MHA Today | February 14, 2020

February 14, 2020
MHA Today: News for Healthcare Leaders

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February 14, 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 & CEOIn several earlier columns, I shared thoughts on the Medicaid payment reform effort. I’ve written about the composition of the current program, aspects of and options for moving toward a value-based system, and the administration’s vision for Medicaid transformation. This week, I want to talk about what we’re doing to engage in the transformation effort.

To help shape our hospital-community transformation principles, MHA established several member workgroups to take a deep dive into the Medicaid program. Each workgroup provided guidance, and their collective efforts helped shape principles later adopted by the MHA Board of Trustees.

As I indicated in an earlier column, MO HealthNet Director Todd Richardson’s goal is to “build a best in class Medicaid program that addresses the needs of Missouri’s most vulnerable in a way that is financially sustainable.” It’s a good goal. However, understanding and agreeing upon what defines “best in class” is essential to reaching the goal.

Whether Medicaid transformation and Medicaid payment reform are one in the same thing, or whether payment reform is a subset of transformation, matters. Changes to payment rates that aren’t focused on delivering value, for example, aren’t reform — they are cuts. However, value-focused payment reform that aligns incentives for patients, providers and the Medicaid program provides an opportunity to materially improve the quality, efficiency, capacity and value of care provided to Medicaid enrollees.

Our vision for reform includes four central pillars: a healthy marketplace, innovative payment reform, high-quality care, and transparency and data sharing. Through these pillars, we believe true transformation is possible.

Medicaid is an essential component of a healthy, functioning marketplace. All the stakeholders should be held to the same standards of accountability for their part of the system, and expectations, incentives and metrics to build around value should apply to all, equally. Changes should move at a rate that allows for both flexibility and an orderly transition toward an improved system.

Transformation only will work if the process is inclusive of all stakeholders and recognizes the differences between programs, providers and populations. The state should maximize federal flexibility on funding and program design, while aligning incentives from top-to-bottom toward value — for the state as the payer, and among the other stakeholders as well. Fair play is essential. Balance between risk and reward should be applied to all participants, and new models and partnerships that help produce value should be allowed to grow.

Medicaid should deliver high-quality care. Transformation must include evidence-based quality improvement programs with stakeholder engagement and accountability at all levels. Better data and additional transparency can help move this effort forward. In fact, to align incentives for providers and payers, data will be a core driver of transformation.

It’s early in the process — the administration’s goals remain aspirational and their plans tentative. We’ve articulated a set of principles that can help guide a process that is both fair and flexible. Further, we are in the process of translating those principles to program-specific initiatives focused on promoting prevention, better use of technology, care coordination, increased accountability for quality and outcomes, and better alignment with behavioral health and post-acute services. My guess is you see a common thread in these programs — it is one based on value-based care.

MHA and its member hospitals are working hard to avoid what regulators know how to do so well — simply turn the knobs of government and cut provider payments. Rather, we’re ready to work in partnership with the state to move torward a robust value-based payment program that puts the patient at the center. That’s how we achieve a “best in class” Medicaid program.

Where there is opportunity, there usually is risk as well. That’s clearly the case with Medicaid transformation.

In an upcoming column, I’ll address some of the opportunities and challenges presented by the transformation effort.

Send me a note to let me know what you’re thinking.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
Legislative Chambers Approve Opioid-Related Bills
Legislative Committees Review Proposals On Hospital Guns, Violence
Federal Court Rejects Medicaid Work Requirements
Flu Activity Remains Widespread
TJC Shares Information On Chart-Abstracted Data Submissions
MHA Presents On Rural Behavioral Health To DMH

state and federal health policy developments

Legislative Chambers Approve Opioid-Related Bills

Staff Contact: Daniel Landon or Rob Monsees

The state House of Representatives gave first-round approval to House Bill 1693, which would authorize the creation of a statewide prescription drug monitoring program. The House narrowly defeated an amendment calling for the program to lapse if opioid-related deaths increase by more than 5%, but then approved the bill by a vote of 95-56. A final House vote is expected next week.

The Senate gave its final approval to legislation concerning litigation between the Attorney General and drug manufacturers and distributors based on damages caused by the promotion and use of opioids. The bill directs proceeds from a settlement agreement to be used exclusively for opioid addiction treatments and services, and health care and law enforcement costs related to opioid addiction treatment. It now moves to the House of Representatives.

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Legislative Committees Review Proposals On Hospital Guns, Violence

Staff Contact: Daniel Landon

A state Senate committee held a hearing on Senate Bill 663, which would expand the settings and circumstances where concealed weapons are authorized. One change in the bill would allow those with concealed weapons permits to bring their weapons into areas of a hospital accessible to the public. Private hospitals could restrict access by adopting policies and posting signs; governmental hospitals could not. MHA opposes the measure.

Another Senate committee reviewed legislation that would create a new system of regulation and reporting regarding workplace violence in hospitals. It is modeled on a California state law. MHA testified in opposition.

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Health Law Insight

Federal Court Rejects Medicaid Work Requirements

Staff Contact: Jane Drummond

The U.S. Court of Appeals for the District of Columbia scrapped an attempt by the State of Arkansas to impose work requirements on Medicaid beneficiaries. The demonstration project had been approved by the Centers for Medicare & Medicaid Services; however, the decision was challenged by residents of the state. In reviewing the Medicaid statute, the court concluded the primary purpose of the program is to provide access to medical care. Because there was evidence the requirements resulted in significant coverage loss, the court deemed the secretary’s approval of the state plan arbitrary and capricious.

While this decision is limited to the Arkansas plan, it has implications for other states attempting to impose work requirements on Medicaid beneficiaries.

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Quality and Population Health

Flu Activity Remains Widespread

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

According to the Missouri Department of Health and Senior Services Weekly Influenza Report for week ending Feb. 8, Missouri’s estimated influenza activity remains widespread. Additionally, this week’s EMResource Enhanced Flu query indicates a rise in both adult and pediatric inpatient flu cases.

Weekly EMResource Enhanced Flu queries will continue, and it is strongly recommended that hospitals continue providing responses to these queries to provide local, regional and statewide data for planning and response initiatives. Weekly flu query reports and data summaries can be reviewed by authorized users in the EMResource library. Links to the Centers for Disease Control and Prevention and Missouri DHSS influenza reports and resources can be found on MHA’s website.

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TJC Shares Information On Chart-Abstracted Data Submissions

Staff Contact: Sherry Buschjost

The Joint Commission shared additional information regarding the Direct Data Submission Platform for calendar year 2020 chart-abstracted data submission.

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MHA Presents On Rural Behavioral Health To DMH

Staff Contact: Mary Becker

Mat Reidhead presents to Missouri DMH Yesterday, members of the Missouri Mental Health Commission heard a presentation from Mat Reidhead, MHA’s Vice President of Research and Analytics, on a new behavioral health report released last week. The report, “Growing Stress on the Farm,” focuses on Missouri’s behavioral health crisis in agriculture. The research elevates awareness of disparities in economic factors for farmers and mental health outcomes for rural Missourians. Policy opportunities designed to expand access to mental health services, reduce stigma and improve mental health outcomes for rural Missourians also are included.

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Did You Miss An Issue Of MHA Today?

February 10, 2020
President Releases 2021 Budget Request
Medicaid Managed Care Plans Explain Transition Care Planning Program In MHA Webinar
State Legislators Consider Higher Standard For Constitutional Changes
Kaiser Family Foundation Summarizes Congressional Maternal Health Legislation
AHA Issues Guidance On USP Guidelines
HRSA Announces Rural Communities Opioid Response Funding Opportunity
CMS Announces Preview Period For April 2020 Hospital Compare Data

February 12, 2020
MHA Engages In Legislative Committee Debates
Legislative Committee Narrows Medicaid Coverage Proposal
Congressional Committees Add To Surprise Billing Debate
MHA Releases Issue Brief On President’s 2021 Budget
Anthem Completes Acquisition Of Missouri Care
Final Rule CY 2020 Medicare OPPS Available
TJC Releases Specifications Manual Version 2020B
Orman Announces Retirement From Samaritan Hospital

Consider This ...

Today is National Donor Day. In 2018, 17,500 donors brought new life to recipients and their families, and since 1988, 750,000 transplants have taken place.

Source: Donate Life America