MHA Today | August 12, 2016

August 12, 2016

MHA Today: News for Healthcare Leaders

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Herb Kuhn, MHA President & CEO Herb Kuhn, MHA President & CEO

Editor's Note: This week's Insights column features commentary from Herb B. Kuhn, Missouri Hospital Association President and CEO, and Tom Bell, Kansas Hospital Association President and CEO.

Yesterday, the Kansas Hospital Association and Missouri Hospital Association jointly released new research on septicemia and sepsis in the two states. Although neither state’s rate deviates significantly from the national average, the research suggests that progress in sepsis identification and care within the states’ hospitals may be bending the curve on mortality and excess sepsis-related hospital inpatient days.

Next month, KHA and MHA will partner in reporting on the systems that are making a difference in sepsis care. The research released this week is designed to identify the scope of sepsis in the two states.

Sepsis is a killer. Patients that present with sepsis, or that suffer from hospital-acquired sepsis, have eight times the mortality rate of patients hospitalized without a sepsis diagnosis. Unfortunately, diagnoses have increased dramatically — especially among patients with community-acquired sepsis. The lethality of the condition and its prevalence create a high-value target for clinicians.

Although septicemia and sepsis require hospital care, hospitals aren’t the source of most sepsis cases. In 2015, approximately one in ten cases of sepsis were hospital-acquired. Among these, trauma admissions constitute nearly half, followed by emergency, urgent and elective admissions.

Older individuals and males are overrepresented in cases of sepsis. Analyzing sepsis prevalence by gender between October 2014 and September 2015, researchers found males experienced a rate of 8.04 percent, while females exhibited a rate of 5.81 percent. The gap widens for individuals with hospital-acquired sepsis, where males nearly double the prevalence of females at .92 percent to .53 percent.

During the same time period, sepsis prevalence for patients ages 18 to 39 was 2.73 percent. However, prevalence was much higher for older patients at 7.10 percent for patients ages 40 to 64, and 8.74 percent for patients ages 65 and older. Similar disparities are seen for hospital-acquired sepsis, with patients ages 18 to 39 at .22 percent, ages 40 to 64 at .76 percent and ages 65 and older at .92 percent.

Several factors influence these age and gender disparities, including access to health care, economic and social factors, type or source of infection, and hormonal differences. In addition, the Centers for Disease Control and Prevention suggests increased prevalence may result from an aging population, chronic illnesses, better surveillance, proliferation of antibiotic-resistant microbes, more invasive procedures, immunosuppressive pharmaceuticals, chemotherapy and organ transplantation.

Programs currently in place are decreasing hospital-acquired sepsis and reducing excess inpatient days connected with the illness. Many Kansas and Missouri hospitals are participating in Hospital Engagement Network programs — through the HEN 2.0 project — designed to prevent sepsis and improve sepsis care. We’ll report on how these programs and others are driving change next month. This month’s research underscores why the efforts in Kansas and Missouri are so important.

The challenges faced by Kansas and Missouri in reducing sepsis and improving sepsis outcomes are nearly as long as the potential influences on prevalence. Nonetheless, hospitals’ work in both states is reducing the harm while helping save health care dollars, improve quality of life and extend patients' lives.

In This Issue
CMS Proposes Medicaid DSH Standards Rule
HRSA Issues Proposed 340B Dispute Resolution Rule
TJC Announces Standards Updates

Regulatory News
the latest actions of agencies monitoring health care

CMS Proposes Medicaid DSH Standards Rule

Staff Contacts: Daniel Landon or Kim Duggan

The Centers for Medicare & Medicaid Services has issued a proposed rule regarding the role of third-party payments in calculating uncompensated care costs and Medicaid Disproportionate Share Hospital payments. The rule is scheduled to be published in the Federal Register on Monday, Aug. 15. The deadline for submitting public comments is Wednesday, Sept.14.

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HRSA Issues Proposed 340B Dispute Resolution Rule

Staff Contacts: Daniel Landon or Steve Renne

The Health Resources and Services Administration has issued a proposed rule that would create new processes for resolving disputes between providers and pharmaceutical manufacturers in the 340B drug discount program. The deadline for submitting public comments is Tuesday, Oct. 11.

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TJC Announces Standards Updates

Staff Contact: Sarah Willson

Throughout the next six months, The Joint Commission will be revising and adding several programs and standards. Hospitals should be aware of the following.


September November
  • 2012 Life Safety Code® — The Centers for Medicare & Medicaid Services and TJC will begin surveying hospitals on the 2012 LSC on Tuesday, Nov.1. The Healthcare Facilities Accreditation Program has released its prepublication standards for LSC surveys as well.
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Did You Miss An Issue Of MHA Today?

August 11, 2016
HIDI HealthStats — Sepsis Hospitalization Five-Year Trends In Kansas And Missouri
HIDI Releases Second Quarter FFY 2016 Update to Discharge Data-Based Quality Indicators
MHA Publishes Quality Resource Brief
CMS Updates IQR Program Known Issues Document
MLN Connects Provider eNews Available

August 10, 2016
MHA Comments On Proposed Rule
CMS To Make Incentive Payments For Independence At Home Demonstration
CMS Announces Next Open Door Forum
CMS Updates Nursing Home Five-Star Quality Ratings
HRSA Provides Shortage Designation Project Webinar Recordings
340B Recertification Process Begins Today

August 9, 2016
TJC Releases Specifications Manual
CMS Provides Updated Tools And Tips For IPF Reporting

August 8, 2016
MHA Distributes Analysis For Proposed Updates To CY 2017 Home Health PPS
Observation Status Notice Law Takes Effect
June MUR Available On HIDI Analytic Advantage®

Consider This ...

Nearly all of the increase observed in adult hospitalizations for septicemia or sepsis lists the condition as the principal diagnosis, which suggests that community-acquired, rather than hospital-acquired sepsis, is driving the increase.

Source: HIDI HealthStats