MHA Today | March 11, 2016

March 11, 2016
MHA Today: News for Healthcare Leaders

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 & CEO

A Medicaid managed care reform bill developed by MHA was scheduled to be heard in a Missouri Senate committee on Thursday. It didn’t happen. Nor did much else between Monday and Wednesday. That’s because the Senate Democrats were engaged in a historic filibuster that locked the chamber in a 36-plus hour talkfest consuming much of the legislative week.

Coincidentally, on Tuesday the “back story” section of my daily email from The New York Times announced the 99th birthday of the parliamentary tactic known as “cloture.” Cloture is a rule that allows the U.S. Senate to stop a filibuster with 60 votes. A similar maneuver, known as the previous question, or “P.Q,” was used by Missouri Senate Republicans on Wednesday to end the Democrats’ debate.

The filibuster timing was interesting and its impact on the Medicaid managed care bill was disruptive. However, that’s not why I mention the filibuster or cloture birthday. Rather, it’s the Times vivid etymology. Let me share and then expand.

Filibuster comes from the Dutch word vrijbuiter (pirate); it became filibustero in Spanish because Caribbean pirates cruised around in a ship called a filibote. In our political chatter, it refers to the pirating of the legislative process.

There’s an ongoing effort to move a significant part of the state’s Medicaid program away from the fee-for-service system and into managed care. The bill on this week’s committee calendar from Sen. Dan Brown — and the House companion that is in the works — would help ensure that Medicaid managed care becomes more value-based, whether or not it expands in scope.

This “regulatory relief” legislation has many parts, but I want to highlight just one — the provision that calls for standardization of utilization and administrative standards, including financial and quality data requirements. I share this because I recently participated in our critical access hospital meeting where several members were discussing the many — and varied — reporting requirements they and their clinical teams had to attend to. Validating these concerns, Health Affairs this week published research finding that physicians spend $15.4 billion per year on reporting and tracking quality measures from Medicare, Medicaid and private insurers. Four-fifths of the physicians surveyed said the problem was far worse than just three years ago. If Missouri’s General Assembly wants to put a stake in the ground to provide much needed regulatory relief in the Medicaid program, MHA’s bill is a great start and a strong signal that the state expects results.

But even with this and other necessary change, the Medicaid managed care program has yet to prove its ability to deliver value. Not only are cost savings for Medicaid managed care highly questionable, but also it doesn’t seem to deliver better — or in some cases even equal value in care delivery.

There’s another problem. The state’s Medicaid managed care program no longer has a provider tax, having been blocked by congressional action. As a result, Missouri's provider tax-based financing system diverts some funds away from hospitals in using them to fund Medicaid managed care. MHA is working to alleviate that diversion. Hospitals carry their weight in financing Missouri’s Medicaid program through the federal reimbursement allowance. We need a system that rewards payers’ and providers’ engagement in and commitment to improving the Medicaid system. We need a system where everyone who participates carries that responsibility fairly and proportionately. What’s not fair is the use of the legislative process to capture and keep value that others are creating. There’s a word for it — in Dutch it’s vrijbuiter.

Maybe the next time we have 36-plus hours of legislative time to discuss how to make the state a better place, we can talk about how hospitals are creating value for the state through 20-plus years of responsibility and partnership.

* * *

Next week, March 13 through 19, is National Patient Safety Awareness Week. The National Patient Safety Foundation and Missouri's Center for Patient Safety have resources available to help hospitals and health care professionals raise awareness of efforts to improve care.

Missouri hospitals continue to significantly invest in efforts to ensure patient safety, improve quality and increase transparency. To help explain these investments, we’re sharing Missouri-specific resources for use in your Patient Safety Awareness Week outreach.

One last thought. The patient safety awareness campaign is for providers, as well as the public. Share your story as part of your internally-focused communications and with your community.

Have a great weekend. Send me a note to share your thoughts.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
Legislators Reverse Votes To Defeat Tort Reform Bill
MHA Announces Transparency Initiative Quality Measure Revisions

state and federal health policy developments

Legislators Reverse Votes To Defeat Tort Reform Bill

Staff Contact: Daniel Landon

A state House committee has voted to defeat Senate Bill 847. The bill is a tort reform measure that would change the “collateral source rule” governing how medical costs are considered in calculating potential damages. MHA, other provider and business organizations, insurers, and other tort reform proponents support the bill. Three committee members who previously supported a similar House bill switched their positions to vote against SB 847 ― state representatives Galen Higdon (R-St. Joseph), Allen Andrews (R-Grant City) and Andrew McDaniel (R-Deering). The House bill handler, who is the committee chairman, also voted against the bill to preserve his right to propose a reconsideration vote at a later time.

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Quality And Population Health

MHA Announces Transparency Initiative Quality Measure Revisions

Staff Contact: Dana Downing

As a result of the October 2015 national conversion to ICD-10, there are anticipated changes to the technical specifications and sources of six of the seven quality transparency initiative infection measures. In response to member feedback indicating a preference to provide consistent quality indicator reporting across initiatives, select measures now will be reported from abstract data instead of HIDI-reported administrative data. Infection outcome reporting within the transparency initiative will use National Healthcare Safety Network data. Infection measures impacted include the following.

  • catheter-associated urinary tract infection
  • central venous catheter-associated bloodstream infection
  • clostridium difficile
  • methicillin-resistant staphylococcus aureus
  • surgical site infection – colon surgery
  • surgical site infection – abdominal hysterectomy


To date, 43 percent of members participating in the transparency initiative have conferred rights from NHSN to MHA. If a hospital reports to NHSN, conferring rights to MHA enables the abstracted data to be obtained by MHA without additional abstraction. If a hospital does not confer rights or does not report to NHSN, data for infection measures will not be displayed on the public transparency reporting website, Focus on Hospitals. The instructions for conferring rights to HIDI/MHA can be found online.

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Did You Miss An Issue Of MHA Today?

March 10, 2016
FRA Reauthorization Gets Committee Review
Supplemental Appropriations Bill Advances
House Completes Budget Work
MHA Releases Issue Brief: Medicare Part B Prescription Drug Model Proposal
CMS Announces QualityNet Secure Portal Downtime
MLN Connects Provider eNews Available
Governor Urges Missourians To Prepare For Severe Weather

March 9, 2016
House Advances State Budget Bills
Senate Filibuster Delays Health Bill Hearings
Committee Considers Health Proposals
Committee Reviews Nurse Licensure Compact Changes
Bill Addresses Off-Label Cancer Drugs
CMS Releases SNF Utilization And Payment Data
CMS Proposes Testing New Medicare Part B Prescription Drug Models
Trajectories – Opioids: A Population Health Dilemma
CMS Announces OQR Webinar

March 8, 2016
MHA Provides FFY 2016-2018 Medicare Pay-For-Performance Reference Guide
January MUR Available On HIDI Analytic Advantage®
CMS Updates OP-33 Flowchart
NIH Publishes Article On Understanding Anxiety Disorders

March 7, 2016
CMS Announces Next Generation ACO Model
Federal Budget Deficit Reduction Group Issues Recommendations
TJC Announces Updates To The Physical Environment Portal
Government Accountability Office Releases Reports
MHA Announces Visionary Leadership Award Call For Nominations
IOM Releases New Report About Social Determinants
CDC Lists Top 10 Public Health Problems And Concerns
James Announces Resignation From Poplar Bluff Regional Medical Center

Consider This ...

Traumatic brain injuries account for 2.5 million emergency room visits and 280,000 hospitalizations each year in the U.S.

Source: Reuters