MHA Today | November 17, 2017

November 17, 2017
MHA Today: News for Healthcare Leaders

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November 17, 2017

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
It’s been a very interesting week to watch Congress. Both the House and Senate are finalizing their tax reform legislation, which is high stakes lawmaking. With the House passing their bill, one could say that it’s the end of the beginning.

It’s safe to say there are winners and losers in almost all legislation of this variety, and there are powerful interests on both sides of the debate. That’s why it was so interesting to read Paul Keckley’s report on what he called the “uncanny similarities” between health and tax reform. The similarities he identified include: “Both pieces of legislation involve federal roles … that have expanded in recent history; both involved legislation sponsored by a political party in control of Congress and fiercely opposed by the other; both provoke strong feelings among voters on personal experiences; both spark hyper-activity among special interests; and both move public policy in a direction desirable to some and feared by others.”

And, like the Affordable Care Act and subsequent legislation to repeal and replace it, hospitals have a significant stake in the tax bill. Although not-for-profit hospitals’ tax-exempt status was not on the table, provisions in the just-adopted House legislation will change certain bonding systems that these hospitals use to reduce the cost of capital investments. There are other worrisome aspects of the House bill, including the imposition of a 20 percent excise tax for certain non-profit hospital employees. The American Hospital Association has been working hard to organize advocacy efforts on these issues, and the Missouri Hospital Association fully supports their efforts.

The intersection between tax and health care legislation took an interesting turn this week when the Senate decided to include the repeal of the ACA’s individual mandate in their package. The Senate action serves two purposes – it allows Congress to continue its pursuit of repealing Obamacare, and it provides for savings of $338 billion throughout a decade. These savings would be used to help finance the tax cuts. But there’s a hitch – congressional analysts believe the repeal would result in 13 million fewer Americans with health coverage. And, premium costs are expected to increase as much as 10 percent across the board.

Although it is unlikely that Democrats will support legislation undoing the individual mandate, the intersection between the tax bill and health care has yet another story to play out – dealmakers discussing linking the Alexander-Murray marketplace subsidy-fix legislation with the tax reform package. It’s too early to know whether that will occur. However, if the individual mandate is repealed, problems in the marketplace are likely to expand.

The way in which this is unfolding generates a lot of concern. The trade-off of tax cuts paid for with lost health insurance coverage is a poor deal for most Americans. Moreover, hospitals are likely to have fewer resources to continue progress in improving care delivery and increasing value. Uncompensated care costs are likely to increase significantly, while opportunities for care coordination will be reduced.

There’s tremendous pressure to get a tax reform package through Congress by the end of this year. Peeling off certain aspects of the ACA to find savings is not repeal and replace. It’s just repeal. It’s a poor trade-off and cost-shift.

Earlier this week, MHA sent letters to Missouri’s House and Senate members underscoring the harm that could be caused by repealing the individual mandate and the loss of capital investment opportunities for not-for-profit hospitals.

As noted earlier, House adoption of legislation this week signals the end of the beginning. As the legislation moves forward, we’ll continue to share how its provisions could affect hospitals — organizationally and operationally.

Let me know what you’re thinking.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
FDA Commissioner Provides Statement On Efforts To Address Impact Of IV Fluid Shortage
CMS Announces Education Sessions
CMS Releases December 2017 Hospital Compare HSRs
HIDI Releases 2016 Annual Survey Seven-Year Trends Report

Quality and Population Health

FDA Commissioner Provides Statement On Efforts To Address Impact Of IV Fluid Shortage

Staff Contact: Jackie Gatz

U.S. Food & Drug Administration Commissioner, Scott Gottlieb, M.D., released a statement with an update on the FDA’s efforts to address IV fluid shortages exacerbated by Hurricane Maria. In conjunction with manufacturers of these products, the FDA is taking the following steps.

  • temporarily allowing the import of IV saline products from facilities outside of the U.S.
  • encouraging the expansion of production at existing facilities to meet shortfalls
  • expediting the review of new product applications that will help address the shortage
As part of their efforts to reduce the risk of further shortages, the FDA has been working with federal and local government partners to prioritize a small number of critical facilities based on public health needs, including those plants that manufacture IV saline bags, for consideration or prioritization to gain earlier access to the electrical grid.

In the meantime, the FDA encourages hospitals to consider clinical recommendations for managing the shortage of these IV fluids, including recommendations by the American Society of Health-System Pharmacists and the University of Utah.

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CMS Announces Education Sessions

Staff Contacts: Sherry Buschjost or Jessica Stultz

The Centers for Medicare & Medicaid Services announced the following upcoming education sessions.


  • Value-Based Purchasing Program at 1 p.m. Tuesday, Nov. 28 — Hospital Improvement Innovation Networks and Hospitals Collaboration to Improve Quality of Care: Healthcare-Associated Infections
  • Inpatient Quality Reporting Program at 1 p.m. Thursday, Nov. 30 — Hospital Quality Star Ratings on Hospital Compare December 2017 Methodology Enhancements
Registration is required and available through the noted links.

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CMS Releases December 2017 Hospital Compare HSRs

Staff Contact: Sherry Buschjost

The release of the December 2017 Hospital Compare Overall Hospital Quality Star Rating Hospital-Specific Reports was announced by the Centers for Medicare & Medicaid Services. Hospitals will receive a QualityNet notification containing detailed instructions on how to access their HSR when it is available for download from the secure portal. The reports will include the Overall Hospital Quality Star Rating results, confidence intervals for group and summary scores, group performance category assignment, and the individual measure scores. Additional information is available on QualityNet.

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HIDI Tech Connect

HIDI Releases 2016 Annual Survey Seven-Year Trends Report

Staff Contact: Shane VanOverschelde

The 2016 Annual Survey Seven-Year Trends report was posted for download to subscribers of the Premier Reporting Package. This report displays tables and graphs depicting seven-year trends of a comprehensive set of financial metrics as reported on the most recent Annual Licensing Survey. Reports are categorized by various peer groups, such as bed size, geographic region, ownership type, hospital type and congressional district. The report can be found on HIDI Analytic Advantage® in the following location and file name.

  • File location: Finance and Policy/Premier Reports
  • File name: MO0000_7-Year_Trends_2016 (11 2017).zip
Hospitals interested in subscribing to the HIDI Premier Reporting Package should review the package information. Current subscribers with questions about downloading files should contact HIDI.

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Did You Miss An Issue Of MHA Today?

November 13, 2017
Trump Names Secretary Nominee
National Rural Health Day Is Thursday
HIDI HealthStats — Hospital Super-Utilizers

November 14, 2017
Three Hospital Groups And Three Provider Organizations Sue HHS
MHA Recognizes Two Missouri Hospitals For Quality Improvement Achievements

November 15, 2017
Week Two Marketplace Enrollment Results Released
Emergency Preparedness Rule Effective Today
End Of Month Deadline To Avoid EHR Payment Adjustments
Pharmacists May Administer Naloxone
Kindred Hospital Kansas City Announces Closure

November 16, 2017
House Passes Tax Bill
MLN Connects Provider eNews Available
Interactive Health Equity Resource Available

Consider This ...

The opioid crisis cost the economy $95 billion in 2016, with $21.4 billion spent on treating patients who suffer from opioid abuse.

Source: Modern Healthcare