MHA Today | November 2, 2018

November 2, 2018
MHA Today: News for Healthcare Leaders

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November 2, 2018

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


MHA's 96th Annual Convention & Trade Show


Herb Kuhn, MHA President & CEO Last week’s column was about the mid-term elections. There’s another election taking place, and voting opened this week — health insurance plan election on the federal health insurance marketplace. In 2018, nearly one-quarter million Missourians purchased insurance through the online marketplace.

The marketplace opened on Thursday, and eligible participants must select a plan by Saturday, Dec. 15. Information about the marketplace is available on MHA’s Enroll Missouri page, and we’ll be promoting enrollment on social media. However, MHA partners with the Missouri Foundation for Health in their Cover Missouri campaign. The Cover Missouri effort is the most comprehensive resource available, providing information for consumers and marketing materials for hospitals and providers.

Hospitals have an important role in helping get the word out. With the multiple attempts to change the Affordable Care Act this year, consumers may be unsure of their options or even the status of the marketplace itself. I encourage hospitals to make the resources from Cover Missouri available widely within their organizations and through community partners and stakeholders.

Next week, MHA will host its 96th Annual Convention & Trade Show. The theme of this year’s convention is “Heroes.”

Planning for each year’s convention begins on the heels of the last, and it is impossible to know what issues will be at the forefront of health care or the national agenda with certainty. However, I can’t imagine a better subject matter to frame next week’s conversation.

The last weeks have shown the depths of the divide in our nation. However, I am reminded again and again that the divisiveness that we see occurring outside of our hospital organizations is balanced by a strong and singular humanity within. Real heroes aren’t made in Hollywood. They are ordinary people who, through courage and skill, respond extraordinarily during moments of extreme difficulty.
Convention Speakers
This year’s convention keynote speaker is Capt. Chesley ‘Sully’ Sullenberger. He successfully navigated his airplane to land on the Hudson River after the plane was struck and incapacitated shortly after takeoff. The landing, and the survival of all of the passengers and crew, has been called the “Miracle on the Hudson.”

Also on Thursday, attendees will hear from Natalie Stavas, M.D. Dr. Stavas was nearing the finish line of her fifth Boston Marathon on April 15, 2013, when bombs exploded. Rather than seek safety, and without knowing whether additional bombs might be present, she ran toward the chaos to assist the wounded.

In a very conventional way, both heroes were just doing what they were trained to do. However, in both cases, without the right person available at the right time, the results may have been very different for some or all of the individuals around them.

Heroes often embody resiliency, and on Friday, Tim Hague, R.N., will recount his experience as the winner of The Amazing Race Canada. A feat in itself, Hague accomplished this goal after being diagnosed with Parkinson’s disease, proving that with enough determination to persevere, you can do more than you ever thought possible.

Wrapping up the speaker lineup will be Doc Hendley, founder and president of Wine to Water. Wanting to make a difference in the lives of those who lack access to clean water, Hendley grew his organization from wine tastings and a tip jar to now having dug, repaired and sanitized drinking wells for 25,000 people in five Third World countries. Being a hero can begin with small action and grow into a vision of helping thousands in need.

And finally, many Missouri heroes will be recognized as we salute our trustees for their tireless volunteer efforts, facilities who have excelled in their pursuit of better quality, legislators whose work is improving care in the state, and hospitals who continue to advance the cause of organ donation. There will be many additional awards and recognitions – it’s a great time to celebrate and take stock in our core tenet of always working to heal.

Hospitals are filled with everyday heroes or heroes in waiting. I hope this year’s convention will inspire attendees — as they look inward toward their organization and outward toward their community.

Let me know what you think.

P.S. — The general election is next Tuesday. With more than 150,000 employees and thousands of volunteers, hospital employees are in a powerful position to make a difference. I encourage you to use MHA's resources to inform your decision at the polls.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
Final CY 2019 Payment And Policy Updates To The Medicare DME And ESRD Programs
CMS Finalizes Medicare Outpatient PPS And ASC Payment And Policy Updates For CY 2019
CMS Finalizes Medicare Physician Fee Schedule Payment And Policy Updates For CY 2019
MLN Connects Provider eNews Available
FMT Releases CHNA And Implementation Plan Report For CAHs
CMS Announces IQR Education Session
Kindred Hospital St. Louis Names New CEO

Regulatory News
the latest actions of agencies monitoring health care

Final CY 2019 Payment And Policy Updates To The Medicare DME And ESRD Programs

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services released the final CY 2019 payment and policy updates for the Durable Medical Equipment Prosthetics, Orthotics and Supplies and End-Stage Renal Disease programs. The rule finalizes market-oriented reforms to the Medicare DMEPOS competitive bidding program, expanding the transitional drug add-on payment adjustment for new ESRD drugs and biologicals, effective Jan. 1, 2020, and strengthens quality incentives, improving patient outcomes and reducing administrative burden. For CY 2019, the ESRD prospective payment system facility base rate will be increased from $232.37 to $235.27. CMS estimates that ESRD facility payments will increase 1.6 percent.

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CMS Finalizes Medicare Outpatient PPS And ASC Payment And Policy Updates For CY 2019

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services released the final CY 2019 payment and policy updates for the Medicare outpatient prospective payment and ambulatory surgical center payment systems. CMS projects that OPPS payment rates will increase 1.35 percent, while ASC rates are projected to increase 2.1 percent. The more notable changes include the following.

  • CMS is not finalizing a policy to pay excepted off-campus provider-based departments a reduced nonexcepted payment rate for new services offered outside of the clinical family of services offered.
  • Begin reducing nonexcepted off-campus PBD payments for certain drugs purchased under the 340B program to ASP minus 22.5 percent on Jan. 1, 2019.
  • Reduce excepted off-campus provider-based department clinic visit payments from the OPPS payment rate to a physician fee schedule equivalent over a two-year period. For 2019, the service will be paid at 70 percent of the OPPS rate. Beginning Jan. 1, 2020, CMS will pay at a rate of 40 percent of the OPPS rate. CMS projects the savings in 2019 to amount to $380 million.
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CMS Finalizes Medicare Physician Fee Schedule Payment And Policy Updates For CY 2019

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services released the CY 2019 final payment and policy updates to the Medicare physician fee schedule. The most notable change is the payment mechanism for evaluation and management services beginning in 2021. For CYs 2019 and 2020, CMS will make no changes to the E/M coding and payment structure. However, beginning in 2021, CMS will group E/M level 2 through 4 into a single payment rate. CMS finalized an increase to the conversion factor from $35.99 in 2018 to $36.04 in 2019.

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MLN Connects Provider eNews Available

Staff Contact: Andrew Wheeler

Updates to MLN Connects Provider eNews were issued by the Centers for Medicare & Medicaid Services. eNews includes information about national provider calls, meetings, events, announcements and other MLN educational product updates. The latest issue provides updates and summaries of the following.

  • Hospital cost report data: user-friendly version
  • Skilled Nursing Facility Quality Reporting Program data on Nursing Home Compare
  • U.S. Department of Health and Human Services advances payment model to lower drug costs to patients
  • Inpatient Rehabilitation Facility payment and coverage policies: FY 2019 final rule call – Thursday, Nov. 15

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Quality and Population Health

FMT Releases CHNA And Implementation Plan Report For CAHs

Staff Contact: Stephen Njenga

The Flex Monitoring Team released the latest briefing paper that examines how critical access hospitals use information gathered from the community health needs assessment process and implementation plans to address community needs. This report describes the needs most commonly identified through the CHNA process and opportunities for CAHs to strengthen their efforts to address the unmet needs of the people they serve.

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CMS Announces IQR Education Session

Staff Contact: Sherry Buschjost

An outreach and education webinar for hospitals participating in the Hospital Inpatient Quality Reporting Program is scheduled at 1 p.m. Thursday, Nov. 15. The presentation will provide information regarding version 5.5a of the IQR specifications manual. Registration is required.

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CEO Announcements

Kindred Hospital St. Louis Names New CEO

Staff Contact: Carol Boessen

Kevin Shrake has been named CEO of Kindred Hospital St. Louis, effective Monday, Nov. 5. He replaces Lourene Money, Kindred Healthcare Resource CEO, who had been serving as interim CEO since April 2018, succeeding Jason Grundstrom. Shrake has more than 35 years of experience as a health care executive and has served in various leadership roles in hospitals in St. Louis. A list of CEO changes is available online.

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Did You Miss An Issue Of MHA Today?

October 29, 2018
Trump Signs Opioid SUPPORT Act
CMS Proposes Select CY 2020 Medicare Advantage And Part D Changes
Advanced Nursing Education Workforce Program Applications Available
Hospital Inpatient Quality Measures Specifications Manual Addendum Available

October 30, 2018
2019 Federal Health Insurance Exchange Open Enrollment Begins Nov. 1
CMS Releases Additional Details About SNF VBP Program
CMS Develops A Market Saturation And Utilization Data Tool
CMS Releases Facility-Specific Reports For OP-32

October 31, 2018
2019 Federal Health Insurance Exchange Options In Missouri
MHA Releases Analysis Of Several Programs
CMS Releases Hospital Quality Reporting Center Fall 2018 Newsletter

November 1, 2018
AHA To Host Webinar Highlighting Legal Resources For Victims Of Human Trafficking CMS Extends Timeline For Publication Of Final Rule On Discharge Planning
CMS Issues Final CY 2019 Payment And Policy Updates For Home Health Agencies
October 2018 Hospital Compare Data Updates Available
USDA Announces Funding To Rural Communities
Bothwell Regional Health Center Names Interim CEO

Consider This ...

New research found that one in five childhood scald burns are caused by instant soups, amounting to nearly 10,000 pediatric burns in the U.S. every year.

Source: CNN