MHA Today | February 8, 2019

February 8, 2019
MHA Today: News for Healthcare Leaders

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February 8, 2019

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 In September 2018, MHA released research on the opportunities that the ICD-10 transition created to better identify and understand social determinants of health. Despite the exponentially growing interest in social factors among the provider community, data limitations force us to rely on blunt instruments of measurement like dual-eligibility and ZIP code-level poverty rates to identify patients’ social complexity. Earlier this week, based on our research, we were invited to take part in a panel discussion on SDOH at the AcademyHealth National Health Policy Conference in Washington, D.C.

Providers have a significant stake in policies related to SDOH. When we released the research, taken together with their known and profound influence on individual health outcomes, I found the definition of SDOH “chilling.” SDOH factors include those that have a defined association with health, exist before the delivery of care and are not readily modifiable by the quality of care received.

If these factors lay outside of our influence, but manifest in patient health at our doors, they present a significant threat to our organizations. However, without a process to identify SDOH, there historically has been little incentive for payers in the health care system to recognize or address them. This results in poor risk adjustment and under-reimbursement for care. Moreover, it reduces the ability of providers to address the cause of illness or utilization through under- and improperly-resourcing the providers who are delivering care. That’s starting to change.

Policy Brief - Social Determinants of Health One of the more interesting takeaways from the panel was that payers recognize the value of addressing the drivers of poor health and outcomes. For example, the Centers for Medicare & Medicaid Services announced a major policy shift in February 2018, enabling added flexibility for Medicare Advantage plans through supplemental benefits that allow reimbursement for nontraditional goods and services, such as transportation, groceries and air conditioning. While early evidence suggests that take-up of these benefits by MA plans was limited, the payer-community panelists at this week’s conference indicated that low participation may have been more about the late timing of the call letter than interest in the opportunity.

It’s clear that CMS is serious about SDOH. The Center for Medicare & Medicaid Innovation is developing a “whole person” model that would allow for housing, utilities, nutrition assistance and other options that eventually could be scaled to cover socially complex fee-for-service beneficiaries. Other agencies are working to coordinate stakeholders and provide better access to nonclinical drivers of health.

The message from the National Health Policy Conference is that the thinking about SDOH and policies that influence health improvement for social determinants are maturing. CMS is beginning to roll out policy options that will offer proof of concept through better health and plan savings.

For patients at risk of poor health outcomes driven by SDOH, a new focus on “health” in a whole person context of care could signal a major change in policy and practice.

Our initial research could help shape how the health care system identifies these patients and arrays resources to improve the nonclinical drivers of their health.

Let me know what you’re thinking.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
MHD Sets New Standards For Home Health Services
NHSC Offers Student Loan Repayment For SUD Workforce

state and federal health policy developments

MHD Sets New Standards For Home Health Services

Staff Contact: Brian Kinkade

Beginning Monday, April 1, the MO HealthNet Division will require home health services to be ordered by a MO HealthNet-enrolled physician who is enrolled pursuant to a written care plan that is reviewed every 60 days. Further, the ordering physician or an eligible nonphysician practitioner must have a face-to-face encounter with the participant related to the condition that necessitates home health care at least 90 days before or 30 days after the commencement of care. Eligible nonphysician practitioners include a nurse practitioner working in collaboration with the ordering physician, a certified nurse midwife, a physician assistant under the supervision of the ordering physician, or an attending acute or post-acute physician when the participant is admitted to home health services immediately following an acute or post-acute stay. Face-to-face encounters may occur via telehealth. Documentation of the face-to-face encounter must be maintained in the patient’s record and include the clinical findings necessitating the care, the reason care is needed, the date of the encounter, and the name and credentials of the practitioner. These changes are being made pursuant to federal regulations at 42 CFR 440.70.

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Workforce News

NHSC Offers Student Loan Repayment For SUD Workforce

Staff Contact: Jill Williams

In an effort to combat the opioid crisis, the Health Resources & Services Administration launched the National Health Service Corps Substance User Disorder Workforce Loan Repayment Program. The program supports the recruitment and retention of health professionals treating SUD in underserved, high-need areas. The program offers up to $75,000 for three years of full-time service at a health care facility designated by HRSA as an NHSC-approved SUD site. Part-time workers may receive up to $37,500 over three years.

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Did You Miss An Issue Of MHA Today?

February 4, 2019
State House Committee Reviews Legislative Proposals
MHD Sets Hospital Outpatient Originating Site Fee
2019 Aim for Excellence Award — Call for Applications
TJC Announces eCQM Expert to Expert Webinar

February 5, 2019
PDMP Bill Advances In House; Debate Expected Later This Week
Punitive Tort Reform Legislation Gets Senate Hearing
MHA Releases Analysis Of Top 50 APC And Drug And Utilization Reports
eCQM Reporting Deadline Approaches

February 6, 2019
Senate Committee Considers Certificate Of Need Repeal
HIDI Releases Third Quarter 2018 VBP Payments Model
TJC Announces Complimentary Integrated Care Certification Workshop

February 7, 2019
Statewide PDMP Legislation Makes Progress In House Of Representatives
State Legislative Committees Approve Bills
HHS Summarizes Trump Plan To Curb HIV Infection
MLN Connects Provider eNews Available
TJC Releases Specifications Manual Version 2019A

Consider This ...

There are more than 100,000 people in the U.S. waiting for a kidney transplant, and the median wait time is more than three years. A Nobel Prize-winning economist has a solution: kidney transplant chains. It starts with a donor giving to a stranger with nothing guaranteed in return. And the momentum builds from there.

Source: PBS NewsHour