MHA Today | July 22, 2016

July 22, 2016

MHA Today: News for Healthcare Leaders

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Herb Kuhn, MHA President & CEO

Although I haven’t discussed it in this column recently, we continue to fight the wage-index manipulation that was included in the Affordable Care Act. This week, I wanted to share a recent column that I co-authored with Bill Pully, President of the North Carolina Hospital Association. It appeared in Modern Healthcare and The Hill.

Imagine a bank robbery gone wrong. Now, imagine the robbers ask the police for a do-over.

We all know that the reward for a botched bank robbery isn't a second shot at someone else's money. Astoundingly, the hospitals in the Commonwealth of Massachusetts are asking for exactly that kind of do-over.

As the Affordable Care Act was winding its way through Congress, a backroom deal allowed every hospital in Massachusetts to benefit from the labor rates paid by tiny 19-bed Nantucket Cottage Hospital. The sweetheart deal came at the expense of nearly every other hospital in the U.S. Known to many as the “Bay State Boondoggle,” the sleight of hand has already resulted in $1.3 billion in additional payments to Massachusetts hospitals and could reach $3 billion over 10 years.

At the heart of the issue is Section 3141 of the ACA. The provision allowed Massachusetts hospitals to gerrymander the arcane Medicare wage index system to their advantage by using an extremely remote, low-volume hospital located on an extremely high-cost-of-living island as the floor for all wages statewide. The increase benefited Massachusetts significantly and a few other states marginally. It disadvantaged the vast majority.

When the Alliance of America's Hospitals recognized that a robbery was underway, we tripped the alarm. Backup appeared quickly. The CMS, the federal agency that administers Medicare, quickly criticized the ACA policy as a “manipulation.” Unfortunately, they are required by law to enforce it. The Medicare Payment Advisory Commission, charged with reviewing Medicare on behalf of Congress, challenged the provision's equity. As MedPAC pointed out, Nantucket Cottage Hospital treats only about 150 inpatients a year, yet it influences payments nationally.

Karma seems to have worked faster than policy change. This year, the hospital's consultants misreported wages. The error was found only after the report was duly validated and accepted by the CMS. Now, some in the commonwealth are asking the CMS to reverse the mistake and restore $160 million in funding that Massachusetts hospitals would otherwise lose in fiscal 2017.

There are some obvious reasons that the CMS should decline the request.

First, the fiscal 2017 submission was made by professional consultants who had ample time to collect the correct data and additional time to review and revise the data after it was submitted. Section 3141 aside, the Medicare wage index process is available to all hospitals, and is transparent and formal. There should be no special exceptions.

Second, Massachusetts' one-year loss of $160 million is a small loss compared with the billions that have already been and will be gained through the manipulation from the budget-neutral program. Massachusetts' hospitals benefited from rules they rigged. Now that the tables have turned, their cries for justice and special treatment should fall on deaf ears.

Finally, the request for resubmission is the strongest evidence yet of a broken system. Inaccurate data from a similar hospital in most states would have resulted in a change reminiscent of a rounding error. Under a rigged system — such as what we are presently witnessing — a data error from Nantucket Cottage Hospital can generate changes national in scope. That's absurd.

The mistake has turned the “Bay State Boondoggle” into the “Bay State's Boondoggle.” We have little sympathy, but a small share of empathy. Hospitals in our states, and throughout the nation, understand how important the wage index system can be. We've been living under this rigged system.

Congress can repair past injustice by repealing Section 3141 of the ACA. Two bills currently before Congress — H.R. 1479 and S. 1135 — would address the manipulation. These bipartisan measures have the support of both House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell. They deserve swift consideration and adoption on behalf of the Medicare beneficiaries that depend on our nation's hospitals.

But in the interim, the CMS should say no to Massachusetts' request, and Congress should act quickly to fix the system. The only do-over that deserves consideration is repeal of the provision.

CMS is expected to make a ruling on this issue by Monday, Aug. 1. MHA has been working with our congressional delegation and our national partners to ensure CMS understands the implications of allowing Massachusetts a do-over.

Missouri already has lost more than $60 million through the wage-index manipulation. We’re continuing the fight to ensure the losses are stopped and the provision is repealed.

Send me a note to let me know what you think.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO


In This Issue
CMS Announces Million Hearts Cardiovascular Disease Risk Reduction Model Participants
HIDI Releases Enhanced Readmissions Report Suite On HIDI Analytic Advantage® PLUS
CMS Announces Availability Of Hospital Compare Reports

Regulatory News
the latest actions of agencies monitoring health care

CMS Announces Million Hearts Cardiovascular Disease Risk Reduction Model Participants

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services previously announced a request for application for the Million Hearts Cardiovascular Disease Risk Reduction Model, which is an opportunity for health care professionals to design sustainable models of care that help reduce the 10-year atherosclerotic cardiovascular disease risk and prevent heart attacks and strokes. CMS received 762 applications and has announced the 516 selected participants. Missouri participants include the following.

  • Big Springs Medical Association, Ellington
  • Bridget P Early MD LLC, Ashland
  • Clay Platte Family Medicine Clinic, PC, Kansas City
  • Family Medicine of Southeast Missouri, LLC, Sikeston
  • Mercy Clinic East Communities, Washington
  • Meritas Health Corporation, Kansas City
  • Missouri Cardiovascular Specialist, LLP, Columbia
  • Nevada Regional Medical Center, Nevada
  • Saint Luke’s Health System, Kansas City
  • Washington County Memorial Hospital, Potosi

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HIDI Tech Connect

HIDI Releases Enhanced Readmissions Report Suite On HIDI Analytic Advantage® PLUS

Staff Contacts: Josette Bax or Shane VanOverschelde

Readmissions reports, including the executive readmissions dashboard, have been expanded and now include condition-specific readmissions for acute myocardial infarction, chronic obstructive pulmonary disease, heart failure, pneumonia, stroke, hip/knee, coronary artery bypass grafting measures and hospitalwide readmissions. The reports have been enhanced to include convenient in-report, user-defined filter and display options, more comprehensive time series displays, and new system aggregation functionality. The measure calculations have been modified to reflect refinements recently adopted by the Centers for Medicare & Medicaid Services as reported publicly on the Hospital Compare website, and used to determine penalties for excess readmissions through the Hospital Readmission Reduction Program. Updated readmissions reports will be available on Monday, July 25, to authorized HIDI Analytic Advantage® quality users and can be found on HIDI Analytic Advantage® PLUS in the “Advantage +,” “Quality,” “Readmissions” folder. Webinars have been scheduled July 25 and Tuesday, July 26, to further discuss the reports. Current subscribers with questions about downloading files should contact HIDI.

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Quality and Population Health

CMS Announces Availability Of Hospital Compare Reports

Staff Contacts: Dana Dahl or Stephen Njenga

The Centers for Medicare & Medicaid Services has announced that now through Friday, Aug. 19, outpatient participating, inpatient quality reporting and PPS-exempt cancer hospitals can view the October 2016 Hospital Compare preview reports through the QualityNet Secure Portal. Hospitals are encouraged to review their reports before they are made available in October.

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Did You Miss An Issue Of MHA Today?

July 21, 2016
U.S. Department of Justice Sues To Block Insurance Mergers
CMS Data Brief Explains Distribution Of Hospital Quality Star Ratings
National Academies Release Social Risk Factors Analysis
MLN Connects Provider eNews Available
DHSS Posts Economic Impact Of CAHs
Barnes-Jewish West County Hospital Names New President

July 20, 2016
State Releases First MMIS RFP
Trajectories — Diabetes: Population Health Improvement
Ozarks Community Hospital Applies For License Suspension
Registration Opens For IRF And LTCH Quality Reporting Program Trainings

July 19, 2016
CMS Announces Outreach And Education Webinars
CMS Posts Additional Sepsis Guidance
AHRQ Medication-Assisted Treatment Of Opioid Abuse Grants

July 18, 2016
MedPAC Releases June 2016 Health Care Spending And Medicare Program Data Book
State Publishes Medicaid Managed Care RFP Addendum 5
CMS Publishes QRDA Resources
NHSN Announces Quality Reporting Reminders
HRET Releases CHNA Process Guide

Consider This ...

The average Medicare spending for a person with Alzheimer's and other dementias is three times higher than for seniors without dementia.

Source: Alzheimer's Readiness Project