MHA Today | October 18, 2019

October 18, 2019
MHA Today: News for Healthcare Leaders

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October 18, 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 Bill Gates was among the handful of tech visionaries who helped create the software platforms that allow you to read this missive. There are few leaders at Missouri’s hospitals — and a dwindling number of our staff at MHA — who will recall that some 20 years ago, our communication involved a ream of printed materials sent on Fridays by U.S. mail instead of daily electronic updates. Gates and his cohort of digital visionaries made that progress possible. However, peering into the future is hard. Gates has been quoted as saying, “640K is more memory than anyone will ever need on a computer.” The statement may be apocryphal, but it is instructive for today’s column.

Wednesday, the American Hospital Association hosted a Stark Law-related webinar featuring Centers for Medicare & Medicaid Services Administrator Seema Verma. She offered her thoughts on the rulemaking process and expected revisions to the Stark Law and Anti-Kickback regulations, which were released last week.

The proposed rules, which are expected to be final early next year, are a major and welcome update. They reflect the fundamentally different needs of a value-based care delivery model. In addition — and in concert with the administration’s Patients Over Paperwork initiative — they provide significant clarity for providers working to embrace value. Verma was very clear — the administration is focused on ensuring health care providers and their organizations can increase the time spent with patients, rather than with lawyers.

The new rules do not abandon the core Stark or Anti-Kickback tenets; however, they attempt to address the very different environment that exists as the nation’s health system moves from fee-for-service to value-based care. Specifically, she acknowledged that the “Stark Law has been contributing to higher costs,” and impedes “commonsense arrangements” that increase a provider’s ability to improve patient care through integration and care coordination. In a nutshell, efforts to promote innovation and teamwork — let alone make care more affordable and accessible — are hampered by these complex sets of rules.

During the RFI, or request for information process, AHA and MHA provided extensive comments. Many of the concerns we both expressed were addressed in the current proposals.

Both the new Stark and Anti-Kickback proposed rules would create permanent safe harbors for value-based arrangements, and the sharing of technology and cyber resources among providers. Importantly, the Stark revisions define or redefine key terms that have confounded providers, consultants and attorneys attempting to structure compliant arrangements for years. A suggested change to the Anti-Kickback rule would create a safe harbor allowing value-based participants to offer in-kind tools and support directly to patients to foster engagement.

Bill Gates certainly regrets his “640K” remarks. And, according to Verma, former Congressman Pete Stark has admitted that he wouldn’t vote for the existing rule today. He recognizes — despite the important protections against misaligned incentives — the rules don’t reflect how great care is delivered today.

Just as electronic health records, health information exchanges, accountable care organizations, shared risk models and other advances couldn’t have been envisioned a generation ago, technology, including the smart phone, tablet and P.C. — all with internet connectivity and Bluetooth — would have been fantastical in the 1980s. If you are reading this on your P.C., your RAM likely is six or 18 gigabytes. A megabyte is 1,024 kilobytes, and a gigabyte is 1,024 megabytes. All of this power is necessary to keep multiple “windows” open at the same time. Provider cooperation, and aligned work and incentives, are the Microsoft Windows and Office suites of health care. The Stark Law updates are a DOS to Windows upgrade — necessary to power the system needed to transform care and create value.

Final comments are due by Dec. 31, and CMS expects the final rule early next year.

Send me an email to let me know what you’re thinking.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
Missouri Catholic Conference Endorses Medicaid Expansion
Missouri Medicaid Caseload Rebounds
NCHS Releases Violent Death Data Brief
MHD Updates Behavioral Health/ABA Provider Bulletin
MLN Connects Provider eNews Available
S.A.F.E.R. Initiative Resources Available For Missouri Hospitals

state and federal health policy developments

Missouri Catholic Conference Endorses Medicaid Expansion

Staff Contact: Mary Becker

On Wednesday, a statement was distributed to parishes and the diocesan press from Missouri’s Catholic Bishops in support of the current effort to expand Missouri’s Medicaid program through a ballot initiative in November 2020. The statement cites the need to cover low-income workers, leading to better health outcomes and enhancing their ability to continue working.

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Missouri Medicaid Caseload Rebounds

Staff Contact: Brian Kinkade

After steadily declining for more than year, the number of parents and children covered by Missouri Medicaid grew in September by 444 and 1,780, respectively. At the end of September, there were 72,251 parents and 523,168 kids enrolled in the program. In spite of last month’s growth, both case counts remain significantly below the counts when Medicaid participation hit its peak in April 2018 when there were nearly 29,500 more parents and 111,500 more children enrolled in the program. The dramatic decline in the caseload corresponds to the Missouri Department of Social Services’ systemic reverification of Medicaid participants’ eligibility, which began in the spring of 2018. Social welfare advocates criticized the reverification process as being cumbersome and inefficient, and incorrectly removing parents and children from the rolls. DSS explained the declining caseload as a “clean-up” after several years of automated systems development and as evidence of Missouri’s improving economy.

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NCHS Releases Violent Death Data Brief

Staff Contact: Sarah Willson

The Centers for Disease Control and Prevention National Center for Health Statistics released a new data brief on the death rates among those aged 10 to 24 from suicide and homicide. The brief highlights increased rates of death from both suicide and homicide in recent years.

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Regulatory News
the latest actions of agencies monitoring health care

MHD Updates Behavioral Health/ABA Provider Bulletin

Staff Contact: Sarah Willson

The MO HealthNet Division published an updated Provider Bulletin clarifying rate increases for covered behavioral health services appropriated for the fiscal year 2020 budget.

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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: Medicare Beneficiary Identifier transition ends in less than 10 weeks
  • Atherectomy: Comparative Billing Report in October
  • CMS Health Equity Award: Submit nomination by Friday, Nov. 15
  • ICD-10 coordination and maintenance: Deadline for comments is Friday, Nov. 8
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Quality and Population Health

S.A.F.E.R. Initiative Resources Available For Missouri Hospitals

Staff Contact: Jackie Gatz

As we conclude Healthcare Security and Safety Week, we thank you for engaging on our social media platforms and sharing your own recognition activities occurring within your hospitals. Efforts by our health care professionals continue on a daily basis to create safe care environments. MHA continues to identify and cultivate resources for member hospitals through its S.A.F.E.R. Initiative.

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Did You Miss An Issue Of MHA Today?

October 14, 2019
State Of Childhood Obesity Report Shows Mixed Results For Missouri
DHSS Finalizes Hospital Licensure Rules
MHA Launches Resources To Promote Safe Care In Hospitals And Clinics

October 16, 2019
MHA Releases Analysis Of Medicare Programs And Quality Trends Reports
HIDI Releases Third Quarter FFY 2019 Inpatient, Outpatient Databases
National Earthquake Drill Provides Opportunity For Hospital Preparedness
CMS Announces Changes To QualityNet Secure Portal
CMS Announces IQR Education Session
MU Extension Hosts Broadband Meeting
Center For Health Policy To Host Annual Summit

Consider This ...

In recent years, it’s estimated that 70-90% of seasonal flu-related deaths have occurred in people 65 years and older, and 50-70% of seasonal flu-related hospitalizations have occurred among people in that age group.

Source: Centers for Disease Control and Prevention