MHA Today | June 10, 2016

June 10, 2016

MHA Today: News for Healthcare Leaders

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Herb Kuhn, MHA President & CEO

On Wednesday, the June issue of HIDI HealthStats — which explores behavioral health in Missouri — was released. We launched HealthStats two years ago as a forum for original state-specific research on health care topics. In those two years, I’ve never seen research as compelling and simultaneously as troubling, as in this edition.

It’s no secret that the state’s behavioral health system suffers from a massive supply and demand imbalance. Hospitals are acutely aware of the problem, having been the front line for the transition from institutional to community-based care. A survey conducted by MHA earlier this year found that 61.3 percent of reporting hospitals had to temporarily board behavioral health patients in their emergency departments during the previous week. Of these, 40 percent stayed longer than eight hours and 9 percent more than 24 hours. In nearly all cases, this was because of a lack of psychiatric beds.

In 1990, Missouri had 1,400 more psychiatric beds than 2012. Although the hospital community supports robust, community-based care, the state has only half of the recommended number of psychiatric beds. This is compounded and exacerbated by the practitioner shortage in many parts of the state. In Missouri, 90 percent of counties are designated mental health shortage areas and 61 percent have no psychiatrists.

Unfortunately, in Missouri, funding for behavioral health is unidirectional — down. The state’s investment in public mental health services is well below the national average, reimbursement rates for community health providers haven’t kept up with inflation and some budget-watchers have pegged the state’s cuts to general revenue for mental health services at 35 percent since 2009.

Utilization is going in the opposite direction. From 2006 to 2015, hospital ED and inpatient visits for all diagnoses grew by 16 percent — a 10 percent decline in inpatient and a 26 percent increase in ED utilization, in aggregate. During the same period, ED visits for behavioral health disorders increased 40 percent and utilization for mental health-related issues outstripped the growth of all other hospital utilization combined by a factor of 2.3 to 1.

The costs of the mental health crisis are significant — financially, and in life quality and expectancy. Between 2006 and 2016, diagnoses of suicide ideation increased 433 percent for all Missouri residents, and nearly 900 percent among children and adolescents. Missouri has the second highest suicide rate in the Midwest and is in the top half of states nationally. The societal burden of suicide — in terms of medical costs and lost productivity — is more than $4.6 billion every year in the U.S.

The medical costs are high in Missouri. In 2015, 77 percent of hospital visits for mental disorders originated in an ED. About half of these visits were admitted with an average length of stay of 6.8 days. The average charge for each visit was $8,550, and total charges for mental health were approximately $1.4 billion. A disproportionately large number of these visits — 52 percent for mental diseases and disorders and 65 percent for substance abuse and induced mental disorders — were among Medicaid recipients and the uninsured. Interestingly, between 2006 and 2015, ED utilization for behavioral health in Medicaid patients increased 40 percent — 111 percent for Medicaid Managed Care and 26 percent for fee-for-service.

Missouri’s behavioral health infrastructure isn’t adequate to manage the growing demand for services. Outpatient hospital and community-based treatments are better than institutional care, if the patient’s condition allows them. However, the insufficient resources available to address the growing demand leaves us with a system in a cyclical crisis.

Missourians with behavioral health needs deserve care. Unfortunately, the average wait time to see a psychiatrist in Missouri is 10 to 30 days for an adult and as long as six months for an adolescent. The psychiatric bed crisis is self-evident — EDs are serving as de facto behavioral health waiting rooms and sadly, the wait time is commonly more than 24 hours.

Here’s one final statistic. One in 10 Missouri adults have a serious mental illness, and 40 percent of those adults go without treatment.

Missouri can do better. We must.

Send me a note to let me know what you’re thinking.

P.S. On Wednesday, Paul Taylor, CEO of Ozarks Community Hospital in Springfield, joined researchers from Georgetown University in a national call on a new study comparing the impact of Medicaid expansion on hospitals in expansion and non-expansion states. I’ll discuss the research and Paul’s insights in next week’s column. However, one of the questions related back to this week’s subject matter.

Following the presentation, a gentleman from Mississippi questioned whether the researchers had investigated the influence of opportunities for behavioral health services provided by Medicaid expansion on the criminal justice system. The authors had not — such data remain elusive. However, we have to wonder how many general revenue dollars devoted to corrections could be matched by federal Medicaid dollars. More importantly, how many incarcerations could be avoided if Missouri’s working poor had the benefit of an adequate behavioral health system?

Ozarks Community Hospital has provided a national example of the very real differences an invisible state line can make in health care. Thank you for your leadership, Paul.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
U.S. Senate Committee Approves Health Appropriations Bill
GAO Report Assesses Medicare Appeals Backlog
Insurance Director Warns Of Worsening Earthquake Insurance Market
CMS Updates IPFQR Program Resources
CMS Releases Supplement To OQR Specifications Manual

state and federal health policy developments

U.S. Senate Committee Approves Health Appropriations Bill

Staff Contact: Daniel Landon

The U.S. Senate Appropriations Committee has approved the fiscal year 2017 appropriations bill for the Departments of Labor, Health and Human Services, Education and related agencies. Sen. Roy Blunt (R-Mo.) chairs the subcommittee that oversees the development of the appropriations bill. The scope of the bill encompasses a wide variety of programs, but key health-related funding increases address medical research through the National Institutes of Health, children’s hospitals’ graduate medical education, opioid abuse treatment and prevention, antibiotic-resistant microbes, and the Medicare coverage and payment appeals process. The committee report accompanying the bill calls for quarterly reporting to congressional committees of data concerning Medicare appeals and the effect of Recovery Audit Contractors on the process.

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GAO Report Assesses Medicare Appeals Backlog

Staff Contacts: Daniel Landon or Andrew Wheeler

A new report by the U.S. Government Accountability Office assesses the backlog of appeals of Medicare payment and coverage decisions. The report notes that the backlog “continues to grow at a rate that outpaces the adjudication process and likely will persist,” despite various reforms and a settlement agreement designed to curb the caseload. GAO also published a one-page summary of the report. The 88-page report delves into the impetus for the growth in appeals of Medicare payment and coverage decisions, their outcomes, and recommendations for improved tracking. The leadership of the U.S. Senate Finance Committee said the report highlights the need for legislation to reform the process. Resolving the Recovery Audit Contractor-driven collapse of the appeals system is an ongoing MHA advocacy priority.

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Insurance Director Warns Of Worsening Earthquake Insurance Market

Staff Contacts: Daniel Landon or Jackie Gatz

In remarks at an insurance symposium, Missouri Department of Insurance Director John Huff commented on the implications of Missouri’s worsening market for earthquake insurance. Noting that “more than a half a million Missourians are at risk of catastrophic financial loss following an earthquake,” he expressed concern that “without the insurance industry fueling recovery and rebuilding efforts, Missouri could also suffer an economic catastrophe.” The department recently issued a supplement to its 2015 Earthquake Report. Premiums are sharply rising and the percentage of residents with coverage in the most susceptible areas has dropped from 60 percent in 2000 to less than 18 percent in 2015.

In August, Missouri will participate in the National Level Mass Care Exercise, testing evacuation and response plans following an earthquake in the New Madrid Seismic Zone. Health and medical providers will assess medical surge capacity, implement regional communication and coordination plans, and deploy the Missouri Disaster Response System.

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Quality and Population Health

CMS Updates IPFQR Program Resources

Staff Contact: Sherry Buschjost

The Centers for Medicare & Medicaid Services recently updated the Inpatient Psychiatric Facility Quality Reporting Program Manual and program abstraction tools available in the resources and tools section on the Quality Reporting Center website.

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CMS Releases Supplement To OQR Specifications Manual

Staff Contact: Sherry Buschjost

The Centers for Medicare & Medicaid Services has determined that supplemental documents to the Hospital Outpatient Quality Reporting Specifications Manual Versions 9.0a and 9.1 are required for implementation beginning Jan. 1 through June 30, 2016 (Version 9.0a), and July 1 through Dec. 31, 2016 (Version 9.1). The supplemental documents include updates to the measure information form for OP-32 and removal of decimals from ICD-10-CM codes. The supplemental documents can be accessed on QualityNet.

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Did You Miss An Issue Of MHA Today?

June 9, 2016
Medicaid Eligibility Change Signed Into Law
Nixon Signs Bills On FRA, Infection Control, Telemedicine and Pharmacy
U.S. Senators Voice Concern About Opioid Antidote Pricing
CMS Announces Medicare Home Health Prior Authorization Demonstration
House Energy And Commerce Committee Approves Preparedness Bill
CMS Updates Short-Stay Patient Status Reviews
MLN Connects Provider eNews Available
HHS Releases Zika Resource Guide
APS Provides Educational Offerings

June 8, 2016
House Of Representatives Passes “Helping Hospitals Improve Patient Care Act”
CMS Announces Delay In JW Modifier Requirement
CMS Releases Proposed Rule That Strengthens Marketplace
HIDI HealthStats — Mental Health In Missouri
April MUR Available On HIDI Analytic Advantage®
MHA Provides Orientation Resources For Quality Staff
AHA And CDC Issue Patient Education Resource On Prescription Opioids
MHA Selects New Patient Safety Organization Vendor

June 7, 2016
Congressional Committee Circulates Draft Of Mental Health Legislation
CMS Releases Final ACO Program Rule
CMS Project Seeks Innovative Hospital Quality Practices
CMS Updates Abstraction And Reporting Tool
CMS Announces Special Edition Rural Health Open Door Forum

June 6, 2016
Issue Brief: Proposed Helping Hospitals Improve Patient Care Act Of 2016
State Releases May 2016 General Revenue Report
MHA Releases Updated Quality Transparency Initiative Data
Kindred Hospital Northland Names New CEO

Consider This ...

Legionnaires’ disease, a serious lung infection, grew by nearly four times from 2000-2014. Almost all outbreaks were caused by problems preventable with more effective water management.

Source: Centers for Disease Control and Prevention