MHA Today | July 8, 2016

July 8, 2016

MHA Today: News for Healthcare Leaders

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Herb Kuhn, MHA President & CEO

I’d be shocked if reducing diabetes directly, or its influence on other chronic conditions peripherally, wasn’t a component of your hospital’s community health needs assessment. In varying degrees, diabetes is everywhere.

In April, HIDI HealthStats investigated the vast differences in diabetes diagnosis and care between not-so-distant Missouri communities. The message was clear — significant health inequities exist and population health work outside of the hospital is necessary to address the disease “upstream” in the communities themselves.

When a problem is as pervasive as diabetes, tackling it can feel overwhelming. And, tackling it outside the four walls of the hospital can lead to additional trepidation. I understand both reactions. Nonetheless, a growing share of payment is linked to outcomes that are influenced by factors outside of the hospital, and historically viewed as outside of hospitals’ control.

Meanwhile, this month’s edition of Trajectories, outlines strategies that hospitals can implement to target and manage patients with, or who are at risk for, diabetes. As I briefly touch on the strategies, let me lay the foundation with an old joke, “How do you eat an elephant? One bite at a time.”

Trying to do everything generally ends in doing practically nothing. Targeting the populations at greatest risk using available datasets allows program planners to identify and stratify the patient population. High-impact opportunities — generally patients at high risk for diabetes or existing high-cost super-utilizers with diabetes and co-morbidities — will emerge. The ability to find and reach these individuals will expand with additional technology and interoperability.

Health insurance disparities may emerge from the data and influence access and affordability of care for patients. However, investments in diabetes prevention could yield significant reductions in future diabetes-related uncompensated care costs. Prevention and management costs for supplies and prescriptions are only a small percentage of the overall national expenditures of $245 billion on diabetes annually. Nearly 90 percent of spending is for diabetes-related complications, preventable hospitalizations and indirect costs. Moreover, harnessing available technology — including telemedicine and patient smartphones — can enhance the provider-to-provider expertise and provider-to-patient contact that can help balance access and affordability challenges. There’s additional good news on this front. Just yesterday, the Centers for Medicare & Medicaid Services released the proposed physician fee payment rule. In that rule, they propose, for the first time, that providers can bill Medicare for diabetes prevention services. If approved, this new service would begin in 2018.

The prevalence of diabetes is far greater than those actually diagnosed. As many as 86 million Americans have prediabetes, a specific condition recognized by providers. Left untreated and unmanaged, one-third will have diabetes in five years. Screenings can help engage at-risk individuals and build their diabetes intervention knowledge. Not only are there significant screening resources available, but also partners are plentiful. As I mentioned in April, the grocery store Hy-Vee and our local YMCA were willing partners at a diabetes policy meeting in mid-Missouri this spring and will join MHA and other partners for the second meeting next week. Other conventional and unconventional partners are out there.

Guidelines for diabetes management are available and should be at the core of any program. However, they are a starting point. Individual care plans that reflect the patient’s reality are essential.

Diabetes is preventable. However, prevention requires the patient’s commitment to self-management. For low health literacy or low health access communities, the approach should be tailored to the factors that can influence self-management. Some strategies will involve cultural change while others will require education and better access to care, counseling and support. It is a complex condition requiring multifaceted approaches.

Each hospital, community and patient is different. The five-point strategy included in Trajectories is a framework for implementing a program; it isn’t a program itself. However, a wealth of resources are available — many for free — to help support hospital efforts.

Diabetes may be pervasive, but the disease is personal. The best way to eliminate it is one bite at a time.

Let me know what you’re thinking.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
U.S. House Committee Approves Rural Direct Supervision Bill
CMS Releases Medicare OPPS Proposed CY 2017 Payment And Policy Updates
CMS Proposes CY 2017 Physician Fee Schedule Payment And Policy Updates
TJC Releases Data On Diagnostic Imaging Compliance
May MUR Available On HIDI Analytic Advantage®

state and federal health policy developments

U.S. House Committee Approves Rural Direct Supervision Bill

Staff Contact: Daniel Landon

The U.S. House of Representatives’ Committee on Ways and Means unanimously approved a bill that waives enforcement of the Centers for Medicare & Medicaid Services’ regulations requiring direct supervision of specified medical procedures delivered in critical access hospitals and small rural hospitals. If enacted, the enforcement waiver would apply to calendar year 2016. Congress previously passed comparable waivers for 2014 and 2015.

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Regulatory News
the latest actions of agencies monitoring health care

CMS Releases Medicare OPPS Proposed CY 2017 Payment And Policy Updates

Staff Contact: Andrew Wheeler

On July 6, the Centers for Medicare & Medicaid Services released the calendar year 2017 payment and policy updates to the Medicare outpatient prospective payment and ambulatory surgical center payment systems. CMS projects that the updates will increase the OPPS payments by 1.6 percent or $671 million, and increase ASC payments by 1.2 percent or $214 million. Highlights of the rule include the following.


  • increasing the number of comprehensive ambulatory payment classifications or C-APCs from 37 to 62
  • policy refinements to packaged services
  • hospital outpatient department site neutral payment provisions, which implements Section 603 of the Bipartisan Budget Act of 2015
  • outpatient quality reporting program revisions


  • ASC quality reporting program revisions


  • removal of pain management dimension from the inpatient prospective payment value-based purchasing adjustment for fiscal year 2018
  • restoration of the CMS tolerance limit for patient and graft survival level to the original 2007 rule, which means that transplant programs would not be out of compliance unless the number of observed events divided by the number of expected events exceeds 1.85
  • 90-day electronic health record reporting period in 2016 for all eligible professionals, eligible hospitals and critical access hospitals

Comments are due by 4 p.m. Tuesday, Sept. 6. MHA has published an issue brief with additional details.

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CMS Proposes CY 2017 Physician Fee Schedule Payment And Policy Updates

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services released the calendar year 2017 payment and policy updates to the Medicare physician fee schedule. CMS projects that the updates will decrease physician payments by 0.08 percent as compared to 2016. The rule includes proposals that CMS believes will transform how Medicare pays for primary care through a new focus on care management and behavioral health. The rule also includes a proposal to expand the Diabetes Prevention Program beginning Jan. 1, 2018. Comments are due by 4 p.m. Tuesday, Sept. 6.

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TJC Releases Data On Diagnostic Imaging Compliance

Staff Contact: Sarah Willson

In July 2015, The Joint Commission made revisions to diagnostic imaging-related standards that addressed magnetic resonance imaging safety, equipment performance evaluations, computed tomography radiation dose monitoring and protocol review, and staff education. To better understand how well organizations were implementing imaging changes, TJC reviewed final accreditation reports for ambulatory care and hospital surveys conducted between July 2015 and March 2016. The data show 57 instances of noncompliance. New standards are proposed to take effect Saturday, Oct. 1.

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HIDI Tech Connect

May MUR Available On HIDI Analytic Advantage®

Staff Contact: Cerise Seifert

Data for the May 2016 monthly utilization report have been posted on HIDI Analytic Advantage® and are available to download for distribution or placement in a network folder. HIDI Analytic Advantage® PLUS has been updated to include this data. The contacts from the participating hospitals have been notified by email, and they may download and save the Excel worksheet to a secure location on their networks or PCs. The data are encrypted on the site and also during the transmission from HIDI. Once transferred, the data must be secured according to the hospital’s security procedures. June data are now being collected and are scheduled to be available Friday, Aug. 5.

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Did You Miss An Issue Of MHA Today?

July 7, 2016
MLN Connects Provider eNews Available
CMS Releases OQR Specifications Manual
TJC Offers eCQM Webinars
AHRQ Releases PSO Program Briefs

July 6, 2016
Governor Acts On Seven Health Bills
Governor Orders $115 Million In Spending Restrictions
U.S. House Advances Mental Health Bill
State Releases June 2016 General Revenue Report
CMS Releases Medicare OPPS And ASC Proposed Payment And Policy Updates
HIDI Releases Second Quarter FFY 2016 Inpatient, Outpatient, Missouri Databases
Trajectories — Diabetes: Population Health Improvement
HRSA Announces 340B Recertification Webinar

July 5, 2016
DOJ Hikes Civil False Claim Penalties
CMS And TJC Release National Inpatient Quality Measures Specifications Manual
CMS Announces PC-01 First Quarter 2016 Data Submission Period Delay

Consider This ...

The average patient with diabetes will incur medical costs of $13,700 per year, with approximately $7,900 directly attributed to diabetes.

Source: July 2016 edition of Trajectories