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Advocacy

Statement of The Hospital & Healthsystem Association of Pennsylvania  

For the House Aging and Older Adult Services Committee

Submitted by

Scott Bishop
Senior Vice President, Legislative Services
The Hospital & Healthsystem Association of Pennsylvania (HAP)

Harrisburg, Pennsylvania
 January 29, 2014

Chairman Hennessey, Chairman Samuelson, and members of the committee, HAP represents and advocates for the nearly 240 acute and specialty care hospitals and health systems across the state and the patients they serve. We appreciate the opportunity to present the views of hospitals and health systems across the state on House Bill 1907, legislation introduced by House Majority Whip Stan Saylor.   

Of the many policy issues the Hospital & Healthsystem Association of Pennsylvania (HAP) addresses on behalf of the hospital community, deciphering the costs of health care is one of the most challenging. Even hospitals struggle with the confusion that stems from constant change in health care financing and reimbursement.   

We commend Rep. Saylor for sponsoring HB 1907, and share in his desire for greater transparency when it comes to patient billing. In fact, HAP’s new strategic plan calls for an increased focus on health consumers. As a result, HAP welcomes the opportunity to work with stakeholders like the Pennsylvania Health Care Association and the AARP to improve the way key billing issues are explained to patients.   

However, when it comes to billing, hospitals and health systems are only part of the equation. To be clear, hospitals must be accountable for the care and services they provide to their patients. But, regardless of how a hospital designates a patient, ultimately the decision on inpatient/outpatient status is made on the payer or insurer side––especially when it comes to Medicare. What complicates the situation even further is that a determination about the medical necessity of a patient’s admission often occurs well after the patient leaves the hospital.   

Therefore, while the notice required by HB 1907 is an important step forward in helping patients and their families make critical health care decisions, real clarity will only be achieved when the Centers for Medicare & Medicaid Services (CMS) establishes clear and consistent definitions for what constitutes an inpatient hospital admission versus outpatient observation status. Or, at the very least, they eliminate their Medicare three-day qualifying hospital stay requirement for reimbursement for nursing home care. Until then, hospitals will be in the difficult position, and financially at risk, because they will not know if the determination they have made about a patient need for hospital care will be upheld by Medicare or other insurers.   

Thank you for the opportunity to present the hospital community’s views on House Bill 1907. I would be pleased to answer any questions you may have.

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