MHA Today | January 5, 2018

January 5, 2018

 

MHA Today: News for Healthcare Leaders

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January 5, 2018

MHA Today is provided as a service to members of the Missouri Hospital Association. Additional information is available online at MHAnet.

 

Insights

Herb Kuhn, MHA President & CEO
New Year’s resolutions are generally admissions that you didn’t do the hard work last year and a commitment to yourself that you’ll try harder in the next. For anyone with a gym membership, you’ll be able to watch resolutions in action as the flood of good intentions becomes a trickle by February or March.

Last year’s failed repeal and replace efforts left a lot of important priorities in the lurch. Congress has only authorized spending through mid-January. To get a long-term spending plan, Congress must authorize an increase in the debt ceiling.

None of this is particularly new. Funding for the Children’s Health Insurance Program expired in October along with Medicare extenders for rural hospitals. The absence of a repeal and replace solution has left Affordable Care Act-required cuts to the Medicaid disproportionate share hospital payment program hanging over some hospitals’ financials like a fiscal version of Damocles’ sword.

This week, we sent a letter to Missouri’s delegation alerting them to the significant problems that could develop without action. In addition, we again encouraged them to address the recent move by the Centers for Medicare & Medicaid Services that significantly reduces 340B funding. To that end, we’re encouraging them to support H.R. 4392 to provide relief from the cuts.

Even as Congress was celebrating its year-end adoption of tax reform legislation, state lawmakers were preparing to return to Jefferson City to work out what implications the federal changes will have on state revenue. This week, they’ve returned.

The state budget has been a perennial problem as slow growth and prior tax cuts resulted in reduced revenue overall — especially in the general revenue fund. The federal cuts could require significant revision to Missouri’s tax code, and early signals indicate that new tax cuts added at the state level could be added to the mix.

The FRA will be up for reauthorization in 2018. Hospitals are already doing their part to support the Medicaid program, and any effort to divert FRA-generated revenue to other programs would be unacceptable. However, we can expect a vigorous discussion about the costs and value of Medicaid.

In addition, neither the federal or state governments have yet to fully develop a plan to address the opioid crisis. Moving the needle on the issue will require a broad partnership and the necessary resources to educate, identify and treat.

Members of Congress and state lawmakers will have some very hard decisions in the coming months. Hospitals, and the communities hospitals serve, have a tremendous stake in those decisions.

If there’s not a systemwide overhaul, then the solutions are pretty clear. And, there’s nothing unrealistic about reauthorizing CHIP and the extenders, fixing the 340B problem, or addressing Medicaid DSH cuts. In fact, there may even be the political will to do these things.

New Year’s resolutions often fail because the goals are too big or not sustainable. That’s not the case for most of the big issues of 2018. The real question is whether there’s the will to address the small problems, which, collectively, could have a very real impact on health care providers and the patients they serve.

Let me know what you think.

Herb Kuhn, MHA President & CEO



Herb B. Kuhn
MHA President and CEO


In This Issue
Proposed Rule Opens Association Health Plans
CMS Clarifies Texting Guidance For Hospitals And CAHs
DHSS Discontinues Zika Testing Services Of Asymptomatic Pregnant Women
Supply Chain Shortage Updates Available
Missouri Hospitals Experience Patient Surge Due To Increase In Influenza
CMS Seeks Public Comments On CLIA Personnel Requirements

Regulatory News
the latest actions of agencies monitoring health care


Proposed Rule Opens Association Health Plans

Staff Contact: Andrew Wheeler

In October, President Trump signed an executive order to issue regulations or revise guidance to allow for more employers to join association health plans. The Department of Labor released a proposed rule, which will open up associated health plans to more employers and the self-employed. The proposal would allow more employers to join AHPs, allow a nexus to be established by geography or industry for the sole purpose of providing health care, and allow sole proprietors to join AHPs. Comments about the rule are due March 6.

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CMS Clarifies Texting Guidance For Hospitals And CAHs

Staff Contact: Jim Mikes

The Centers for Medicare & Medicaid Services revised its guidance on texting patient information to clarify that hospitals and critical access hospitals are affected by this policy.

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Quality and Population Health


DHSS Discontinues Zika Testing Services Of Asymptomatic Pregnant Women

Staff Contacts: Toi Wilde or Jackie Gatz

The Missouri Department of Health and Senior Services will no longer provide Zika testing services for the routine testing of asymptomatic pregnant women who had possible recent, but not ongoing, Zika virus exposures. On July 24, 2017, the Centers for Disease Control and Prevention published updated guidance, indicating the routine testing of these persons is no longer recommended. The updated testing guidance was due, in part, to the declining prevalence of Zika virus disease in the World Health Organization’s Region of the Americas, resulting in an increased likelihood of a false-positive test result. An updated interim CDC guidance for health care providers is available.

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Noteworthy


Supply Chain Shortage Updates Available

Staff Contact: Jackie Gatz

Food and Drug Administration Commissioner Scott Gottlieb issued a statement summarizing the administration’s role in recovery and the anticipated relief to health care providers to secure adequate supplies. Based on information received from the manufacturers, Gottlieb states, “We expect that the shortage of IV saline fluids will improve in early 2018 with continuing improvements in the weeks ahead. Moreover, all the other companies that manufacture products that were on our initial list of drugs that we considered critical and at risk of potential shortages – because the drugs were largely or entirely manufactured in Puerto Rico – are now on the power grid.” Providers are encouraged to monitor the FDA’s drug shortage website as it remains the best source of information regarding product availability.

MHA continues to monitor the impact of this supply disruption on Missouri hospitals. Our recent subject matter expert column summarizes the cause for the shortage and strategies to mitigate its impact on health care delivery.

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Missouri Hospitals Experience Patient Surge Due To Increase In Influenza

Staff Contact: Jackie Gatz

MHA is actively monitoring the increased patient loads due, in large part, to a rise in seasonal influenza cases. Yesterday, a query was activated in EMResource to capture baseline information related to current bed capacity, medical countermeasures and personal protective equipment. At this time, PPE supplies and antivirals are being conserved, but no immediate shortage is evident. Inpatient surge is the identified concern, primarily in the metropolitan areas. Patient flow is being managed organizationally and with regional coordination, as necessary and appropriate. MHA staff continue to monitor the situation and will activate additional statewide queries early next week.

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CMS Seeks Public Comments On CLIA Personnel Requirements

Staff Contact: Jim Mikes

The Centers for Medicare & Medicaid Services released a request for information related to requirements of the Clinical Laboratory Improvement Act. CMS is seeking comments on a variety of educational requirements, including accepting nursing degrees as meeting the requirements for technical consultants and moderate and high complexity testing personnel. CMS also has renamed the Survey and Certification Group the Quality, Safety and Oversight Group.

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Did You Miss An Issue Of MHA Today?


January 2, 2017
CMS And TJC Release National Hospital Inpatient Quality Measures Specifications Manual Version 5.4
CoxHealth Acquires Barton County Memorial Hospital

January 3, 2017
General Assembly Convenes 2018 Legislative Session
CMS Launches Data System For Clinicians
Missouri Physicians Advocate For Medication-Assisted Treatment
CMS Reviews Third Quarter 2017 Inpatient Provider Participation Report Discrepancy
FCC Seeks Comments On Proposed Rule

January 4, 2017
MHA And Three Physician Organizations Thank McCaskill For Anthem Inquiry
Gubernatorial Appointment Creates State Senate Vacancy
MHA Resolves Nurse Licensure Compact Glitch
DEA Imposes Highest Restrictions On Cyclopropyl Fentanyl
Analysis Of 2018 Medicare Clinical Lab Fee Schedule Available
MLN Connects Provider eNews Available
MHA Activates EMResource Query To Monitor Flu Activity In Missouri
CMS Announces OQR Education Session



Consider This ...

Seniors 65 or older comprise 14 percent of the U.S. population but account for 34 percent of inpatient procedures and 37.4 percent of diagnositc treatments and tests.

Source: HealthLeaders Media