MHA Today | February 15, 2019

February 15, 2019
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MHA Today: News for Healthcare Leaders

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February 15, 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 This week, the Missouri House debated and adopted legislation to establish a statewide prescription drug monitoring program. The legislation, House Bill 188, was sponsored by Rep. Holly Rehder of Sikeston. She was the sponsor of PDMP legislation last year and has been a vocal advocate for additional resources to manage the state’s opioid and substance use crisis.

Despite Missouri’s status as the only state without a PDMP, the House vote wasn’t a slam-dunk. A full one-third of those voting didn’t support the legislation. And, one member of the House argued a PDMP wouldn’t be effective, saying, “You make everybody feel good, but you don’t really do anything. It’s kind of like peeing your pants in the dark: You get a warm feeling, but nobody really notices.”

For hospital workers on the front line of the opioid crisis, a PDMP would provide much more than a “warm feeling.” In fact, it’s clear from the voluntary uptake at the county and municipal level that not all leaders share a belief that giving providers additional tools is a bad idea. More than 80 percent of Missourians and 90 percent of providers are covered by the St. Louis County Department of Public Health’s PDMP system. Unfortunately, there still are nearly 50 — primarily rural — counties outside of the PDMP network.

Rep. Rehder’s bill now moves to the Senate. The Senate historically has been the place where PDMP legislation stalls. Despite senatorial retirements of PDMP foes, opposition still exists in the chamber. And a small number of fervent senators can block legislation through filibuster or other means. Although the vote may be reconsidered, a Senate version of the legislation failed in committee last week.

There’s important work being done by hospitals and other stakeholders to help Missourians end the cycle of substance abuse that has ruined and ended far too many lives. These efforts will continue whether lawmakers adopt a statewide PDMP or not. However, it is sad that as a state we haven’t been able to deliver this important decision-making tool to the caregivers most likely to be able to intervene in real time.

There was another very interesting development this week. The consulting firm McKinsey & Company released a report on the state’s Medicaid program, suggesting changes that could save the state as much as $1 billion throughout the next four years. Too often, when we hear about savings, the term is used as a euphemism for rate cuts. We must be vigilant, but that’s not what seems to be going on here.

Medicaid “reform” has been the watchword in the Missouri Capitol, but there hasn’t been a clear picture of what reform looks like. Attempts to improve the program by growing the share of lives covered through Medicaid managed care has resulted in additional, not reduced, costs. And, there’s little evidence that managed care expansion is bringing value to anyone but the managed care companies.

The new MO HealthNet director, Todd Richardson, is looking for big, transformational ideas to improve the program. McKinsey provides several. Now it’s time to take this information and engage in a broader discussion with stakeholders from across the state. A strong partnership with providers can help policymakers evaluate the recommendations that can work in our state, and create opportunities to identify additional, innovative improvement options that are not included in this report.

Hospitals have a long history in partnering to strengthen the state’s Medicaid program. This is a credible starting point for reform that can create value for the state and providers.

Send me a note to let me know what you think.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
CMS Proposes CAR T-Cell Therapy National Coverage
CMS Announces IQR Education Session

Regulatory News
the latest actions of agencies monitoring health care

CMS Proposes CAR T-Cell Therapy National Coverage

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services announced a proposal to cover FDA approved chimeric antigen receptor T-cell therapy. There is currently no national Medicare policy to cover CAR T, leaving local Medicare administrative contractors the discernment to pay for it. CMS is now proposing a national coverage determination that would require Medicare to cover the therapy nationwide “when it is offered in a CMS-approved registry or clinical study, in which patients are monitored for at least two years post-treatment.” Comments about the proposed NDC must be submitted by Sunday, March 17.

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Quality and Population Health

CMS Announces IQR Education Session

Staff Contact: Sherry Buschjost

An outreach and education session for hospitals participating in the Inpatient Quality Reporting Program is scheduled at 11 a.m., Tuesday, Feb. 26. The presentation, titled SEP-1 Early Management Bundle, Severe Sepsis/Septic Shock: v5.5a Measure FAQs, will clarify the most frequently asked SEP-1 measure questions in version 5.5a of the specifications manual. Registration is required.

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Did You Miss An Issue Of MHA Today?

February 11, 2019
CMS Advances Interoperability And Patient Access Proposed Rule
CMS Releases Independence At Home Demonstration Performance Year 3 Results
ASPR TRACIE Hosting Small And Rural Hospital-Based Incident Command Systems Webinar
CMS Announces OQR Education Session

February 12, 2019
Report Assesses Missouri Medicaid Reform Opportunities
Senate Committee Approves Punitive Damages Legislation
MHA Distributes Wage Index, Occupational Mix Data For Review
Preview Data For April 2019 Hospital Compare Available

February 13, 2019
MHA Raises Concerns About Fetal Death Reporting Change
State Legislators Act On PDMP Legislation
Legislators Review Certificate Of Need Legislation
State House Adopts Hospice Investigation Legislation
CVS Caremark Reverses 340B Payment Cut Policy
Trump Administration Considers Changes To HIPAA Regulations

February 14, 2019
Legislators Consider Repeal Of Motorcycle Helmet Law
HHS Launches New Emergency Triage, Treatment And Transport Model
MLN Connects Provider eNews Available
MHA Hosts Quality And Safety Showcase
AHA Offers Webinar On Human Trafficking And The Opioid Crisis
AHA Offers Strategic Cybersecurity And Risk Issues Webinar

Consider This ...

Preliminary figures suggest this year's flu vaccine is 47 percent effective in preventing flu illness severe enough to send someone to the doctor's office. Officials are generally pleased if a flu vaccine works in 40 to 60 percent of people.

Source: AP/U.S. News & World Report