MHA Today | February 7, 2020

February 7, 2020
MHA Today: News for Healthcare Leaders

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February 7, 2020

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 & CEOEarlier this week, MHA joined the Missouri Department of Mental Health, Missouri Coalition for Community Behavioral Healthcare, Missouri Farm Bureau and the University of Missouri Extension in releasing new research on the behavioral health crisis in Missouri’s agriculture community. The research is powerful. It also includes voices from the hospital community and other stakeholders on the front lines of the crisis.

The inadequacy of behavioral health resources in Missouri’s rural communities is well documented. Each of Missouri’s 99 rural counties is a designated Mental Health Professional Shortage Area. With just 3.7% of the recommended number of practitioners, Missouri faces the largest shortage of behavioral health care providers among the states.

Driven by what have come to be known as “deaths of despair,” life expectancy for rural Americans is more than two years shorter than their urban counterparts. This is due in large part to higher rates of drug overdoses, alcohol-related diseases and suicide. Suicide is growing at an alarming rate in rural Missouri. Between 2003 and 2017, the suicide rate among rural Missourians grew by 78%, and throughout the last decade, their hospital emergency department visits for suicide attempt or ideation increased 177%. Rural men between the ages of 35 and 44 have triple the statewide suicide mortality rate.

Growing Stress on the Farm Agriculture is at the center of the economic and cultural heart of rural communities. Unfortunately, the agricultural sector has struggled since the great recession. While the U.S. economy largely has experienced quarter-over-quarter growth since the recession ended in 2009, the farm sector has experienced six periods of recession. Missouri has nearly 16,000 fewer family farms today compared to 20 years ago, and bankruptcies are on the rise. A variety of factors outside of farmers and ranchers’ control have affected yields, commodity prices and markets. And, since 2012, farm income and credit conditions have deteriorated.

The farm crisis is driving a behavioral health crisis, and too few rural Missourians are getting the help they need.

Access is part of the challenge. However, stigma plays a role as well. I know this because I’ve seen it.

In the report, I talk about a conversation I had with my barber while visiting my old hometown about 20 years ago. As he was cutting my hair, we were chatting. I brought up the issues of rural health and behavioral health. The barber confided in me that he had struggled with behavioral health issues. He often has found himself walking the streets of our town, struggling to understand his feelings, looking for meaning and wondering what people would think if they knew he was troubled. He was afraid of the stigma getting care locally could bring because he, as a barber, was intimate with the small-town grapevine.

Brent McGinty, President and CEO of the Missouri Coalition for Community Behavioral Healthcare and a partner in the research, put it succinctly, “Farmers are less likely to seek out mental health care even if they do live near a behavioral health clinic. Everyone in town knows what your truck looks like, and they put two and two together when it’s parked out front.”

There’s a lot more anonymity in an emergency department. Kristen T. DeHart, CEO of Excelsior Springs Hospital, put a fine point on the issue saying, “I know there’s something missing from the rural mental health care continuum when my 25-bed critical access hospital in rural Clay County is seeing such an alarming increase in patients admitted for care related to suicide attempts in our emergency room.”

The goal of the report was two-fold. We wanted to investigate the anecdotal evidence that hospitals were experiencing a significant jump in behavioral health care — including for suicide attempt or ideation — and dig deeper to understand the potential drivers of that trend. The ongoing difficulties in agriculture, when combined with the other known factors that disproportionately affect rural populations, create strong correlations.

However, and perhaps more importantly, the report is designed to start a broader conversation about rural behavioral health. The cultural impediments to access can be as limiting as the physical and economic aspects of the challenge. Together with our partners in the health, behavioral health, government and agriculture communities, we can reduce barriers to what can be lifesaving care by normalizing the issue.

The report’s findings are troubling. However, the critical work being done by hospitals and our partners provide a ray of hope. We’re leveraging training, technology and existing assets across the health care continuum to bridge the gap. We’re also advocating for additional resources.

We have a long way to go to build the system that’s needed to match the scope of the challenge. But, we’re talking about it. That’s an important step in the right direction.

Let me know what you think.

Herb Kuhn, MHA President & CEO



Herb B. Kuhn
MHA President and CEO

In This Issue
CMS Issues Proposed Medicare Advantage And Part D Rule
CMS Releases Coronavirus Policy Memo
MHA Distributes Wage Index, Occupational Mix Data For Review
MLN Connects Provider eNews Available
HIDI Releases Fourth Quarter FFY 2019 Inpatient, Outpatient Databases
CDC-NCHS Release Updated Maternal Mortality Statistics
DEA Promotes MAT Efficacy Treating Opioid Use Disorder
Mosaic Life Care At St. Joseph Medical Center Names New President
Keim Announces Retirement From Ste. Genevieve County Memorial Hospital



Regulatory News
the latest actions of agencies monitoring health care


CMS Issues Proposed Medicare Advantage And Part D Rule

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services issued a proposed rule for contract year 2021 and 2022, as well as the 2021 Advance Notice Part II to “further advance the agency’s efforts to strengthen and modernize the Medicare Advantage and Part D prescription drug programs.” The rule is expected to increase plan revenue by 0.93%. The rule also requires Part D plans to offer real-time drug price comparison tools beginning Jan. 1, 2022. Other proposals include revising current Medicare Advantage telehealth benefits, enhancing the MA and Part D Star Ratings, and implementing several provisions of the SUPPORT Act. MHA published an issue brief with additional details.

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CMS Releases Coronavirus Policy Memo

Staff Contact: Sarah Willson or Jackie Gatz

The Centers for Medicare & Medicaid Services released a guidance memo for health care facilities concerning the 2019 novel coronavirus illness. The memo urges all Medicare-certified health care facilities to adhere to nationally accepted infection prevention and control standards, specifically highlighting the Centers for Disease Control and Prevention’s updated guidance on 2019-nCoV.

The memo sends a strong message to facilities on the importance of including “emerging infectious diseases” in the facility’s emergency preparedness plans, ensuring adequate supplies are available for infection prevention and control measures, and that staff are adhering to infection prevention and control practices. The memo also provides numerous resources for facilities to use as they educate, monitor and respond to emerging threats.

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MHA Distributes Wage Index, Occupational Mix Data For Review

Staff Contact: Andrew Wheeler

On Jan. 31, the Centers for Medicare & Medicaid Services released revised public-use files used to develop the federal fiscal year 2021 Medicare wage index. Hospitals can review their hospital-specific data and request any revisions until Friday, Feb. 14. Direct requests and supporting documentation for revisions to the CMS Medicare Administrative Contractor. Requests for revisions are limited to mishandling of the data or revisions of desk review adjustments to wage index data. MHA has posted these files to HIDI Analytic Advantage® for review.

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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.

  • Skilled Nursing Facility Quality Reporting Program: Fiscal year 2022 Annual Payment Update table
  • Quality Payment Program
    • Updated explore measures tool
    • Merit-based Incentive Payment System 2020 call for measures and activities
  • Medicare Promoting Interoperability Program
    • Deadline to submit 2019 data is Monday, March 2
    • Requirements for 2020
  • Open payments registration

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HIDI Tech Connect


HIDI Releases Fourth Quarter FFY 2019 Inpatient, Outpatient Databases

Staff Contact: Shane VanOverschelde

The fourth quarter federal fiscal year 2019 inpatient and outpatient databases, including HIDI-reporting hospitals in Missouri, Illinois and Kansas City, Kan., now are available for download to subscribers of the Premier Data Package on HIDI Analytic Advantage®. The databases consist of a patient-level limited dataset, including all HIDI-reported discharges and visits to hospitals. Files are delivered as both text files and ready-to-query Microsoft Access database files. The files are located in “Strategic Planning/Premier Data” and are organized in the following categories.

  • Q4 FFY2019, Inpatient
  • Q4 FFY2019, Outpatient Classified
  • Q4 FFY2019, Outpatient Unclassified

Hospitals interested in subscribing to the HIDI Premier Report Package should review the package information. Current subscribers with questions about downloading files should contact HIDI.

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Quality and Population Health


CDC-NCHS Release Updated Maternal Mortality Statistics

Staff Contact: Alison Williams

Last week, for the first time since 2007, the National Center for Health Statistics released new data on how many women die either during pregnancy or soon after giving birth. The new data present a much more accurate picture of what is happening in the U.S., along with the ability to compare rates nationally and globally. The data also allow officials and researchers to track the results of health care interventions to improve maternal care. The report states that, ultimately, a redesign of maternity care in the U.S. will be essential to protect pregnant and postpartum women, and to provide the care and resources necessary for them and their families to thrive.

Heart disease and stroke caused more than one in three pregnancy-related deaths between 2011 and 2015 in the U.S., according to the CDC. MHA and partners, such as the Missouri Department of Health and Senior Services, currently support a quality improvement collaborative with 34 health care organizations across the state to improve management of severe hypertension in pregnancy, which can lead to stroke and lifelong cardiovascular-related health issues.

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DEA Promotes MAT Efficacy Treating Opioid Use Disorder

Staff Contact: Shawn Billings

The Drug Enforcement Administration is working to expand access to medication-assisted treatment for individuals with opioid use disorder. Partnering with the American Medical Association Alliance to produce two informative videos – “The Partnership: Law Enforcement and the Medical Community” and “The Advantages of Becoming a DATA-Waived Physician” –the DEA hopes to dispel the notion that the DEA does not support MAT for OUD and to prevent deaths due to opioids.

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CEO Announcements


Mosaic Life Care At St. Joseph Medical Center Names New President

Staff Contact: Carol Boessen

Dr. Davin Turner was named president of Mosaic Life Care at St. Joseph Medical Center in early January. Dr. Turner had been serving as interim president since Nov. 22, 2019, when Brady Dubois resigned for a CEO position in Indiana. Dr. Turner will be responsible for medical center operations in addition to his role as chief medical officer. He has been with the organization for more than 24 years as a practicing family medicine physician. A list of CEO changes is available online.

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Keim Announces Retirement From Ste. Genevieve County Memorial Hospital

Staff Contact: Carol Boessen

Tom Keim, CEO of Ste. Genevieve County Memorial Hospital, has announced his plans to retire this year. Keim has served as CEO for more than 13 years. A search is being conducted for his replacement, and he has agreed to stay in his role until his successor is named to ensure a smooth transition. A list of CEO changes is available online.

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Did You Miss An Issue Of MHA Today?


February 3, 2020
GAO Assesses Effect Of Medicaid Payment On SUD Treatment
CMS Releases Fact Sheet On FY 2020 HAC Reduction Program
DHSS Highlights Hepatitis C
2020 Aim for Excellence Award — Call for Applications
CMS Announces Education Session

February 5, 2020
MHA, Partners Release New Research On Behavioral Health Crisis In Agriculture
Trump Delivers State Of The Union Address
MHA, Child Advocates Speak Against Managed Care For Foster Kids’ Behavioral Health
HIDI Releases Fourth Quarter FFY 2019 Inpatient, Outpatient Databases
eCQM Reporting Deadline Approaches
Perimeter Behavioral Hospital Of Springfield Names New CEO
Fulton Medical Center Names New CEO



Consider This ...

Today is National Wear Red Day. While one in 31 American women dies from breast cancer each year, heart disease is the cause of one out of every three deaths. That’s roughly one death each minute.

Source: American Heart Association