MHA Today | February 23, 2018

February 23, 2018
MHA Today: News for Healthcare Leaders

twitter linkedin
February 23, 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

The 2018 Winter Olympics ends Sunday. The final medals for curling will be awarded this weekend.

Curling may not have the refinement of ice dancing or require the athletic ability of downhill skiing, but it certainly requires some skill. Like every other Olympic sport, it has a common set of rules governing equipment and performance. However, raw athleticism isn’t one of the traits we’ve come to expect from participants. In fact, according to a report by Reuters, “Canadian skip Eddie ‘the Wrench’ Werenich was told by the Canadian Curling Association to lose a few pounds so as not to embarrass the country and the Olympics” before his appearance in the 1988 games.

Nonetheless, this year’s Russian curling team is accused of doping.

This got me thinking about Anthem’s policy changes related to emergency department care. First, there’s a clear rule in place — the “prudent layperson standard.” Earlier this week, the Missouri Senate held a hearing on legislation that would strengthen the state’s definition of prudent layperson by clarifying the standard as “regardless of the final diagnosis that is given.” Anthem has been focused on the ED physician’s diagnosis, not the symptoms experienced by the patient presenting for care. That’s changing the rules after the fact.

There’s more. The gold standard for heart attack advice comes from the American Heart Association. They have spent decades working to educate the public about heart attack symptoms and what to do if they present. Anthem’s policy flies in the face of these recommendations. With the benefit of world-class talent and technology, ED staff can determine the difference between indigestion and a heart attack. Most Missourians can’t.

Late last week, Sen. McCaskill and the American College of Emergency Physicians castigated Anthem for trying to move their ED use exceptions from the Hog Line to the Tee Line, by advancing a new set of “always pay” exceptions. McCaskill’s response, “This isn’t going to cut it.” When you attempt to change the rules mid-game, it’s not a negotiation.

There’s a clear information asymmetry between Anthem’s post-diagnosis rejections, and a patient’s in-the-moment understanding of the emergency. Recall that Anthem denied a claim for one Missourian who was injured in a motor vehicle accident. Why? Because they did not review the symptoms that resulted in the patient being rushed to the emergency department. They only reviewed the diagnosis codes. In this case, the patient was lucky and escaped the accident with scrapes, bruises and cuts. But, this same review process is costing hundreds of others untold concern and confusion. We believe the prudent layperson standard is clear in statute — and we’re working to clarify any ambiguities.

There is one other rule in the Olympics that is worth noting. That’s the one where in several competitions, each athlete gets three tries to put forth their best performance. The best time is accepted.

Throughout this experiment with many patients’ health care, Anthem has refined their policy on several occasions in their search for the “best time.” I believe there are many in Missouri who would instead prefer that Anthem follow the rule that historically has served our state so well for decades. That would be to simply throw out their recent experiments and put in place a collaborative, care coordination policy where well-meaning policyholders can get the right care at the right time.

Let’s face it, all the brooms in curling couldn’t sweep away the shame of a doping in what is basically competitive shuffleboard on ice.

As for Anthem’s signal to their policyholders — well that’s just a shame.

Let me know what you think. And, Go Team U.S.A. for gold against Sweden on Saturday!

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
MHA And Fellow State Hospital Associations File Amici Brief In 340B Appeal
CMS Extends Submission Deadline For eCQM And Medicare EHR Incentive Program
CMS Announces CQL Education Session


Health Law Insight

MHA And Fellow State Hospital Associations File Amici Brief In 340B Appeal

Staff Contact: Jane Drummond

The Missouri Hospital Association joined 34 other state hospital associations in filing an amici curiae brief in support of the 340B litigation pending in the U.S. Court of Appeals for the District of Columbia Circuit. The underlying appeal seeks to overturn the district court’s dismissal of the case brought by the American Hospital Association and others to enjoin the recent cuts to reimbursements made under the 340B program.

The parties to the appeal are expected to file their final briefs in early April, with oral argument to occur as soon as possible thereafter.

Back To Top


Quality and Population Health

CMS Extends Submission Deadline For eCQM And Medicare EHR Incentive Program

Staff Contact: Sherry Buschjost

The Centers for Medicare & Medicaid Services notified eligible hospitals and critical access hospitals participating in the Hospital Inpatient Quality Reporting Program and/or the Medicare Electronic Health Record Incentive Program of a deadline extension. The deadline for the submission of electronic clinical quality measure data for the calendar year 2017 reporting period, pertaining to the fiscal year 2019 payment determination, has been changed from Wednesday, Feb. 28, to Friday, March 16. Additional details are available.

Back To Top

CMS Announces CQL Education Session

Staff Contact: Sherry Buschjost

The Centers for Medicare & Medicaid Services invites hospitals to participate in the webinar, “Clinical Quality Language for Clinicians and Quality Professionals: What It Means for You.” The webinar is scheduled at noon Wednesday, Feb. 28. The CQL standard is a Health Level Seven International standard that aims to unify the expression of logic for electronic clinical quality measures and clinical decision support. This session is intended to provide a high-level overview of CQL, review how CQL benefits eCQM development and reporting, and share examples of workflow impacts. Registration is required for the webinar.

Back To Top


Did You Miss An Issue Of MHA Today?

February 19, 2018
Updated Model Medical Staff Bylaws Available
Mercy Rehabilitation Hospital Springfield Names New CEO

February 20, 2018
HHS Proposes Changes To Short-Term, Limited-Duration Insurance Plans
MHA And DPS Offer Regional Workshops For Hospital, EMS And Law Enforcement

February 21, 2018
Missouri Faces Certified-Provider Shortage For Opioid Treatment

February 22, 2018
House Health Committee Advances Hospital Regulatory Relief Legislation
State Senate Committee Reviews Helmet Law Repeal
CMS Releases Hospice CAHPS Results
MLN Connects Provider eNews Available
CDC Launches Antibiotic Stewardship Online Course
HSHS St. Elizabeth’s Hospital CEO Resigns

Consider This ...

Every year, about 790,000 Americans have a heart attack. One in five heart attacks is silent — the damage is done, but the person is unaware.

Source: Centers for Disease Control and Prevention