MHA Today | January 23, 2017

January 23, 2017

MHA Today: News for Healthcare Leaders

twitter linkedin MHA Today is provided as a service to members of the Missouri Hospital Association. Additional information is available online at MHAnet.

In This Issue
Trump Signs Executive Order To Ease Burden Of The ACA
CDC Issues Communicable Disease Final Rule
HIDI HealthStats — Medicaid Utilization
CMS Announces QualityNet Secure Portal Delay
CMS Announces Availability Of CART Inpatient 4.19.1
Judge Blocks Aetna/Humana Merger
RUPRI Highlights Differences Between Urban And Rural Medicaid Enrollment
CDC Report Focuses On Reducing Mortality In Rural America

What You Need To Know This Week

  • An executive session on Senate Bill 237 regarding medical liability is scheduled this week. Last week, MHA asked you to contact Gov. Greitens and your local legislators on the issue.
  • Watch for information regarding potential actions related to the repeal of the Affordable Care Act.

Advocate
state and federal health policy developments


Trump Signs Executive Order To Ease Burden Of The ACA

Staff Contact: Andrew Wheeler

President Trump signed an executive order that directs federal agencies to stop issuing regulations that expand the reach of the Affordable Care Act, including those that grant waivers and exemptions, and delay provisions that impose cost on states or individuals. Although the order lacks specific details about the substance of the modifications to the ACA, the order does provide insight into areas of interest, such as exemptions to the individual and employer mandates, the definition of essential health benefits, and flexibility for states in the Medicaid program.

Back To Top


Regulatory News
the latest actions of agencies monitoring health care


CDC Issues Communicable Disease Final Rule

Staff Contacts: Sarah Willson or Jackie Gatz

The Centers for Disease Control and Prevention has issued a final rule to strengthen the federal government’s ability to prevent the introduction, transmission and spread of communicable diseases in the U.S. The regulation is intended to aid public health responses to outbreaks of new or re-emerging communicable diseases and provide due process to individuals subject to federal public health orders. The final rule updates regulatory language; sets new criteria for traveler health screenings, detainment and notification; addresses the medical examination and review process; and discusses payment for treatment and care. The rule takes effect Tuesday, Feb. 21.

Back To Top


HIDI Tech Connect


HIDI HealthStats — Medicaid Utilization

Staff Contact: Mat Reidhead

The February edition of HIDI HealthStats highlights opportunities to generate better value in Missouri’s Medicaid program. The asymmetrical distribution of hospital utilization by MO HealthNet beneficiaries resembles the national cost concentration curve. During 2016, half of MO HealthNet patients accounted for just 3.9 percent of total hospital charges, while the top 1 percent accounted for 20.8 percent. The distribution was more skewed for the managed care delivery model component of MO HealthNet, with the top percentile of patients accounting for 23.6 percent of total charges, compared to 19 percent for beneficiaries covered by the traditional fee-for-service delivery model. Top percentile utilizers in the fee-for-service model were on average 20 years older and diagnosed with nearly twice the number of chronic diseases compared to their counterparts in managed care. Feb HIDI HealthStats

During 2016, the consumption of hospital goods and services across all MO HealthNet beneficiaries in each delivery model was equally disparate (Figure 1). The bottom 80 percent of managed care and fee-for-service beneficiaries consumed just 24.4 and 21.2 percent of hospital services, respectively. Conversely, the top 20 percent of hospital patients accounted for 75.6 percent of managed care charges and 78.8 percent for fee-for-service. The top 10 percent of managed care and fee-for-service beneficiaries consumed 59 and 62 percent of hospital charges in 2016, respectively.

Back To Top


Quality and Population Health


CMS Announces QualityNet Secure Portal Delay

Staff Contact: Sherry Buschjost

The Centers for Medicare & Medicaid Services has announced that the QualityNet Secure Portal will not be available until the end of March for hospital entry of calendar year 2016 web-based Outpatient Quality Reporting Program measure encounters for payment year 2018. The submission deadline of Monday, May 15, remains unchanged for OQR measures submitted through a web-based tool (OP-12, OP-17, OP-22, OP-25, OP-26, OP-29, OP-30, OP-31 and OP-33). OP-27 influenza summary data is submitted through the National Healthcare Safety Network website and is not affected.

Back To Top


CMS Announces Availability Of CART Inpatient 4.19.1

Staff Contact: Sherry Buschjost

The Centers for Medicare & Medicaid Services has announced that the CMS Abstraction and Reporting Tool Inpatient 4.19.1 has been released and is available on QualityNet. The release includes updates to CART Inpatient with the codes in Appendix A to support the inpatient quality reporting specifications manual version 5.2a addendum for discharges beginning Jan. 1.

Back To Top


Noteworthy


Judge Blocks Aetna/Humana Merger

Staff Contact: Jane Drummond

U.S. District Judge John Bates ruled against the proposed Aetna/Humana merger, putting a nationwide stop to the transaction unless the companies appeal. In a detailed opinion, Judge Bates determined that the merger would significantly impact the insurance marketplace by overwhelmingly increasing market concentration and reducing direct competition between the two companies. The court also was concerned about the detrimental effect on Medicare Advantage consumers in 364 counties across the country, including a number in Missouri.

Back To Top


RUPRI Highlights Differences Between Urban And Rural Medicaid Enrollment

Staff Contact: Jim Mikes

The Rural Policy Research Institute released a report that analyzes the differences in Medicaid enrollment between rural, micropolitan and metropolitan areas in both expansion and nonexpansion states before and after implementation of the Affordable Care Act.

Back To Top


CDC Report Focuses On Reducing Mortality In Rural America

Staff Contact: Jim Mikes

The Centers for Disease Control and Prevention’s recent edition of the Morbidity and Mortality Weekly Report describes potential excess mortality from the five leading causes of death in rural areas of the U.S. The report offers suggestions for mitigating the factors involved with excess rural mortality. According to CDC Director Tom Frieden, this issue is the first in a series of reports on the disparities that create “a striking gap in health between rural and urban Americans.”

Back To Top



Consider This ...

The death rate from cervical cancer in the U.S. is increasing. The mortality rate for black women is 10.1 per 100,000. For white women, it is 4.7 per 100,000.

Source: The New York Times