MO HealthNet Revises Pharmacy Reimbursement Methodology
Staff Contacts: Kim Duggan or Brian Kinkade
Today, MO HealthNet announced a revision in the reimbursement methodology for retail pharmacies. The change will not affect hospitals, as they will continue to be reimbursed on the percent of billed charges. The new methodology sets a hierarchy for determining the rate paid instead of the current methodology that pays the lowest of several published rates. Reductions in ingredient reimbursement costs are offset by an increase in dispensing fees so that the policy change is budget neutral. The new methodology has a 30-day comment period and takes effect Saturday, April 1.
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CMS Releases Memo On New Emergency Preparedness Rule
Staff Contacts: Sarah Willson or Jackie Gatz
Late last year, the Centers for Medicare & Medicaid Services released a final rule integrating emergency preparedness requirements into CMS Conditions of Participation. MHA also released a Subject Matter Expert Spotlight on the topic. To assist providers and suppliers in meeting the new training and testing requirements, CMS has released a memo encouraging them to seek out and participate in a full-scale, community-based exercise with their local and/or state emergency agencies and health care coalitions. The memo includes a checklist of requirements for compliance and a state-by-state list of health care coalitions.
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Trajectories — Infection Control Strategies
Staff Contacts: Alison Williams or Jessica Rowden
The March 2017 issue of Trajectories highlights integrated infection control strategies. Antibiotic stewardship programs seek balance in antimicrobial use — maximizing clinical outcomes while minimizing the growth in antibiotic resistance. Simultaneously, stewardship programs can reduce health care costs without adversely affecting quality of care. Striking this balance is critical to the larger population health issue of antibiotic resistant “super bugs.”
ASPs align well with the Triple Aim — better health, better care and lower costs. Antibiotic resistance in the U.S. costs an estimated $20 billion a year in excess health care costs, $35 million in other societal costs and more than 8 million additional hospital days.
The population health repercussions of widespread, untargeted use of antimicrobials is concerning considering the lack of new antibiotic discoveries of any significance in the last 30 years. The World Health Organization now sites antibiotic resistance as a “major threat to public health globally.” Not since the time of the discovery of penicillin has the world seen such broad and effective medications to treat infections. However, even the powerhouse penicillin was not immune to developing resistance issues; within 10 years of penicillin’s discovery in 1928, group A streptococci and pneumococci already had developed modes of resistance.
In Missouri, Senate Bill 579 requires hospitals, excluding mental health facilities and ambulatory surgery centers, to have ASPs based on national guidelines in place by August 28. In addition, once regulations concerning Stage 3 of the Medicare and Medicaid Electronic Health Records Incentive Programs, promulgated by the Centers for Medicare & Medicaid Services that enable the electronic interface for such reporting, are effective, hospitals will be required by law to report to NHSN’s antimicrobial use or resistance module. The bill, currently in the rule-writing phase at the Missouri Department of Health and Senior Services, is regarded as the most proactive and advanced state policy in the U.S. Many state and national organizations are monitoring its effect on health outcomes.
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RWJF Releases County Health Rankings Annual Report
Staff Contact: Leslie Porth
Today, the University of Wisconsin and the Robert Wood Johnson Foundation released their 2017 county health rankings report, which includes Missouri-specific information. Key findings for the U.S. include an increase of premature deaths among younger generations influenced by drug overdose and injuries.
In Missouri, the suburban counties of Kansas City (Platte and Clay) and St. Louis (St. Charles) ranked as the top three Missouri counties for health outcomes, measured by length and quality of life. St. Charles and Platte counties also ranked as the top two counties for health factors, measured by health behaviors, clinical care, social and economic factors, and physical environment. MHA efforts to reduce opioid misuse and address social determinants, support the findings of the county health rankings report.
The data provide meaningful, county-based health status information that is useful in conducting community health needs assessments and strategic planning. MHA recently updated CHNA guidance to assist hospitals with the CHNA process.
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