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Progress Notes
May 2019

In This Issue

340B Drug Pricing Program Has Its Day in Court

In early May, a federal court ruled that the 2019 cuts to the 340B Drug Pricing Program were improper. In December 2018, this same court ruled that the U.S. Department of Health and Human Services (HHS) 2018 Medicare payment cuts to the program were unlawful. In both instances, the court ruled that the Health and Human Services Department exceeded its statutory authority in implementing the 30 percent cuts. The federal judge has ordered HHS to develop appropriate remedial measures to the cuts. The Healthcare Association of New York State (HANYS), of which the Suburban Hospital Alliance is a partner, filed an amicus brief in support of the litigation along with more than 30 state hospital associations. The judge set an August 5, 2019 date for parties to the lawsuit to submit a status report. However, plaintiffs in the case recently asked a federal judge to set a firm June 2019 deadline for HHS to propose remedies to the nearly 30 percent cuts to the Medicare payments affecting hospitals that participate in the 340B Drug Pricing Program. Plaintiffs seek this earlier deadline as a proactive measure against a proposed 2020 outpatient prospective payment rule that could again propose a 30 percent payment cut – a cut that would also be unlawful.

The federal government created the 340B Drug Pricing Program in 1992. It requires drug manufacturers to provide outpatient drugs to certain not-for-profit hospitals, health centers, and specialty clinics at significantly reduced prices. The program allows safety net, critical access, and children’s specialty hospitals to offer affordable prescription drugs to financially vulnerable and fragile patients by purchasing drugs from manufacturers at a discounted rate. The savings are then reinvested by hospitals into their communities to provide greater access to pharmaceuticals and more comprehensive services. The 340B Drug Pricing Program operates at no cost to taxpayers, as the discounts are offered by drug manufacturers.

The Health Resources and Services Administration (HRSA) administers the 340B Drug Pricing Program. In April, HRSA launched its website that enables providers participating in the 340B program to see the maximum amount drug companies can charge for prescription drugs under the program. The website is part of the 340B ceiling price rule that took effect on January 1, 2019. HHS delayed implementation of this rule six times. The rule enhances drug pricing transparency, long sought by hospitals, and it imposes civil monetary penalties on drug manufacturers.

House Members Call for DSH Cut Delay

In a rare show of bipartisanship, 302 members of the U.S. House of Representatives signed on to a letter urging House leadership to prioritize the delay of Disproportionate Share (DSH) Medicaid cuts. In New York, 26 out of 27 House congressional members signed on, with only Rep. Chris Collins declining to add his name. The letter calls for the delay of DSH cuts for at least two federal fiscal years. New York Rep. Eliot Engel and his House colleague Pete Olson from Texas led the bi-partisan letter signing.

New York’s hospitals face more than $7 billion in Medicaid cuts through 2025 if the scheduled DSH cuts take effect October 1, 2019. DSH funds help cover the costs incurred by hospitals that serve a disproportionate number of Medicaid and uninsured patients. 

Wage Index Challenges

The Medicare Inpatient Prospective Payment System rule proposed in April includes a Medicare wage index proposal that will move Medicare funding out of New York. As proposed, the measure would offer an increased adjustment to the Medicare rate for the 25 percent of the nation’s hospitals with the lowest average wages at the expense of lowering the wage index adjustment for the 25 percent of hospitals with the highest average wages. No New York hospital would benefit from this proposal. In fact, hospitals on Long Island, the Hudson Valley, and New York City would be especially hard hit. The change would take about $83 million out of New York State and redistribute it to other states. The Suburban Hospital Alliance is aggressively weighing in on this proposal that could take effect in the fall. The Medicare Wage Index is a formula that adjusts for differences in hospital wages by geographic areas. 

Pressure against Mandated Staffing Ratios Continues

With just about a month left in the New York State legislative session, Suburban Hospital Alliance leaders are continuing to aggressively push back against mandated nurse staffing ratio legislation. SHANYS leaders, along with representatives from hospitals from Long Island and the Hudson Valley, were in Albany May 21, 2019, to take part in HANYS Nurse Staffing Lobby Day. 

Currently, there are no bills on either floor, but momentum for such legislation remains strong. The state has asked for a study on all staffing levels. The report is due December 1, 2019.

Mandated nurse staffing ratios set unrealistic expectations in terms of financial and human capital. All evidence concludes that staffing is best handled on an individual hospital-by-hospital basis, which accounts for patient complexity, surge capacity, and other local situations. 

Other Legislation to Watch

Independent Dispute Resolution - A bill now pending in the Assembly Insurance Committee (A.264-B) and in the Senate Insurance Committee (S.3171-A) would amend the Financial Services Law to extend the dispute resolution process to include disputes between payers and hospitals regarding out-of-network emergency services charges. The bill adds administrative complexity and burden on hospitals without benefiting consumers. In 2014, New York passed an out-of-network bill that protects consumers from getting caught in the middle of payment disputes between physicians and insurers in the case of out-of-network charges for emergency services. There was no need to include hospitals in the dispute resolution process, as the Department of Financial Services agreed to extend a hold harmless provision to all regulated insurance products that had been in place for certain payers. This process has and continues to protect patients from surprise balance bills from hospitals for emergency services charges. The proposed legislation may motivate some plans to underpay hospitals and rely on the dispute resolution process, and may also lead to less robust networks.

Community Advisory Board - Proposed legislation A.1148 and S.576 would require every general hospital to establish a community advisory board, which would be integrated into the hospital’s development and review of its Community Service Plan. All hospital governing boards currently have the responsibility to represent their communities. The proposed legislation is duplicative. The bill would also require all public hospitals to furnish a Community Service Plan – a requirement that does not currently exist due to the inherent charitable mission of public hospitals, which are safety net hospitals for their regions. 
 

News Briefs

Nurse Staffing Ratio Lobby Day - On May 21, representatives from SHANYS and its allied associations met with legislators and key legislative staff to advocate against bills that would implement government-mandated nurse staffing ratios. The bills currently under consideration (A.2954/S.1032) had been gaining traction earlier in the legislative session until the governor included language in Fiscal Year 2019-2020 budget that required the Department of Health to complete a study examining the impact of staffing enhancements on patient safety and healthcare quality in hospitals and nursing homes. The New York State Nurses Association held a lobby day last week urging lawmakers last week to pass legislation this session despite the governor’s new strategy. The bill, if passed, would come at considerable expense to hospitals and nursing homes in New York State despite the fact that mandated ratios have not been directly correlated with improvement in patient care or outcomes.

Danielle Butin, president and founder of the AFYA Foundation, spoke to members of the board of the Nassau-Suffolk Hospital Council and the Northern Metropolitan Hospital Association at each group’s board meeting held in May. AFYA collects medical supplies and equipment from hospitals, nursing homes, corporations, and individuals in the United States and ships these critical materials to health initiatives worldwide. The foundation specializes in the reuse, resale, or donation of surplus supplies, equipment, and furniture in a way that is consistent with medical institution policy and regulatory requirements. From its warehouse in Yonkers, NY, AFYA has delivered $34 million worth of life-saving supplies to date. For more information visit www.afyafoundation.org or call 914-920-5081. 

Dahill Dose Blog – Check out the latest posts at www.dahilldose.com. Authored by SHANYS President/CEO Kevin Dahill, the blog offers informed and insightful commentary about healthcare policy, legislation, and regulation.

HANYS' Community Benefit Spotlight – A new series showcasing the work of HANYS' member hospitals and health systems do to improve population health, address regional health disparities and deliver care to local communities outside of facility walls. Get your success stories shared on HANYS website, in email, and on social media with policymakers, leading healthcare professionals and the public! Submit your story today.

CMS Releases Proposed Guidance on Ligature Risks

On April 19, CMS released draft revised guidance regarding the agency’s policies for addressing ligature risks in healthcare facilities, an area that has been under increased scrutiny as suicide rates rise. The guidance builds upon policies released in 2017. It clarifies the definition of a ligature risk and outlines the environmental standards that hospitals will be required to meet and demonstrate upon survey of their facility.

Ligature risk is defined in the guidance as “anything that could be used to create a sustainable attachment point (cord, rope or other materials that could be used for hanging or strangulation)”. Psychiatric hospitals, hospitals with locked psychiatric units and emergency departments with locked psychiatric units will be expected to achieve a ligature resistant environment that accounts for all possible attachment points in a patient care area including those that may be presented by beds, furniture, doors, fixtures, and medical equipment. Unmitigated risks in locked units will be grounds for an Immediate Jeopardy citation.

Unlocked units are held to a slightly less rigorous standard. These units do not have to meet the expectation of ligature resistance, but a plan to evaluate the patient care environment for risks and implement mitigation strategies to address the risks must be in place to be in compliance with CMS regulations. Safety measures that could be implemented to mitigate risk for self-harm include 1:1 monitoring, or continuous visual or video monitoring, removal of sharp objects, removal of dangerous equipment, securing personal belongings, and removal of any other items that may contribute to harmful behavior. 

The proposed guidance also addresses CMS policies for the education and training of hospital staff. All patient care employees will be required to be trained on the screening and assessment of patients potentially at risk of harm to themselves or others, identification of environmental risk factors, and mitigation strategies to address them. Non-patient care employees who work in patient care areas (including security guards, dietary staff, registration staff, etc.) will need to be trained to identify and report environmental patient safety risk factors. 

CMS will be asking surveyors from state agencies and accreditation organizations to ensure that hospital policies and procedures meet the intent of the new guidelines. As such, survey-specific procedures have been revised to require that surveyors not only review the written policies regarding ligature risk but that they also interview hospital staff to determine the frequency with which the hospital provides training. Training must focus on how staff can help to meet the needs of the patient population served, identify risks in the patient care environment and the reporting mechanisms for the risks identified. Surveyors will be advised to ask staff about the hospital’s definitions for 1:1 care or continuous observation and policies for intervention when a patient is at risk. They will also be asked to review policies for assessing and reassessing patients according to nationally accepted standards of practice.

Comments on the proposed guidance will be accepted through June 17. 


News from
Long Island

HANYS' Member Innovation Spotlight - Highlighted this month in the HANYS' Innovation Spotlight for transforming healthcare was Long Island Community Hospital in Patchogue for their efforts to reduce HAIs. Read about these efforts and others at www.hanys.org/tripleaim. 

Helathgrades Are In - Hospitals achieving the Healthgrades 2019 Patient Safety Excellence Award™ included,
  • Glen Cove Hospital, Glen Cove
  • Huntington Hospital, Huntington
  • Long Island Jewish Medical Center, New Hyde Park
  • Long Island Jewish Forest Hills, Forest Hills
  • Long Island Jewish Valley Stream, Valley Stream
  • North Shore University Hospital, Manhasset
Additionally, the following Long Island hospitals achieve the Healthgrades 2019 Outstanding Patient Experience Award™
  • Saint Francis Hospital Roslyn, Roslyn
  • Mather Hospital, Port Jefferson
More Top Grades - The Leapfrog Group released its Spring 2019 Hospital Safety Grades. Of the 11 New York hospital receiving an "A" grade, Long Island hospitals achieving the top honor included Mather Hospital in Port Jefferson, St. Charles Hospital in Port Jefferson, and St. Francis Hospital, The Heart Center, in Roslyn.

Blood Donations - Representatives from the New York Blood Center presented achievement awards to hospital leaders at the NSHC May 2, 2019 board meeting. Recognized were,
  • South Nassau Communities Hospital 
    Highest Number of Blood Donations (1,058) and
    Highest Blood Donation Rate (33 pints per 100 employees)
  • NYYU Winthrop University Hospital
    Highest Number of Blood Donations (1,230) and
    Highest Blood Donation Rate (16 pints per 100 employees)
  • Huntington Hospital
    Highest Blood Donation Rate (41 pints per 100 employees)
  • Peconic Bay Medical Center
    Highest Number of Blood Donations (240)
  • Mather Hospitalynavarro@nybc.org
    Largest Increase in Blood Donations (57.9% increase, 390 blood donations)
Since 2000, Long Island hospitals have held 1,893 blood drives resulting in 143,916 pints of blood donated. To arrange for a hospital blood drive, contact Yadira Navarro, 516-478-5026
 

Stony Brook Nursing Professor Named Top Nurse

Nurse Excellence Event recognized 22 nurse nominees 

Nurse leaders from Long Island’s hospitals and nursing education programs gathered Wednesday, May 15, 2019, at the Watermill Inn in Nesconset, NY to bestow recognition upon their nurse peers at the Nurse of Excellence Award Ceremony hosted by the Nassau-Suffolk Hospital Council (NSHC). One nurse from each of the Hospital Council’s member hospitals was nominated for the award, which recognizes outstanding leadership and clinical practice. Deans of area nursing schools also submitted nominations recognizing nursing excellence in education and clinical practice.

Patchogue resident Justin Waryold, DNP, RN, clinical assistant professor and director of the Advanced Practice Nursing Program in Adult Health at Stony Brook University, rose above a field of 22 nominees. Those nominees were selected from about 500 nurses at hospitals and teaching institutions from across Long Island.

Waryold’s commitment to nursing education and clinical practice is outstanding, say his peers. He has focused on improving access to care for vulnerable adults, in particular, the LGBT and homebound patient populations. His teaching methodology related to LGBT care has been published and adopted nationally by schools of medicine, nursing, and allied health. Waryold developed a house call program to address the needs of patients who cannot access care in a traditional office setting or who need palliative care. For the past 10 years, he has been nurturing the next generation of nursing professionals as an educator and also serves as a volunteer mentor for nurse practitioner students. He began his career as a licensed practical nurse, but continued his pursuit of education, becoming an RN, a nurse practitioner, and then a doctorate of nursing practice. Even with his busy teaching schedule, Waryold still finds time to volunteer at the RotoCare Clinic in Nassau County. This clinic provides free healthcare for people in need.

The Hospital Council’s annual salute to nurses is fashioned after the New York State Legislature’s Nurse of Distinction Program that ended in 1995. NSHC is one of the few hospital associations in the state to continue this program voluntarily. It is now in its 24th year. The NSHC represents Long Island’s not-for-profit and public hospitals.
 


From left: Valerie Terzano, RN, Chief Nursing Officer/Senior Vice President, NYU Winthrop Hospital; 2019 Nurse of Excellence Justin Waryold, DNP, RN; Lee Xippolitis, PhD, RN, Dean of Stony Brook University School of Nursing; and Marie Mulligan, PhD, RN, Chief Nursing Officer and Vice President, Mather Hospital, and Chairperson of the Nassau-Suffolk Hospital Council Nurse Executive Committee.


 

NSHC, GNYHA Ventures Announce Renewed Partnership


The Nassau-Suffolk Hospital Council is pleased to announce that it has renewed its partnership with GNYHA Ventures to facilitate the offerings of its companies Acurity and Nexera to Long Island’s hospitals and health systems.

Acurity is committed to helping providers deliver better care and reduce operating expenses through enhanced supply chain performance. It has combined a regional contracting program with the power of national aggregation to deliver a best-in-class purchasing portfolio. Acurity's leading industry experts identify data-driven methods that optimize hospital and health-system resources to improve both quality and the bottom line. 

NSHC members have access to Acurity's regional group purchasing portfolio, which includes regional contracts at superior pricing, as well as strategic agreements, focused on information technology and staff augmentation services; emergency preparedness and response; cybersecurity; financial management and revenue enhancement, and many other solutions addressing health industry needs that will be shared more fully in future communications. 

This partnership also offers NSHC members access to Nexera's supply chain consulting services in the areas of Financial Improvement, Operations Improvement, Clinical Engagement, and Workforce Solutions. Nexera is a national healthcare supply chain consulting firm that ties total costs and care quality to financial outcomes to deliver value-driven healthcare business solutions. Nexera tailors its work to each client's culture and resources in order to create long-term success. 

The Nexera service model delivers solutions that are actionable and replicable beyond a consulting engagement to help clients implement meaningful change. Nexera's team doesn't just offer recommendations—they deliver results. 

For more information, please contact Wendy Darwell, 631-963-4152, or Donna Gammarato, 212-506-5436.
 


News from the
Hudson Valley

HANYS' Community Health Spotlight - Highlighted this month in the HANYS' Community Health Spotlight for transforming healthcare were,
  • White Plains Hospital, for their Healthy Community Initiative, 12 Weeks to Wellness, a pilot program to promote healthy eating and physical activity for the underserved population in its community,
  • and the Greater Hudson Valley Health System for their partnership with the American Heart Association, Boys & Girls Clubs of America, Cornell Cooperative Extension, Eat Smart New York, Studio Ayo Fitness, local schools, and camps, to develop their Warrior Kids program.
  • Read about these efforts and more at www.hanys.org/community_spotlight
Helathgrades Are In - Hospitals achieving the Healthgrades 2019 Patient Safety Excellence Award™ included,
  • Glen Cove Hospital, Glen Cove
  • Huntington Hospital, Huntington
  • Long Island Jewish Medical Center, New Hyde Park
  • Long Island Jewish Forest Hills, Forest Hills
  • Long Island Jewish Valley Stream, Valley Stream
  • North Shore University Hospital, Manhasset
Additionally, the following NorMet hospitals achieve the Healthgrades 2019 Outstanding Patient Experience Award™
  • Northern Westchester Hospital, Mount Kisco
  • White Plains Hospital, White Plains
More Top Grades - The Leapfrog Group released its Spring 2019 Hospital Safety Grades. Of the 11 New York hospital receiving an "A" grade, White Plains Hospital was the only NorMet member to achieve the top honor.

Quality Recognized - Intalere, a national group purchasing organization, presented Ellenville Regional Hospital with an Intalere Healthcare Achievement Award in the category of Quality/Patient Care Delivery and/or Patient Satisfaction, for their efforts in fighting the opioid epidemic including strong collaboration between the hospital and the Institute for Family Health.

CMS AwardPhelps Hospital in Sleepy Hollow received a four-star rating from the Centers for Medicare & Medicaid Services (CMS), the highest rated hospital in Westchester County, NY. 

Heroism in the ER - Ulster County Police Chief’s Association honored Ellenville Regional Hospital with a Meritorious Citizenship Award for Heroism for their response to an incident in September 2018, involving an armed robbery in the Emergency Department. 

Urgent Care Accreditation - Greater Hudson Valley Health System Medical Group Urgent Care, part of the Greater Hudson Valley Health System, has received the highest level of distinction for urgent care centers – accreditation through the Urgent Care Association (UCA). Both Orange Regional and Catskill Regional Urgent Care facilities have met all of the Urgent Care Association’s established standards and criteria for quality of patient care, safety, and scope of services.

Committee Updates

Revenue Cycle Committee - The Revenue Cycle Committee met on April 5 when the group was provided with updates on the Affordable Care Act and recent litigation regarding the law’s constitutionality and stabilization efforts. Hospital Council staff provided an overview of proposed federal surprise billing legislation and an overview of the state budget outcomes.

Fiscal Policy Committee - At the May 8 Fiscal Policy Committee meeting, Hospital Council staff provided members of the committee with a detailed analysis of the Medicare wage index policy proposals included in the Inpatient Prospective Payment System Proposed Rule and the ongoing appeal of a malpractice exclusion policy included in last year’s rule. Updates the state budget outcome and on advocacy priorities were also provided. 

Corporate Compliance Committee - On May 14, members of the corporate compliance committee were provided federal updates on legislative initiatives to address surprise billing, new caps on HIPPA fines and new Conscience Law regulations. Hospital Council staff also provided important information about an expedited Medicare Advantage appeals process and recently released guidance from CMS regarding revisions to its Immediate Jeopardy policies.

Quality Committee - The Hospital Council’s Quality Committee convened May 22, 2019, for its second meeting of the year. Staff from Long Island Community Hospital presented on the Opioid Addiction Detection and treatment campaign. Hospital Council staff provided updates on proposed changes to federal quality improvement programs and proposed guidance from CMS on addressing ligature risks. Updates regarding the state’s stroke designation program and NYPORTS program were also provided. 

Upcoming Events

HANYS' 2019 Annual Membership Conference
June 19 through 21  |  Saratoga Springs, New York


Registration is now open for HANYS' 2019 Annual Membership Conference, Resilience in Healthcare: Building a Sustainable Future. Attend three days of educational sessions, networking, and celebration of member achievement.

The pace of change in healthcare delivery continues to accelerate, requiring organizations to proactively adapt and innovate. This year's programming is focused on four strategies for resilience developed by HANYS after our recent yearlong strategic planning initiative:
  • Control the dollar
  • Understand consumers
  • Embrace technology
  • Innovate in the workforce
Presentations and panel discussions will provide all members of the C-suite with best practices and insight to help maintain and grow your healthcare organizations.

Visit the website to find details about the conference agenda, speakers, hotel accommodations, online registration, and more.

The Academy for Healthcare Leadership Advancement
September 22 - 24 (at Cornell University)
October 1 - October 23 (Virtual Sessions) 
November 3 - 5 (at Cornell University)

 

Registration is now open HANYS and The Cornell SC Johnson College of Business at Cornell University's 2019 Academy for Healthcare Leadership Advancement.

The Academy combines the nationally recognized data analytics excellence and in-depth healthcare system knowledge of HANYS with the executive education and business expertise of The Cornell SC Johnson College of Business — one of the nation's premier universities and business schools.
 
Through The Academy, healthcare professionals gain focused insight on the healthcare environment, data analytics, and cutting-edge business leadership strategies. The seven-week Cornell certificate program provides healthcare professionals with the skills, insight, and expertise to effectively lead their organizations in today's complex and changing healthcare environment.
 
Academy participants also benefit from the opportunity to exchange ideas and network with their colleagues from across the nation.

Visit the website to find details about the program and registration, and to download a brochure.

HANYS' 2019 Executive Assistants to the C-Suite and Board Coordinators Workshop
Save the Date | July 9-10 | Albany Renaissance Hotel


HANYS and Healthcare Trustees of New York State are developing an exciting agenda using input from across the state. The program this year will include presentations on generational differences in the workplace, how to effectively communicate better with diverse groups, governance trends, emergency preparedness and much more.

This year, Workshop participation is open to all c-suite executive assistants and board coordinators, so please share this information with your colleagues who also support the leadership teams at your hospitals/health systems!

More information to come.
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