MHA Today | January 17, 2020

January 17, 2020
MHA Today: News for Healthcare Leaders

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January 17, 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 & CEOLast week, I provided background on the state’s Medicaid program. This week, I will opine on payment policy — and future reform and transformation efforts — expected from the MO HealthNet Division.

A system delivering value is a system with aligned interests. More than a decade ago, Don Berwick, M.D., former head of the Institute for Healthcare Improvement and Centers for Medicare & Medicaid Services, envisioned value as the “Triple Aim.” Berwick’s aspirational definition, which included “better care, better health and lower costs,” provided inspiration for value-based payment programs that have flourished.

VBP commonly is defined as a “form of reimbursement that ties care delivery to the quality of care provided and rewards providers for both efficiency and effectiveness.” The system is growing in the Medicare program and among some private payers. Moreover, it is at the core of the transition from fee-for-service to a value model — a notion that’s driving the thinking behind Missouri’s Medicaid payment reform.

For providers, the transition from fee-for-service to value-based care has been challenging in several areas. Among the various payers, with their developing models of reimbursement, health care providers have one foot on the dock and the other foot on a boat. Straddling those two worlds is both cumbersome and financially challenging — it’s increasingly being called health care’s “dilemma zone.”

Medicare and Medicaid are very different programs. Transferring models between the programs requires attention to the differences. Medicare is dominated by individuals age 65 and older — often with multiple chronic conditions. Additionally, in the Medicare system, VBP programs generally are focused on institutional providers, although the programs are beginning to extend to individual practitioners.

For hospitals, programs such as the Medicare Shared Savings Program (dominated by Accountable Care Organizations), Value-Based Purchasing Program, Hospital-Acquired Condition Payment Reduction and the Hospital Readmissions Reduction Program dominate Medicare’s value-based payment programs. The End-Stage Renal Disease, Medicare Advantage and Skilled Nursing Facilities Programs also have forms of VBP incentives. Because of seniors’ medical conditions, the top priority of these incentives is to improve care and discharge procedures in institutional settings.

Conversely, the Medicaid program’s VBP movement seeks to leverage primary care, focusing on prevention and access. Medicaid value programs largely rely on arrangements with primary care providers — creating incentives for regular wellness visits, adherence to medication management, population health, and better direction and support of the patient through the health care system.

More recently, Medicaid has transitioned toward institutional incentives. These programs are driven largely by state flexibility options granted in the Affordable Care Act. Using these tools, some states are experimenting with episode-based payments and global budgets, while others are looking to model Medicare’s ACO/shared-savings initiative for Medicaid.

Missouri has made some important movements in the VBP direction.

Missouri was a pioneer in efforts to launch its successful and nationally recognized patient-centered Medicaid Health Home program. With MHA’s encouragement and financial support, the initiative has expanded over time to generate even more savings.

The Hospital Industry Data Institute is partnering with Missouri’s Medicaid program to develop an Admission Discharge Transfer data exchange platform to provide near real-time electronic care coordination tools. Hospitals partnered with the state, using the Federal Reimbursement Allowance, to fund the program. Working with lawmakers, we secured state funding to capture a 90% match from the federal government if approved by CMS.

MHA also encouraged the state to expand its definition of VBP programs through a multipronged approach. This includes payment programs that would promote prevention, better use of technology, improved care coordination, increased accountability for quality and outcomes, and improvements in behavioral health and post-acute services.

Finally, the state needs to follow other states’ lead and seriously explore the impact of social determinants of health. As new research from HIDI demonstrates, social factors — issues such as housing, food insecurity, employment and education — have a significant influence on patient health. There’s growing consensus among researchers and clinicians that SDOH account for more than 50% of health care spending — a person’s ZIP code truly can be a more powerful predictor of health than their genetic code. To bend Medicaid’s cost curve, the state must begin to address the upstream nonclinical drivers of downstream cost and poor health.

To say hospitals are stakeholders is to significantly understate the issue. Our long and continuing partnership with the state through the FRA is proof of our commitment to helping the state maximize the benefit of the Medicaid program. As the program evolves, hospitals have a responsibility to encourage the movement toward value.

To make VBP work requires a collaborative and integrated approach among all stakeholders — hospitals, physicians and other clinicians, health plans, and the state Medicaid program. However, VBP is a payment system. Real value occurs in Medicaid at the intersection of the clinical space and the enrollee’s environment.

The move to value will take time and cause disruption. Success will depend on keeping all parties — health care providers, health plans, and law and policymakers — focused on the opportunity to improve the program. And, central to any discussion of value are the needs of the individual patient.

Send me a note with your thoughts.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
Medicaid Expansion PowerPoint Presentation Available
MedPAC Recommends Payment Changes For FY 2021
CMS Issues CLIA Memo
OMB Releases Revised Notification Forms
MLN Connects Provider eNews Available
CDC COCA Hosts Call On Current Influenza Season
Cardinal Health Recalls Surgical Gowns Due To Contamination

state and federal health policy developments

Medicaid Expansion PowerPoint Presentation Available

Staff Contact: Mary Becker

A PowerPoint presentation with accompanying script on the case for a Medicaid expansion ballot initiative has been developed for member hospitals to use in presentations in the hospital or community. As new information becomes available, the presentation will be updated. The presentation was sent out earlier today to hospital chief executives, governmental relations executives and public relations executives.

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Regulatory News
the latest actions of agencies monitoring health care

MedPAC Recommends Payment Changes For FY 2021

Staff Contact: Andrew Wheeler

The Medicare Payment Advisory Commission is recommending that 2021 Medicare payments to hospitals should increase by 3.3%. MedPAC continues to back a proposal to replace the existing quality programs by splitting the payment update into a 2% overall rate increase and tying 1.3% to enacting a Hospital Value Incentive Program. MedPAC remains concerned that hospitals are operating with negative Medicare margins. In 2018, Medicare margins fell to a negative 9.3%, and MedPAC expects margins to improve to a negative 8% for 2020.

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CMS Issues CLIA Memo

Staff Contact: Sarah Willson

The Centers for Medicare & Medicaid Services issued a memo on the applicability of proficiency testing referral to cytology/histopathology slide staining by a separate entity. CMS clarified that staining of cytology/histopathology slides is not considered a part of examination, and those entities that only engage in these preparatory steps are not considered laboratories. Therefore, they are not subject to Clinical Laboratory Improvement Amendments, and CMS would not consider it a proficiency testing referral.

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OMB Releases Revised Notification Forms

Staff Contact: Sarah Willson

The Centers for Medicare & Medicaid Services will require hospitals to use newly revised forms, including “Important Message from Medicare” and “Detailed Notice of Discharge,” beginning Wednesday, April 1. The forms recently were revised by the Office of Management and Budget. The Important Message from Medicare form number has changed to CMS-10065. The Detailed Notice of Discharge form number remains CMS-10066. Both forms can be accessed in English or Spanish.

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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
    • Merit-based Incentive Payment System 2020 payment adjustments
    • New MIPS participation framework for 2021 performance period
  • Comparative Billing Reports: Access via CBR portal
  • CMS reduces psychiatric hospital burden with new survey process

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Quality and Population Health

CDC COCA Hosts Call On Current Influenza Season

Staff Contact: Jackie Gatz, Keri Barclay or Carissa Van Hunnik

The Centers for Disease Control and Prevention Clinician Outreach and Communication Activity will host a call at 1 p.m. Tuesday, Jan. 28, to discuss the current 2019-2020 influenza season, specifically addressing clinical issues and pertinent CDC recommendations.

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Cardinal Health Recalls Surgical Gowns Due To Contamination

Staff Contact: Jackie Gatz

On Wednesday, Cardinal Health issued a letter to customers regarding issues related to the environmental conditions at a facility that manufactures certain AAMI Level 3 surgical gowns and procedure packs. Cardinal Health customers may contact their sales representative to obtain lot numbers for surgical gowns and procedure packs affected by a quality issue at a contract manufacturing facility. Currently, Cardinal Health is unable to offer sterility assurance for those items, which prompted the notice to customers.

Missouri hospitals impacted by this recall may contact Jackie Gatz if resource request coordination is necessary to sustain health care operations.

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Did You Miss An Issue Of MHA Today?

January 13, 2020
MHA Releases Analysis Of Medicare Program And Quality Trends Reports
MHA Comments On Transparency In Coverage Proposed Rule
CMS Revises Psychiatric Hospital Survey Process
HIDI HealthStats Explores The Use Of Z Codes For SDOH
CMS Selects Random Sample For IQR Program Validation
TJC Offers Complimentary Certification Webinars
AHA Releases Report On Hospital And Health System Workforce Strategic Planning
HRSA Announces Scholarships For Disadvantaged Students Program
Prime Healthcare Names Regional CEO

January 15, 2020
Parson Delivers State Of The State Address
Legislators Review Restrictions On Punitive Damages Liability
Medicaid Caseload Falls In December 2019
Transparency In Coverage Proposed Rule Comments Due Jan. 29
Missouri Foundation For Health Announces New Board Of Directors
Pinnacle Regional Hospital Announces Closure

Consider This ...

New data from the Centers for Disease Control and Prevention show that more than one in seven adults across all U.S. states and territories are physically inactive.

Source: STAT