MHA Today | April 6, 2018

April 6, 2018


MHA Today: News for Healthcare Leaders

twitter linkedin
April 6, 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

Last week, Alex Azar, Secretary of the U.S. Department of Health and Human Services, spoke about his vision for the agency at an “all staff meeting” at the Centers for Medicare & Medicaid Services. He gave a similar speech to the Federation of American Hospitals in early March. Both offered a road map to Azar’s goals for his tenure at HHS.

Azar served as chief counsel and as deputy secretary at the same time as I served in various leadership capacities at CMS during the Bush administration in the mid-2000s. He’s a very thoughtful guy with an ambitious agenda for HHS and CMS. He understands HHS manages more than $1 trillion in annual spending — one-quarter of all government spending — and that 40 percent of Americans benefit directly from CMS programs. Moreover, he knows the order of magnitude that Medicare, Medicaid and other HHS policies bring to the debate and how they can influence the entire health care system.

His remarks included four areas of focus. Two of these — action on drug pricing and opioids — address immediate needs. Another, ensuring access to health insurance, is important as well. And, Azar spoke to work that HHS will do to ensure that commercial insurance is available and affordable for individuals in the marketplace, while making traditional Medicaid and Medicaid expansion populations “as individualized, as affordable, as choiceful and as state devolved as possible.”

The remaining focus area, value-based transformation, powers Azar’s vision for the health care system as a whole. In his remarks to FAH, Azar said, “Simply put, I don’t intend to spend the next several years tinkering with how to build the very best joint-replacement bundle — we want to look at bold measures that will fundamentally reorient how Medicare and Medicaid pay for care and create a true competitive playing field where value is rewarded handsomely.”

Further indicating his understanding of the power of HHS, he said, “If we are serious about transforming our health care system toward paying for value, Medicare and Medicaid will play a key role. Only Medicare and Medicaid have the heft, the market concentration, to drive this kind of change, to be a first mover.”

To a large extent, Medicare continues to be a passive payer of services — simply paying the bills when people get sick. It’s clear from these two speeches that he is determined to transform Medicare and CMS into an increasingly active purchaser of health care services. Given some of the rollbacks we witnessed under Secretary Tom Price’s short tenure at HHS, this is a major change that should be at the top of mind for all health care providers.

To make the point even more clear, we shouldn’t miss Azar’s comments to CMS staff about his hope that — during the Trump administration — HHS can create a “hockey stick” moment. In what was certainly a legacy speech, he articulates a hope that 15 years from now, people will look back at this time as the defining moment of paying for value rather than volume.

As he says in his remarks, this isn’t a partisan issue. There’s general consensus that the system isn’t delivering results commensurate with its cost. Nonetheless, a hockey stick moment will require massive systemic change.

The journey from volume to value is more than a decade old, and the results point to how difficult it can be to deliver. Azar notes in the FAH remarks, “As just one example, we are looking at our efforts regarding Accountable Care Organizations. The program was intended to give providers three years to learn how to accept risk and share savings, but the results have been lackluster. In retrospect, this is not such a surprise: Providers were not given new meaningful space to experiment — such as the arrangements they needed to truly take on the risk of a patient’s outcomes. Meanwhile, they were allowed to share in modest cost savings, but not asked to accept responsibility for cost overruns.”

The power of HHS and CMS to disrupt the status quo is unquestionable, and their first-mover advantage in additional movement toward value, clear. However, close attention must be paid to the balance between speed and risk.

In his FAH remarks, Azar said that this was, “no time to be timid. Today’s health care system is simply not delivering outcomes commensurate with its cost.” He added, “There is no turning back to an unsustainable system that pays for procedures rather than value. In fact, the only option is to charge forward — for HHS to take bolder action, and for providers and payers to join with us.”

It’s not only critical to examine what Azar has shared with hospitals and CMS, it’s also instructive to take note of what he has shared with Congress. During his confirmation hearing, in response to a question from one Senator regarding CMS testing new payment systems, he stated, “I believe that we need to be able to test hypotheses … I want to be transparent and follow appropriate procedures, but, if to test a hypothesis there around changing our health care system, if it needs to be mandatory as opposed to voluntary to get adequate data, then so be it.”

I’m encouraged by Secretary Azar’s commitment to continuing the journey to building a better system. And per the aforementioned quote, it’s very possible we’ll see the first trip up the on-ramp for this vision in the annual IPPS rule update expected by mid-April.

As stakeholders, we want a better performing system as well. However, getting it right matters.

Note: Azar’s comments begin at approximately 10:45 in the video, immediately following Adminstrator Verma who begins at 8:20.

Let me know what you’re thinking.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
Prescription Drug “Take-Back” Legislation Expanded, Approved
Senate Committee Advances Hospice Investigation Bill
Senate Committee Advances Medicaid Telehealth Bill
MO HealthNet Updates Diabetic Supply Reference Products
Federal Appellate Court Invalidates DSH Audit Methodology
CDC Issues Outbreak Alert Of Potential Life-Threatening Vitamin K-Dependent Antagonist Coagulopathy Associated With Synthetic Cannabinoids Use
Surgeon General Advocates For Increased Access To Opioid Overdose Reversal Medication
CMS Announces Education Sessions


state and federal health policy developments

Prescription Drug “Take-Back” Legislation Expanded, Approved

Staff Contacts: Daniel Landon or Rob Monsees

House Bill 1618 was approved by a Senate committee after it expanded the bill. As previously passed by the House of Representatives, the bill authorizes broader opportunities for collecting and disposing of unused controlled substances. The committee added limits on initial prescriptions of opioids, and revised standards for drug substitution by pharmacists and vaccination administration and recordkeeping, as well as created an advisory council on rare diseases.

Back To Top

Senate Committee Advances Hospice Investigation Bill

Staff Contacts: Rob Monsees or Sarah Willson

A Senate committee approved House Bill 1895. The legislation removes the requirement that a coroner or medical examiner investigate a hospice patient’s death if the death is certified by the treating physician or hospice medical director. It also extends the deadline for notifying the coroner or medical examiner of the death of a hospice patient. MHA is promoting the legislation.

Back To Top

Senate Committee Advances Medicaid Telehealth Bill

Staff Contacts: Daniel Landon or Brian Kinkade

A Senate committee approved a new version of House Bill 1617, which addresses Medicaid coverage of services delivered through telemedicine. A summary describes the revised proposal.

Back To Top


Regulatory News
the latest actions of agencies monitoring health care

MO HealthNet Updates Diabetic Supply Reference Products

Staff Contact: Brian Kinkade

MO HealthNet updated its list of diabetic supply reference products. Effective Sunday, April 15, Abbott Diabetes Care and Lifescan are designated as the preferred suppliers of diabetic products for MO HealthNet participants. Ascensia diabetic supply products, along with Novofine and BD pen needles, will no longer be covered.

Back To Top


Health Law Insight

Federal Appellate Court Invalidates DSH Audit Methodology

Staff Contact: Jane Drummond

The First Circuit Court of Appeals dealt another blow to the audit methodology used by the Centers for Medicare & Medicaid Services to determine the limit of disproportionate share hospital payments that may be made to a particular hospital. CMS had appealed a ruling by the New Hampshire district court invalidating the use of Medicare and third party payments to offset Medicaid costs in calculating a hospital’s DSH specific limit. The lower court determined that the methodology, which was announced by CMS in FAQ guidance, could only be imposed through notice-and-comment rulemaking. The Court of Appeals agreed.

The appellate court did not reach the substance of the methodology, nor was the final rule codifying the use of the offsets at issue in the case. The plaintiffs, which include the New Hampshire Hospital Association, are pursuing a separate action in federal court challenging the 2017 rule.

All six courts in which the FAQ guidance has been challenged have ruled adversely to CMS. Two courts, including a federal court in Missouri, invalidated the same methodology expressed in the 2017 rule as contrary to the Medicaid statute. CMS has the opportunity to appeal both of those decisions.

Back To Top


Quality and Population Health

CDC Issues Outbreak Alert Of Potential Life-Threatening Vitamin K-Dependent Antagonist Coagulopathy Associated With Synthetic Cannabinoids Use

Staff Contact: Jackie Gatz

The Centers for Disease Control and Prevention released a bulletin on March 5 about a potential long-acting vitamin K-dependent antagonist toxicity. From March 10 through April 5, 94 people presented to emergency departments in Missouri (1), Illinois (89), Indiana (2), Wisconsin (1) and Maryland (1) with serious unexplained bleeding. Laboratory investigation confirms brodifacoum exposure in at least 18 patients.

Health care providers, particularly those based in Illinois and neighboring states, should maintain a high index of suspicion for vitamin K-dependent antagonist coagulopathy in patients presenting with clinical signs of coagulopathy, bleeding unrelated to an injury, or bleeding without another explanation and with a possible history of synthetic cannabinoids (e.g., K2, Spice and AK47) use; some patients may not divulge use of synthetic cannabinoids. These patients should be screened for vitamin K-dependent antagonist coagulopathy.

Identified cases of suspected vitamin K-dependent antagonist coagulopathy associated with synthetic cannabinoids use need to be reported to your local health department. In addition, report any similar cases encountered since Feb. 1 to your local health department.

For updated information about the Illinois outbreak, connect with the Illinois Department of Health.

Back To Top

Surgeon General Advocates For Increased Access To Opioid Overdose Reversal Medication

Staff Contacts: Leslie Porth or Shawn Billings

U.S. Surgeon General Jerome Adams, M.D., issued a public health advisory stressing the importance of widespread opioid overdose education and increased access to naloxone – an FDA-approved medication that temporarily reverses the effects of an opioid overdose.

Back To Top

CMS Announces Education Sessions

Staff Contact: Sherry Buschjost

The Centers for Medicare & Medicaid Services announced the following education sessions for hospitals participating in the Value-Based Purchasing and/or Inpatient Quality Reporting programs.

  • VBP — 1 p.m. Tuesday, April 17 — “Hospital IQR and VBP Programs: Reviewing Your Claims-Based Measures Hospital-Specific Reports”
  • IQR — 1 p.m. Wednesday, April 18 — “Hospital IQR Program CY 2018 Voluntary Reporting – Hybrid Hospital Wide 30-Day Readmission Measure Overview”

Registration is required and available at the noted links.

Back To Top


Did You Miss An Issue Of MHA Today?

April 2, 2018
MO HealthNet Announces Reimbursement For Psychological Intern Services
MO HealthNet Updates CDT Code Requirements
Minnesota Hospital Leverages Community-Level Support To Tackle The Opioid Crisis

April 3, 2018
Missouri Providers Write U.S. Cabinet Secretaries On Anthem ED Coverage Restrictions
Medicare Value-Based Purchasing Program And Hospital Readmissions Reduction Program Analysis Available
Committee Approves Helmet Law Repeal
CMS Finalizes Updates For Medicare Advantage And Prescription Drug Program For 2019
CMS Offers Hospitals Who Contract With MA Plans A Reprieve From 340B Cuts
MHA Award Reminders: Aim for Excellence, Visionary Leadership
MHA Hosts Boot Camps To Increase Workers’ Safety
St. Anthony’s Medical Center Announces New Name

April 4, 2018
Committee Considers New Standards For Forensic Blood Tests
Final 2018 Exchange Enrollment Information Available
HHS Releases Guide On Accessing Health Records
“Healthcare Response No-Notice Incident: Las Vegas” Webinar Recording Available
CMS Announces Forum Regarding New Medicare Card Project
Hybrid Measure Information Available

April 5, 2018
House Approves Hospital Licensure Reform Legislation
Committee Revamps APRN Collaborative Practice Legislation
Congressional Committees Schedule Opioid Hearings
House Committee Advances “Right to Shop” Legislation
Bill Permits Patients To Refuse Opioids
Legislators Consider Radiation Therapy Measures
Senate Committee Considers Bone Marrow Registry Bill
Committee Approves Bill Regulating Medical Residency Placements
MLN Connects Provider eNews Available
MHA Sends Survey On OUD And NAS To Hospital Members
SAMHSA Announces Grant Opportunity To Treat Serious Mental Illness

Consider This ...

April is STD Awareness Month. In the U.S. one in five HIV diagnoses were in young people aged 13 to 24. Only 10 percent of U.S. high school students have ever been tested for HIV.

Source: Centers for Disease Control and Prevention