MHA Today | November 28, 2018

November 28, 2018
MHA Today: News for Healthcare Leaders

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November 28, 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
OIG Releases Report Citing Wage Index Vulnerabilities
Medicare Surgical Procedure Pricing Tool Available For Consumers
CMS Releases Marketplace Enrollment Data, Enhances Enrollment Process
HIDI Releases Second Quarter 2018 VBP Payments Model
CMS Updates eCQI Resource Center

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state and federal health policy developments


OIG Releases Report Citing Wage Index Vulnerabilities

Staff Contact: Andrew Wheeler

The U.S. Department of Health & Human Services’ Office of Inspector General released a report, which describes “significant vulnerabilities in the wage index system.” The vulnerabilities include the following.

  • lack of authority to penalize hospitals that submit inaccurate or incomplete wage data
  • Medicare administrative contractor limited reviews do not always identify inaccurate wage data
  • the national application of the rural floor decreases wage index accuracy
  • hold-harmless provisions and policies pertaining to geographically reclassified hospitals’ wage data

The OIG recommended the secretary of HHS revisit the possibility of comprehensive wage index reform.

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Medicare Surgical Procedure Pricing Tool Available For Consumers

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services has developed a new pricing tool that allows consumers to compare Medicare payments and copayments for certain procedures that are performed in hospital outpatient departments and ambulatory surgical centers. CMS Administrator Seema Verma stated, “Working with their clinicians, Procedure Price Lookup will help patients with Medicare consider potential cost differences when choosing among safe and clinically appropriate settings to get the care that best meets their needs.” The Procedure Price Lookup tool includes the average Medicare payment, the average patient out-of-pocket expenses, and average total cost or payment if a service is performed at an ASC or HOPD.

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CMS Releases Marketplace Enrollment Data, Enhances Enrollment Process

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services released marketplace enrollment data through Nov. 24. For the first three weeks of the 2019 open enrollment period, 2,424,913 beneficiaries made plan selections in states where the HealthCare.gov platform is being utilized. Through the third week of open enrollment for 2018, 2,781,260 plan selections had been chosen. In Missouri, 59,121 beneficiaries made plan selections for 2019, approximately 25 percent less than the 78,676 plan selections through the third week last year.

CMS also released the number of effectuated enrollments for the first six months of 2018. An average of 10.3 million individuals effectuated their coverage through June 2018, which is a 1 percent increase from the same time period in 2017.

To make the enrollment process more user-friendly and seamless, CMS also developed a new enhanced direct enrollment pathway for consumers to enroll in marketplace coverage. The enhanced pathway improves upon the current direct enrollment pathway, which has been in place since 2013.

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HIDI Tech Connect


HIDI Releases Second Quarter 2018 VBP Payments Model

Staff Contact: Shane VanOverschelde

The Value-Based Purchasing Payments Model is a companion utility to the VBP Analysis that was produced for hospitals on Oct. 31. The VBP Payments Model is an interactive tool that provides hospitals with the ability to manipulate their hospital-specific quality scores to evaluate the associated change to estimated VBP payments. The VBP Payments Model is provided to subscribers of the 2018 Premier Reporting Package. The modeling utility is located on HIDI Analytic Advantage® in the “Finance and Policy/Premier Reports” or “Quality/Premier Reports” folders, with the following file name: MOxxxx_VBP FFY2019 Payments Model_2018_Q2_(2018.11.28).xlsx. Hospitals interested in subscribing to the HIDI Premier Report Package should review the package information. Current subscribers with questions about downloading files should contact HIDI.

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Quality and Population Health


CMS Updates eCQI Resource Center

Staff Contact: Sherry Buschjost

Based on feedback from the community, the Centers for Medicare & Medicaid Services updated the Electronic Clinical Quality Improvement Resource Center website to promote a more user-friendly experience. The eCQI Resource Center is a one-stop shop for federal eCQI initiatives that includes the most current electronic clinical quality measure specifications, as well as links to the tools, standards, education and materials critical to support development, testing, implementation and reporting of eCQMs. The redesign aligns with the Quality Payment Program website to promote continuity amongst CMS resources. The update also simplifies navigation and presents eCQI resources and information in a more manageable and meaningful way.

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Consider This ...

Total alcohol deaths – through cancer, liver cirrhosis, pancreatitis, suicide and other causes – increased 35 percent from 2007 to 2017. The greatest increases were among people over 30 and women, who saw an 85 percent jump.

Source: USA Today