MHA Today is provided as a service to members of the Missouri Hospital Association. Additional information is available online at MHAnet.
In This Issue
MHA Distributes CAH Databook
MO HealthNet Issues Managed Care Bulletin
Trajectories — Infection Control Strategies
state and federal health policy developments
Staff Contact: Andrew Wheeler
MHA has made available the 2017 Critical Access Hospital Databook, which includes quality performance, financial indicators, and Medicare inpatient and outpatient utilization. In addition, assorted state and national indicators are listed to serve as benchmarks. The analysis will be available online for authorized users of HIDI Analytic Advantage.®
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the latest actions of agencies monitoring health care
Staff Contacts: Sarah Willson or Brian Kinkade
MO HealthNet’s managed care bulletin focuses on the expansion of the MO HealthNet managed care program to all 114 counties and the city of St. Louis. The expansion begins Monday, May 1, and will result in 251,000 current MO HealthNet participants moving into managed care. The three Medicaid managed care providers are Missouri Care, United Healthcare and Home State Health. Open enrollment ends Monday, April 3.
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Quality and Population Health
Staff Contacts: Alison Williams or Jessica Rowden
The March 2017 issue of Trajectories highlights integrated infection control strategies. The “Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)” was published by the Journal of the American Medical Association in 2016. Researchers noted the limitations of previous definitions which included an excessive focus on inflammation, the misleading model that sepsis follows a continuum through severe sepsis to shock, and inadequate specificity and sensitivity of the systemic inflammatory response syndrome criteria. The task force concluded that the term severe sepsis was redundant, and recommended “sepsis” as a diagnosis with “septic shock” as a subset of sepsis, noting profound circulatory, cellular and metabolic abnormalities associated with a greater risk of mortality than with sepsis alone. Essentially, the task force validated that while the term “severe sepsis” should no longer be used, the recognition and treatment are essentially unchanged. Further, they included a stronger suggestion that clinicians include invasive hemodynamic monitoring to provide more patient-centric response and management. These recommendations are based on multiple observational studies showing that any delay in antibiotic administration is associated with an increased risk of death. In January 2017, the fourth revision of the “Surviving Sepsis Guidelines” was published reflecting these updates.
At this time, the Centers for Medicare & Medicaid Services has not changed the sepsis process measures as a result of recent studies from JAMA and the Surviving Sepsis Campaign. The studies validate that sepsis, severe sepsis and septic shock recognition and treatment are essentially unchanged and that the prognosis can be more accurately predicted by using the Sepsis-Related Organ Failure Assessment (qSOFA) — a rapid triage assessment tool for early sepsis recognition. The presence of two qSOFA criteria is a predictor of both increased mortality and ICU stays of more than three days, in non-ICU patients. The new sepsis definitions recommend using a change in baseline of the total qSOFA score of two or more points to represent organ dysfunction. ICD-10 codes have not changed.
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Physician appointment wait times have increased by 30 percent since 2014. It takes an average of 24 days to schedule a new patient appointment, which is up from 18.5 days in 2014.