MHA Today | February 2, 2018

February 2, 2018
MHA Today: News for Healthcare Leaders

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February 2, 2018

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
Earlier this week, Warren Buffett said, “Ballooning costs of health care act as a hungry tapeworm on the American economy.” His words were part of a joint statement issued to announce a new partnership between Buffett’s Berkshire Hathaway, Amazon and JPMorgan Chase “to create solutions that benefit our U.S. employees, their families and, potentially, all Americans.”

According to news reports, the three firms have more than 1 million employees combined. Together, the corporations intend to form a separate firm initially focused on technology but with the goal of providing “high-quality and transparent health care at a reasonable cost.” This type of entry is disruptive in a marketplace — and that’s not necessarily bad. However, the proposal is remarkably thin on detail. After calling the employee health sector a parasite, Buffett added, “Our group does not come to this problem with answers. But we also do not accept it as inevitable.”

The challenges of building a better health care system — not just for corporate employees, but for all — are many. Disruption can be the enemy of the status-quo. However, anyone paying attention to the whole system knows that the current level of disruption is high. Aside from the systemwide turmoil last year — including the stalled “repeal and replace” efforts and the removal of the Affordable Care Act’s individual mandate, among others — there are constant disruptive forces shaping the system.

The 340B drug discount system is an example. Although a majority of hospitals benefit from a redistribution of Medicare savings from a 28.5 percent payment cut for 340B drugs, Missouri loses $9 million overall. In addition, the 18 hospitals that significantly lose represent a large share of the state’s safety net care. This could fray the safety net and lead to cost shifting to the very employers Buffett, et. al. are trying to protect. The courts, Congress and the administration all are active in finding a 340B resolution, but not all paths lead in a direction that will be good for hospitals and the safety net.

Earlier this week, a Missouri House committee approved an amendment to Rep. Keith Frederick’s House Bill 2088, which restricts the use of covenants not to compete. Among other changes, the bill would bar most covenants not to compete in employment contracts but allow them for 501(c)(3) organizations under certain circumstances. This would create a differing set of rules for for-profit and not-for-profit hospitals.

Finally, the U.S. health care system is practically under siege from seasonal influenza. Diversion is up, and bed space in emergency departments and inpatient wings is near capacity at some hospitals throughout the nation. Reporters are telling the story of beds in hallways and tents — although that is not happening in Missouri, as far as we can tell. Earlier this week, we shared regional data with The Kansas City Star about diversion and ED bed status during January after the newspaper sent a Sunshine Law request for the data to an emergency response partner. Our message is that a resilient system expands and contracts, as necessary, through a coordinated system.

Each of these examples illustrates disruption — within a payment system, through laws and regulations, and external forces. There are countless more.

Hospitals are focused on improving the system as a whole. The improvements Buffett mentioned, including “high-quality and transparent health care at a reasonable cost,” sound very similar to our focus on the Triple Aim.

Buffett thinks the health care system is a tapeworm — a parasite. When functioning well, the nation’s health care system would be a symbiotic relationship. That’s the outcome we want.

Buffett said he doesn’t have the answers. We’re trying to bring answers with the Triple Aim. Buffett says he doesn’t accept the inevitable. And we don’t either.

Let me know what you’re thinking.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
2019 Medicare Advantage Plans For 1.84 Percent Increase In Payments
MO HealthNet Relaxes Telehealth Reimbursement Policy
CMS Releases Hospital Compare Preview Reports
CMS Reschedules IQR Education Session

Regulatory News
the latest actions of agencies monitoring health care

2019 Medicare Advantage Plans For 1.84 Percent Increase In Payments

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services released the 2019 Medicare Advantage and Part D Advance Notice Part II and Draft Call Letter. Within the notice, CMS is proposing to increase payments to Medicare Advantage companies by 1.84 percent, up from 0.45 percent in 2018. After coding adjustments, the increase amounts to 3.1 percent. CMS also proposed payment and policy changes for the Part D program and includes important new steps to ensure new patient-doctor-plan communication in combatting the opioid crisis. Comments on the proposals must be submitted by Monday, March 5. The final 2019 rate announcement and final call letter will be published Monday, April 2.

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MO HealthNet Relaxes Telehealth Reimbursement Policy

Staff Contact: Brian Kinkade

MO HealthNet issued guidance that removes existing restrictions on the reimbursement of telehealth services. Existing regulations are being rescinded. Telehealth services permitted by the Revised Statues of Missouri, sections 191.1145 and 191.1146, will be reimbursed, with the exception of services delivered within the same facility. This change is effective for dates of service on and after Feb. 1.

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Quality and Population Health

CMS Releases Hospital Compare Preview Reports

Staff Contact: Sherry Buschjost

The Centers for Medicare & Medicaid Services released April 2018 Hospital Compare preview reports for participating hospitals. CMS encourages hospitals to access and download reports early in the preview period to have time for a thorough review. The preview reports are only available during the preview period, which ends Friday, Mar. 2. The data in the preview reports will be reported on Hospital Compare.

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CMS Reschedules IQR Education Session

Staff Contact: Sherry Buschjost

The outreach and education webinar for participants in the Hospital Inpatient Quality Reporting Program, originally scheduled for Tuesday, Jan. 30, has been rescheduled for 1 p.m. Wednesday, Feb. 7. Participants are asked to reregister for the webinar, “Hospital IQR Program Requirements for CY 2018 (FY 2020 Payment Determination).”

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Did You Miss An Issue Of MHA Today?

January 29, 2018
Senator Hatch Letter Suggests CMS Is Better Suited To Administer 340B
HIDI HealthStats — The Economic Cost Of The Opioid Epidemic In Missouri
HIDI Releases Fourth Quarter FFY 2017 Inpatient, Outpatient, Missouri Databases
Resources For EHR Attestation Available

January 30, 2018
340B Payment Cut And Redistribution Infographic Available
CMS Seeks IPFs Test Sites For New Quality Measure Testing And Development

January 31, 2018
Legislative Committee Advances Restrictions On Non-Compete Employment Contracts
10 Things To Know About BPCI Advanced
MO HealthNet Releases 2018 Claim Coding Requirements
MO HealthNet Modifies Nursing Facility Cost Reporting Process
February Is American Heart Month
CMS Reminds Hospitals Of eCQM Data Submission Deadline

February 1, 2018
MLN Connects Provider eNews Available
HIDI Releases Fourth Quarter FFY 2017 Inpatient, Outpatient, Missouri Databases

Consider This ...

Today is National Wear Red Day® About 2,200 Americans die of cardiovascular disease each day. That's an average of one death every 40 seconds.

Source: American Heart Association