MHA Today | April 8, 2016

April 8, 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

According to Mapquest, I live 3.5 miles from the office. The fastest route is a bit circuitous, but it’s a quick commute that cuts through a variety of neighborhoods and business areas. I was thinking about those 3.5 miles as I drove to work Monday.

It’s been said that ZIP code is a powerful predictor of health. On Monday, the most recent edition of HIDI HealthStats was released, addressing diabetes disparities in Missouri. It unfolds a powerful narrative about differences in community and health equity, and illuminates the story with two infographics that compare ZIP codes in St. Louis and Kansas City.

The cycle of chronic disease is exacerbated by social factors such as poverty, amalgamates with disparate outcomes for the mind and body, culminates in severe health and social consequences and sadly, repeats. In St. Louis, a distance of 10 miles separates a difference of 18 years in average life expectancy. In Kansas City, four miles of separation yields 11 additional years of life. These communities are separated by only a few miles, but are worlds apart.

On Friday, MHA joined numerous organizations in a stakeholder discussion about how to better address the challenge of diabetes in Missouri. The diversity of the coalition was both interesting and powerful. There were public health and health policy attendees, academics and quality improvement voices, and perhaps most unconventionally, Hy-Vee and the YMCA. The coalition was broad because so are the needs.

Diabetes has a profound impact on lives. It’s a burden that is disproportionately high for racial and ethnic minorities. Last year in Missouri, 6.8 percent of black adults were diagnosed with diabetes during an inpatient hospitalization or emergency department visit. In relative terms, this was 71 percent higher than 4 percent of white adults diagnosed in a hospital setting.

Betty Drees, one of the attendees who has a foot in the academic, provider and public policy space, pointed out the pernicious effect of the disease. “Diabetes is a leading cause of death, both directly and as a contributing factor for those with cardiovascular and other conditions — it has a profound impact throughout the state,” Drees said.

The data bear that out. The state’s highest overall rates of diabetes were in Iron and Jasper counties. Higher diagnosis rates for black Missourians were found throughout the state, most notably in Monroe and Pettis counties where 10 percent of black adults were diagnosed in a hospital setting last year. High diagnosis rates for black adults also were observed in Lincoln, Warren, Lafayette, Bates and Jasper counties, where 8 percent or more of black adults were diagnosed with diabetes during 2015.

The cost is in both lives and treasure — diabetes is driving health care costs. Researchers suggest that 1 in 10 health care dollars is attributed to diabetes care in the U.S. In Missouri the state’s economic burden may exceed $5.1 billion annually.

Drees is a physician, Professor of Medicine and Dean Emerita at the University of Missouri-Kansas City School of Medicine, President of the Kansas City area Community Leadership Board for the American Diabetes Association, and a council member of the Missouri State Medical Association. She also knows that the progress will require unconventional thinking. “The good news,” she said, “is that we can make a difference — especially by working together.”

From my office, Hy-Vee is about one mile and the YMCA has a facility just behind it. From MHA to MSMA is seven miles. The distances between the partners from Kansas City and St. Louis and their local peers are similar. Yet all of the stakeholders have been working relatively independently toward the common goal of reducing diabetes.

The importance of these groups is that they all engage Missourians where they live, work, shop and seek care, recreation and fitness. Each is in a different and unique relationship with diabetes sufferers and individuals at risk for diabetes. However, their relationship with one another when combatting this disease is mixed, even with their close proximity to one another. Last week’s meeting changed that relationship — hopefully creating new partnerships to rally support and share best practices for meeting the challenges of diabetes in our state. This presents a real "belt and suspenders" opportunity — a low-risk, high-value and mutually-supporting opportunity to engage on a major health care issue.

We know that health inequities exist. Together, we can craft better, more targeted solutions that expend resources where they can make the most difference. This week’s meeting was a start in that direction.

Think about it on your drive home. Then, let me know what you think.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
State Senate Completes Budget Work
Infection Reporting Bills Advance
Senate Committee Approves Workforce Data Center Bill
Price And Contract Disclosure Removed From Legislation
AHA Launches Comprehensive Telehealth Resource
Studies Show Biological Myths Can Lead To Racial Disparities In Pain Treatment
COCA Announces Zika Clinical Guidance Webinar

state and federal health policy developments

State Senate Completes Budget Work

Staff Contact: Daniel Landon

The Missouri Senate has completed its work developing a version of the state’s operating budget for the fiscal year that begins Friday, July 1. The appropriations bills now will be discussed by legislative conference committees created to negotiate a resolution to the differences between the House and Senate versions of the budget. Differences between the two versions of the main Medicaid hospital line-item are modest and largely reflect more recent data regarding projected expenditures and federal matching fund rates. A reduction in Medicaid general revenue spending for hospitals and other Medicaid providers was offset by increased federal funding made possible by a $55 million settlement agreement between the state and federal governments regarding Youth Services funding. The so-called “fund switch” involves one-time funds, and likely will create a Medicaid funding shortfall to be addressed by next year’s legislature.

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Infection Reporting Bills Advance

Staff Contact: Daniel Landon

A Senate committee has approved House Bill 1855 that would update state laws governing infection control. It is a slightly updated version of a 2015 negotiated accord that would curtail duplicative state and federal reporting. Also, a House committee has approved an identical bill, Senate Bill 579. Each was previously approved by its chamber of origin. MHA supports the bill.

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Senate Committee Approves Workforce Data Center Bill

Staff Contact: Daniel Landon

A Senate committee has reviewed and approved House Bill 1850, which would authorize the development of a center for compiling and analyzing data regarding the health care workforce.

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Price And Contract Disclosure Removed From Legislation

Staff Contact: Daniel Landon

A state House committee has approved Senate Bill 608, which defines charges that may be imposed on Medicaid enrollees for unnecessary emergency department use and missed appointments. A successful committee amendment removed sections added by the Senate requiring disclosure of health care prices by providers and insurers and, under certain circumstances, payment rates of contracts between insurers and providers.

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Quality and Population Health

AHA Launches Comprehensive Telehealth Resource

Staff Contact: Alison Williams

The American Hospital Association has launched a Web resource offering comprehensive information on telehealth. The site includes information on federal and state telehealth initiatives, research documenting telehealth value, AHA-member case studies showing telehealth in action and AHA TrendWatch reports on telehealth benefits to patients. Regular updates are planned.

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Studies Show Biological Myths Can Lead To Racial Disparities In Pain Treatment

Staff Contact: Alison Williams

According to two related studies reported this week in the Proceedings of the National Academy of Sciences, many white medical students and residents hold false beliefs about biological differences between black and white people, which may contribute to racial disparities in pain assessment and treatment. Half of white medical students and residents, and 73 percent of white lay people participating in the studies identified at least one of 11 false statements about biological differences as “possibly,” “probably” or “definitely” true. The measuring instrument included statements such as “black people have less sensitive nerve-endings” or “black skin is thicker than that of whites.” Participants then read mock medical cases about black and white patients with kidney stone or ankle fracture injuries, and were asked to estimate their pain on a traditional 11-point medical scale and recommend a pain medication. Participants with false beliefs about racial biological differences were more likely to rate the black patient’s pain lower and less likely to recommend an accurate pain treatment option. Previous research has shown that black patients are more likely to be undertreated for pain.

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COCA Announces Zika Clinical Guidance Webinar

Staff Contacts: Sarah Willson, Jackie Gatz or Alison Williams

The Centers for Disease Control and Prevention has updated its interim guidelines for U.S. health care providers caring for pregnant women and women of reproductive age during active Zika virus transmission. The guidelines apply to health care providers caring for women of reproductive age in the U.S. and will continue to be updated as more information becomes available. The CDC Clinician Outreach and Communication Activity announced an upcoming webinar, titled “Updated Interim Zika Clinical Guidance for Reproductive Age Women and Men, Sexual Transmission of Zika, and the U.S. Zika Pregnancy Registry,” which will cover the new guidelines. The webinar is scheduled at 1 p.m. Tuesday, April 12. Dial 888/769-8519 and enter passcode 1002827 to participate.

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Did You Miss An Issue Of MHA Today?

April 7, 2016
Senate Committee Advances Medicaid Managed Care Reform Bill
House Committee Advances STEMI/Stroke Certification Bill
Committees Address Hospital Regulatory Concerns
House Approves Life Safety Code Legislation
Senate Advances Helipad Fencing Bill
House Approves Legislative Proposals
Departments Announce New Summary Of Benefits And Coverage
MLN Connects Provider eNews Available
AAMC Report Predicts Physician Shortage

April 6, 2016
CMS Offers IRF QRP Training
TJC Releases 2015 Most Cited Standards List
CMS Accepts Primary Source Verification For Laboratories
Department Of Social Services Engages Contractor To Conduct Audits
ONC Offers New Website Resources To Manage Opioids
JAMA Study Notes Increase In Average Price Of Insulin

April 5, 2016
Bill Restricts Bail Bond Recovery Arrests In Hospitals
Bill Advances With Hospital Regulatory Relief Amendment
MO HealthNet Issues 2016 Outpatient Radiology Fee Schedule
February MUR Available On HIDI Analytic Advantage®
CMS Adjusts Medicare Advantage Plans Based On Dually-Eligible
Stakeholders Meet To Improve Diabetes Care, Health Outcomes And Health Equity
CMS Reminds Hospitals Of IQR Reporting Deadlines
CMS Releases Quality Reporting Checklists
HRSA Hosts Webinar On New GME Tool For Rural Areas

April 4, 2016
Report Assesses 2014 Commercial Insurance Market
State Releases March 2016 General Revenue Report
TJC Revises Deemed Program Requirement For Psychiatric Hospitals
HIDI HealthStats — Diabetes And Health Equity
TJC Announces Pioneers In Quality Program Education Session

Consider This ...

April is Sexually Transmitted Disease Awareness Month. Twenty million new STD infections occur each year in the U.S., costing the health care system nearly $16 billion in direct medical costs.

Source: Centers for Disease Control and Prevention