MHA Today | January 20, 2017

January 20, 2017

MHA Today: News for Healthcare Leaders

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MHA Today is provided as a service to members of the Missouri Hospital Association. Additional information is available online at MHAnet.


Herb Kuhn, MHA President & CEO

If I mention the name Tom Sawyer, your mind will probably take you to English class, Mark Twain, a family trip to Hannibal or scenes of life on the Mississippi from a bygone era. That’s not the Tom Sawyer I’m thinking about today. I want to share an idea from the lyrics of the song Tom Sawyer from the rock band Rush.

This week, MHA released the annual Community Investment Report. This year’s report, in addition to underscoring the essential contributions that hospitals make to support the communities they serve, provided a compelling and timely data point. For the first time in more than a decade, uncompensated care costs dropped between 2014 and 2015. Uncompensated care is still higher than it was in 2013. However, it’s no coincidence that in 2015, a growing number of Missourians had insurance through the federal marketplace.

The release comes amid action in Congress to modify the Affordable Care Act, and a promised strategy for repeal and replacement of the law by President Trump, who was inaugurated earlier today. We don’t yet know what “repeal and replace” looks like, but it’s clear that change is coming. That’s where the Tom Sawyer lyric comes in: “He knows that changes aren’t permanent. But change is.”

We all know that the Affordable Care Act has been controversial — it also has been transformational. Hospitals and the health care system have come a long way since the ACA was adopted in 2010. Subsequent legislation and countless regulations have pushed hospitals in new directions. Care is more coordinated, information has become more integrated and accessible, and value has become a central component of delivery and payment. None of this was easy. This progress must, and will, continue.

This year’s Community Investment Report underscores the influence of coverage on the use of resources to improve the health care system. The report finds that despite a drop in uncompensated care, total community benefit provided in 2015 was stable. This indicates that when hospitals have a reduced uncompensated care cost, they continue to invest in services that improve their communities. Think about the opportunities for individual and community health if hundreds of millions of dollars were available for targeted health improvement.

The new administration is expected to issue executive orders, and expand on their heretofore limited policy pronouncements about the future of the ACA, almost immediately. As we know from ACA implementation, real change will take time. However, individual health, and the stability of the health care system, hang in the balance.

Coverage will be a central issue in the replace effort. Health insurance, including Medicaid, can make a difference in individual health. That’s why the “replace” part of Washington’s deliberations is important. Replace signals both an understanding and acceptance that health care coverage is important and necessary. That’s critical for Missouri. The Community Investment Report shows that even with the improvements that have been made over the past few years, on average — every minute of every day, 365 days a year — an uninsured person is presenting themselves to a hospital emergency department in Missouri seeking health care services.

Since the ACA was funded in part through cuts to hospital payments, replacement should deliver either expanded coverage — which would be optimal — or a roll back of the cuts made to pay for it. Further, it is important that policymakers understand that the significant increase in charity care at Missouri hospitals — more than 450 percent increase throughout a decade — signals that growth in uncompensated care is unsustainable.

MHA is putting the opportunity to work. We’ve met with members of the federal delegation, and continue to work with state lawmakers to inform how change can be harnessed to benefit the state’s health care delivery system.

It’s clear the ACA isn’t permanent. However, recognizing that change itself is, gives us a clearer view of the options moving forward.

Let me know what you are thinking.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
CMS Reminds Providers About MOON Implementation Deadline
Surveillance Report Finds Increased Flu Activity In Missouri
CMS Posts Additional Notes For Sepsis Abstraction
CMS Seeks Comments On Proposed Medication Reconciliation On Admission Quality Measure

Regulatory News
the latest actions of agencies monitoring health care

CMS Reminds Providers About MOON Implementation Deadline

Staff Contacts: Sarah Willson or Jim Mikes

The Notice of Observation Treatment and Implication for Care Eligibility Act requires all hospitals, including critical access hospitals, to provide both written and oral notification of observation status to any beneficiary who is receiving observation services and not inpatient services during their stay. The Centers for Medicare & Medicaid Services has posted the official Medicare Outpatient Observation Notice form, and accompanying form instructions, on their website. Manual instructions will be made available in the coming weeks. All hospitals and CAHs are required to provide MOON notification beginning no later than Wednesday, March 8.

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Quality and Population Health

Surveillance Report Finds Increased Flu Activity In Missouri

Staff Contacts: Jackie Gatz or Toi Wilde

Yesterday, the Missouri Department of Health and Senior Services released its weekly influenza surveillance report indicating widespread flu activity in Missouri. More than 70 percent of the season-to-date total of 6,128 laboratory-positive influenza cases have been reported in the last three weeks. According to the report, influenza-like illness activity is above baseline for both the Missouri Outpatient ILI Surveillance Network and the hospital emergency room visit chief complaint data reported through ESSENCE.

Despite this spike in activity, trends throughout the next several weeks will better indicate the severity of this season’s flu and better identify the season’s peak. Health care providers are encouraged to continue promoting prevention methods, including proper handwashing, covering coughs and remaining home when symptomatic. As a reminder, MHA made a seasonal flu fact sheet available last fall.

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CMS Posts Additional Notes For Sepsis Abstraction

Staff Contact: Sherry Buschjost

The Centers for Medicare & Medicaid Services has posted additional notes for abstractors tasked with collecting data on sepsis-related cases for Jan. 1 to Dec. 31, 2017, discharges. CMS recommends participants in the Inpatient Quality Reporting program review this guidance in conjunction with specifications manual version 5.2a and other SEP-1 documentation. The information is available on QualityNet.

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CMS Seeks Comments On Proposed Medication Reconciliation On Admission Quality Measure

Staff Contact: Sherry Buschjost

The Centers for Medicare & Medicaid Services is seeking comments concerning the importance, relevance, scientific acceptability and feasibility of the proposed Medication Reconciliation on Admission quality measure. The measure is being developed under the Inpatient Psychiatric Facility Outcome and Process Measure Development and Maintenance Project for proposed adoption into the Inpatient Psychiatric Facility Quality Reporting Program. The measure assesses the average completeness of three components of the medication reconciliation process within 48 hours of admission.

  • comprehensive prior to admission medication information gathering and documentation
  • completeness of critical PTA medication information
  • reconciliation action for each PTA medication
To be considered, comments should be submitted by Friday, Feb. 10.

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Did You Miss An Issue Of MHA Today?

January 19, 2017
8.8 Million Americans Sign Up For Marketplace Coverage
CMS Announces APM Participants For 2017
SAMHSA Issues Confidentiality Final Rule
CMS Issues Cybersecurity Recommendations
MLN Connects Provider eNews Available
CMS Extends eCQM Data Submission Deadline
MedPAC Discusses Unified Payment For Post-Acute Care
Mercy St. Francis Hospital Names New Administrator

January 18, 2017
Gov. Greitens Presents State Of The State Address
State Legislators Hold Hearings On Health, Tort Reform Bills
MHA Distributes Financial Indicators Analysis
CMS Updates Known Issues Documents
TJC Sets Deadlines For Returning 2017 ORYX Measure Set Selections
HIDI Releases Fourth Quarter FFY 2016 Inpatient, Outpatient Databases
Rusk Rehabilitation Center Names New CEO

January 17, 2017
MHA Releases Annual Community Investment Report
CBO Estimates Repealing Portions Of ACA Would Affect Coverage And Premiums
CMS Issues Medicaid Managed Care Supplemental Payments Final Rule
CMS Reminds IPFQR Facilities To Enroll With NHSN
CMS Seeks Nominations For The IPFQR Technical Expert Panel
TJC Announces Pioneers In Quality Webinar
HHS Releases Trauma-Informed Resource Guide
HIDI Releases Third Quarter 2016 VBP Payments Model

January 16, 2017
Greitens Announces Spending Withholding Choices
HHS Finalizes New Medicare Appeals Procedures
FDA Regulation Bans Powdered Gloves
New Missouri RAC Contractor Hosts Webinar
HIDI HealthStats — Medicaid Utilization
CMS Announces Upcoming Education Sessions
RUPRI Releases Marketplace Rural Enrollment Brief
Henze Announces Retirement From Lake Regional Health System

Consider This ...

About 3 million Americans have glaucoma, the second leading cause of blindness worldwide. Glaucoma is a group of diseases that damage the eye's optic nerve and can result in vision loss and blindness.

Source: Centers for Disease Contol and Prevention