MHA Today | June 23, 2017

June 23, 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
Yesterday, the U.S. Senate released its much anticipated discussion draft in answer to the U.S. House of Representative’s American Health Care Act. Although the Senate’s Better Care Reconciliation Act differs from the House version, it’s more of a change in lyrics than an entirely different tune. Deep cuts to the Medicaid program would occur over time as the program transitions to a per-capita cap or block grant program. Provider tax rates are reduced — a Senate addition. And, the health insurance marketplace subsidized premium support is shifted downward to provide subsidies for those with incomes from zero to 350 percent of the federal poverty level, as opposed to the ACA’s 100 to 400 percent of the FPL.

Coverage remains of paramount importance. Any reform plan should include more, rather than less coverage.

Although the Senate bill is important, its release was a discussion draft. The Senate would like to vote on the bill before the Fourth of July recess. However, it isn’t clear whether the Republican caucus has the required 51 votes to move the bill to the next step. At this point, any portion could be modified, removed or replaced with something different, to appease members in either chamber, or on either side of the distribution within the GOP.

AHCA Preexisting ConditionsWe released a summary yesterday, and I encourage members of the hospital community to take a look. Missouri Sen. Roy Blunt sent a tweet yesterday saying he will be reviewing the legislation to determine "... how it will help address problems Missourians are facing." We plan to help him answer that question with a detailed analysis, bolstered with information from the Congressional Budget Office and Joint Committee on Taxation that’s expected next week.

Since the policy is a moving target, I want to focus on the people behind the proposed bill — not the decision makers, but the ones affected by the policies. The same kind of analysis Sen. Blunt is seeking.

On Thursday, as the Senate’s draft was being released, MHA released a policy brief on the prevalence of preexisting conditions in Missouri. Research takes lead-time and the brief has been a priority since the AHCA was adopted. The Senate’s announcement stepped on the story, but the data remain timely as debate continues.

I’ve already buried the lede. The research identified 1.2 million Missourians who were diagnosed in a hospital with a preexisting condition that would have been declinable by an insurance company prior to the ACA. That’s 33 percent of the population ages 18 to 64. And, that’s only the diagnoses made in a hospital during the two-year evaluation period of 2015 to 2016.

The majority of these patients had only one identified preexisting condition. However more than four out of 10 were diagnosed with more than one potentially declinable condition, and 9.4 percent were diagnosed with four or more conditions like heart disease, cancer or diabetes. Of the 114 Missouri counties and the City of St. Louis, 27 had more than 40 percent of the total population ages 18 to 64 diagnosed with a declinable preexisting condition. There was significant variation geographically. The prevalence of declinable preexisting conditions in the survey population ranged from 10.9 percent in Lewis County, to 52 percent in DeKalb County.

All of this is important because the efforts to replace the ACA are very much in play. The AHCA would allow states to seek waivers to federal requirements — including eliminating the existing requirement for 10 essential health benefits included in the ACA and potentially a return to medical underwriting. This could have significant and perverse consequences for the marketplace and could reduce access to insurance for Missourians with preexisting conditions. The CBO warned about this in its analysis of the AHCA. According to the CBO, younger or healthier individuals may avoid the community-rated market and take advantage of the return to medical underwriting. This would benefit the healthy, but could lock Missourians with preexisting conditions into prohibitively-priced individual insurance markets.

This is no small problem. Missouri had a high-risk pool — the Missouri Health Insurance Pool — that served as an alternative insurance option for higher-risk individuals searching for more affordable or more complete coverage, and those who had recently lost coverage through a group plan. However, the legislation that authorized MHIP included exclusions for individuals with preexisting conditions. Under the exclusions, individuals treated, diagnosed or receiving prescription medication for a medical condition in the six-month period before the enrollment date would have no benefits provided for treatment of that same condition for 12 months.

Any guess at the MHIP participation level? The highest enrollment year for the pool was 4,116 individuals in 2010.

One-third of Missourians 18 to 64 were diagnosed with a potentially declinable preexisting condition in a hospital in 2015 and 2016. The solutions to getting them, and keeping them, in the health insurance system will have to be as big as the problem.

Send me a note with your thoughts.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
HIDI Releases Second Quarter FFY 2017 Inpatient, Outpatient, Missouri Databases
First Quarter 2017 HCAHPS Data Submission Deadline Approaching
CMS Releases Hospital-Specific Reports For IPPS Deficit Reduction Act, Hospital-Acquired Conditions Measures

HIDI Tech Connect

HIDI Releases Second Quarter FFY 2017 Inpatient, Outpatient, Missouri Databases

Staff Contact: Shane VanOverschelde

The second quarter federal fiscal year 2017 inpatient and outpatient databases, including HIDI-reporting hospitals in Missouri, Illinois and Kansas City, Kan., are now available for download to subscribers of the Premier Data Package on HIDI Analytic Advantage®. The databases consist of a patient-level limited dataset, including all HIDI-reported discharges and visits to hospitals. Files are delivered as both text files and ready-to-query Microsoft Access database files. The files are located in the “Strategic Planning/Premier Data” section and are organized in the following categories.

  • Q1-Q2 FFY2017, Inpatient
  • Q1-Q2 FFY2017, Outpatient Classified
  • Q1-Q2 FFY2017, Outpatient Unclassified

Hospitals interested in subscribing to the 2017 HIDI Premier Data Package should review the package information. Current subscribers with questions about downloading files should contact HIDI.

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Quality and Population Health

First Quarter 2017 HCAHPS Data Submission Deadline Approaching

Staff Contact: Sherry Buschjost

The submission deadline for the Hospital Consumer Assessment of Healthcare Providers and Systems patient perspectives on care survey data for first quarter 2017 discharges (Jan. 1 – March 31) is Wednesday, July 5. The Centers for Medicare & Medicaid Services encourages all hospitals to submit data at least two days prior to the deadline to allow time to address any submission issues. Inpatient prospective payment system hospitals participating in the Hospital Inpatient Quality Reporting Program must collect and submit HCAHPS data to qualify to receive their full annual payment update. Non-IPPS hospitals must meet the same submission deadline for their data to be published on Hospital Compare.

The review and correction period is July 6-12, during which participating hospitals and survey vendors have the opportunity to access and review the HCAHPS data review and correction report. The report includes a summary of the data accepted into the warehouse for the quarter. New data are not accepted into the warehouse during the review and correction period. However, errors in data accepted into the warehouse by the July 5 deadline can be corrected during this period and resubmitted.

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CMS Releases Hospital-Specific Reports For IPPS Deficit Reduction Act, Hospital-Acquired Conditions Measures

Staff Contact: Sherry Buschjost

Hospital-specific reports for the fiscal year 2018 Hospital Readmissions Reduction Program are now available on the QualityNet secure portal. The Centers for Medicare & Medicaid Services encourages hospitals to review their report, including discharge-level data, and submit any questions during the review and corrections period that ends Thursday, July 20.

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Did You Miss An Issue Of MHA Today?

June 22, 2017
Senate Reveals AHCA Proposal
MHA Policy Brief Finds 1.2 Million Missourians Have Preexisting Conditions
MHA Distributes FFY 2018 Medicare VBP Projection And Pay-For-Performance Measure Trends
CMS Opens 60-Day Comment Period On CLIA Changes
MLN Connects Provider eNews Available
CMS Releases 1Q2017 Quality Reporting Checklists
CMS Updates IPFQR Program Resources
CMS Updates Known Issues Documents
Videos: Rural Health Care Workforce Insights

June 21, 2017
Trajectories — Opioid Use Disorder
MHA Distributes Wage Index Data For Review
MO HealthNet Notifies Medicare-Only MO Rx Participants About Coverage Termination
CMS Proposes Changes To MACRA In Second Year Of Quality Payment Program

June 20, 2017
State House Of Representatives Debates Abortion Legislation
Anthem Offers 2018 Marketplace Plans In Missouri
CMS Releases New Medicare Card Details
CMS Issues New Guidance In Several Key Areas
TJC Releases New Pain Management Standards

June 19, 2017
CMS Releases Hospital-Specific Reports
WPS Offers Informational Teleconference
Golden Valley Memorial Healthcare Names New CEO

Consider This ...

Nearly one-third of kids are overweight, and 17 percent meet the standard for obesity, meaning that for their age and sex they have a body mass index that is in the 95th percentile or higher

Source: Kaiser Health News