MHA Today | May 26, 2017

May 26, 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.

Editor’s Note: MHA Today will not be published Monday, May 29. Publication will resume Tuesday, May 30.


Herb Kuhn, MHA President & CEO

This week’s news got me thinking about the game Jenga. In Jenga, players remove wooden bricks from a tower and place the bricks on the top of the stack. As bricks are removed, the tower becomes less and less stable, and the players increasingly risk that their next move will cause a collapse — and loss of the game.

Sadly, it seems that federal policies are increasingly moving toward a Jenga-like approach to investments in the health care safety net. This week has been full of signals about the hollowing out of the structure.

On Tuesday, the Trump administration delivered its first full budget to Congress. The proposal included significant and wide-ranging cuts to social service programs. The magnitude of cuts to Medicaid and other health-related programs was shocking. In fact, many in Congress seemed gobsmacked.

The federal budget cuts include $800 billion in reduced funding for the Medicaid program through partial repeal of the Affordable Care Act and cuts in other Medicaid spending, including the Children’s Health Insurance Program. The federal cuts would come with increased program flexibility for states, but ultimately represent an unprecedented cost shift. States like Missouri would have no choice but to limit eligibility, benefits or provider payments — or all three.

The budget proposal includes a 64 percent decrease in nursing workforce development funding, a $146 million reduction, while maintaining funding for several other nursing workforce initiatives. Last week, I discussed the nursing shortage in this column. In 2016, staff registered nurses were the largest single category of hospital employee and had the highest level of vacancy among the 36 positions included in the research. We need to invest more, not less, in future nurses.

On Wednesday, the Congressional Budget Office released its scoring on the American Health Care Act — the U.S. House’s “repeal and replace” plan. The bill was adopted without the CBO’s scoring on cost. Release of the score has been highly anticipated, as it would signal the federal savings and potential increase in the number of the nation’s uninsured.

The CBO anticipates that 23 million Americans will lose health insurance throughout a decade, with more than half coming from reduced Medicaid eligibility. The last minute additions to help protect individuals with preexisting conditions reduced the earlier CBO estimate by about one million individuals. However, the uninsured rate in 2026 under the AHCA was estimated to be 18.6 percent, rather than the 10 percent anticipated under the ACA. That’s a major policy reversal, and higher than the pre-ACA rate of 16.3 percent in 2010.

Wednesday delivered additional bad news. Blue Cross and Blue Shield of Kansas City decided to pull out of the ACA’s individual insurance marketplace in 2018. The insurer offered the only individual policies in the marketplace in 25 Missouri counties. Unless another insurer steps into these markets, a large section of northcentral and northwest Missouri will be without individual marketplace options. To take advantage of federal subsidies, Missourians must purchase policies available on For these Missourians, there may be no policies, and therefore no subsidies, to make them affordable.

Since President Trump has yet to signal his position on the extension of marketplace subsidies, many insurers are considering pulling out of the program. Anthem, another major player in Missouri’s marketplace, stated this week that it has yet to make a decision on participation.

The silver lining, if there is one, would be the low likelihood that either the president’s budget or the AHCA will be enacted in their present form. However, the lack of a firm decision by the White House on the insurance subsidies is creating a self-fulfilling prophecy in the marketplace — the long discussed death spiral. Absent action, the marketplace could collapse from benign neglect.

There are important fights ahead as the budget and health care legislation move forward. States like Missouri must receive equitable treatment as the future of Medicaid expansion or Medicaid restructuring takes place. The AHCA attempts to promote funding equity between Medicaid expansion states and states like Missouri that took a conservative approach to the ACA. However, it falls far short of the mark. MHA, as part of a coalition of providers, recently sent a letter to Sen. Roy Blunt underscoring the importance of equity in any changes to the ACA.

The future of provider taxes is not mentioned in the budget or AHCA. The Federal Reimbursement Allowance and other provider taxes are essential building blocks in the state match for the existing Medicaid program. Without this system, the state would be billions of dollars farther in the hole if federal changes are made.

Finally, according to the CBO, the AHCA creates $119 billion in federal savings. These savings are the result of benefit cuts that exceed the taxes and provider payment reductions that are imposed by the ACA to pay for the program. The AHCA doesn’t roll back all of the payment reductions to hospitals. Under the House version of the AHCA, Missouri hospitals would lose more than $5 billion throughout a decade, while seeing the cost of the uninsured skyrocket. This is unfair and unsustainable.

There are only so many blocks that can be removed before the structure crumbles. When you lose at Jenga, you set the tower back up and start over. Breaking the health care system has much higher stakes.

The House now has the president’s budget and the Senate now has the AHCA. There’s a bright light shining on efforts to move blocks from the bottom to the top. And, there’s a growing awareness that the leadership in Washington will be responsible if the system collapses.

Have a good holiday weekend. Send me a note to let me know what you’re thinking.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
Missouri State Board Of Nursing Issues Emergency Rule
TJC Releases First SAFER™ Matrix Results

Regulatory News
the latest actions of agencies monitoring health care

Missouri State Board Of Nursing Issues Emergency Rule

Staff Contacts: Sarah Willson or Jill Williams

The Missouri State Board of Nursing has issued an emergency rule, approved by the Secretary of State, recognizing those who have completed the Air Force Basic Medical Technician Corpsman Program 4N051 – 5 Skill Level and above to meet educational standards and academic preparation for licensure as a practical nurse. It is noted in the rule that approximately 27 individuals will be immediately eligible for application for licensure upon effective implementation of the rule, which occurred May 9.

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TJC Releases First SAFER™ Matrix Results

Staff Contact: Sarah Willson

The Joint Commission began using the SAFER™ Matrix in deemed psychiatric hospitals in the summer of 2016. Based on surveys conducted between August 2016 and February 2017, TJC has released the first set of data using the new scoring methodology. TJC notes that the new scoring methodology allows organizations to see aggregate data and areas of significant risk. The recently released data provides an overview of the top areas of compliance risk.

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Did You Miss An Issue Of MHA Today?

May 25, 2017
General Assembly Proceeds With Special Session
MHA Releases Issue Brief On CBO’s AHCA Score
Missouri HIIN Provides Educational Conference
HIDI Hosts Monthly Focus Session On Market Trend Reports
HIDI Posts Hospital Profile Report

May 24, 2017
CBO Issues Score On American Health Care Act
MHA Releases Statement On Trump Budget Plan
BCBS Of Kansas City Exits Individual Marketplace In 2018
MHA Supports Proposed Change To Medicare DSH Formula
MO HealthNet Posts Managed Care Training Presentation
MHA Distributes Analysis Of Proposed Medicare Inpatient PPS For FFY 2018
CMS Updates Known Issues Documents

May 23, 2017
Trump Releases FY 2018 Budget
MHA Submits AHCA Comments To Senate Finance Committee
MO HealthNet Clarifies Outpatient Lab Billing
CMS Posts CY 2017 eCQM Reporting Resources
Moberly Regional Medical Center Names New CEO

May 22, 2017
HHS Delays Effective Date Of 340B Drug Pricing Rule
CMS Updates Quality Reporting Center IPFQR Resources
HIDI Hosts Monthly General Session Training Webinar
USDA Offers Distance Learning And Telemedicine Grant Workshop

Consider This ...

According to the North American Meat Institute, Americans are expected to consume more than 100 million pounds of ground beef throughout the Memorial Day weekend. That equates to 400 million quarter pound hamburgers. The day before Memorial Day has been coined National Hamburger Day.

Source: Missouri Cattlemen’s Association