MHA Today | March 16, 2018

MHA Today: News for Healthcare Leaders

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March 16, 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, the legislature adjourned for their legislative spring break. Prior to their departure, the House Budget Committee approved their version of the state fiscal year 2019 budget. It included both good and bad news regarding Medicaid spending for hospitals. The good news is that the committee endorsed the committee chairman’s recommendation to restore $38 million in Medicaid hospital payments. The bad news is that $36 million of hospital payment cuts remain.

In past years, I’ve used the St. Patrick’s Day holiday — which is Saturday — to expound on Irish wit and wisdom, dispel myths, and laud the important contributions of the Irish to our system of health care. This year, let me talk about the state budget and leprechauns.

In Irish folklore, leprechauns are known for — among other things — their pots of gold. Although stories about leprechauns have existed for centuries, their pots of gold have resulted in very little actual enrichment. A hard look at the evidence suggests that, in fact, leprechauns might not even be real.

When Gov. Greitens released his budget recommendations in January, there was an ominous item included — $40 million in undefined “efficiencies” to reduce general revenue spending within the Medicaid budget. Last year, a similar item was included. However, one person’s efficiencies can result in another’s cuts. The Medicaid laboratory payment cuts are generally credited as last year’s “efficiencies.”

The Missouri House, bent on clarifying Greitens’ murky language — and responsible for specific spending authority — swept away the fairy dust and delineated where the cuts would occur. There are significant problems with the budget committee’s recommendation. Hospital payments account for 18.1 percent of the total GR appropriated for Medicaid. A proportionate cut would be approximately $7.2 million. Unfortunately, a GR cut of $7.2 million would result in a total reduction of $20.8 million when federal match is included.

A $20.8 million cut would be unwelcome, but it would be fair. The Missouri Department of Social Services’ recommendation is actually much worse. The House Budget Committee chairman agreed to eliminate the payment cuts associated with the Federal Reimbursement Allowance ― the hospital provider tax ― restoring $38 million. He also said that he would work with hospitals, departmental officials and the Senate to resolve concerns about the remaining excess cuts. The Senate Appropriations chair has expressed similar sentiments. But this won’t be easy. Even with the House-recommended adjustments, the percent of reduced hospital payments is nearly twice as large as a fair representation of hospitals’ GR share.

As tempting as it would be to believe that there is a pot of gold to be had in the end of hospital Medicaid payments, there isn’t. This is, in part, because for nearly 30 years, there’s been a partnership between hospitals and the state to maximize the value of state revenue through the FRA. That means the state has been able to use FRA to fund a significant portion of the state share, and direct GR elsewhere.

There’s more work to do as the budget advances. We may well be asking for your help along the way.

Lawmakers need to understand that there’s no pot of gold. Some do, especially in times of budget cutbacks.

There only are hard decisions. Those decisions should be fair and reflect hospitals’ commitment to helping shoulder the state’s safety net.

Let me know what you’re thinking.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
HIDI Releases Fourth Quarter CY 2017 Update To Discharge Data-Based Quality Indicators
Buprenorphine Treatment Webinar Available
CMS Announces IQR Education Session


HIDI Tech Connect

HIDI Releases Fourth Quarter CY 2017 Update To Discharge Data-Based Quality Indicators

Staff Contact: Josette Bax

HIDI has refreshed the readmissions, hospital-acquired conditions and AHRQ Quality Indicators data within HIDI Analytic Advantage® PLUS to include measure calculations based on fourth quarter of calendar year 2017 discharge data.

CMS recently released an ICD-9/10 compliant risk-adjusted readmissions model that will be used for Q4 2017 readmission data. When comparing the differences between CMS/Yale models (ICD-9/10 compliant and HIDI GEM-mapped), HIDI observed very modest levels of variation between the model results that could easily be attributed to common cause variation or updates in the cohort definitions by the CMS/Yale models for the 2017 evaluation. Documentation on additions/exclusions from the cohort definitions are available through CMS/Yale on QualityNet.

These quality data updates are included in various reports in the following Analytic Advantage PLUS locations.

  • Quality > Benchmarking
  • Quality > Readmissions
  • Quality > Strategic Quality Initiatives

If you have technical questions regarding these measures, please contact Josette Bax. For questions about accessing the website or running these reports, please contact HIDI.

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Quality and Population Health

Buprenorphine Treatment Webinar Available

Staff Contacts: Leslie Porth or Shawn Billings

The Missouri Coalition for Community Behavioral Healthcare is hosting a webinar, “Getting Started on Buprenorphine: Options for the Practice and the Patient.” The webinar will address the pros and cons of buprenorphine prescribing practices in formalized clinical settings and home-based self-dispensing models. Both models have risks – and both can be effective. A review of practical guidance on prescribing strategies will be discussed.

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CMS Announces IQR Education Session

Staff Contact: Sherry Buschjost

An outreach and education session for hospitals participating in the Inpatient Quality Reporting Program has been scheduled for 1 p.m. Thursday, March 29. Registration is required for the webinar, “Hospital Readmissions Reduction Program: Early Look Hospital-Specific Reports.”

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Did You Miss An Issue Of MHA Today?

March 12, 2018
Patient Transport By Uber And Lyft Raise Compliance Concerns

March 13, 2018
Committee Reviews Litigation Legislation
House Budget Committee Advances FRA Bills
2018 Aim For Excellence Award — Call For Applications
Mercy Rehabilitation Hospital St. Louis Names Interim CEO

March 14, 2018
Committee Considers Certificate Of Need Reform Legislation
Missouri House Perfects FY 2018 Supplemental Appropriations Bill
Senate Committee Considers Expansion of Short-Term Insurance Policies
Simon’s Law Proposal Advances
State House Approves Bone Marrow Registry
HIDI Schedules Regional Meetings
HIDI Releases First Quarter FFY 2018 Inpatient, Outpatient, Missouri Databases
Trajectories: Broadening The Culture Of Safety: Addressing Workplace Violence
CMS Announces Education Session

March 15, 2018
Missouri House Budget Committee Reverses Missouri
Medicaid Hospital Reductions
Senate Approves Medicaid Telemedicine Bill
Senate HELP Committee Receives Testimony About 340B Program
MHA Releases Bipartisan Budget Act Projection
MLN Connects Provider eNews Available

Consider This ...

This week is Patient Safety Awareness Week. Patient harm is the 14th leading cause of the global disease burden, comparable to diseases such as tuberculosis and malaria. It is estimated that there are 421 million hospitalizations in the world annually, and approximately 42.7 million adverse events occur in patients during these hospitalizations.

Source: World Health Organization