MHA Today | July 13, 2018

July 13, 2018
MHA Today: News for Healthcare Leaders

twitter linkedin
July 13, 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 & CEOIf you ask 34 people for the perfect gumbo recipe, you’ll probably get 34 different answers. However, at the heart of gumbo is a roux. It thickens the broth, adds a lot of the flavor and brings the other aspects of the dish together.

A good roux is a partnership. The flour and oil work together to form the base for everything else.

For decades, the state’s hospitals have worked together with state government to create a policy framework that maximized resources, improved access and enabled better outcomes. After the past few weeks, I’m starting to question the state’s commitment to the partnership.

On July 1, despite fierce opposition from providers, the Department of Social Services implemented a policy that could undercut providers’ negotiations with the state’s Medicaid managed care contractors. This was done with little regard to our nearly 30-year partnership to fund the safety net. Moreover, it was done without waiting for the findings from a new state contract with the McKinsey consulting firm to assess the Medicaid program.

Late last week, Gov. Parson announced line-item vetoes of funding items within the state budget. Among the more than $12 million in vetoed funding was a $150,000 cut, including three full-time equivalent employees for the Time Critical Diagnosis system at the Department of Health and Senior Services.

The cut shouldn’t have had major repercussions. Hospitals have worked to streamline the program by limiting the burden of duplicate certification where federal or nationwide accreditation agencies already certify.

Certainly the program wasn’t bankrupting the department. The division requested 460 FTE in the current budget and was authorized 460 FTE even after the veto. In addition, the department returned $1.1 million to the state in unspent personnel spending in 2017. That’s probably because of the 460 authorized staff, the division employed 447. There should be excess capacity to offset the cut.

The trauma, stroke and STEMI system is important to Missouri. It directs patients with time-critical diagnoses to treatment that yields the best outcomes, and it informs emergency medical systems’ transport planning. And, a TCD data registry can help improve care.

In rural Missouri where access to lifesaving care isn’t always around the corner, the stakes are high. The department recently articulated its understanding of the access challenges after the closure in Kennett. However, that recognition has not extended to access to better outcomes created through TCD.

Although DHSS has not finalized a plan for TCD in the long term, they have suggested that the cuts may result in a new fee-based system. Hospitals already invest in developing the capacity to be certified. The program is voluntary, and depending on the department’s proposal, the costs could prohibit expansion or unduly burden hospitals that already receive certification elsewhere.

Consistency and transparency are essential in a long-term relationship. However, it’s as if the state has decided that since hospitals and the state have traditionally blended a good roux, the mix doesn’t matter anymore. A gumbo can be forgiving, but a burnt roux is obvious and leaves a bad taste.

Tuesday, the Missouri House Budget Committee will meet to discuss the DSS Medicaid managed care amendment, TCD veto and McKinsey contract. Although the cuts to TCD were included in Gov. Greitens’ recommendations, lawmakers restored the funding and staff during the appropriations process. They are likely to ask hard questions.

A strong partnership between hospitals and the state benefits all of the stakeholders. We know what the recipe looks like. It sounds like the 34 members of the House Budget Committee know, too.

Send me an email with your thoughts.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

Quality and Population Health

CMS Announces IQR Education Session

Staff Contact: Sherry Buschjost

An outreach and education webinar for participants in the Hospital Inpatient Quality Reporting Program and Promoting Interoperability Program (previously known as the Electronic Health Record Incentive Program) is scheduled at 1 p.m. Tuesday, July 24. Registration is required for the webinar, “CY 2018 eCQM Self-Directed Tools and Resources for the Hospital IQR and Promoting Interoperability Programs.”

Back To Top


Did You Miss An Issue Of MHA Today?

July 9, 2018
Governor Signs Health-Related Legislation
DUI Blood Draw Legislation Becomes Law
May MUR Available On HIDI Analytic Advantage®
FDA Revises Recommendations For Testing Donated Blood For Zika
CMS Encourages Collection Of NIH Stroke Scale In ICD-10-CM Codes

July 10, 2018
Regulatory Streamlining Legislation Becomes Law
Governor Approves Pharmacy Legislation
MO HealthNet Increases Rates For School-Based IEP Services
Secretary Azar Discusses 340B Drug Discount Program
CMS Freezes 2017 Risk-Adjustment Program
2018 Medicare National Training Program Workshops
CART Tool Updated For Outpatient Encounters

July 11, 2018
House Budget Committee Schedules Hearing On Managed Care Contract Amendment
CMS Releases Proposed Payment And Policy Updates For ESRD And DME
MHA Offers New Quality Director Orientation

July 12, 2018
U.S. House Energy And Commerce Approves Clinical Workforce Bills
CMS Releases Proposed Payment And Policy Updates For ESRD And DME
CMS Releases Proposed Payment And Policy Updates To The CY 2019
Medicare Physician Fee Schedule
MHA Distributes CAH Databook
MLN Connects Provider eNews Available
FCC Proposes $100 Million For Pilot Program
HIDI Hosts Training Webinars For Long-Term Care, Rehabilitation And Psychiatric Hospitals

Consider This ...

The economic cost of excessive alcohol use in the U.S. reached $249 billion in 2010, or about $2.05 per drink. Excessive alcohol use is known to kill about 88,000 people in the U.S. each year.

Source: Centers for Disease Control and Prevention