President's ReportThe #123forEquity PledgeWashington UpdatePhysician RecruitmentNew Highlights from AHRQ's Patient Safety NetworkNDHA Education Update

Click on link to view attachments:https://www.ndha.org/resources/publications/2017-2019 Revenue ForecastConsumer Family Network Conference

Phone: 701-224-9732Fax: 701-224-9529Web Site: www.ndha.org

Jerry Jurena, PresidentTim Blasl, Vice PresidentCallen Cermak, Finance ManagerLori Schmautz, Executive AssistantPam Cook, Education DirectorMelissa Hauer, General Counsel

A portion of this publication is supported by The Center for Rural Health’s Medicare Rural Hospital Flexibility Program. Visit their site at http://rural-health.und.edu/projects/flex/.

The InformerPresident’s Report ~ Jerry Jurena

In This Edition:

Attachments:

NDHA Contacts

March 3, 2017

March 9, 2017 Revenue Forecast: On Thursday morning to a full house OMB pre-sented the March revenue forecast to a joint session of Appropriations. Governor Burgum opened the meeting and presented a short overview of the long awaited numbers. Pam Sharp, Director of Office of Management and Budget, gave the details.

The shortfall for the remainder of this fiscal year ending June 30, 2017 is $46 mil-lion, or a decrease from the January 2017 numbers of 0.96%. The shortfall projected for the 2017-2019 biennium from the January numbers is $103 million, or a decrease of 2.81%.

I have attached a copy of the 2017-2019 Revenue Forecast that was handed out. Appropriations in both chambers will now have to find/make additional adjust-ments to balance the budget. They will have to either make cuts or find additional money. My assumption is they will be making additional cuts. For the remainder of this year they will need to reduce spending by 1% and for the next biennium they will need to reduce spending by 3%. In the next two weeks, the House and the Sen-ate Appropriates Committees will be working hard to discover areas where they can make changes to reduce spending.

The base budget for the 2017-2019 biennium was set at 90%.

The Department of Human Services will begin providing testimony on their bud-get (HB 1012) on Monday, March 13th beginning at 10 am. The public testimony for Medical Services will begin at 9:30 am on Tuesday, March 14th.

I am sure that all departments and services will be reviewed for any and all possible savings. Last week at the legislative call I shared the consequences of HB 1024; this bill provides for $9 million in deficiency appropriations for the Department of Human Services. The House removed $4 million from the bill, and it is now in the Senate. We need to have the $4 million restored. If the funds are not restored payment for health care services could be delayed affecting cash flow in this biennium and it would likely cause a shortfall in the next biennium.

Evidence indicates that racial and ethnic disparities in health care continue to af-fect patients. The American Hospital Association’s #123forEquity pledge campaign supports the elimination of disparities in three ways:

• Collection and use of race, ethnicity, language preference and other socio-economic data • Cultural competency training • Diversity in leadership and governance

More than 1,445 health care organizations have taken the #123forEquity pledge. Has yours? Visit www.equityofcare.org to learn more and take steps to eliminating disparities in your community.

Click logo to open Bill Tracking Update

The #123forEquity Pledge

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Washington Update ~ John Flink

As you no doubt know from the news, this was a big week for the Republican effort to repeal the Affordable Care Act. It began Monday night when GOP leaders released their proposal to repeal certain parts of the ACA, including the Medicaid expansion and the individual and employer coverage mandates, and replace them with a new system of tax credits and a new Medicaid financing scheme.

By Thursday, two House committees – Energy and Commerce and Ways and Means – had voted along party lines to approve the proposal. (Rep. Cramer, on Energy and Commerce, voted for committee passage and joined his Republican colleagues in op-posing Democratic amendments.)

The House committees acted even though the Congressional Budget Office – normally the Holy Grail on major legislation – had not released its projections of how the measure would affect coverage levels or how much it would cost. Those could be released early next week.

I won’t dwell on the proposal’s specifics – the AHA and others have published excellent summaries of the measure’s provi-sions (I am available at your convenience to discuss specific policy provisions.) But I do want to comment on process and politics.

The Republican proposal has drawn quick opposition from all major national hospital groups, especially the AHA, the Ameri-can Medical Association and AARP. In addition, a number of independent analyses have concluded that health insurance cover-age levels would drop – perhaps very significantly – under the GOP plan.

The plan also has drawn fire from conservative House and Senate Republicans, including the 30-member House Freedom Caucus, who don’t believe it goes far enough in repealing the ACA, and as many as 8 – 10 moderate Senate Republicans who are concerned about its Medicaid provisions. House leaders need at least 21 of the Freedom Caucus to vote for their bill. In the Senate, they will need at least 50 of the 52 Republicans to vote for it.

House Republican leaders hope to move the bill to the Budget Committee next week – the next stop in the reconciliation process – and onto the House floor the week of March 20. However, leaders will first have to round up the 218 votes needed for passage.

If passed by the House, the bill would go to the Senate. GOP leaders hope to have a bill on the president’s desk before the Easter recess, which starts April 7. President Trump has endorsed the measure.

The long term outlook for the Republican initiative is uncertain. As of today, it most likely doesn’t have the votes to pass either the House or the Senate. So, now we enter the secret part of the process during which Speaker Paul Ryan (R-WI), the president and other GOP leaders will use all sorts of tactics and cut all sorts of deals to find the votes to pass it.

Finally, on Wednesday as the Energy and Commerce mark-up began, we sent the following statement from Jerry to Rep. Cramer:

“Throughout the debate over the future of the Affordable Care Act, NDHA has said that IF the ACA is to be repealed whatever comes after it should provide the same or better coverage levels as were achieved under the 2010 law.

“The absence of coverage projections from the Congressional Budget Office make it impossible to determine whether this bill would achieve that goal.

“In addition, this bill’s Medicaid provisions have long-term implications for our state’s Medicaid program. Again, the absence of an analysis of their impact raises concerns.

“For these reasons, we agree with the American Hospital Association, other national hospital organizations and the American Medical Association who have said they cannot support this bill as introduced.”

The next few weeks promise to be full of action as Republicans attempt to move their repeal and replace bill.

Meanwhile, they also are promising a range of regulatory actions to make changes in the ACA and a second round of legislation to fix issues that can’t be addressed during reconciliation. That almost certainly would require Democratic help in the Senate.

Stay tuned.

NDHA’s Annual Convention & Trade Show - October 3-5, 2017 at the Fargo Hilton Garden Inn.HSI Solution’s Update Conference - October 2-3, 2017 at the Fargo Hilton Garden Inn.

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The Site Visit - Get Everyone Involved

When inviting a physician candidate to our community, try to involve several people. It takes a village to recruit and place. By several local people participating in the site visit, this will influence candidates significantly.

Plan an itinerary that allows the candidate to meet with physicians, administration and other hospital personnel leadership, nursing and staff etc. Be sure to include Board Members, they can be some of our biggest advocates. Include in the list, com-munity leaders, school administration and teachers and social and church leaders. The candidate should have a broad scope of our community representatives.

Plan a separate itinerary for the spouse or significant other. The spouse or SO is key in the decision making process. Recruit the spouse or SO as aggressively as you recruit the physician.

Finally include meals in the site visit event. This is generally an opportunity to meet with the physician and spouse in an in-formal setting. I would encourage a dinner at someone’s home, much less formal and much better opportunity for us to visit with our guests.

If I can assist you in your physician recruitment efforts, please contact me. I can be reached at northdakotarec@comcast.net or 701-320-2109

Physician Recruitment ~ Kevin Malee

New Highlights From AHRQ’s Patient Safety Network AHRQ’s Patient Safety Network (PSNet), which highlights journal publications, books and tools related to patient safety, has featured a new set of articles including:

• Opioid-prescribing patterns of emergency physicians and risk of long-term use • Use of unsolicited patient observations to identify surgeons with increased risk for postoperative complications • From board to bedside: how the application of financial structures to safety and quality can drive accountability in a large health care system

Review additional new publications in PSNet’s Current Issue or access recent cases and commentaries in AHRQ’s WebM&M (Morbidity and Mortality Rounds on the Web).

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Below is a listing of webinars that may be of interest to you. Registration fees for webinars are $175/NDHA member, and $300/non-member. This fee is “per facility” and you can have as many staff sit in on one connection as you’d like. If a webinar is co-sponsored by either ND HFMA or ND HRMS, individuals who are members of those groups can register at the member rate. Their logo will appear on the flyer if it is co-sponsored by either group.

Blocking Blood Clots & Tracking VTE Date: 03/15/2017 From: 1:00 PM to 2:00 PM

Infant & Pediatric Abductions Date: 03/20/2017 From: 9:00 AM to 11:00 AM

Human Resource Standards Date: 03/28/2017 From: 10:00 AM to 11:30 AM

Bullying in the Healthcare Professions Date: 03/28/2017 From: 12:30 PM to 1:30 PM

Understanding Peer Review & Performance Improvement Processes Date: 03/30/2017 From: 10:00 AM to 11:30 AM

Observation: Coding, Billing and Financial Impacts Date: 03/30/2017 From: 12:00 PM to 1:30 PM

CMS Medical Records Date: 04/03/2017 From: 9:00 AM to 11:00 AM Communicating & Negotiating Persuasively Date: 04/04/2017 From: 9:00 AM to 10:30 AM Texting & Mobile Devices for Practioners & Patient Communication: Getting the Most from New Technology within the LImits of HIPAA, TCPA, and the Joint Commission Date: 04/06/2017 From: 12:30 PM to 2:00 PM Informed Consent *Presented by Melissa Hauer, NDHA General Counsel Date: 04/20/2017 From: 10:30 AM to 11:30 AM CMS Hospital QAPI Standards & Worksheet Date: 04/24/2017 From: 9:00 AM to 11:00 AM Patient Safety & the Nat’l Patient Safety Goals Date: 04/25/2017 From: 10:00 AM to 11:30 AM Understanding CMS Credentialing & Privileging Requirements for Hospitals, CAH & Medicare Advantage Organizations Date: 04/27/2017 From: 10:00 AM to 11:30 AM

Follow this link to register! https://www.ndha.org/education/education-events/

NDHA Education Update