MHA Today | August 9, 2019

August 9, 2019
MHA Today: News for Healthcare Leaders

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August 9, 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 When you think of chess, you might conjure a vision of the board and the various game pieces or think about the highly structured rules governing play. However, as a master game of strategy, chess has a weakness — it lacks dimension. The flat board, strictly defined movements and limited number of pieces confine play. Chess is a two-dimensional game in a three-dimensional world.

Thursday, a recently established task force held its first meeting. Gov. Parson created the task force by executive order to evaluate state actions that would provide “significant innovation in the Missouri health insurance market.” The appointees largely are elected officials, members of the administration and representatives of the state’s marketplace insurers. Parson appointed Gary D. Fulbright, chief financial officer of Citizen’s Memorial Hospital in Bolivar, to represent the hospital community.

Parson’s goal is for the group to evaluate the utility of a Section 1332 waiver — authorized by the Affordable Care Act and recently broadened by the Trump administration — for alternative coverage systems in individual- and small-group insurance markets. The waivers allow a state to implement innovations as long as they are at least as comprehensive and affordable as coverage provided absent the waiver.

First, it’s important to applaud Parson’s initiative. Missouri state government’s historical rejection of the Affordable Care Act — including legislation ratified by the voters to stymie state government participation in the health insurance marketplace — has limited the state’s ability to influence consumers’ options. That lack of engagement has a cost. Although employer-sponsored insurance, Medicare and Medicaid cover the majority of Missourians, approximately 7 percent — nearly 415,000 individuals — are in the nongroup marketplace. To create more value for these Missourians, the state can’t sit on the sidelines.

It’s too early to know where the discussions will go or what options the task force might recommend when they submit their findings in January 2020. However, a smart approach would be a broad approach. The governor and the task force can look at the problem in two dimensions — taking into consideration only the relatively small marketplace — or they can play chess in three dimensions, recognizing the natural interaction between coverage domains.

Since Missouri has not expanded Medicaid and uncompensated care continues to drive a hidden health care tax on individuals with commercial coverage, adding Medicaid expansion to the discussion makes sense. No part of the health care system exists removed from another. And, as long as Missouri has a comparatively large share of uninsured, cost control will be difficult.

There’s some evidence that they already are considering the multilevel, integrated approach. According to Parson, his goal is to drive heath care costs down and make the market more competitive. While the task force is focused primarily on the individual and small group market, he’s left options open.

For example, in talking to St. Louis Public Radio on Saturday, Parson said rural health is a “top priority.”

“I came from one of those towns with 356 people. And the reality is, you don’t have doctors there, you don’t have medical services in those small towns. So one, you’ve got to figure out how do we get services to them, whether that’s telemedicine or we get a central office, or maybe it’s something mobile,” Parson said. “If we don’t take care of them in the counties, you know, and they end up getting in worse situations, they end up just costing more money. So anything we can be on the prevention side of it will be important to me and how they look at that through the task force.”

That wasn’t all. He also indicated that while he views the Medicaid program as “broken,” the task force could look at Medicaid expansion as it reviews the health insurance marketplace. According to NPR, Parson said, “We’ll have everything on the table we can put on the table, and see what’s best for Missouri citizens.”

Parson continues to add talent to his pool of resources for health insurance transformation. He appointed former Speaker of the House Todd Richardson to be MO HealthNet Director, and his administration recently engaged former state Rep. Kirk Mathews to head up the new Medicaid Office of Transformation.

As the administration moves forward, they can address the problems of the existing program as they expand. Playing in three dimensions will allow the state to get the best value out of the existing Medicaid program, bring new value to the state and its citizens through expanded coverage, and reduce the costs to individuals and businesses picking up the tab through the hidden health care tax.

Speaking of the current system in his NPR interview, Parson said, “Here’s the one thing we all want from Medicaid: The people that need it, that should be getting it — we want to make sure they get it.”

If we realize we’re playing in three dimensions, we can fix the system while we’re expanding it.

Let me know what you’re thinking.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
Management And Productivity Report Available
Naloxone Access Increases, Gaps Still Remain
CMS Offers Listening Session Regarding OPPS And ASC Proposed Rule
Mercy Hospital Joplin Names New President

HIDI Tech Connect

Management And Productivity Report Available

Staff Contact: Cerise Seifert

MHA-member hospitals that submitted second quarter data for the “Management & Productivity Report” can access their completed reports online through a secure, password-protected website. Access to this report is limited to hospitals that participate in HIDI’s voluntary management and productivity program. The reports are located on HIDI Analytic Advantage® in the “Management & Productivity” folder under the “Finance and Policy” tab. Contacts from the participating hospitals have been notified by email. Staff may download and save the reports to a secure location on their networks or PCs. The data are encrypted on the site and also during the transmission from HIDI. Once the data have been transferred, they must be secured according to the hospital’s security procedures.

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Quality and Population Health

Naloxone Access Increases, Gaps Still Remain

Staff Contact: Shawn Billings or Tiffany Bowman

While the number of prescriptions dispensed for naloxone doubled in 2018, the Centers for Disease Control and Prevention released a report outlining the gaps that remain. The disparity in access remains for rural communities and patients receiving prescribed high-dosage opioids. The full CDC report outlines multiple potential steps that could serve to reduce the disparity in access, including consideration of keeping the medication in stock in pharmacies and reducing the insurance co-payment for patients.

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CMS Offers Listening Session Regarding OPPS And ASC Proposed Rule

Staff Contact: Sherry Buschjost

The Centers for Medicare & Medicaid Services announced a listening session during which CMS experts will briefly cover provisions from the Medicare Hospital Outpatient Prospective Payment System and ambulatory surgical center proposed rule. Registration is required for the session which is scheduled at 1:30 p.m. Wednesday, Aug. 14. CMS encourages participants to review the proposed rule, press release and fact sheet before the call.

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CEO Announcements

Mercy Hospital Joplin Names New President

Staff Contact: Carol Boessen

Jeremy Drinkwitz was named president of Mercy Hospital Joplin, effective Aug. 2. He has served as chief operating officer at the hospital since 2016 and has 15 years of administrative experience in health care. He succeeds Gary Pulsipher who retired July 26. A list of CEO changes is available online.

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Did You Miss An Issue Of MHA Today?

August 5, 2019
CMS Releases Final FY 2020 Medicare Inpatient And LTCH PPS
DHSS And MPRO Collaborate To Increase Utilization Of Self-Measured Blood Pressure Monitoring
TJC Releases Specifications Manual Version 2020A
July 2019 Hospital Compare Data Updates Available
Nurse Leadership Fellowship Financial Aid Available
Nominations Open For Distinguished Quality Professional Award

August 7, 2019
MHA Releases Issue Brief On Medicare CY 2020 Proposed Physician Fee Schedule
MHD DME Face-To-Face Requirements Extend To Managed Care
June MUR Available On HIDI Analytic Advantage®
National Association of Attorneys General Recommends Increased Access To Treatment For OUD
The Beryl Institute Hosts PX Pop-Up Event At Children’s Mercy Kansas City
AHA’s The Value Initiative Hosts Executive Forum

August 8, 2019
Special Edition: Issue Brief: Medicare Final FY 2020 Inpatient And LTCH PPS

Consider This ...

Social isolation is increasingly recognized as a public health issue. According to a recent poll, about 14 million rural residents, or 7 percent, say they have no friends or family nearby to rely on.

Source: NPR