MHA Today | August 2, 2019

August 2, 2019
MHA Today: News for Healthcare Leaders

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August 2, 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 A book I recently read used an interesting bit of wordplay. As the author was comparing modern versus traditional learning strategies, he said that premodern learners “can’t see the forest for the trees,” while modern learners “can’t see the trees for the forest.” New data from the Centers for Disease Control and Prevention, and the subsequent analysis, got me thinking about differing views of the opioid crisis.

The first big data dump included the per-capita number of opioid pills prescribed by county throughout the past two decades. The CDC data allowed researchers to identify the percent growth in opioid prescriptions between 2006 and 2012, and the number of daily dose-equivalents available annually by county during the same period. Missouri was among the states with a high rate overall and in numerous counties.

Although the prescription-rate data are indicative of how the crisis materialized, another recent dataset is more alarming. Between 2017 and 2018, there was a downward trend in drug overdose deaths — 5.1 percent nationally. However, Missouri was trending the wrong direction. Missouri drug overdose deaths increased 16.3 percent during the same period, placing Missouri the second highest in the nation behind Delaware.

These data validate that many of the strategies stakeholders have put in place are correct. Prescribing guidelines, for example, are an important tool in reducing unnecessary opioid prescriptions. Extension of naloxone availability will reduce opioid overdose risk.

The data, which is retrospective, help us view the forest. Progress occurs at the tree level and in real time.

A 16.3 percent increase in drug deaths between 2017 and 2018 represents 229 additional lives. Not all of these are opioid-related — as opioids become more difficult to find, methamphetamine is making a comeback. However, it’s clear that the dramatic increase in opioid prescriptions since the mid-2000s contributed to an addiction crisis, with significant individual and societal costs, regardless of the drug.

We’re making progress. Missouri’s medication first, evidence-based recovery model is expanding throughout the state, although the system has yet to scale to address the scope of the problem. However, existing behavioral health services that could reduce opioid misuse and abuse in the state are inadequate to the challenge.

Challenges exist. There’s evidence that the crisis is shifting from rural communities to urban communities, and that fentanyl — a much more powerful synthetic opioid — is replacing prescription misuse and heroin as an overdose killer. Despite expansion of the county-level prescription drug monitoring program, some communities still lack access to this front-line safeguard.

Seeing the forest-level challenges can help us understand the environment. The data indicate we need policies and resources to support increased access to evidence-based care — statewide and nationally.

The front-line of care is tree-focused. We can, and must, do more.

Let me know what you’re thinking.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
Congressional Committee Leaders Needle Agencies On Hospice Deficiencies And Air Ambulances
MHA Releases Issue Briefs On Payment And Policy Updates
MHD Issues New Prescriber Guidelines For Benzodiazepines
CMS Revises Immediate Jeopardy Criteria
MLN Connects Provider eNews Available
Planned Parenthood Challenges Changes To Abortion Laws
FY 2020 Hospital VBP Payment Adjustment Factors Available For Review

state and federal health policy developments

Congressional Committee Leaders Needle Agencies On Hospice Deficiencies And Air Ambulances

Staff Contact: Sarah Willson or Daniel Landon

Democratic and Republican leaders of the U.S. House of Representatives Ways and Means Committee sent two joint letters to agency officials. One relays concerns and a list of questions to the Centers for Medicare & Medicaid Services regarding quality of care deficiencies in Medicare hospices. The other calls for the Department of Transportation to convene an advisory committee to develop recommendations to Congress regarding patient billing by air ambulance services. The advisory committee was mandated by a 2018 federal law; the agency is eight months overdue in creating it. The letter notes another tardy DOT report to Congress is to review air ambulance regulatory oversight.

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Regulatory News
the latest actions of agencies monitoring health care

MHA Releases Issue Briefs On Payment And Policy Updates

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services recently released final payment and policy updates for FY 2020.

CMS finalized Medicare FY 2020 hospice payment and policy updates, which estimates that the updates will increase hospice payments by 2.6 percent, or $520 million. Major provisions of the proposed rule include modifying the hospice election statement content requirements and finalizing the use of concurrent inpatient prospective system wage index for adjusting hospice payment rates.

Also finalized by CMS is FY 2020 Medicare Inpatient Rehabilitation Facility Prospective Payment System payment and policy updates. CMS estimates that the updates will increase Medicare IRF payments by 2.5 percent, or $210 million. Major provisions of the proposed rule include case-mix group revisions, clarifying the determination of whether a physician qualifies as a rehabilitation physician and updating the IRF Quality Reporting Program.

MHA published issue briefs with additional details.

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MHD Issues New Prescriber Guidelines For Benzodiazepines

Staff Contact: Brian Kinkade

The MO HealthNet Division will implement new controls on the prescription of benzodiazepines, effective Thursday, Aug. 8. The clinical edit is being put in place to ensure appropriate use of the drug, especially in combination with opioids, antipsychotics and sedative hypnotics. The clinical edit is MHD’s response to Section 1004 of the federal SUPPORT Act, which passed last October.

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CMS Revises Immediate Jeopardy Criteria

Staff Contact: Sarah Willson or Jane Drummond

In March, the Centers for Medicare & Medicaid Services revised the Immediate Jeopardy Conditions of Participation, and this week, the agency issued an updated QSO memo, which addresses criminal acts. The new language mandates reporting to local law enforcement if the noncompliance was caused by or led to a criminal act. If the surveyor determines the facility has refused to report or they cannot discern a report was made, the surveyor must consult with the state agency to report the potential criminal incident to law enforcement immediately.

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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.

  • fiscal year 2020 payment and policy updates
    • skilled nursing facilities
    • inpatient psychiatric facilities
  • Medicare coverage for treatment services furnished by opioid treatment programs
  • disaster preparedness resources
  • open payments program expansion
  • reducing administrative burden: comments by Monday, Aug. 12
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Health Law Insight

Planned Parenthood Challenges Changes To Abortion Laws

Staff Contact: Jane Drummond

Planned Parenthood filed a lawsuit challenging certain provisions of House Bill 126, which passed during the 2019 legislative session and implemented changes to Missouri’s abortion laws. The bill made numerous revisions to chapter 188 of the Missouri Revised Statutes; however, Planned Parenthood only seeks to enjoin the provisions banning abortions at eight, 14, 18 and 20 weeks, respectively, along with the prohibition on performing abortions sought solely because of the sex of the child or presence of Down syndrome.

The law will go into effect on Wednesday, Aug. 28, unless the court enters the requested injunction. Oral arguments have been scheduled for Monday, Aug. 26. Even if the court enjoins the requested statutory sections, the remaining provisions of the bill will take effect as scheduled, barring additional litigation by another party.

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Quality and Population Health

FY 2020 Hospital VBP Payment Adjustment Factors Available For Review

Staff Contact: Sherry Buschjost

Now available on the QualityNet secure portal are the Percentage Payment Summary Reports for the fiscal year 2020 Hospital Value-Based Purchasing Program. The reports provide hospitals with their total performance score and value-based incentive payment adjustment factors. Additional details are available.

The Centers for Medicare & Medicaid Services are offering two webinars on the PPSR. Registration is required.

  • 1 p.m. Wednesday, Aug. 7 — Where’s My Report? Everything You Want to Know About the FY 2020 Hospital VBP Percentage Payment Summary Report
  • 1 p.m. Thursday, Aug. 8 — What’s My Payment? Understanding the Hospital VBP Program Calculations Step-by-Step in the Percentage Payment Summary Report
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Did You Miss An Issue Of MHA Today?

July 29, 2019
CMS Releases Medicare CY 2020 Proposed Rules For OPPS, ESRD And PFS
Health Care Costs Reach More Than $28,000 For Family Of Four
HIDI Posts Hospital Profile Report Online
Research Medical Center Names New CEO

July 31, 2019
GAO Examines States' Supplemental Medicaid Payments To Hospitals
Governor Appoints State Health Insurance Innovation Task Force
MHA Distributes Financial Indicators Analysis
MHA Releases Issue Briefs On Medicare Payment And Policy Updates
DHSS Publishes Legionella News Release
CMS Issues PHI Memo

Consider This ...

The Centers for Disease Control and Prevention found that both urban and rural overdose death rates have been rising, but the urban rate shot up more dramatically after 2015.

Source: AP