MHA Today | February 22, 2019

MHA Today: News for Healthcare Leaders

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February 22, 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 Some things that seem impressive on their own are even more so when put into context.

Tuesday, MHA released the annual Community Investment Report and the accompanying hospital-specific data on The report includes data from 2017 and shows that hospitals’ provision of uncompensated care reached $1.4 billion — an all time high.

For the last several years, we’ve included some comparatives to our news release to help ground the big numbers in something concrete — like what $795 million in charity care statewide means. One of the examples we use is that $795 million is roughly equal to the cost of 18,793 physician office visits, provided at no cost, every day for a year. Although this type of comparison can help Missourians understand the numbers, what it does not do is help them understand the environment.

This week, two other things happened that helped put hospitals’ community benefit for 2017 in sharp focus. First, MHA’s hospital finance expert looked at 2017 data for hospital margins. The numbers are pretty grim. In 2017, 62 percent of hospitals had a positive operating margin, which was actually an improvement over 2016. However, when segmenting rural hospitals from all hospitals, the percent of positive operating margins fell to 55 percent.

Also this week, Navigant released a nationwide report on rural hospital sustainability. Although Missouri wasn’t among the cohort of states with the most hospitals at risk, nearly one-quarter of the state’s rural hospitals were deemed to be at “high financial risk.” Of the 14 hospitals identified in Missouri as at-risk rural, seven were identified as “essential” using the criteria of trauma status, service to vulnerable populations, geographic isolation and economic impact.

MHA Quality & Safety Showcase
So, the context of this year’s community investment report is that hospitals — many of which are operating under, at or near breakeven from an operational perspective — remain essential to the communities they serve.

All of this is occurring at the same time as Congress is renewing its pressure on hospitals to demonstrate and deliver value for non-profit status. U.S. Senator Chuck Grassley (R-IA), Senate Finance Committee chairman, said, “I'm going to do oversight work, and then what that leads to, I don't know. But through oversight work, I intend to make sure that non-profit hospitals meet their non-profit responsibilities. That is, to serve people that can't pay for their services.”

The community investment report certainly points to hospitals providing care for the uninsured and underinsured. And, when other benefits like absorbing the unpaid costs of treating Medicare and Medicaid patients, health professions education, clinics and health improvement activities, and donations to local causes are added, hospitals provided $3.3 billion in value.

Those are the numbers. And, that is the context.

Let me know what you’re thinking.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
SAMHSA Report Reviews Behavioral Health Spending Trends
Study Assesses Rural Hospital Sustainability
DHSS Publishes Draft Medical Marijuana Rule
VA Issues Proposed Rule On Access To Community Providers
MHD To Allow Claims For LARCs From Administering Providers Only
MLN Connects Provider eNews Available
DHSS Releases Health Update For Ebola Virus Disease

state and federal health policy developments

SAMHSA Report Reviews Behavioral Health Spending Trends

Staff Contact: Daniel Landon or Sarah Willson

The federal Substance Abuse and Mental Health Services Administration published a report on trends in behavioral health spending from 2006-2015. Spending for mental health and substance abuse disorder increased by 62 percent during that period. The growth rate for substance abuse spending exceeded that of mental health, particularly from 2010-2015. The report examines spending trends by type of provider, service and setting.

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Study Assesses Rural Hospital Sustainability

Staff Contact: Daniel Landon or Andrew Wheeler

An analysis by Navigant consulting firm includes a state-specific assessment of the financial viability of rural hospitals. It also includes a metric for determining which of these rural hospitals are essential to their communities. Sixty-four percent of the nation’s rural hospitals meet that threshold.

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Regulatory News
the latest actions of agencies monitoring health care

DHSS Publishes Draft Medical Marijuana Rule

Staff Contact: Jane Drummond

The Missouri Department of Health and Senior Services published a draft rule outlining the process for qualifying patients and primary caregivers to obtain medical marijuana identification and cultivation cards. The proposed rule also specifies limits on the amount of medical marijuana a patient or primary caregiver may cultivate and possess.

This is the first of numerous topics the department will cover through rulemaking, all of which are listed on its website. The department intends to release its medical marijuana rules in draft form for public input before filing proposed notices of rulemaking. The public may comment on the rules via a suggestion form provided by DHSS.

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VA Issues Proposed Rule On Access To Community Providers

Staff Contact: Daniel Landon or Andrew Wheeler

The U.S. Veterans Administration previously announced new standards governing access to non-VA providers through the Veterans Community Care Program. A new VA proposed regulation provides detail of the proposal. The access criteria include drive time to, and waiting times for, treatment by VA providers. They are one of several options for qualifying for VA coverage of community providers’ services. Comments regarding the proposed regulation can be submitted on or before Monday, March 25.

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MHD To Allow Claims For LARCs From Administering Providers Only

Staff Contact: Brian Kinkade

Beginning Sunday, April 14, the MO HealthNet Division will not reimburse pharmacies for long-acting reversible contraceptive products and instead will require the provider inserting the product to include LARC in the claim for the insertion procedure.

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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.

  • CMS: Beyond the Policy — Podcast
  • Promoting Interoperability Program: 2019 resources
  • CAR T-cell therapy: CMS proposes coverage with evidence development
  • Skilled Nursing Facility PPS Patient Driven Payment Model: Updated resources
  • Inpatient Rehabilitation Facility – Patient Assessment Instrument clinical help desk: New address for questions
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Quality and Population Health

DHSS Releases Health Update For Ebola Virus Disease

Staff Contact: Jackie Gatz

The Missouri Department of Health and Senior Services has been monitoring reports from the Centers for Disease Control and Prevention and the World Health Organization pertaining to the Ebola Virus Disease outbreak declared on Aug. 1, 2018, in the Democratic Republic of the Congo. As reported in WHO’s Disease Outbreak News on Feb. 7, the global risk level for the spread of Ebola from this outbreak remains low. However, the fact that the outbreak is ongoing serves as a reminder to Missouri health care providers to review infection prevention and control procedures as they relate to communicable infections, including EVD. CDC’s Division of Healthcare Quality Promotion shared the information update with state healthcare-associated infection programs to help guide preparedness efforts.

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Did You Miss An Issue Of MHA Today?

February 18, 2019
CMS Issues Emergency Preparedness Updates
DHSS Files Controlled Substance Rules
Research Finds Underinsured Numbers Increase

February 19, 2019
Uncompensated Care And Community Benefit Set Record Totals In 2017
Hospice Death Investigation Bills Advance

February 20, 2019
House Budget Subcommittee Advances Recommendations
Legislative Committee Approves Medicaid Work Requirement
State House Approves Medical Futility Legislation
MHA Supports Liability And Utilization Review Legislation
OIG Report — CMS Improperly Paid SNFs $84 Million
Crittenton Children’s Center Names New President

February 21, 2019
Senate Committee Reviews FRA Reauthorization Legislation
MHA Opposes Maternal Mortality Review Legislation
AHA Releases Surprise Billing Principles
MHA Releases CAH And PPS Rate Comparison
CMS Releases National Health Expenditure Projections
MHD To Require NDC Reporting For Outpatient 340B Drug Reimbursement

Consider This ...

Death rates from excessive cold or hypothermia are highest for elderly Americans age 85 and up and are nearly twice as high among elderly people living in nonmetropolitan counties versus those in metropolitan counties.

Source: Centers for Disease Control and Prevention