MHA Today | June 21, 2019

June 21, 2019
MHA Today: News for Healthcare Leaders

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June 21, 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 If you haven’t said it, you’ve probably thought it: “There ought to be a law.” From annoying to dangerous, people do things they shouldn’t. However, a change in the law often is unnecessary, because a change in culture is the real solution.

Last week, MHA held a series of educational sessions throughout the state to help hospitals with their ongoing effort to develop, implement and evaluate workplace violence programs on their campuses and clinics. The sessions were designed to provide tools that hospitals’ safety, security and risk management staff could take back to their facilities and implement immediately. Violence in hospitals is increasing, and every hospital must have an effective plan to avoid, mitigate and react.

It’s a complicated problem. Violence in a hospital already is unlawful, and Missouri law includes tougher criminal penalties for assaulting a hospital worker. However, hospitals' mandate to protect staff, patients and visitors can present problems when the Occupational Safety and Health Administration regulations govern workplace safety and the Centers for Medicare & Medicaid Services regulations govern patient safety. If patient violence harms a worker, it can result in action from OSHA; conversely, staff actions to protect themselves could incite CMS action.

On June 10, the American Hospital Association sent a letter to the leadership of the U.S. House Committee on Education and Labor opposing new legislation to address workplace violence. The message was two-fold. First, hospitals already are working on the issue. Second, the legislation — which would expand OSHA standards — is being expedited, which would preclude significant public comment. I could not agree more with AHA’s stance.

Addressing the epidemic of violence that has permeated hospitals is necessary. However, we’re still waiting on a report that was mandated in last year’s federal budget exploring how CMS and OSHA could work collaboratively to ensure that hospitals can coherently address the dual responsibilities to protect staff and nonstaff. Missouri Sen. Roy Blunt added the language at hospitals’ request, and the report is months overdue. At a minimum, the report could inform the path ahead. Ideally, the agencies would recognize the problem and work with stakeholders to design a system — and support services — that clarifies the guardrails for leaders responsible for safety.

Knowing violence is a problem is one thing. Understanding where, how and by whom it occurs is another. Earlier this year, MHA began asking hospitals to collect and report incidents of violence as part of a program to better understand what’s happening and which resources are needed to mitigate the problem.

Healing Happens Here Although new laws or regulatory changes could clarify some of the “how” in efforts to stem violence in hospitals, the cultural problem — the “why” — would remain. MHA’s “Healing Happens Here” resources are designed to inform patients and visitors about expected behaviors in hospitals. The resources are free and available to download. It’s important to both patients and staff that we clarify what is acceptable behavior.

Cultural change is hard. As hard as getting a law passed can be, cultural change is harder. New legislation or regulation won’t significantly alter bad behavior. Only a cultural change that reestablishes hospitals as safe places of healing will reduce violence.

I encourage every hospital to work with our staff to submit workplace violence data to help us better understand what’s occurring, and to use the Healing Happens Here materials to send a clear message about what behaviors are acceptable within our hospitals.

Tell me what you’re thinking.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
MHA Comments On Proposed FY 2020 IPPS And LTCH Payment And Policy Updates
CMS Hosts Co-Location Listening Session
MLN Connects Provider eNews Available
Connecting Justice-Involved Individuals To Medicaid Helps Address The Opioid Epidemic
AHA Releases 2019 National Health Care Governance Survey Report
Menorah Medical Center Names New CEO

MHA Seeks Member Feedback

MHA Today now is only published on Mondays, Wednesdays and Fridays. As we work to redesign the publication, MHA seeks feedback to better meet the needs of our membership.

Regulatory News
the latest actions of agencies monitoring health care

MHA Comments On Proposed FY 2020 IPPS And LTCH Payment And Policy Updates

Staff Contact: Daniel Landon or Andrew Wheeler

MHA submitted comments about the proposed federal fiscal year 2020 Inpatient and Long-Term Care Hospital Prospective Payment System payment and policy updates. MHA previously submitted comments about proposed changes to the wage index within the rule. Comments on the rule can be submitted until 4 p.m. Monday, June 24.

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CMS Hosts Co-Location Listening Session

Staff Contact: Sarah Willson

The Centers for Medicare & Medicaid Services is hosting a Hospital Co-location Listening Session at 1 p.m. Thursday, June 27. CMS wants feedback on new draft guidance for Appendix A of the State Operations Manual. Under the Medicare Conditions of Participation, hospitals may co-locate with other hospitals or health care entities, meaning they share certain common areas on the same campus or building.

Comments and questions may be emailed in advance of the listening session; these may be addressed during the session or used for other materials following the session.

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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.

  • New Medicare card: 75 percent of claims submitted with Medicare Beneficiary Identifier
  • Medicare Shared Savings Program: Submit notice of intent to apply by Friday, June 28
  • CMS proposes to update e-Prescribing standards
  • Inpatient Rehabilitation Facility: Voluntary appeals settlement options

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Quality and Population Health

Connecting Justice-Involved Individuals To Medicaid Helps Address The Opioid Epidemic

Staff Contact: Shawn Billings or Tiffany Bowman

One critical vulnerability to opioid relapse and overdose occurs when individuals with justice system involvement are being released. Several states, including Missouri, are tackling that need by increasing access to Medicaid upon release for individuals who are Medicaid-eligible prior to incarceration. This is one way the justice system can improve outcomes for individuals experiencing opioid use disorder at reentry.

Key ways Medicaid access can assist those returning from justice involvement include access to medication-based treatment for OUD, substance use disorder treatment, mental health treatment and access to health care. A full summary of strategies used by Missouri, Ohio, New Mexico and Rhode Island is included within the article. The need for access to Medicaid and the impact on the opioid epidemic are meaningful for individuals involved with the justice system.

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AHA Releases 2019 National Health Care Governance Survey Report

Staff Contact: Dana Dahl

The American Hospital Association released its 2019 National Health Care Governance Survey Report. The survey results reflect how boards within systems are redefining roles, responsibilities and levels of decision-making authority to clarify and effectively integrate governance across multiple boards. The survey, conducted in 2018, gathered data on a variety of questions about board membership, structure and practices. Similar to the 2014 survey, this report also continues to examine findings across all respondents and by system, system subsidiary hospitals and freestanding hospital boards.

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CEO Announcements

Menorah Medical Center Names New CEO

Staff Contact: Carol Boessen

Phil Buttell was named CEO at Menorah Medical Center in Overland Park, Kan., effective June 1. Buttell served as chief operating officer at Centerpoint Medical Center in Independence since 2009. Before that, he was vice president of business development for Creighton University Medical Center in Omaha, and also served at Centennial Medical Center in Frisco, Texas, and John F. Kennedy Memorial Hospital in Indio, Calif. He succeeds Charles Laird who accepted the CEO position at St. David’s Medical Center in Austin, Texas. A list of CEO changes is available online.

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Did You Miss An Issue Of MHA Today?

June 17, 2019
CMS Issues First Order Under NQIIC
CDC Releases Information On First Cases of Ebola Virus Disease In Uganda
MACPAC Report To Congress Recommends Removing Third-Party Payments From DSH Calculation

June 19, 2019
Groups Urge Veto Of Motorcycle Helmet Repeal Legislation
MHA Submits Comments On Regulations, Interpretive Guidance
Regulators Propose Surprise Billing Arbitration Process
MedPAC Publishes June Report To Congress
CMS Issues FY 2020 IPPS And LTCH Correction Notice

Consider This ...

In Missouri, children’s enrollment in Medicaid and the Children's Health Insurance Program fell nearly 10 percent throughout the last 14 months — the second biggest decline of any state after Idaho.

Source: KCUR