MHA Today | August 16, 2019

August 16, 2019
MHA Today: News for Healthcare Leaders

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August 16, 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 Last week, I suggested that Gov. Parson’s task force charged with strengthening the individual and small group insurance marketplace should avoid two-dimensional solutions. Numerous factors influence plans’ decisions to participate in the marketplace, and consumers’ decisions to purchase a plan, their choices in the marketplace and plan costs. In addition, state and federal policies matter.

During their first meeting last Thursday, task force members were briefed on the challenges of the state’s marketplace. They are real. Far too many Missourians living in rural communities have only one insurer option — 101 of 114 counties in the individual and group marketplace in 2019. Competition and consumer choice are more robust in the state’s metro areas. The state would like to increase insurer and consumer participation in both.

The task force’s initial briefing included 45 PowerPoint slides reviewing Missouri’s health insurance coverage source, uninsured rates, insurer market concentrations and policy cost statistics. However, slide 44 — relating to health care spending in Missouri — deserves special attention. The slide found hospital spending growing at a significantly higher rate than either physician services or pharmaceuticals. The implication — that was followed by insurance industry participant validation — was that hospital costs were driving unsustainable insurance price increases, and negatively affecting participation in the marketplace.

Last week, I encouraged the task force to think in three dimensions. However, I didn’t anticipate that three-dimensional data — all health spending — would be used as a metric to inform what’s happening in the two-dimensional world of the individual and small group market.

Missouri is not a high-cost state for hospital services. In fact, in the employer-sponsored commercial marketplace, Missouri is 11th lowest in per-capita spending on health care. That’s not all. National commercial market data indicate that Missouri is the eighth lowest state for hospital prices, while concurrently, the 12th largest for utilization per capita. Considering the environment for hospitals — Missouri’s poor health behaviors and outcomes, sociodemographic challenges, high rates of uninsured, and high uncompensated care costs — hospitals are adding a lot of value. Moreover, hospitals work individually, collectively and with other stakeholders to build a high-quality, high-value system for patients and payers.

Last week, I commended Parson for undertaking this important work. It is very encouraging that he has made addressing the individual and small group market a priority, because it is an essential source of health insurance coverage — especially in rural areas. The compliment stands. His administration is the first in recent memory to address this issue head-on.
MHA Affordability Fact Sheet
However, if this is to be more than an exercise, the members of the committee need information that will inform rather than confuse their work. MHA created a fact sheet to disabuse participants of the notion that hospital prices are driving the problems that exist in the individual and group market.

An honest discussion would recognize that Missouri hospital prices for commercial insurers are below the national average, while for Medicare they are middle of the pack, and in Medicaid — largely due to the FRA’s influence — overall health care spending is higher than average nationally. To solve the challenges of the marketplace and improve the health care system, we need to have an honest discussion.

I often use the term “stakeholders” when referring to the various players in our complex health care system. This implies that the other parties have the same goals of producing better value and better health for individuals and populations. For decades, hospitals have put skin in the game to make the system better. That’s the kind of stakeholders that will be needed to address the big challenges — cost, health improvement, access and others.

The task force shouldn’t get into a “slide 44” mindset and assume the problem is easy to identify and fix. If the problem was that simple, we wouldn’t need a task force.

Hundreds of thousands of Missourians count on the marketplace. There’s room for innovation, and the Trump administration is practically encouraging states to submit federal “Section 1332” waivers. If we do the hard work, Missourians will benefit.

Send me a note with what you’re thinking.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
State Legislative Committee Hears Comments On Health Costs And Access
National Report On Mass Violence Considers Causes, Impacts And Solutions
CDC Releases Free Infection Control Training Courses
CMS Releases Updated IQR And OQR Specifications Manuals

state and federal health policy developments

State Legislative Committee Hears Comments On Health Costs And Access

Staff Contact: Daniel Landon

A state House of Representatives subcommittee held the first of three meetings to hear testimony on several health topics. MHA staff provided remarks on the “Drivers of Health Care Costs” topic. Randy Tobler, M.D., FACOG, CEO of Scotland County Memorial Hospital in Memphis, Mo., spoke on impediments to access, and the need and proposals for system reform to strengthen the clinician-patient relationship.

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Quality and Population Health

National Report On Mass Violence Considers Causes, Impacts And Solutions

Staff Contact: Jackie Gatz or Sarah Willson

The National Council for Behavioral Health published “Mass Violence in America: Causes, Impacts and Solutions” following the convening of an expert panel of individuals experienced in the areas of mental health care and violence. The panel specifically examined the extent to which mental illness is or is not a contributing factor resulting in these incidents of violence and found that “simplistic conclusions [following a traumatic incident] ignore the fact that mass violence is caused by many social and psychological factors that interact in complex ways; that many, if not most, perpetrators do not have a major psychiatric disorder; and that the large majority of people with diagnosable mental illnesses are not violent toward others.”

Two strategies for improvement provided in the report that engage health care providers include increased and ongoing threat assessment and management, as well as identifying comprehensive solutions at the community level with pertinent partners to include health care, law enforcement and the judicial system.

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CDC Releases Free Infection Control Training Courses

Staff Contact: Toi Wilde, Jessica Stultz or Jackie Gatz

The Centers for Disease Control and Prevention released the first in a new series of free online training courses to help health care organizations prevent and control infections. Developed by the American Hospital Association’s Health Research & Educational Trust, the first courses cover competency-based training, hand hygiene and strategies for preventing healthcare-associated infections. Eight more courses — on topics such as environmental cleaning, building a business case for infection prevention, and engaging patients and family members — will be added throughout the next few months. The Health Research & Educational Trust, part of the AHA Center for Health Innovation, led a team of national infection prevention experts to develop the STRIVE curriculum with funding from the CDC. All courses offer free continuing education.

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CMS Releases Updated IQR And OQR Specifications Manuals

Staff Contact: Sherry Buschjost

The Centers for Medicare & Medicaid Services released Specifications Manual for National Hospital Inpatient Quality Measures, version 5.7, for the Hospital Inpatient Quality Reporting Program. Version 5.7 is for implementation with acute inpatient discharges dated Jan. 1 through June 30, 2020.

Also released was Hospital Outpatient Quality Reporting Specifications Manual, version 13.0, effective with encounters dated Jan. 1 through Dec. 31, 2020.

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Did You Miss An Issue Of MHA Today?

August 12, 2019
MHA Submits Response To Federal Regulatory Relief Solicitation
Rural-Focused Learning Opportunities Available For Community Health Improvement
Opportunities For Buprenorphine Waiver Training Available

August 14, 2019
D.C. Court Rules Against Hospitals In DSH Litigation
CMS Reports On Enrollment In Individual Insurance Market
CMS Releases CART-Inpatient Version 4.23.1
Hospital-Specific Reports Available For CMS Hospital Readmission Reduction Program
CMS Selects Hospitals For eCQM Validation

Consider This ...

From 2013 through 2016, more than 35 percent of nonsmoking youths aged 3 to 17 were exposed to secondhand tobacco smoke.

Source: The New York Times