MHA Today | September 27, 2019

September 27, 2019
MHA Today: News for Healthcare Leaders

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September 27, 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 The average charge, payment and cost per hospital stay in Missouri are less than the national average. Overall spending for employer-sponsored insurance plans is 11th lowest nationally, while hospital prices for ESI are 8th lowest. However, Missouri has the 12th highest hospital utilization rate nationally within the ESI-covered population. In the ESI category, low prices are mitigating the costs of high utilization.

In 2018, health care accounted for nearly 18 percent of gross domestic product — a total of $3.5 trillion, or $10,739 per person. According to recent data from the Kaiser Family Foundation, the average annual cost for ESI, for the first time, pushed past the $20,000 mark. National health expenditure data doesn’t account for the value of health or health care, only cost. Bending the cost curve requires a system where all stakeholders understand where value exists.

Hospitals’ Triple Aim approach to health — better care, better health and lower costs — is a movement toward better value for patients, payers and the health care system as a whole. Each part of the aim connects to the others, and an improvement in one area influences achievements in the others. Similarly, the Triple Aim’s success will depend on the partnerships we can forge among the provider community, with insurers and other stakeholders within and upstream of the health care system.

It will be difficult to bend the cost curve without addressing Missouri’s high hospital utilization rates or poor health status, currently 37th nationally. The uninsured rate in Missouri remains comparatively high, and this contributes to growing uncompensated care costs, cost shifting that leads to higher prices and reduced access to services that can lead to poorer health. Hospitals cannot independently address these challenges.

Controlling costs will require ongoing partnerships with payers. Investment in public health and community health could help improve Missouri’s health status and reduce utilization. Passive payers can’t influence costs. Engaged payers can help address upstream challenges. Better-aligned, value-focused policies can help their enrollees reduce unnecessary utilization while improving individual health.

Better value won’t occur if we focus on costs and not the drivers of costs.

There are very promising programs underway. MHA and the MO HealthNet Division continue to work to implement a system to better manage patients with high utilization. Primary care-driven Medicaid health care homes can ensure that care is delivered in the most appropriate setting, with an eye toward prevention and disease management upstream of the hospital. Improved pre and post-delivery maternal care and care collaborative-driven diabetes care management are examples of efforts to improve value overall. All of these improvements fit well into the Triple Aim framework. However, they depend on strong partnerships among the stakeholders.

Forty percent of Missouri hospitals operate with a negative margin. The average margin is 1.5 percent. The majority of insurers and pharmaceutical manufacturers have profits in the double digits.

Affordable health care will demand better alignment of value. As hospitals work to deliver value from better care, and improved community and population health, our partners must share the goal of improvement leading to reduced costs systemwide. A sustainable health care system requires agreement on the idea of value — is value something delivered or something captured? The answer will determine our ability to control costs.

Let me know what you’re thinking.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
Congress Approves Funding Bill To Keep Federal Government Operating Through Mid-November
MHA Summary And Recording Of MHD, Hospital Systems Meeting Now Available
CMS Releases Omnibus Burden Reduction (Conditions Of Participation) Final Rule
CMS Publishes Discharge Planning Final Rule
MLN Connects Provider eNews Available
CMS Launches Redesigned QualityNet Website
AHA Report Highlights Artificial Intelligence In Health Care Workforce

state and federal health policy developments

Congress Approves Funding Bill To Keep Federal Government Operating Through Mid-November

Staff Contact: Brian Kinkade

Congress passed a continuing resolution that will keep the federal government operating through Thursday, Nov. 21, while deliberations on the fiscal year 2020 budget continue. The new fiscal year begins Tuesday, Oct. 1. Notably, the bill provides funding to forestall the scheduled reduction in Disproportionate Share Hospital funding. Congress is expected to act to delay the imposition of DSH funding reductions, and the continuing resolution will give time for Congress to address this issue.

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MHA Summary And Recording Of MHD, Hospital Systems Meeting Now Available

Staff Contact: Kim Duggan or Brian Kinkade

The MO HealthNet Division’s quarterly meeting with system hospitals was held at the University of Missouri Hospital on Sept. 19. MHA’s recording and notes of the proceedings are available for members who were unable to attend.

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Regulatory News
the latest actions of agencies monitoring health care

CMS Releases Omnibus Burden Reduction (Conditions Of Participation) Final Rule

Staff Contact: Andrew Wheeler

In an effort to “cut red tape,” the Centers for Medicare & Medicaid Services released an omnibus burden reduction final rule. The rule finalizes the provisions of three proposed rules.

  • regulatory provisions to promote program efficiency, transparency and burden reduction (omnibus burden reduction)
  • hospital and critical access hospital changes to promote innovation, flexibility and improvement in patient care
  • fire safety requirements for certain dialysis facilities

The rule removes Medicare regulations identified as unnecessary, obsolete or excessively burdensome to hospitals. MHA published an issue brief with additional details.

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CMS Publishes Discharge Planning Final Rule

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services released a final rule that gives patients the ability to make informed decisions about their care received in a post-acute care environment. The rule requires the discharge planning process to focus on the patient’s goals of care and treatment preferences. The rule also “supports CMS’ interoperability efforts by promoting the seamless exchange of patient information between health care settings, and ensuring that a patient’s health care information follows them after discharge from a hospital or PAC provider.” MHA published an issue brief with additional details.

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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.

  • Quality Payment Program: Submit comments on 2020 proposed rule by Friday, Sept. 27
  • Post-Acute Care and hospice utilization and payment Public Use Files
  • Medicare Diabetes Prevention Program: Become a Medicare enrolled supplier
  • Skilled Nursing Facility Prospective Payment System Patient Driven Payment Model: Get ready for implementation on Tuesday, Oct. 1
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Quality and Population Health

CMS Launches Redesigned QualityNet Website

Staff Contact: Sherry Buschjost

CMS launched the redesign of the QualityNet website. Improvements have been made to enhance the performance and usability of the site. In addition, the new design allows users to easily view the website on a variety of devices and from multiple web browsers. Users will continue to access QualityNet at the same web address, and use the secure portal in the same fashion for tasks such as data submission and secure file transfer. Resources are available to introduce the new functionality, including a YouTube video, quick start guide and user manual.

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Workforce News

AHA Report Highlights Artificial Intelligence In Health Care Workforce

Staff Contact: Jill Williams

The AHA Center for Health Innovation released a report providing useful frameworks and tools for hospital and health system leaders to critically think about how Artificial Intelligence may affect their workforce strategy, and to successfully integrate AI technologies into their workforce and workflows.

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Did You Miss An Issue Of MHA Today?

September 23, 2019
MHA Distributes Analysis For FFY 2020 Medicare Final LTCH PPS
USP Announces Implementation Delay For General Chapters <795>, <797> and <825>
Trajectories: Strategies To Reduce Workplace Violence To Achieve The Quadruple Aim
CDC Hosts Call Outlining Recommendations For Influenza Prevention And Treatment In Children
CMS, TJC Release Addendum For National Hospital Inpatient Quality Measures Specification Manual
Quality Reporting Center Summer Newsletter Available

September 25, 2019
HRSA Releases HPSA Scores
DHSS Seeks Public Comment On STEMI Rule
MHA Distributes Analysis Of Final Updates To 2020 Medicare SNF PPS
CORH Opens Rural Hospital Assistance Program
CMS Issues Final Rule On State Medicaid DSH Allotment Reductions
CMS Offers Complimentary Webinars To Preview Redesigned Medicare Plan Finder
OIG Releases Data Brief Outlining Opioid Use Among Missouri Medicare Patients
NASEM Releases Report On Social Care In The Health Care Setting

Consider This ...

During 2016-2017, flu vaccination prevented an estimated 5.3 million influenza illnesses, 2.6 million influenza-associated medical visits and 85,000 influenza-associated hospitalizations.

Source: Centers for Disease Control and Prevention