MHA Today | November 1, 2016

November 1, 2016

MHA Today: News for Healthcare Leaders

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Your Vote Matters Icon MHA Today is provided as a service to members of the Missouri Hospital Association. Additional information is available online at MHAnet.

Information about the Nov. 8 election is available on the Your Vote Matters page of Missouri Health Matters. Hospitals can help educate their communities about the election using the resources on MHAnet.

Editors Note: MHA Today will not be published Wednesday, Nov. 2, and Thursday, Nov. 3, during MHA’s convention and trade show. Publication will resume Friday, Nov. 4.

Don’t forget to follow @MOHospitals and tweet using #MHAConvention.

In This Issue
CMS Releases Value-Based Purchasing Fact Sheet
CMS Issues Final CY 2017 OPPS And ASC Payment And Policy Updates
CMS Releases Final Payment And Policy Updates To Home Health PPS
Fourth Open Enrollment On HealthCare.gov Starts Today
CMS Awards New Contracts For RACs
Study Finds Patient Risk Factors A Key Driver Of Readmissions In Minority-Serving Hospitals
Study Shows Increase In Pediatric Hospitalizations For Prescription Opioid Poisonings
CMS Announces IPFQR Webinar
Aetna Protests Medicaid Managed Care Contract Award


UPCOMING WEBINAR
Conducting a Proactive Risk Assessment: Failure Mode Effects and Critical Analysis

Tuesday, Nov. 29
10-11:30 a.m.


Advocate
state and federal health policy developments


CMS Releases Value-Based Purchasing Fact Sheet

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services released a Medicare value-based purchasing program fact sheet for fiscal year 2017. According to CMS, $1.8 billion will be available for value-based incentive payments. The fact sheet also includes information about the program domains and their weighting, scoring methodology, reference materials and new program requirements for FY 2018. It is estimated that in aggregate, Missouri hospitals will receive payment reductions due to the FY 2017 VBP program amounting to $791,000.

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Regulatory News
the latest actions of agencies monitoring health care


CMS Issues Final CY 2017 OPPS And ASC Payment And Policy Updates

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services has finalized the payment and policy updates for the calendar year 2017 outpatient PPS and the ambulatory surgical center payment system. CMS also issued an interim final rule with comment period which would establish Medicare physician fee schedule rates for certain items and services furnished by certain off-campus outpatient departments of a provider. CMS estimates that the 2017 payment updates will increase OPPS payments by 1.7 percent and ASC payments by 1.9 percent. Major provisions of the final rule include the following.

  • OPPS
    • Section 603 – site neutral payment provisions
    • Packaged service policy refinements
    • Inpatient only list updates
    • Outpatient quality reporting program changes for 2018 - 2020
  • ASC payment updates
  • Acute inpatient PPS value-based purchasing program use of pain management HCAHPS questions

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CMS Releases Final Payment And Policy Updates To Home Health PPS

Staff Contact: Andrew Wheeler

Yesterday, the Centers for Medicare & Medicaid Services announced final changes to the calendar year 2017 Medicare home health PPS. MHA has published an issue brief with additional details.

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Fourth Open Enrollment On HealthCare.gov Starts Today

Staff Contact: Mary Becker

The U.S. Department of Health & Human Services has launched a broad public education campaign, including working with enrollment assisters to promote the open enrollment period that starts today. With the increase in premium prices throughout most of the country, HHS Secretary Sylvia Burwell is stating that, “the vast majority of consumers will qualify for tax credits that help keep coverage affordable.” The open enrollment period runs through Tuesday, Jan. 31, 2017.

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CMS Awards New Contracts For RACs

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services announced the Recovery Audit Contractors who will serve under the Medicare fee-for-service program. Contractors in Regions 1-4 will perform post-payment reviews for Medicare payments made under Parts A and B. The Region 5 contractor will review post payments for durable medical equipment, prosthetics/orthotics and supplies, and home health/hospice claims. The contractors that will serve as a RAC include the following.

  • Region 1 – Performant Recovery, Inc.
  • Region 2 – Cotiviti, LLC
  • Region 3 – Cotiviti, LLC
  • Region 4 – HMS Federal Solutions
  • Region 5 – Performant Recovery, Inc.


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Quality and Population Health


Study Finds Patient Risk Factors A Key Driver Of Readmissions In Minority-Serving Hospitals

Staff Contacts: Alison Williams or Mat Reidhead

According to a study published by the journal Surgery, patient-related risk factors appear to be the primary driver of readmissions in hospitals serving a higher proportion of minority patients. Researchers examined outcomes and patient factors in more than 168,000 colorectal surgery patients treated in 374 California hospitals from 2004-2011, including 47 hospitals with a high percentage of minority patients (63 percent) compared with other hospitals (17 percent). The study found that patient factors, such as race, low income and insurance status, accounted for up to 65 percent of the increased odds for readmission at the minority-serving hospitals, while hospital-level factors, such as procedure volume and type, accounted for up to 40 percent.

The Centers for Medicare & Medicaid Services’ Hospital Readmissions Reduction Program penalizes hospitals for higher-than-expected readmission rates for certain conditions. “These findings suggest that CMS should account for patient socioeconomic factors when they compare readmission rates,” said Waddah Al-Refaie, M.D., the study’s senior investigator and Chief of Surgical Oncology at MedStar Georgetown University Hospital in Washington, D.C.

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Study Shows Increase In Pediatric Hospitalizations For Prescription Opioid Poisonings

Staff Contacts: Leslie Porth or Alison Williams

According to a study published by JAMA Pediatrics, hospitalizations for prescription opioid poisonings increased 165 percent among children and adolescents to 3.7 per 100,000 children between 1997 and 2012. The largest increases in hospitalizations occurred among children ages 1-4 (205 percent) and ages 15-19 (176 percent). Adolescents ages 15-19 had the highest hospitalization rates in each of the six years examined. Among 15 to 19 year olds, opioid poisonings that attributed to suicide or self-inflicted injury increased 140 percent, while those attributed to accidental intent increased 303 percent. “Reducing pediatric opioid exposure and misuse will require a combination of public health interventions, policy initiatives and consumer-product regulations,” the authors said.

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CMS Announces IPFQR Webinar

Staff Contact: Sherry Buschjost

The next national provider webinar for participants in the Inpatient Psychiatric Facility Quality Reporting Program has been rescheduled from Nov. 3 to 1 p.m. Monday, Nov. 14. The webinar, titled “IPFQR Program FY 2019 New Measures Review,” will provide an overview of the measure specifications and data reporting requirements for the newly adopted measures: Alcohol and Other Drug Use Disorder Treatment Provided or Offered at Discharge (SUB-3) measure, its subset the Alcohol and Other Drug Use Disorder Treatment at Discharge (SUB-3a) measure, as well as the 30-Day All-Cause Unplanned Readmission Following Psychiatric Hospitalization in an IPF measure. Registration is required.

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Noteworthy


Aetna Protests Medicaid Managed Care Contract Award

Staff Contacts: Steve Renne or Daniel Landon

Aetna is protesting MO HealthNet’s recent awarding of Medicaid managed care contracts that take effect May 2017. The contract awards went to Home State (Centene), Missouri Care (Wellcare) and United Healthcare. Aetna, the largest vendor of Medicaid managed care services in the current contract, was excluded.

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Consider This ...

November is Lung Cancer Awareness Month. Lung cancer is the leading cancer killer of both men and women in the U.S. It also has one of the lowest five-year survival rates of all cancer types.

Source: American Lung Association