MHA Today | March 31, 2017

March 31, 2017

MHA Today: News for Healthcare Leaders

twitter linkedin 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

In a natural disaster or large scale, man-made emergency, hospitals plan for, and expect, a patient surge. As a result, planning, equipment and training for patient surge are components of hospitals’ broad-based preparedness plans. Many emergencies are demographically indifferent — an earthquake or tornado may produce patients of all ages with lacerations or crush injuries, while a biological disaster may require mass prophylaxis or respiratory support. However, not all emergencies are populationwide.

This week, members of the St. Louis Pediatric Advisory Council held a workshop on the region’s capacity to handle a very different type of emergency — a pediatric-specific emergency. Participants’ mission was to evaluate the capacity to handle a significant surge of acute pediatric patients while identifying safe and appropriate care venues for approximately 20 percent of pediatric hospitals’ current census.

The goal of the workshop was to provide a foundation for a statewide pediatric surge plan. Specifically, participants worked to identify gaps in provider capability, transportation, staff and specialty equipment.

The exercise was largely clinician-led. Although the audience included administrators, hospital and health care organization emergency response staff, and regional emergency response coordinators, the goal was to safely and efficiently transition pediatric patients in and out of children’s hospital care — an effort with a strong clinical decision-making bias, despite the logistical elements. In part, this is because pediatric surge presents a special challenge. Although most hospitals have some pediatric care capacity, few have the staff, space and equipment to take on complicated pediatric patients for extended periods. The limited pediatric bed space in the full-service acute care setting is a testament to the strength of the children’s and pediatric hospital community. It’s also a point of concern that planners can begin to address to ensure better preparedness for all-hazards readiness.

One takeaway from the effort was the absence of an established pediatric-specific bed tracking process in EMResource — a tool to quickly evaluate capacity. Fortunately, the capability exists and will be implemented immediately based on participant input.

As with many of the lessons of training and real-world response, the takeaways are transferable. A better understanding of capacity can help support response to less extraordinary events — like an influenza outbreak that disproportionately affects children.

It’s worth mentioning also, that the workshop is another example of the strong partnership between MHA and hospitals — individually and collectively. Hospital preparedness reflects our statewide goal of increased community resiliency, which aligns with the better health aspect of the Triple Aim.

Thank you to all of the hospital staff and associated response personnel that participated in the workshop. It was an important step in building a stronger system.

Send me an email to let me know what you’re thinking.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue

Committee Defeats, Advances APRN Bills
MO HealthNet Revises Presumptive Eligibility Authorization Notices
Trump Executive Order Creates Opioid Abuse Commission
CMS Finalizes Rule Addressing Hospital-Specific DSH Limits
DHSS Updates Controlled Substance List
HIDI Releases First Quarter FFY 2017 Update To Discharge Data-Based Quality Indicators
St. Anthony’s Medical Center Names Interim President And CEO

state and federal health policy developments

Committee Defeats, Advances APRN Bills

Staff Contact: Daniel Landon

The House Professional Registration and Licensing Committee voted on House Bill 165 and defeated the measure. It would have eliminated various requirements governing collaborative practice arrangements between advanced practice registered nurses and physicians, redefined the scope of practice of APRNs, revised APRNs’ authority to prescribe controlled substances and created a separate category of professional licensure for APRNs. The committee did approve a more limited bill relating to APRN practice, House Bill 244.

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MO HealthNet Revises Presumptive Eligibility Authorization Notices

Staff Contact: Brian Kinkade

MO HealthNet has issued an alert to providers about a change in the authorization notice for presumptive eligibility participants. The old authorization notice assigned the participant a temporary department client number that was designated with a “P” prefix. Temporary DCNs are no longer used. The new authorization form will have a regular eight-digit DCN assigned for each eligible participant. The change affects both presumptive eligibility categories: PE-3 (children, former foster children, qualifying adult caretakers); and PE-3 TEMP (pregnant women).

Providers should verify participant eligibility at the time services are rendered by contacting the interactive voice response system at 573/751-2896 or through the division’s billing website. Questions about new authorization notices should be directed to the Family Support Division’s information center at 855/373-4636.

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Trump Executive Order Creates Opioid Abuse Commission

Staff Contacts: Leslie Porth or Daniel Landon

President Trump has issued an executive order creating a President’s Commission on Combatting Drug Addiction and the Opioid Crisis. It will be chaired by New Jersey Gov. Chris Christie.

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Regulatory News
the latest actions of agencies monitoring health care

CMS Finalizes Rule Addressing Hospital-Specific DSH Limits

Staff Contacts: Jane Drummond or Kim Duggan

The Centers for Medicare & Medicaid Services finalized its proposed rule for calculating uncompensated care costs to determine a hospital’s specific disproportionate share hospital payment limit. The agency asserts that the rule merely clarifies its existing policy that uncompensated care costs are equal to the net costs of caring for Medicaid beneficiaries after accounting for all payments made on their behalf, including Medicare and other third-party payments. The rule codifies a methodology that first appeared in 2010 FAQ guidance, which was used in determining hospital-specific DSH limits in the 2011 to 2013 audits. This methodology has been challenged in several courts, including a pending lawsuit filed by MHA in the Western District of Missouri. The rule will be published in the Federal Register on Monday, April 3, and takes effect 60 days thereafter. MHA has published an issue brief with additional information.

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DHSS Updates Controlled Substance List

Staff Contacts: Sarah Willson or Leslie Porth

The Monday, April 3, edition of the Missouri Register includes amendments to 19 CSR 30-1.002 relating to controlled substances. The Missouri Department of Health and Senior Services is authorized to update the state list of controlled substances by rule to match the federal controlled substance list pursuant to section 195.015, RSMo. A notice of proposed rulemaking that includes the proposed amendment was published Nov. 1, 2016. The changes are effective 30 days after publication.

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HIDI Tech Connect

HIDI Releases First Quarter FFY 2017 Update To Discharge Data-Based Quality Indicators

Staff Contact: Josette Bax

The Readmissions, Hospital-Acquired Conditions and AHRQ Quality Indicators datasets have been refreshed in HIDI Analytic Advantage® PLUS to include measure calculations based on discharge data from the first quarter of federal fiscal year 2017. These quality data updates can be found in various reports in the following Analytic Advantage Plus locations.

  • Quality > Benchmarking
  • Quality > Readmissions
  • Quality > Strategic Quality Initiatives

Users with technical questions about the measures should contact Josette Bax. For questions about accessing the website or running reports, please contact HIDI.

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CEO Announcements

St. Anthony’s Medical Center Names Interim President And CEO

Staff Contact: Carol Boessen

Kelly Wetzler, Senior Vice President, has been named Interim President and CEO of St. Anthony’s Medical Center in St. Louis. She joined St. Anthony’s in 2015 as Senior Vice President of Special Projects and was appointed Interim President and CEO following the death of Dave Sindelar earlier this month. Wetzler previously served as Senior Vice President of Corporate Development and Risk Management at Viasystems Group. St. Anthony’s doesn’t plan to name a new permanent CEO until after its affiliation with Mercy Health is completed. A list of CEO changes is available online.

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Did You Miss An Issue Of MHA Today?

March 30, 2017
Committee Approves Tort Reform Bills
State House Advances Prescription Drug Monitoring Legislation
MHA Distributes Analysis Of Medicare’s HAC Reduction Program
MLN Connects Provider eNews Available
CMS Announces OQR Education Session
Americans Celebrate National Doctors’ Day 2017

March 29, 2017
MO HealthNet Revises Pharmacy Reimbursement Methodology
CMS Releases Memo On New Emergency Preparedness Rule
Trajectories — Infection Control Strategies
RWJF Releases County Health Rankings Annual Report

March 28, 2017
Missouri House Of Representatives Passes FY 2017 Supplemental Budget Bill
Hospital Tort Reform Bill Receives House Hearing
Hospital Regulatory Relief Bill Receives Hearing In Senate Committee

March 27, 2017
Rating Agency Suggests AHCA Halt May Increase Uncompensated Care Costs
CMS Releases HCP Measure Checklist

Consider This ...

Opioids were involved in the overdose deaths of more than 33,000 Americans in 2015, nearly quadruple the number from the year 2000 and more than any year on record. The estimated lost productivity for people in the U.S. with opioid-use disorder totaled $20.4 billion in 2013.

Source: The Centers for Disease Control and Prevention Foundation