November 1, 2004
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MHA's Monday Executive Briefing
November 1, 2004
In this week's edition...
State News
1. Barbour, GOP endorse candidates for state Supreme Court
2. New attitude for Mississippi Supreme Court
3. Supreme Court candidates file contributions
National News
4. MedPAC backs argument against specialty hospitals
5. Medicare should cover heart device, but proposal needs work, AHA says
6. AHA finds design flaws in proposed payment error system
7. House bill in works to address vaccine shortages
8. Shortages of space, beds, staff cause capacity crunch
State News
1. Barbour, GOP endorse candidates for state Supreme Court
About 350,000 Mississippi voters have received a letter from Gov. Haley Barbour urging them to cast ballots for Republican candidates, including some running in the nonpartisan state Supreme Court races.
In Mississippi, state law prohibits judicial candidates from aligning themselves with a political party. A portion of the 1999 law that barred political parties from endorsing judicial candidates was struck down in 2002 by U.S. District Judge Henry T. Wingate. The Mississippi Republican Party paid for the mass mailings, state GOP chairman Jim Herring said on Nov. 1.
In the letter, Barbour solicits votes for President George Bush. It also states: "Attached is the slate of Republican candidates that will appear on your ballot. Feel free to take it with you to your polling place Tuesday."
Herring said the GOP endorsed Supreme Court Justice Mike Randolph, who is facing Appeals Court Judge Joe Lee in a southern district race. The party also endorsed Justice George C. Carlson in Northern District, Post 3 and Presiding Justice Bill Waller Jr. in Central District, Post 1. Waller faces Byram attorney Richard Grindstaff. Carlson is opposed by William L. Bambach of Columbus.
Herring said Randolph, a Hattiesburg attorney who began practicing law in 1975, was endorsed because he was appointed by Barbour to the Supreme Court in April to complete the unexpired term of former Chief Justice Ed Pittman. The other judicial candidates were endorsed because they embraced GOP principles, Herring said.
The Republican Party hasn't endorsed a candidate for the Central District, Post 2, which is currently held by Justice James Graves, Herring said. Graves' challengers are Rankin County Judge Samac Richardson, Hinds County Justice Judge William Skinner and former chancery judge Ceola James.
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2. New attitude for Mississippi Supreme Court
The state Supreme Court has taken a hard right turn this year, perhaps the most visible shift by the court in decades. In 2001, the high court upheld a mass tort lawsuit that included out-of-state plaintiffs. But in a series of decisions and rule changes that started this past February, justices are calling for separate trials for plaintiffs in mass lawsuits and are telling out-of-state plaintiffs to go home. For the full story from The Clarion Ledger, click here.
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3. Supreme Court candidates file contributions
Candidates for the Mississippi Supreme Court have raised more than a half-million dollars in campaign contributions in less than a month, according to the latest reports filed with the secretary of state's office.
The nine candidates who filed by the Oct. 26 5 p.m. deadline had raised $501,765 - much of it generated from lawyers, business and special interest groups. William Bambach, who is running for Northern District, Post 3, did not meet the deadline.
Supreme Court Justice Mike Randolph raised $153,700, the highest amount reported. Among his donations was a $5,000 contribution from the AmSouth Bank political action committee and $1,000 each from the American Insurance Association PAC and the Mississippi Power Company State PAC. Randolph has raised $517,349 so far this year.
Joe Lee, Randolph's challenger for Southern District, Post 3, raised $7,650 during the reporting period of Oct. 1 through Oct. 23. Lee has raised a total of $52,455.
In the Central District, Post 2 race, Justice James Graves raised $135,645, with most of his contributions comes from attorneys. Graves' campaign has raised a total of $484,465. Graves is challenged by Rankin County Circuit Judge Samac Richardson, Hinds County Justice Court Judge Bill Skinner and former chancery judge Ceola James.
Richardson raised $59,382, including a $5,000 contribution from the Pfizer State PAC; a $4,000 contribution from The Hartford Advocates Fund of Hartford, Conn.; and a $3,500 donation from Mississippians for Civil Justice Reform.
Skinner, who has said he won't accept donations from trial lawyers or special interest groups, raised $8,705 during the period. His total was $39,772. Skinner also filed a 48-hour report for a $500 contribution.
James raised $840, bringing her year-to-date total to $2,015.
Justice George C. Carlson, who is being challenged by Bambach in the Northern District, Post 3 position, raised $78,125. He received a $2,500 contribution from Mississippians for Civil Justice Reform and a $5,000 contribution from First Security Bank in Batesville.
In the race for Central District, Post 1, Justice William L. Waller Jr. raised $54,580, bringing his total to $324,127. His opponent, "Richard" Ray Grindstaff, raised $2,638, bringing his year-to-date total to $24,103.
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National News
4. MedPAC backs argument against specialty hospitals
Physician-owned specialty hospitals treat a more favorable selection of patients than the average community hospital, supporting arguments made by the acute-care industry that specialized facilities take the most profitable cases from nearby general hospitals. That is a preliminary conclusion of the Medicare Payment Advisory Commission, which is studying the specialty hospital issue under a mandate from the Medicare Modernization Act. In a preliminary report released at its fall meeting, MedPAC said all hospitals have an incentive to specialize in certain DRGs -- such as coronary bypass with cardiac catheterization -- and to treat low-severity patients within those DRGs. Thus, it's attractive for physicians to set up specialized hospitals that focus exclusively on high-paying heart, orthopedic or surgical services.
"It destroys our payment system to have this going on," MedPAC Commissioner Ralph Muller said. The group, which advises Congress on Medicare payment issues, will release a larger report on specialty hospitals in March. A moratorium on new physician investment in specialty hospitals written into the Medicare act expires in June 2005.
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5. Medicare should cover heart device, but proposal needs work, AHA says
In comments submitted Oct. 27 to the Centers for Medicare & Medicaid Services, the AHA said it supports expanding Medicare coverage for implantable cardioverter defibrillators but expressed concern with CMS’ proposal to create a national ICD patient registry linked to provider payment. AHA said CMS had not adequately defined the purpose, structure, management or funding of the national registry, and that hospitals and other stakeholders should have an opportunity to discuss both the registry and the certification criteria hospitals must meet to qualify for ICD implantation. Given this lack of information and that no billing codes exist for primary prevention ICD implantation, AHA said it was “unrealistic” to require registry participation by Jan. 1, 2005. ICDs have been shown to be effective as a primary prevention therapy against deaths associated with sudden cardiac arrest, with a recent clinical trial revealing that 2,500 Medicare patients would be saved during the first year of expanded Medicare coverage for the devices. The comment letter will be available soon at www.aha.org.
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6. AHA finds design flaws in proposed payment error system
Although well-intentioned, the Centers for Medicare & Medicaid Services’ proposed system for estimating improper Medicaid and State Children’s Health Insurance Program payments features design problems that could make it ineffective and problematic, AHA wrote in comments submitted Oct. 27 to CMS. Specifically, AHA asserted that the Payment Error Rate Measurement system’s largely paper-based design could lead to an overstatement of payment errors and an increased paperwork burden for Medicaid and SCHIP claims, increasing payment delays and denied claims for health care providers. It said the PERM system also could duplicate eligibility verification programs already in use in the states, and urged CMS to reevaluate its entire approach to the system. The comments will be available soon at www.aha.org.
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7. House bill in works to address vaccine shortages
Rep. John Dingell (D-Mich.) is working on legislation to prevent future shortages of flu vaccine by improving inspection of vaccine manufacturing; authorizing emergency procedures for flu vaccine allocation; enhancing research; and improving the Food and Drug Administration's review process for new vaccines. The legislation was described in a news release from Dingell's office. Dingell's office said an estimated cost was not available, and the bill would not be introduced until the next session of Congress. A Senate bill introduced in October would deem a flu vaccine shortage, such as the current one, a "public health emergency" and authorize federal steps to ensure that priority groups receive vaccine first. The bill is awaiting action in the Senate Health, Education, Labor and Pensions Committee.
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8. Shortages of space, beds, staff cause capacity crunch
Nearly six in 10 chief executive officers say too little space, too few beds or not enough staff are contributing to a capacity crunch at U.S. hospitals, according to a survey of CEOs at general acute-care hospitals by the American College of Healthcare Executives. The Chicago-based ACHE released the survey recently.
The survey, which was conducted via fax in July, included responses from 487 hospital CEOs, or 57% of respondents, who named shortages in nursing and clinical staff as the first- and second-greatest culprits for the lack of capacity.
A little more than 70% said they were experiencing a nursing shortage and 67% identified a shortage of "other clinical staff." Too little space in the emergency department was a problem for 64%, followed by 41% who reported they lacked enough intensive-care beds. Too few general medical or surgical beds contributed to capacity shortages for 32% of hospitals and 28% struggled with operating room availability.
The survey also asked respondents to identify how they tackled capacity shortages, and which measures were most effective. Of the 76% of respondents who practiced the most popular choice - using quality initiatives to identify bottlenecks or inefficiencies - 62% described the measure as effective or very effective.
Building a new or replacement hospital was ranked as the most helpful strategy, with three out of four of the 21% that did so saying construction was effective or very effective.
Expanding physical capacity - adding monitored beds or reopening "mothballed space" - tied as the second most-effective measures. Far more CEOs, 46%, reported increasing the number of beds than those who reported reopening space, 20%, but in both cases, 73% said the move was effective or very effective.
Developing comprehensive outpatient centers, which 28% of CEOs reorted undertaking, was No. 3, with 72% reporting it was effective or very effective in addressing capacity shortages.
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