvement activities and other business analytics Recent data breaches have shown that the health care industry is at an increasing risk of sophisticated hacking 6

9 Cybersecurity Challenges/ Big Data Breaches (cont.) Data warehouses are a prime target for stealing both proprietary information for business espionage and patient information for identity theft What should hospitals be thinking about to respond? Security risk assessment and security risk management plan Implement a breach response team and communication plan Determine federal and state breach reporting obligations Managed Care Litigation and Disputes Negotiated Rates (and the lack thereof) Limits on Participation Disputes concerning participation in narrow networks Potential litigation risks related to Accountable Care Organizations Any willing provider 7

10 Managed Care Litigation and Disputes (Cont.) Out-of-network litigation, including: provider actions, affirmative actions by payers, recent federal decisions addressing payers recoupment practices, state legislative reforms concerning balance billing Questions/Comments Ben Peltier Minnesota Hospital Association (651) ~ office (651) ~ 8

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