MHA Today | February 26, 2016

February 26, 2016
MHA Today: News for Healthcare Leaders

February 26, 2016

MHA Today is provided as a service to members of the Missouri Hospital Association. Additional information is available online at MHAnet. Connect with us on LinkedIn.


Herb Kuhn, MHA President & CEONo system invented by humankind is perfect. However, some systems work better than others.

Monday is Feb. 29 because 2016 is a leap year. Unless you celebrate a birthday on Monday, the fact that there is an extra day every four years isn’t really a problem.

Adopted initially by the Catholic Church in 1582, the Gregorian calendar has stood the test of time. Leap years are just a quirk of the system that we otherwise credit with doing a good job of organizing time.

Not all systems hold up that well. For example, our nation’s health insurance system is arguably less than perfect. Some would argue that it’s a mess.

Earlier this week, Bloomberg carried a story about the bad debt costs that are weighing heavily on the nation’s hospitals. As it turns out — and this isn’t a surprise — health insurance is only as good as enrollees’ ability to access the plans’ benefits.

Two weeks ago we released the annual Community Investment Report for Missouri hospitals. Same story. Bad debt continues to grow in Missouri increasing to more than $593 million in 2014.

Part of the problem is the proliferation of high deductible health insurance plans. The Bloomberg article cites patients’ lack of ability to fund deductibles, as well as patients dropping plans, as key drivers in the increase of bad debt. That’s a trend we’ve been seeing for years. However, with the expansion of access to commercial insurance through the marketplace created by the Affordable Care Act, a much larger segment of the insured population has low premium, high deductible coverage. It’s been called the “Bronzing of America,” a reference to the lowest cost “medal plan” that is now being offered on the health insurance exchanges. And, for many lower-middle and working class Missourians, the deductibles in these plans are out of reach.

Earlier this month, with the help of hospitals throughout the state, we were able to stop the progress of a bill that would have allowed some insurers to increase plan co-payments to more than 50 percent of the cost of a service. As with any issue before the General Assembly, nothing is certain until the final gavel. However, we’ll continue to fight legislation that prices Missourians out of access to coverage.

There’s significant evidence that cost influences health care decisions. Delaying care because of a high deductible can lead to higher costs, and poorer outcomes in the long term.

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Speaking of messes, last year federal policymakers resolved the annual Sustainable Growth Rate-driven Medicare physician pay crisis through the Medicare Access and CHIP Reauthorization Act. The new program creates two incentive structures for physicians designed to improve quality and accountability.

As the number of hospital-employed physicians grows, physician pay systems are having a greater impact on hospitals’ financials. Moreover, how these systems integrate with hospital performance and quality systems will influence both physicians’ and hospital organizations’ success.

Tuesday, March 1, MHA is offering a webinar, “After the SGR: Learn the Basics of MACRA.” Each MHA-member hospital can receive a complementary registration if confirmation is received by Monday, Feb. 29.

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When a system is broken, it’s appropriate to work to fix it. However, it’s important that the “fix” works better than the system it’s replacing.

Not every problem in health care can be solved by giving patients more financial “skin in the game.” In fact, that approach can harm the system more than help it in some cases.

It’s too early to know how the SGR replacement will work. However, it’s hard to imagine a system that would cause as many problems as the SGR — especially because the MACRA promises better alignment of provider pay and incentives.

Nonetheless, if your birthday happens to be Monday, you may have a legitimate gripe with the Gregorian calendar. There’s the present need for a leap year, and the fact that a day will need to be dropped in about 3,000 years. Those are fair points. But, it’s a system that works, despite these problems.

And, there’s good news for the leap year babies. Unlike the rest of us, they reach Medicare eligibility by their 17th birthday!

Have a good weekend. Email me with your thoughts.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
MHA Requests Hospitals Contact Lawmakers Regarding Prescription Monitoring Bill
Hospital Construction Regulatory Relief Legislation Advances To House Floor

CMS Issues Program Integrity Enhancements Proposed Rule For Provider Enrollment Process
WPS Denying Claims In Error Due To LCD Edits
TJC Updates Specifications Manual

state and federal health policy developments

MHA Requests Hospitals Contact Lawmakers Regarding Prescription Monitoring Bill

Staff Contacts: Daniel Landon or Rob Monsees

The sponsor of legislation to authorize a state prescription drug monitoring program is urging supporters to contact their state representatives to express support for the bill. House Bill 1892 is slated for a vote in the House of Representatives next week. MHA is part of a broad coalition promoting the legislation. According to the sponsor, some of her undecided colleagues say constituents are not contacting them to express support for the proposal. MHA is encouraging members of the hospital community to use the Missouri Health Matters advocacy portal to send a message to members of the House of Representatives. Every state but Missouri has implemented a prescription drug monitoring system. Opposition focuses on privacy concerns.

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Hospital Construction Regulatory Relief Legislation Advances To House Floor

Staff Contact: Rob Monsees

Yesterday, the Missouri House Select Committee on Social Services voted House Bill 2402 do pass with an amendment favored by MHA. The legislation revises hospital licensure standards to reflect updated life safety and construction codes and reduces the burden of complying with differing state and federal regulations. It was developed in consultation with the Missouri Society of Hospital Engineers.

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Regulatory News
the latest actions of agencies monitoring health care

CMS Issues Program Integrity Enhancements Proposed Rule For Provider Enrollment Process

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services released a proposed rule that would implement additional provider enrollment provisions to ensure that entities and individuals who pose risks to the Medicare program are kept out of or removed from Medicare for extended periods of time. The rule would grant CMS the authority to do the following.

  • deny or revoke a provider's or supplier’s Medicare enrollment if currently revoked under a different name
  • revoke a physician’s or eligible professional’s enrollment if a pattern of practice of ordering services which represent a threat to the health of Medicare beneficiaries is established
  • increase the maximum reenrollment bar from 3 to 10 years
  • prohibit a provider or supplier from enrolling in the Medicare program for up to 3 years if its enrollment application is denied due to false or misleading information
MHA has published an issue brief with additional details. Comments will be due 60 days after the date of publication in the Federal Register.

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WPS Denying Claims In Error Due To LCD Edits

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services’ Medicare Administrative Contractor, Wisconsin Physicians Service Insurance Company, is denying claims and making payments in error due to local coverage determination edits. WPS states that they will be issuing an eNews message soon. Until that time, WPS has asked MHA to share the following message.

Coverage for services under Medicare is based on medical necessity. Title XVIII of the Social Security Act, Section 1862(a)(1)(A) excludes services that are not “reasonable and necessary” unless otherwise specifically noted. WPS Medicare has implemented automated system editing for Part A Local Coverage Determination (LCD) coverage criteria to prevent improper payments.

Medicare claims associated with LCD coverage criteria that do not have a payable diagnosis will be denied. WPS Medicare will be performing mass adjustments to identify two types of claims; 1) claims denied in error with payable diagnosis and 2) claims paid in error with non-payable diagnosis. We will be publishing information on the mass adjustments via the website. During this time we ask that you review the website for periodic updates. Providers may correct a diagnosis by submitting an adjustment or written correspondence. Actual changes to coverage criteria will be identified in the LCD history. Reconsideration requests of an LCD should follow the appropriate protocol.

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Quality And Population Health

TJC Updates Specifications Manual

Staff Contact: Sherry Buschjost

The Joint Commission has updated version 2016A of the Specifications Manual for Joint Commission National Quality Measures due to a typographical error for gestational age in the PC-03 algorithm picture. The weeks value has been revised from ">=24 and <32" to ">=24 and <34." The updated manual, which covers July 1 to Dec. 31, 2016 discharges, is available on PET.

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Did You Miss An Issue Of MHA Today?

February 25, 2016
State House Sends Bills to Senate
Missouri Senate Advances Legislation
MMAC Sends DRA Attestations To Providers
FSD Updates Matrix For Submitting Supporting Documentation
MLN Connects Provider eNews Available
HIDI Releases Report On 2014 Average Hospital Charges For Medicare Patients
CMS Releases CART Paper Tools For Fourth Quarter 2015 Encounters
Improvement Guide And Toolkit Available For Critical Access Hospitals
BKD Offers Free Webinar On Rural Health Reimbursement Opportunities

February 24, 2016
Committee Reviews Health Information Exchange Bill
Committee Considers Price Transparency Bill
State House Approves Bills
U.S. Senate Committee Considers Opioid Abuse
CMS Approves April Start For Iowa Medicaid Managed Care
CMS Updates OQR Program Known Issues Document
MHA Posts MACRA Resources
CMS Reschedules Rural Health Open Door Forum
SSM Health Cardinal Glennon Children’s Hospital Names New President

February 23, 2016
Missouri Children's Trauma Network Offers Motivational Interviewing Training Program
MHD Posts Draft 1115 Waiver For Mental Health Crisis Prevention Project
CMS Publishes Medicare Fee-For-Service Provider And Supplier List
AHRQ Releases Health Literacy Toolkit For Primary Care Practice
HRSA Announces Rural Telehealth Grants
CMS Issues AHRQ PSI-90 Technical Updates

February 22, 2016
CMS Issues 2017 MA And Part D Advance Notice And Draft Call Letter
HIDI HealthStats — Sociodemographic Factors In Risk-Adjusted Readmission Measures

Consider This ...

There are about 187,000 people in the U.S. and 4 million people in the world who were born on Leap Day.