MHA Today | August 24, 2018

August 24, 2018
MHA Today: News for Healthcare Leaders

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August 24, 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 Kansas City Royals were “mathematically eliminated” from this year’s baseball playoffs. This late in the season, leading teams are tracking the number of wins necessary to get a playoff berth — known by many as the “magic number.” The Royals, conversely, reached what is referred to as their “tragic number.” This means that although the Royals have games left to play in the regular season, their abysmal performance earlier this year eliminated any path to the post-season. That must be dispiriting.

There may be a magic and tragic number parallel in health care. Specifically, I’m thinking about primary care and underserved communities.

On Wednesday, MHA released new research on the status of the primary care physician workforce in Missouri. Although more than 600 additional primary care physicians are practicing in Missouri since MHA’s last report in 2014, the state isn’t producing or attracting enough primary care physicians to meet the expected demand.
Primary Care Physicians Shortage
The problem isn’t exclusive to Missouri. Nationally, the shortage of primary care physicians is expected to be between 14,800 and 49,300 by 2030. However, Missouri will compete with other states to attract and retain these highly skilled professionals.

Since primary care is the gateway to health care and is essential to improving individual, community and population health, a strong workforce matters. And, Missouri is starting behind in the rankings — 40th nationally in health rankings overall, 42nd for senior health, and 35th for women and children.

Rural areas are significantly at-risk. There are fewer primary care providers in rural Missouri per capita, and these providers serve an older, sicker and poorer population. In addition, Missouri’s urban/rural divide is significant. Urban areas of the state have 139 primary care physicians for every 100,000 residents, while rural areas have 55.9.

There’s some good news. Policy changes are increasing the capacity of physician extenders like advanced practice registered nurses and physician assistants to support primary care delivery. In addition, Missouri’s medical schools are growing their capacity to educate the next generation of providers.

Hospitals, as stakeholders in the workforce, have been important players in building primary care physician numbers. Since 1993, hospitals have invested $12 million in the state’s Primary Care Resource Initiative for Missouri. PRIMO provides forgivable loans for physicians and other clinicians who practice in rural or underserved communities.

There is no single solution to closing the expected supply and demand gap for primary care. Building the workforce will require innovation and disruption.

Recently, New York University announced it would eliminate tuition for its medical school students to address physician student debt. Imagine students attending their “white coat” ceremony knowing they won’t be burdened with student debt. NYU isn’t the first medical school in the country to deploy such a program. The real question for these and other free tuition medical school programs is the specialty the students will ultimately pursue and where they want to practice. Time will tell. What we do know is that primary care generally pays less than physician specialties, and debt load has been blamed for fewer doctors choosing primary care.

Strategic thinking is happening in Missouri as well. The University of Missouri-Columbia School of Medicine established a Rural Track Pipeline Program designed to address rural primary physician shortages in the state. It’s an important model as it targets both an area of great need and a population of medical school students disposed to serve rural communities.

Other changes are necessary.

Additional residency slots at Missouri’s teaching hospitals could limit the loss of professionals who graduate here and practice elsewhere. Research suggests that 68 percent of physicians who complete all of their training in a state end up practicing in that state. Currently, 21.5 percent of medical students who graduate from a school in the state remain here.

Missouri should address scope of practice limits on its most highly skilled physician extenders. The recently released 2018 workforce report underscored the demand for these professionals. The vast majority of APRNs and PAs support primary care delivery.

Missouri is moving in the right direction. We need to keep the winning streak going (I can already hear the St. Louis Cardinals fans, as they watch the current hottest team in baseball). Without an adequate primary care delivery system, underserved communities — largely in rural Missouri — could find their primary care access mathematically eliminated.

Fortunately, health care isn’t baseball. There’s no rule or schedule that will keep communities and their health care systems out of contention. However, there will be fierce competition.

Unlike the Royals, we’re still in the game.

Let me know what you're thinking.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
CMS Announces New CHIP Model For Children’s Behavioral Health Services
CDC Releases 2018 Breastfeeding Report Card
CMS Releases HSRs For FY 2019 Readmissions Reduction Program

Regulatory News
the latest actions of agencies monitoring health care

CMS Announces New CHIP Model For Children’s Behavioral Health Services

Staff Contact: Brian Kinkade

The Centers for Medicare & Medicaid Services announced a new payment and delivery model for better integrated care as part of a larger strategy to address the opioid crisis. According to CMS, Integrated Care for Kids participants will benefit from systematic integration, coordination and management of core child services, including clinical care, school-based health services, housing and other health-related supports. In the selected states, participants in the Children’s Health Insurance Program will be eligible. Application information will be released this fall. CMS will provide $16 million in funding for as many as eight states.

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Quality and Population Health

CDC Releases 2018 Breastfeeding Report Card

Staff Contact: Alison Williams

Of the approximately 4 million babies born in the U.S. in 2015, 83.2 percent started out breastfeeding – but many mothers stop breastfeeding earlier than recommended, according to the 2018 Breastfeeding Report Card released this week by the Centers for Disease Control and Prevention. The report recommends the following actions to improve the percentage of women who continue to breastfeed through the initial six months of a newborn’s life.

  • increase support of women in the early postpartum period to initiate and sustain breastfeeding
  • increase the number of Baby Friendly-designated hospitals in the U.S.
  • encourage greater employer support of breastfeeding women in the workplace, i.e. through time allocation and ensuring privacy to pump breast milk

Missouri performs better than the national average with 31 percent of infants exclusively breastfed through the first six months; however, the national trend of not sustaining breastfeeding holds true in Missouri as well. While 82 percent of women initiate breastfeeding, only 33 percent are still breastfeeding at some level at six months.

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CMS Releases HSRs For FY 2019 Readmissions Reduction Program

Staff Contact: Sherry Buschjost

The Centers for Medicare & Medicaid Services released Hospital Readmissions Reduction Program Hospital-Specific Reports via the QualityNet Secure Portal. These reports summarize hospitals' results under the new stratified methodology and include payment adjustment factor information, dual stays and national readmission rates, detailed discharge-level data, and risk factor information for the calculations of the Excess Readmission Ratios. The 30-day review and corrections period closes Friday, Sept. 14. Additional information is available.

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Did You Miss An Issue Of MHA Today?

August 20, 2018
MHA Distributes Analysis For Proposed Updates To CY 2019 Medicare Home Health PPS
CMS Awards $8.6 Million To Help Stabilize Markets
HIDI HealthStats — How Effective Are Medicaid MCOs At Managing Care In Missouri?

August 21, 2018
MHA Responds To CMS Stark Law RFI
Primary Care Physicians: Missouri Workforce Update Available

August 22, 2018
MO HealthNet Increases Reimbursement For Behavioral Health Services
Place Of Service Code Requirements For MO HealthNet Telehealth Claims
Analytic Tool Available To Assess Wage Index Reclassification For FFY 2020
CMS Announces IPFQR Education Session

August 23, 2018
MO HealthNet Increases Reimbursement For Physician Services
MO HealthNet Implements Payment Edit For Daily Maximum Drug Limits
MLN Connects Provider eNews Available
Registration Open For Webinar On Expanding Access To Addiction Medicine
CMS Releases Fall OQR Newsletter
340B Recertification Deadline Approaching

Consider This ...

According to a new study, to minimize health risks, the optimal amount of alcohol someone should consume is none. This is a sobering report for the roughly 2 billion human beings who drink alcohol. At one drink a day, a person’s risk of developing one of the 23 conditions associated with alcohol increases by 0.5 percent. At two drinks a day, the risk is 7 percent higher. At five drinks a day, it’s 37 percent higher.

Source: The Washington Post