MHA Today | December 13, 2019

December 13, 2019
MHA Today: News for Healthcare Leaders

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December 13, 2019

MHA Today is provided as a service to members of the Missouri Hospital Association. Additional information is available online at MHAnet.


Insights


Herb Kuhn, MHA President & CEOMissouri fares poorly among the states for rates of maternal morbidity and mortality. The December edition of MHA’s Trajectories outlines what hospitals and other stakeholders are doing to improve numbers. Part of that effort is rethinking the “birth story.” That birth story narrative — for pregnant individuals, and the state’s health care system that supports them — informs the strategy and tactics needed to move the numbers.

Clinical interventions are important. Two statewide private-public sector initiatives — the Missouri Maternal-Child Learning and Action Network and the state’s Alliance for Innovation on Maternal Health, or AIM Collaborative, launched in 2018 and 2019, respectively — are at the center of care improvement efforts. Both programs bring together experts in maternal health care to provide guidance and oversight in the deployment of evidence-based practices in Missouri.

The transformation that’s happening in the maternal care space exceeds just the aspects that are connected to the clinical space. These changes include a focus on maternal care from the beginning of a pregnancy through the “fourth” trimester — the year after childbirth. This much broader approach recognizes that morbidity and mortality isn’t exclusively a factor of the birthing experience, but includes health in the months before and after delivery.
Trajectories: Maternal Mortality
The structure of the system that supports pregnant women and new mothers is important to improving outcomes. Significant areas of the state are considered maternal care deserts. This influences the care available to mothers and children, especially in communities that already may have limited health care assets and significant challenges among other social determinants of health.

In Missouri, more than 40% of births are to mothers in the Medicaid program. Gov. Parson has embarked on a new initiative to transform the state’s Medicaid program, with the goal of increasing quality, improving outcomes and reducing costs. Systems to improve Medicaid’s performance during pregnancy and after are essential to efforts to transform the state’s Medicaid program for pregnant women and new mothers. Currently, mothers lose Medicaid coverage shortly after childbirth while new babies retain coverage. Increasing access to coverage for these new mothers warrants consideration.

The state isn’t the only other stakeholder. Trajectories includes several examples of how community and provider partnerships are creating a safer environment for women, pre and post-childbirth.

As best-practices in care are delivered to the front lines and implemented throughout the system, the clinical aspects of maternal care will continue to improve. However, until all of Missouri’s stakeholders view the state’s “birth story” as a continuum — from the beginning of a pregnancy, through and beyond the first year of motherhood — we only will have limited success in reducing our rates of morbidity and mortality.

I encourage you to have a look at this edition of Trajectories. And, please let me know what you think about this issue, or whatever is on your mind.

P.S. — I want to give a brief shout-out to Dr. Nick Holekamp, vice president and chief medical officer at Ranken Jordan Pediatric Bridge Hospital in St. Louis, and former member of the MHA Board of Trustees. Nick was honored with the Missouri Foundation for Health Dr. Corinne Walentik Leadership in Health Award for 2019. During his service to MHA, Nick provided important perspectives as we developed our agenda. Join me in congratulating Nick on this great honor.

Herb Kuhn, MHA President & CEO



Herb B. Kuhn
MHA President and CEO

In This Issue
Congressional Committee Unveils New Surprise Bill Proposal
Missouri’s Growth In Uninsured Kids Highest In Nation
CMS To Repay Hospitals For Off-Campus Outpatient Clinic Visits
Medicare And MHD To Deny All Claims With HICNs Beginning Jan. 1
OIG Finds MA Plans Paid $6.7 Billion For Added Diagnoses To Increase Risk-Adjusted Payments
Supreme Court Changes Course On Negligent Credentialing Case
Vaping-Related Illness Death Count Surpasses 50
Moberly Regional Medical Center Names New CEO


Advocate
state and federal health policy developments


Congressional Committee Unveils New Surprise Bill Proposal

Staff Contact: Daniel Landon

The Democratic and Republican leaders of the U.S. House of Representatives Ways and Means Committee released a summary of a new legislative proposal on “surprise billing” by health care providers who do not participate in a provider network covered by the patient’s insurer. The proposal reflects the two advocacy messages emphasized by MHA and its members ― do not supersede current state laws, and allow billing disputes between insurers and providers to be resolved by negotiation and arbitration rather than a payment rate set by the government. Other recent surprise billing proposals in Congress are less favorable to hospital interests.

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Missouri’s Growth In Uninsured Kids Highest In Nation

Staff Contact: Brian Kinkade

The Georgetown University Health Policy Institute reports young children are losing health care coverage “at an alarming rate” nationwide, and that the increase in the number of uninsured children in Missouri is among the highest in the country. Between 2016 and 2018, the rate of uninsured children under age 6 grew from 3.8% to 4.3% nationwide and from 3.6% to 5.3% in Missouri. Missouri’s increase of 1.7 percentage points was the highest in the nation. The number of children covered by Missouri’s Medicaid program has decreased by 110,000 since 2016.

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CMS To Repay Hospitals For Off-Campus Outpatient Clinic Visits

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services finalized a payment policy to pay excepted off-campus provider-based departments a physician fee schedule equivalent payment rate for evaluation and management services. CMS implemented the policy by paying 70% of the Outpatient Prospective Payment System rate in CY 2019 and 40% in CY 2020. CMS estimated the total payment reductions in CY 2019 to be $380 million.

The Association of American Medical Colleges, the American Hospital Association and nearly 40 hospitals challenged the policy. A federal judge ruled last September that CMS did exceed its authority and instructed CMS to immediately cease the payment reductions. CMS now stated that it will begin reprocessing the claims from 2019. CMS stated, “Starting Jan. 1, 2020, the Medicare Administrative Contractors will automatically reprocess claims paid at the reduced rate; no provider action needed.”

Although CMS is repricing the 2019 claims, it will continue paying clinic visits in excepted off-campus provider-based departments at 40% of the OPPS rate.

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Medicare And MHD To Deny All Claims With HICNs Beginning Jan. 1

Staff Contact: Andrew Wheeler or Brian Kinkade

Beginning Wednesday, Jan. 1, 2020, Medicare claims must be submitted with the new Medicare Beneficiary Identifier. After this date, claims filed with patients’ old Health Insurance Claim Numbers will be denied.

In the same manner, the MO HealthNet Division will require crossover claims for Missouri Medicaid-eligible Medicare beneficiaries to be filed with patients’ MBIs beginning Jan. 1. After this date, MHD also will deny claims filed with HICNs.

The Centers for Medicare & Medicaid Services produced a pamphlet for providers that explains this change and how providers can obtain patients’ MBIs they do not have.

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Regulatory News
the latest actions of agencies monitoring health care


OIG Finds MA Plans Paid $6.7 Billion For Added Diagnoses To Increase Risk-Adjusted Payments

Staff Contact: Andrew Wheeler

The U.S. Department of Health and Human Services Office of Inspector General released a report finding that Medicare Advantage organizations are more likely to add diagnoses codes that increase risk-adjusted payments than remove codes that decrease risk-adjusted payments. The OIG also found that diagnoses that MAOs reported only on chart reviews and not on any service records resulted in approximately $6.7 billion in additional risk-adjusted payments.

The OIG recommended that the Centers for Medicare & Medicaid Services “(1) provide oversight of MAOs that had payments resulting from unlinked chart reviews for beneficiaries who had no service records in 2016, (2) conduct audits that validate diagnoses reported on chart reviews in the encounter data, and (3) reassess the risks and benefits of allowing unlinked chart reviews to be used as sources of diagnoses for risk adjustment.”

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Health Law Insight


Supreme Court Changes Course On Negligent Credentialing Case

Staff Contact: Jane Drummond

The Missouri Supreme Court granted a new trial to the plaintiffs in a negligent credentialing case. The court previously reversed the trial court’s judgment in favor of the plaintiffs, holding they failed to make a submissible case for negligent credentialing. Plaintiffs sought a rehearing on the grounds the case should have been remanded for a new trial.

In its new opinion, the court reiterated its position on the negligent credentialing claim, concluding the plaintiffs failed to show that the facility breached its duty to ensure its privileged physicians were qualified and competent. However, it agreed the plaintiffs should have the rare opportunity for a new trial because the underlying appeal was the first time a Missouri court specifically expressed the elements of negligent credentialing and the proof required to make a submissible case. Because plaintiffs claimed to have such evidence and were justified in failing to offer it at trial, they were entitled to a remand of the case.

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Quality and Population Health


Vaping-Related Illness Death Count Surpasses 50

Staff Contact: Shawn Billings or Tiffany Bowman

The death toll in the vaping illness outbreak has topped 50, U.S. health officials declared on Thursday. Updated numbers highlight a grim reality, including a total of 52 deaths in 26 states. And, 2,409 individuals have been hospitalized with E-cigarette, or vaping, product use associated lung injury. One region hard hit by EVALI cases has been in the Midwest including Illinois, Indiana and Wisconsin. MHA offers tools and provides guidance on this crucial public health concern on its website.

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CEO Announcements


Moberly Regional Medical Center Names New CEO

Staff Contact: Carol Boessen

Brent Parsons has been named CEO of Moberly Regional Medical Center, effective Monday, Jan. 6, 2020. He replaces Ranee Brayton, who has served as CEO since November 2016, and will return to her CEO role at Northeast Regional Medical Center in Kirksville on a full-time basis. Parsons has served as CEO of Bluffton Regional Medical Center in Bluffton, Ind., since 2016. A list of CEO changes is available online.

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Did You Miss An Issue Of MHA Today?


December 9, 2019
Congressional Leaders Announce Compromise On Surprise Billing Legislation
DHSS Asks Mandated Reporters To Report Online
MHA Releases Trajectories, Highlights Missouri’s Birth Story
CDC Releases Updated Information On E-cigarette Use
Fitzgibbon Hospital Names New President And CEO

December 11, 2019
Medicaid Caseload Falls In November
Weekly Snapshot: Marketplace Enrollment For Week 6
Analysis Of S-10 Data And Medicare DSH Implications Available
Missouri Supreme Court Hears Arguments On Reproductive Health Funding Ban
CMS Updates eCQM Known Issues Document
Hospital Quality Reporting Center Fall Newsletter Available
HRSA Launches Hospital Organ Donation Campaign



Consider This ...

Studies indicate more than 30,000 babies with neonatal abstinence syndrome are born every year in the U.S. — about one every 15 minutes.

Source: Kaiser Health News