MHA Today | March 2, 2018

MHA Today: News for Healthcare Leaders

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March 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

This week, the Missouri Department of Social Services, Health and Senior Services, and Mental Health jointly announced a new initiative to regulate opioid prescribing practices in the Medicaid program. At the same time, MHA hosted a full-day workshop, “2018 Opioid Summit: Treating Opioid Misuse and Opioid Use Disorder.”

A day without a story about the opioid crisis is like a day without the sun coming up. However, the timing is interesting and provides a contrast in approaches.

There’s likely to be a strong response that the announcement from the state is scapegoating prescribers. That’s not entirely unfair in a state that has been unable to adopt a prescription drug monitoring system statewide — although the St. Louis County PDMP now covers a large part of the population. Where the state has been able to invest in opioid-related technology, the target has been to identify variation in prescribing practices that could leave physicians that treat cancer patients and those in chronic pain, among others, the target of increased scrutiny. Some may take this as an affront.

Although the scope of the state’s initiative is uncertain — they project between 2,500 and 8,000 providers could receive notification that they are outside of the recommended guidelines — the total is likely to be a significant portion of the Medicaid physician community. Practitioners will be notified by mail that they fall outside of the norm, and the mailing will include a “feedback form” to “facilitate provider communication in response to issues identified in the individualized opioid prescription intervention mailing.”

Opioid Prescribing GuidelinesThe state indicates this type of practice advisory letter has been sent to prescribers for years. However, in the past there has been limited state follow-up or enforcement. The recent rollout indicates providers who do not respond will be sent a second letter requesting a response within 20 business days. Further failure to respond will result in referral to the state Bureau of Narcotics and Dangerous Drugs, the State Board of Registration for the Healing Arts or other appropriate licensure board, and the practitioner’s employer. That’s pretty ominous.

Conversely and simultaneously, MHA and a coalition of other provider groups held an “Opioid Summit” today in St. Louis. The summit focused on expanding access to evidence-based guidance for treatment of pain, opioid use disorder, community-based services and policy solutions.

This may seem an exercise in opposites. Not necessarily so.

As a provider community, we should be working toward a better understanding of what works and what doesn’t. Providers who are on the margin of opioid prescribing should know where they are against their peers and best practices. In addition, as a state, we should be focused on strategies like medication-assisted treatment, community-based care models, behavioral health interventions, and the intersection of all the systems and resources that can assist in addiction avoidance and recovery. This only can happen through strong local, state and federal partnerships.

Solutions to the opioid crisis won’t be derived exclusively from pressure on, or scrutiny of, the provider community. Progress will require systems that are patient-, provider- and payer-focused. Just because the only tool available in Missouri is a hammer, doesn’t mean that everything is a nail. The state is using a proprietary system operated by CMT/Relias to determine variance. What will be telling is whether this system can intelligently evaluate whether physicians — who are face-to-face with patients and using their best clinical judgement — are outliers or patient advocates.

I think the state has the best of intentions. But, it’s time the resources are brought to address the problem as more than a provider problem. That means giving hospitals, physicians and behavioral health partners the resources needed to address the issue broadly.

That’s what we are discussing at the “Opioid Summit” in St. Louis. When we look at those challenges simultaneously, we’ll start bending the curve.

Send me an email with your thoughts.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
CMS Launches Initiative Simplifying Documentation
CMS Seeks Feedback On Evaluation And Management Guidelines
Influenza Activity in Missouri Declines
HIDI Posts 2017 Annual Licensing Survey Of Missouri Hospitals
Ken Bacon Announces Departure From Shawnee Mission Health


Regulatory News
the latest actions of agencies monitoring health care

CMS Launches Initiative Simplifying Documentation

Staff Contacts: Sarah Willson or Jim Mikes

The Centers for Medicare & Medicaid Services launched the Patients Over Paperwork initiative, which focuses on reviewing and reducing regulations to decrease regulatory burden, increase efficiencies and improve the beneficiary experience. One area of emphasis is on simplification of provider documentation requirements. Several changes have been made, including proof of delivery requirements for Durable Medical Equipment, signature requirements, and relaxing the time requirements of inpatient rehabilitation facilities in order to bill claims and receive payment. CMS is urging all health care providers, hospitals, inpatient rehabilitation facilities, long-term care facilities and the like to offer suggestions at

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CMS Seeks Feedback On Evaluation And Management Guidelines

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services announced an upcoming listening session about evaluation and management service guidelines. CMS is seeking feedback and comments on potential updates to the E/M guidelines to reduce burden and better align coding and documentation with current medical practices. The target audience includes physicians and non-physician practitioners, as well as other interested parties. The session is scheduled for 12:30 p.m. Wednesday, March 21. Registration is required.

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Quality and Population Health

Influenza Activity in Missouri Declines

Staff Contacts: Jackie Gatz or Carissa Van Hunnik

The Missouri Department of Health and Senior Services’ Weekly Influenza Surveillance Report for the period Sunday, Feb. 18, to Saturday, Feb. 24, indicates that although activity remains above baseline, a decrease in outpatient visits and ED visits for influenza-like illness was reported. Regional and state coordination systems began monitoring Missouri ILI activity in early January. In support of monitoring activities, MHA conducted routine EMResource queries and compiled data to evaluate potential impacts to health care facilities. As a downward trend in flu activity has been reported, a decision has been made to suspend additional EMResource queries at this time. Regional and state partners will continue to monitor all activity through the Centers for Disease Control and Prevention and DHSS weekly reports.

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HIDI Tech Connect

HIDI Posts 2017 Annual Licensing Survey Of Missouri Hospitals

Staff Contact: Cerise Seifert

The Hospital Industry Data Institute posted the 2017 Annual Licensing Survey of Missouri Hospitals to HIDI Analytic Advantage® on Thursday, March 1. The survey is a combined data collection effort of the Missouri Hospital Association, the American Hospital Association, and the Missouri Department of Health and Senior Services. Data from the annual survey is used to support various MHA advocacy efforts and is a key source of information regarding the hospital industry in Missouri. Various reports, including trends analysis and margins analysis, are available to participating hospitals upon request. Completed surveys are due to HIDI by Friday, April 6.

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CEO Announcements

Ken Bacon Announces Departure From Shawnee Mission Health

Staff Contact: Carol Boessen

Ken Bacon, chief executive officer of Shawnee Mission Health in Shawnee Mission, Kan., announced he will be leaving the organization, effective Friday, April 6. He will return to Colorado to join the Centura Health South Denver group of hospitals and represent Adventist Health System’s Rocky Mountain Region. He served as CEO of Shawnee Mission Health since April 2012. A search is being conducted for a permanent replacement. A list of CEO changes is available online.

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Did You Miss An Issue Of MHA Today?

February 26, 2018
MHA Opposes Legislation To Expand Concealed Weapons In Hospitals
Anthem Rescinds Modifier 25 Policy
MO HealthNet Tightens “Refill Too Soon” Criteria

February 27, 2018
State House Committee Approves Bill On Assistant Physicians
Missouri Joins Coalition Of States Seeking To Overturn The Affordable Care Act
CMS Clarifies ED Measures Time Difference Calculation Methods For CY 2017 eCQM Hospital Quality Reporting
CMS Accepts Comments On Draft 2019 CMS QRDA I Implementation Guide
CMS Updates OQR Known Issues Document

February 28, 2018
State Launches Opioid Prescriber-Accountability Initiative
State Senate Approves Hospital Regulatory Relief Legislation
MMAC Rescinds Audit Letter
HIDI Releases Third Quarter 2017 VBP Payments Model
Missouri Board Of Nursing Hosts First Military Connect Meeting

March 1, 2018
AHA Releases 340B Community Benefit Report
Analysis Of Medicare Spending Per Beneficiary Report Available
House Committee Advances “Right To Shop” Legislation
Legislative Committee Considers Mental Health Parity Bill
State House Approves Bill Easing Hospice Death Investigations
State Senate Approves Hospital Regulatory Relief Legislation
Issue Brief Reviews BBA Medicare Extender Provisions
MLN Connects Provider eNews Available
MHA Announces Visionary Leadership Award Call For Nominations
CMS Announces Education Session
CMS Announces Next Rural Open Door Forum

Consider This ...

Saturday, March 3 is World Hearing Day. Almost twice as many people report hearing loss as report diabetes or cancer. In the U.S., about one in four adults who report “excellent to good” hearing already have hearing damage.

Source: Centers for Disease Control and Prevention