MHA Today | July 28, 2017

July 28, 2017
MHA Today: News for Healthcare Leaders

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Insights

Herb Kuhn, MHA President & CEO
Reading through the opinion pages this week, I came across a quote from a U.S. Supreme Court decision written by Oliver Wendell Holmes, “A page of history is worth a volume of logic.” That thought framed my thinking on two other columns published early this week — one from health care expert Paul Keckley and another from Steve Lipstein, CEO of BJC Healthcare. Each was prescient in light of this morning’s action in the U.S. Senate.

Keckley’s column includes a history of health care reform on the federal level. For more than 70 years, presidents and Congress have attempted to build a national health care system. There have been pendulum-swings in the level of government involvement, but always some degree of commercial insurance and marketplace role. The first major health legislation was offered by President Truman in 1945. The most recent is being discussed this week in the U.S. Senate.

Truth be told, nearly everyone can find something not to like about the nation’s health care system. There’s a reason. Each and every step forward has been a compromise between the powerful tensions that underpin the great American narrative — the ability of a strong federal government to solve national problems, and the individual freedom and independence granted to citizens to make economic decisions.

As Lipstein points out in his thoughts on compromise, “Democrats would need to yield on a single-payer public option. And Republicans would need to yield on their desire for a private-sector solution. Some of our health system would be financed with taxes, and some of our health system would be financed with insurance premiums and out-of-pocket cost sharing. Not coincidently, this tenuous compromise is in place today.”

The system was much different, but the values were similar, in 1945 when Truman proposed — as part of a five part health agenda — a national health insurance plan. Ultimately, his national insurance plan failed. Other components, including significant new investment in hospitals and health system infrastructure through the Hill-Burton Act, transformed the nation’s health care system — especially in rural America. It was a compromise, and reflective of the state of health care at the moment. LBJ

The most significant change to health care came in 1965 with the adoption of legislation to establish the Medicare and Medicaid programs. President Johnson invited Truman to the signing ceremony, and in January of 1966, Mr. and Mrs. Harry Truman received Medicare cards number one and two.

From the ’60s through the present, the nation’s system has evolved. Under Republican and Democratic leadership in the White House and Congress, Medicare, Medicaid and commercial insurance have become the three-legged stool of the nation’s system. Even as changes have been made within these programs, the disagreements have generally been about the scope and value created within the programs — not questions of their necessity. The Affordable Care Act was designed to double down on these systems.

Keckley points out “for more than 70 years, our political system has struggled with a coherent, comprehensive health care policy. The political parties have consistently advanced their views for and against government involvement even as health care grew to be 28% of total federal spending. In retrospect, the current debate about Repeal and Replace vs. Fix and Repair is another chapter in the same book.”

The politicization of health care didn’t start with the ACA. It has always existed in the debate. It reflects the difficulty in building a system that reflects the struggle between health needs and liberty. Throughout more than seven decades, there’s been a lot of progress — and significant compromise to achieve balance.

This week’s Senate debate viscerally exposed the tensions in the system. This morning’s vote wasn’t a stop; it was a pause. Time will tell whether the ACA will endure or if another national health care model will emerge. Either case will lead to change. However, as Lipstein suggests, some form of compromise must prevail for that change to be sustainable.

Share your thoughts.

Herb Kuhn, MHA President & CEO



Herb B. Kuhn
MHA President and CEO

In This Issue
U.S. Senate Defeats ACA Repeal Legislation
Organizations Voice Concern About ED Payment Policy
MO HealthNet To Correct Payments For Certain Outpatient Radiology Codes
MHA Offers CHNA Resources
State Committee Of Psychologists Seeks Regulation Comments
CMS Updates EHR Known Issues Documents
CMS Announces OQR Education Session


Advocate
state and federal health policy developments


U.S. Senate Defeats ACA Repeal Legislation

Staff Contact: Daniel Landon

Because of a “no” vote by U.S. Senator and former Republican presidential nominee John McCain (R-AZ), the U.S. Senate defeated the “Health Care Freedom Act,” also called the “skinny repeal” bill. The Congressional Budget Office concluded that the eight-page bill would increase the nation’s uninsured by 16 million and increase nongroup premiums “by roughly 20 percent relative to current law in all years between 2018 and 2026.” In a statement, McCain voiced concern about the bill’s content and process. Also, McCain shared concerns with other senators that the legislation would not be an interim step in legislative negotiations, but instead be endorsed by the House of Representatives and sent to President Trump to be signed into law.

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Organizations Voice Concern About ED Payment Policy

Staff Contact: Daniel Landon

Three physician organizations and MHA have sent a letter to the state insurance department director expressing concern about Anthem’s recent policy change regarding payment for emergency department services. The policy calls for denial of payment for ED visits that do not meet the insurer’s standards for defining an emergency. The four provider organizations previously met with Anthem executives to discuss the policy. The letter urges the state Department of Insurance to enforce “prudent layperson” laws for defining an emergency condition and to “take a very hard and earnest look” at the new policy. The three physician organizations are the Missouri State Medical Association, the Missouri Association of Osteopathic Physicians and Surgeons, and the Missouri College of Emergency Physicians.

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MO HealthNet To Correct Payments For Certain Outpatient Radiology Codes

Staff Contact: Kim Duggan or Amy Volkart

The MO HealthNet Division will process a mass adjustment of outpatient claims with dates of service on or after Jan. 1 to correct reimbursement for radiology codes 93320, 93321, 93325, 92979 and 93317. The codes were incorrectly excluded from the outpatient fee schedule and, as a result, were paid based on a percentage of billed charges using each hospital’s outpatient percentage rate. The mass adjustment will be reflected on the Friday, Aug. 4, Medicaid remittance advice.

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Quality and Population Health


MHA Offers CHNA Resources

CHNA Resources Staff Contact: Stephen Njenga

MHA has released resources to assist hospitals in community health needs assessment implementation. The new guide incorporates the most current regulatory requirements from the Internal Revenue Service and tools to complete hospitals’ implementation plan. Additional CHNA resources are available on MHA’s website. Hospitals needing assistance with their CHNA can contact MHA for resources and support. In the coming months — through a partnership between the Hospital Industry Data Institute, the Washington University School of Medicine, and BJC HealthCare — MHA will release ZIP-code level health rankings for Missouri to support CHNA activities.

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State Committee Of Psychologists Seeks Regulation Comments

Staff Contact: Sarah Willson

The State Committee of Psychologists is seeking comment on its existing regulations. The request comes as part of fulfilling the governor’s executive order requiring every state agency to review regulations to determine their continued relevancy and effectiveness. Comments can be submitted online through Friday, Dec. 15.

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CMS Updates EHR Known Issues Documents

Staff Contact: Sherry Buschjost

The Centers for Medicare & Medicaid Services has updated the known issues documents associated with the Electronic Health Record Program. The document has been updated with issue resolutions and newly identified issues, and is available on QualityNet.

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CMS Announces OQR Education Session

Staff Contact: Sherry Buschjost

An outreach and education session for hospitals participating in the Outpatient Quality Reporting Program has been scheduled on Wednesday, Aug. 2. The webinar, titled “CY 2018 Hospital OQR Program Proposed Rule: For The Hospital OQR Program,” is offered at 9 a.m. and 1 p.m.. Registration is required.

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Did You Miss An Issue Of MHA Today?


July 27, 2017
Federal Appeals Court Strikes Medicare DSH Regulation
CMS Issues Proposed Rules On Medicaid DSH Allotment Reductions
MO HealthNet Posts Medicaid Home Health Rate Cut
CMS Releases Information On Exemptions From The Medicare Quality Payment Program
CMS Announces Steps To Address CLABSI, CDI, CAUTI Data Errors
CMS Updates Hospital Compare Website

July 26, 2017
U.S. Senate Fails To Repeal Affordable Care Act
General Assembly Wraps Up Special Session On Abortion Legislation
CMS Proposes Changes To Medicare Home Health Regulations
New Marketplace Insurer Map Projects 2018 Participation

July 25, 2017
U.S. Senate Embarks On ACA Repeal And Replace Legislation
MO HealthNet Posts Additional Medicaid Rate Cuts
MedPAC Releases Annual Report On Medicare Spending
CMS Releases Hospital-Specific Reports For HAC Reduction Program
Fulton Medical Center Announces Closure

July 24, 2017
State Officials Distribute Joint Letter On State Opioid Initiatives
MHA Writes Governor About Stroke And STEMI Regulation
MHA Distributes Occupational Mix Data For Review



Consider This ...

Even at low doses, taking an opioid for more than three months increases the risk of addiction by 15 times.

Source: Centers for Disease Control and Prevention