MHA Today | August 27, 2018

August 27, 2018

MHA Today: News for Healthcare Leaders

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August 27, 2018

MHA Today is provided as a service to members of the Missouri Hospital Association. Additional information is available online at MHAnet.


In This Issue
MO HealthNet Meets With Hospitals On Managed Care, Reimbursement Changes
MHA Distributes Analysis For Proposed CY 2018 Medicare Outpatient PPS
CMS Releases Report About Next Generation ACO Model
HIDI HealthStats — How Effective Are Medicaid MCOs At Managing Care In Missouri?
MHA Releases 2019 Annual Quality Report
Ebola Outbreak Now At 105 Cases, And Bordering Countries Are On Alert
Clinician Shortages Driving Up Hospital Labor Budgets

What You Need To Know This Week

  • Many of the state laws enacted during the 2018 state legislative session take effect Tuesday, Aug. 28. MHA’s end-of-session report summarizes the new enactments. Staff is publishing documents and offering a series of webinars regarding the new laws.

Advocate
state and federal health policy developments


MO HealthNet Meets With Hospitals On Managed Care, Reimbursement Changes

Staff Contact: Brian Kinkade

The MO HealthNet Division officials met with a large contingent of hospital representatives on Friday, Aug. 24, at Truman Medical Center to discuss a variety of topics, including the recent contract amendment limiting reimbursement by managed care plans for nonparticipating hospitals, as well as planned changes in hospital reimbursement protocols. MHA recorded the meeting’s morning and afternoon sessions. Hospitals expressed great frustration with the department’s 90 percent non-par reimbursement limit amendment, but MHD gave no indication it would modify its decision. However, hospitals appeared to make headway in explaining how the decision to cut 340B pharmacy reimbursement to WAC minus 49 percent is excessive. MHD committed to reviewing this policy in light of the discussion. MHD Acting Director Jennifer Tidball discussed working with hospitals in the near future to develop new policy in several areas, including inpatient and outpatient Medicaid reimbursement, ER utilization, maternal and fetal health, rural provider sustainability, and boarding. MHD agreed to meet again with hospitals in early November.

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MHA Distributes Analysis For Proposed CY 2019 Medicare Outpatient PPS

Staff Contact: Andrew Wheeler

MHA has prepared an analysis illustrating the financial effect of the proposed calendar year 2019 Medicare outpatient prospective payment system rule. The analysis, which is available online for authorized users of HIDI Analytic Advantage®, includes a summary for the nation, state and individual hospitals. Hospitals in Missouri are projected to receive a payment decrease of -0.18 percent for services provided under the OPPS. Although footnoted, the analysis does not reflect the effects of the 2 percent sequestration. Hospitals have until Monday, Sept. 24, to review their hospital-specific data and submit comments.

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CMS Releases Report About Next Generation ACO Model

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services released a report evaluating the first performance year of the Innovation Center’s Next Generation Accountable Care Organization Model. For performance year 2016, Medicare saved approximately $62 million while maintaining quality of care for beneficiaries. CMS Administrator Seema Verma stated, “These results provide further evidence that ACOs succeed under two-sided risk. ACOs in the Next Generation Model are being held accountable with strong financial incentives and are provided with substantial flexibility and regulatory relief.”

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HIDI Tech Connect


HIDI HealthStats — How Effective Are Medicaid MCOs At Managing Care In Missouri?

Staff Contact: Mat Reidhead

In May 2017, Medicaid managed care was expanded statewide in Missouri, adding 240,000 new MCO enrollees. The August 2018 edition of HIDI HealthStats examines managed Medicaid delivery models in Missouri and evaluates the effectiveness of MCOs to deliver efficiencies and cost savings while improving health outcomes for enrollees.
HIDI HealthStats
The statewide expansion of Medicaid Managed care had a profound impact on the actuarial risk pool of MCO and fee-for-service enrollees in Missouri. Now, the managed care program is populated by families, children, and new or expectant mothers, while the fee-for-service program is reserved exclusively for clinically and behaviorally complex patients and the elderly. Better understanding how MCOs are succeeding at their directive to “coordinate care to help individuals and families stay healthy” carries growing importance for Missouri’s Medicaid program and health care system at large. Effectively managing and coordinating care will move the system toward the triple aim of health care. Constraining utilization to shift costs from shareholders to patients and providers will carry the opposite effect.

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Quality and Population Health


MHA Releases 2018 Annual Quality Report

Staff Contact: Peter Rao

Primary Care Physicians Report Missouri hospitals continue to make progress in improving quality with patient safety, hospital-acquired infections and readmissions. The latest Aiming for Excellence Annual Quality Report summarizes 17 key metrics currently tracked by Missouri hospitals.

The report finds that there is increased focus on transitions of care and support mechanisms for patients when leaving the hospital with state and community partners. The efforts of Missouri hospitals was recognized through the American Hospital Association’s Dick Davidson Quality Milestone Award.

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Ebola Outbreak Now At 105 Cases, And Bordering Countries Are On Alert

Staff Contact: Jackie Gatz

The Washington Post published an article about the recent outbreak in Congo’s North Kivu. The World Health Organization and the U.S. have moved quickly into the area to intervene. So far, it is not necessary to test travelers at the U.S. ports of entry, in part because there are no direct flights to the U.S. from the affected region and screening of outgoing travelers is being conducted.

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Workforce News


Clinician Shortages Driving Up Hospital Labor Budgets

Staff Contact: Jill Williams

Clinician shortages are challenging hospital leadership to reduce labor costs, a new Navigant/HFMA analysis suggests. Addressing the shortage of these specialized positions likely is causing hospitals to project higher labor budgets in the coming year. The survey also suggests leadership is targeting labor and supply chain productivity improvements to reduce hospital operating expense throughout the next 12 months.

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Consider This ...

The percentage of people with disabilities who are employed increased to 47 percent from 41.3 percent in states with expanded Medicaid coverage, while staying relatively constant in non-expansion states.

Source: St. Louis Post-Dispatch