Cut Restored

After heavy lobbying, hospitals got what they wanted: The final Medicare Inpatient Prospective Payment System rule for the next federal fiscal year is missing a proposed 0.8% “coding offset” increase. If it had been implemented, New York hospitals would have seen a $66 million annual cut, reports HANYS. The trade group opposed the proposed cut on the grounds it used a flawed methodology and ignored the impact of the federal Recovery Audit Contractor program. Hospitals argued that the methodology failed to distinguish between case-mix increases created by coding and case-mix changes that reflected real changes in a patient’s health and treatment. CMS has maintained that “coding offsets” are necessary to recoup hospital payments that had little to do with the worsening of a patient’s illness. Click here for CMS’ final rule.

Legislative Update

Gov. Andrew Cuomo signed into law two insurance bills, one on managed care and another that mandates that insurers cover reconstructive surgery following a partial mastectomy. Supported by providers, the managed care bill prevents insurers from making unilateral coding adjustments without first reviewing a medical record. The legislation lets a provider resubmit a claim, with a medical record, within 30 days to dispute the insurer’s lower level of reimbursement. If the plan upholds its coding determination, it must provide the hospital with a specific reason. The law also stops plans from denying hospital reimbursement when the provider fails to give the insurer timely notice of an emergency admission. The bill limits a hospital’s penalty for untimely notification to $2,000, or 12% of the payment, whichever is less.

Prescription Safety

A group of patient advocates is taking issue with the state’s implementation of a bill that improves access to prescription information for non-English speakers. New York Lawyers for the Public Interest, Make the Road New York and the Center for Popular Democracy issued a report to the New York State Board of Pharmacy that recommends changes to its implementation of SafeRx legislation, which requires chain and mail-order pharmacies statewide to provide comprehensive translation and interpretation services. The groups lobbied heavily for the bill’s passage this year. Their report calls for mandating the translation of prescriptions into the top six or seven languages spoken in the state, or the top languages spoken by 1% or more of the limited-English population in a given area. They also say that it is insufficient for the Board of Pharmacy to hold only one formal public hearing on the topic, in Buffalo this month.

Help Wanted: 1199’s job fair

Health care union 1199-SEIU held a job fair on July 31 at its Manhattan headquarters that attracted some 150 job-seekers, about half of them not currently union members, and most of them unemployed. The turnout was “substantial,” said Rosa Mejita, director of the union’s employment center. She added that the event offered a snapshot of the health care employment picture, with only a small showing of in-demand social workers, lab techs and respiratory therapists.

The event was open to the public because the union does not currently have a large pool of laid-off union members—despite hospital closings and downsizings. The union performed the screenings. About half of the job-seekers were asked to return for longer interviews, after which they will be matched with potential employers.

Many of the rejected hopefuls lacked recent job experience or proper credentials and licensing, Ms. Mejita said. “It can be a Catch-22 situation for people who just graduated or haven’t worked for a while,” she added. “Employers mostly want people who were just in the workplace months ago.”

Although there is a shortage of respiratory therapists, for example, one applicant had not worked for 20 years. She will be hard to place, Ms. Mejita said.

Another hurdle for some unemployed workers is that job qualifications have changed in their fields. Substance-abuse counseling jobs once were open to recovering addicts, regardless of education. “Now they want them to have a master’s degree,” she said.

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