MHA Today | March 8, 2019

March 8, 2019
MHA Today: News for Healthcare Leaders

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March 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 2016, MHA researchers found that Missouri hospitalization for suicide ideation among children and adolescents had grown 900 percent throughout a decade. Lending credence to this finding, data from the Centers for Disease Control and Prevention indicate Missouri had the 11th highest rate of suicide among 5 to 19 year olds in 2017, nationally. Between 2003 and 2017, the rate of child and adolescent suicide in Missouri exceeded the national rate by 57 percentage points.

Suicide is the second leading cause of death for this age group. And, for every suicide death, research suggests an additional 50 to 100 children have attempted suicide.

Adolescent Suicidality Policy Brief Graph This is a public health crisis of significant magnitude. However, there hasn’t been a public health emergency declaration. Conversely, Washington State issued a public health emergency for its measles outbreak. To be fair, measles can be deadly — especially to those too young to be vaccinated or seniors who have never had the disease or the vaccine. Presently, there are approximately 70 confirmed cases in Washington State, but the emergency declaration by Gov. Inslee was triggered very near to patient zero, with the 26th confirmed case.

We can’t vaccinate against suicidal ideation. Yet, we know young Missourians are exposed to bullying and toxic social media at unprecedented rates. We also know that antidepressants fail many in this age group — or even enhance suicidal thinking — while specialized behavioral health services for children and adolescents are exceedingly scarce in Missouri, particularly if the child’s family can’t afford to pay out-of-pocket.

There are a lot of things we can’t control. Then, there are the things we can. We can ensure that youth who enter the mental health care system receive prescribed levels of care required for stabilization before discharge. New research calls into question whether the system is delivering that care.

The Hospital Industry Data Institute recently identified an opportunity to evaluate how Medicaid was serving this at-risk population. The statewide expansion of Medicaid managed care in May 2017 presented an opportunity to evaluate pre-post differences in outcomes for hospital patients with Medicaid in a controlled, quasi-experimental research design. Similar to the famous “Oregon Experiment,” this is one rung below the vaunted, randomized control trial in experimental designs.

Adolescent Suicidality Policy Brief Table A small population of Medicaid enrollees — 2,152 children, ages 5 to 19, with an inpatient psychiatric hospitalization both before May 2017 and after — was identified to evaluate differences between the fee-for-service and managed care delivery models. With Medicaid FFS coverage, during the six quarters leading up to the statewide Medicaid managed care expansion, the children affected by the policy experienced suicidality rates similar to the larger population. Following expansion, with Medicaid managed care coverage, the same group of patients experienced significantly higher rates of suicidality that coincided with a sharp decline in the average length of stay for these patients.

The new data validate not only the concerns long expressed by behavioral health providers, but the need to improve the mental health delivery system and standards of care for children with Medicaid. Further, they call for additional examination of the systems and policies that lead to payment refusal for levels of care prescribed by front-line behavioral health providers.

A public health crisis of this magnitude deserves the attention and resources it is due. For children in crisis, the source of payment shouldn’t matter. Front-line clinician judgement should govern treatment. These providers are positioned to understand whether the child is stabilized and prepared to move to a lower level of care or back to the community. Reimbursement for this care should follow.

There was a time when discussing behavioral health and suicide were taboo. Today, we know that getting help for those in crisis literally saves lives. Doing anything less is the new taboo.

The data show that far more than 26 children are at risk of experiencing suicide ideation or attempt in Missouri. And this comes as a result of a policy shift that allows insurers to deny levels of care prescribed by psychiatrists standing at the child’s bedside, from a distance. Yet, where is the public health emergency declaration? This report provides compelling evidence that Missouri can and must do more.

Send me a note to let me know what you’re thinking.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
State House Approves Supplemental Spending Bill
Senate Committee Approves Regulatory Reform Legislation
MedPAC Posts Meeting Materials
January MUR Available On HIDI Analytic Advantage®
Reports Find Deaths Due To Alcohol, Drugs And Suicide Are On The Rise
New Webinar Focuses On Addiction And The ED
CMS Announces OQR Education Session

state and federal health policy developments

State House Approves Supplemental Spending Bill

Staff Contact: Daniel Landon or Brian Kinkade

The state House of Representatives approved House Bill 14. Dubbed the “supplemental appropriations” bill, the legislation authorizes additional spending to address budget shortfalls or unforeseen expenses of the current state fiscal year, which ends Sunday, June 30. The measure provides $147.5 million in additional funding for Medicaid hospital services. It now moves to the Missouri Senate.

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Senate Committee Approves Regulatory Reform Legislation

Staff Contact: Rob Monsees or Ted Wedel

A state Senate committee approved legislation to promote timely notification of emergency rules, which can take effect with little warning. Senate Bill 328 also would require that new emergency rules have fiscal estimates of their cost to private entities. MHA developed and is promoting the bill. The committee revised the bill to permit electronic rather than written copies of proposed and final regulations, a change sought by the Missouri Secretary of State.

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Regulatory News
the latest actions of agencies monitoring health care

MedPAC Posts Meeting Materials

Staff Contact: Andrew Wheeler

The Medicare Payment Advisory Commission released materials that were presented at its meeting on March 7, including the following.

  • two Medicare payment strategies to improve price competition and value for Part B drugs: reference pricing and binding arbitration
  • Medicare Advantage encounter data
  • options for slowing the growth of Medicare fee-for-service spending for emergency department services
  • Medicare’s role in the supply of primary care physicians
  • mandated report on clinical payment in Medicare
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HIDI Tech Connect

January MUR Available On HIDI Analytic Advantage®

Staff Contact: Cerise Seifert

Data for the January 2019 monthly utilization report have been posted on HIDI Analytic Advantage® and are available to download for distribution or placement in a network folder. HIDI Analytic Advantage® PLUS has been updated to include this data. Contacts from participating hospitals have been notified by email, and they may download and save the Excel worksheet to a secure network location or PC. The data are encrypted on the site and also during the transmission from HIDI. Once the data have been transferred, it must be secured according to the hospital’s security procedures. February 2019 data are being collected now and are scheduled to be available Friday, April. 5.

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Quality and Population Health

Reports Find Deaths Due To Alcohol, Drugs And Suicide Are On The Rise

Staff Contact: Shawn Billings or Mat Reidhead

The Trust for America’s Health and the Well Being Trust revealed findings and recommendations regarding the dramatic spike in death due to alcohol, drugs and suicide in the U.S. Items for consideration include addressing the underlying causes of these public health concerns, increasing resiliency among children and reducing trauma in childhood. The report shows trends in each area, as well as trends in all areas combined from 1999-2017.

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New Webinar Focuses On Addiction And The ED

Staff Contact: Shawn Billings or Tiffany Bowman

According to a study by the Centers for Disease Control and Prevention, emergency departments saw a spike in opioid-related visits between July 2016 and September 2017. CHESS Health is offering a webinar, “Addiction and the Emergency Department: Making Radical Improvements in Intervention, Initiation and Treatment Follow-Through,” at 11 a.m. Wednesday, March 13. Mark O’Brien and Hans Morefield will explore the unique opportunities EDs have to improve long-term recovery success rates.

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CMS Announces OQR Education Session

Staff Contact: Sherry Buschjost

An outreach and education session for hospitals participating in the Outpatient Quality Reporting Program has been scheduled on Wednesday, March 20. The webinar, “The Life and Times of a Measure: An Overview of the Measure Development Process,” is offered at 9 a.m. and 1 p.m. Registration is required.

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Did You Miss An Issue Of MHA Today?

March 4, 2019
MHA Supports APRN Legislation
Code Of State Regulations Adds Controlled Substance Rules
Statewide PFAC Releases Vlog
CMS Updates Hospital Compare Data

March 5, 2019
MHA To Release New Report On Adolescent Suicidality
State Senate Approves Liability Legislation Compromise
Legislation Sets New Standards For Hospital Inspectors
CMS To Hold National Call On Star Ratings
CDC Releases COCA Now On Ebola Considerations
The FDA Addresses The Opioid Crisis
Mosaic Medical Center — Maryville Names New President

March 6, 2019
MHA Opposes Legislation To Expand Authorization Of Concealed Weapons In Hospitals
CMS Issues Revised Immediate Jeopardy Conditions
MHD Corrects RHC Distant Site Telehealth Billing Requirements
Training On Medication First Treatment Of Opioid Use Disorder Available
CMS Reminds Hospitals Of HCAHPS Submission Deadline
CMS Invites Feedback On Draft eCQM Packages

March 7, 2019
House Committee Begins FY 2020 State Budget Mark-up
MHA Releases Map To Evaluate Proposed Access Standards For Veterans
CMS Seeks Recommendations About Purchasing Insurance Across State Lines
MLN Connects Provider eNews Available
Hospital Quality Reporting Center Winter 2019 Newsletter Available
CMS Announces Education Session
Nevada Regional Medical Center Names New CEO

Consider This ...

Over nearly a quarter-century, the overall cancer mortality rate has fallen 26 percent, resulting in almost 2.4 million fewer deaths than if peak rates had continued.

Source: The Washington Post