MHA Today | January 10, 2020

January 10, 2020
MHA Today: News for Healthcare Leaders

linkedin twitter facebook
January 10, 2020

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 & CEOThroughout the next few weeks, this column will be dedicated to discussing potential changes in the state’s Medicaid program. Gov. Mike Parson and leaders at the Department of Social Services have indicated Medicaid reform is a high priority issue for the administration. In 2020, we expect the principles of a Medicaid transformation to begin to materialize in the state budget, legislation and through regulation. To understand how the changes might affect hospitals and the health care system, I’ll be providing perspective on the existing program, how value-based care in Medicaid may evolve, the administration’s vision for the program, our options to respond to change, and the opportunities and barriers to reform in Missouri.

Early signals point to the administration focusing on costs and value. How they approach these goals matters.

As stakeholders in Medicaid, we understand that the program is not monolithic. Children — covered in traditional Medicaid and through the state’s Children’s Health Insurance Program — are the largest single category of enrollee, comprising more than two-thirds of all covered lives. However, children are less than one-third of Medicaid spending. The aged, blind and disabled enrollees are the inverse. The ADB Medicaid population is approximately one quarter of the enrollment, but account for two-thirds of the cost. Non-disabled adults under the age of 65 are approximately 10% of the Medicaid population — mostly custodial parents and pregnant women. Based on data from the Hospital Industry Data Institute, Medicaid “superutilizers” with ten or more hospital visits during 2019 accounted for 1.4% of all Medicaid hospital patients, but 12.5% of hospital spending.

How the state finances care for Medicaid is as varied as the enrollment. Children’s coverage receives an enhanced federal match and certain children’s coverage requires cost sharing. Most other categories of coverage have a lower federal matching funds rate. General revenue is only one of a variety of sources the state uses to earn federal matching funds. The largest sources of funding outside of the federal contribution are the state’s provider taxes, including the Federal Reimbursement Allowance — hospitals’ provider tax. The FRA and the federal matching funds it generates pays for 80% of the state’s share of hospital Medicaid payments. When paired with the federal match, the hospital tax funds one-third of the state’s Medicaid program.

This wasn’t always the case. In the 1990s, Medicaid costs were swallowing a growing share of state general revenue. For nearly 30 years, the FRA and other provider taxes have insulated the state from much of the GR commitment otherwise necessary to fund the state’s Medicaid program. In 1990, the GR share of the Medicaid budget was nearly 40%. Because of the state’s aggressive use of provider taxes, by 2018, the GR portion of the Medicaid budget was only 16%. Provider taxes covered 25% of the Medicaid budget share.

FY 2018 MO HealthNet Appropriations The growth in GR costs and Medicaid’s share of total GR were evaluated in a report commissioned by the state from McKinsey & Co. Demographic challenges, health care inflation, the economy, policy and other factors all contribute to the cost of the program. However, the state’s ability to manage externalities is small, and eligibility categories — other than non-disabled children — offer few opportunities to limit enrollment to reduce costs to state government. Moreover, the transition to Medicaid managed care coverage for non-ABD enrollees has increased the cost of the program. Federal law limits the state’s ability to set managed care rates by requiring rates that are actuarily sound.

Reducing the state’s cost of the program by reducing provider payments is a blunt instrument. Reducing rates could lead to more limited access to services for primary care and drive additional volume to the emergency department — a much more expensive and inefficient venue of care for most services. Participating providers will have a very limited ability to cost shift to recover new Medicaid losses, and decreased Medicaid rates would negatively influence the funds available through the FRA.

A better, more efficient system is possible. The medical homes concept has been in place in parts of Missouri and has a good track record of achieving results. And, last year the state’s budget included funding for an Admission Discharge Transfer data exchange program for Medicaid to support better continuity of care through public-private partnership.

Unfortunately, the state’s Medicaid technology infrastructure is dated and evidence suggests that the enrollment backbone of the program isn’t working well. These are necessary components of an efficient program. Better technology and better patient-provider-payer engagement will be needed to move toward a truly value-driven system.

Change is coming. Many of today’s Medicaid policies are based on long-term partnerships and shared vision about how to fund and deliver services to the most vulnerable. A sound Medicaid program for the future will require similar stakeholder investment and ownership.

Next week, I will discuss the idea of value-based care from a payer and provider perspective.

Send me an email with your thoughts.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
CMS Releases Final 2020 Marketplace Enrollment Snapshot
MLN Connects Provider eNews Available
CMS Innovation Center Highlights Recently Released Reports
New CDC Report Shows Marked Improvement In ED Opioid Prescribing Practices
CMS Announces Hospital Quality Reporting January 2020 System Release
CMS Announces Upcoming Education Sessions
Mercy Springfield Communities Names New President

state and federal health policy developments

CMS Releases Final 2020 Marketplace Enrollment Snapshot

Staff Contact: Andy Wheeler

The Centers for Medicare & Medicaid Services released the final marketplace enrollment data for 2020. For calendar year 2020, 8,286,871 beneficiaries made plan selections in states where the platform is being utilized. This is a decrease of 1.5% from 2019’s enrollment of 8,411,614. In Missouri, 202,750 beneficiaries made plan selections for 2020, approximately 8% less than the 220,461 plan selections last year.

Back To Top


Regulatory News
the latest actions of agencies monitoring health care

MLN Connects Provider eNews Available

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services issued updates to MLN Connects Provider eNews. 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.

  • Hospitals: new beneficiary notices (IM, DND, and MOON) required April 1
  • Hospital outpatient departments: prior authorization process begins July 1
  • Qualified Medicare beneficiary billing requirements
  • Quality Payment Program
    • 2018 performance data
    • Participation status tool includes third snapshot of data
    • Recheck your final 2019 MIPS eligibility
    • Check your initial 2020 MIPS eligibility
Back To Top

CMS Innovation Center Highlights Recently Released Reports

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services Center for Medicare and Medicaid Innovation has released a newsletter highlighting reports on the comprehensive care for joint replacement, the Medicare prior authorization model for non-emergent hyperbaric oxygen services and independence at home demonstration.

Back To Top

Quality and Population Health

New CDC Report Shows Marked Improvement In ED Opioid Prescribing Practices

Staff Contact: Shawn Billings or Tiffany Bowman

The Centers for Disease Control and Prevention National Center for Health Statistics report estimates that the percentage of emergency department visits by adults, which resulted in an opioid prescribed at discharge, decreased from 2010–2011 through 2016–2017. Opioid prescription rates in EDs increased from 19% between 2006-2007 to nearly 22% by 2011. The rates then decreased to around 15% by 2017, for an overall reduction of around 30%.

  • Opioids prescribed: The most common opioids prescribed, based on 2016-2017 data, were acetaminophen-hydrocodone and tramadol. Acetaminophen-hydrocodone made up more than half of all prescriptions in 2006, before tapering off at around 41% of prescriptions a decade later.
  • Primary diagnoses: Dental pain, stones in the kidneys or urinary tract, fractures, and back pain were among the most common diagnoses for which ED visitors were prescribed opioids.

Back To Top

CMS Announces Hospital Quality Reporting January 2020 System Release

Staff Contact: Sherry Buschjost

The Hospital Quality Reporting January 2020 system release was announced by the Centers for Medicare & Medicaid Services. The release includes all applications, processes and reports necessary to support the Hospital Inpatient Quality Reporting Program specifications manual version 5.7 and Outpatient Quality Reporting Program specifications manual version 13.0.

Back To Top

CMS Announces Upcoming Education Sessions

Staff Contact: Sherry Buschjost

The Centers for Medicare & Medicaid Services announced the following education opportunities for hospitals participating in the Hospital Inpatient Quality Reporting and Promoting Interoperability and/or Hospital Outpatient Quality Reporting Programs.

  • Wednesday, Jan. 15, 1 p.m. — CY 2019 eCQM Reporting Tips and Tools for the Hospital IQR and Promoting Interoperability Programs
  • Wednesday, Jan. 22, 9 a.m. and 1 p.m. — You Have Reached Your Destination: CY 2020 OPPS/ASC Final Rule

Registration is required and available at the corresponding links.

Back To Top


CEO Announcements

Mercy Springfield Communities Names New President

Staff Contact: Carol Boessen

Craig McCoy was named president of Mercy Springfield Communities, effective Monday, Jan. 6. He has more than 10 years of experience as a health system CEO and most recently served as CEO of Bon Secours St. Francis Health System in Greenville, S.C. McCoy fills the vacant position which has recently been covered by Jon Swope, Senior Vice President and Regional President of Mercy Central Region, since Nov. 2017. A list of CEO changes is available online.

Back To Top

Did You Miss An Issue Of MHA Today?

January 8, 2020
2020 State Legislative Session Convenes
DHSS Releases Missouri Nosocomial Infection Report
November MUR Available On HIDI Analytic Advantage®
Flu Monitoring Elevates In Response To Widespread Activity
CMS Awards Funding To Combat Opioid Misuse
FDA Finalizes Enforcement Policy On Unauthorized Flavored Cartridge-Based E-Cigarettes
Health Outreach Conference Issues Call For Proposals
CMS Reminds Hospitals Of 3Q2019 Submission Deadlines
AHA Announces Melinda Estes, M.D., As New Chair Of Board Of Trustees

January 6, 2020
CMS Releases Performance Year 2018 Results Of The Medicare Quality Payment Program
HIDI HealthStats Investigates Coding Social Determinants Of Health
SOR Announces 2020 MAT Waiver Trainings
CMS Releases Abstraction Paper Tools
Government Encourages Cyber Vigilance
Don Babb Celebrates Retirement
Sinek Announces Retirement From Boone Hospital Center

Consider This ...

The Centers for Disease Control and Prevention and state agencies have reported 2,602 lung injury cases that required hospitalization and 57 deaths linked to vaping.

Source: The New York Times