MHA Today | April 3, 2020

April 3, 2020
MHA Today: News for Healthcare Leaders

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April 3, 2020

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

COVID-19 Updates


For the latest updates and most current information on coronavirus disease 2019, visit MHA's website.


Herb Kuhn, MHA President & CEOWe live in an era of many choices with few truly hard decisions. Abundance is such a virtue in the U.S. that it is hard to imagine that anything we need — or believe we need — won’t be readily available when we need it. We’re accustomed to not only volume, but variety. As anyone who has an Amazon Prime membership knows, virtually anything can arrive tomorrow or the next day, right at your front door.

Hospitals are part of the model. They offer 24-7 care, year-round. In most cases, if an illness is identified early enough, there usually is a treatment. Sometimes these interventions are transformative — a pill, device or surgical procedure. It may take extraordinary measures, but the health care system is joined with the patient in a fight against disease.

Sadly, this system and its capabilities are being tested by the coronavirus. The virus has challenged our public health agencies and our health care system in ways not seen in generations. As an invisible but aggressive opponent, it has required highly societally disruptive policies to reduce the toll, while flanking and enveloping our best attempts to fight back clinically.

These interventions are, given preliminary data, beginning to reduce the overall harm. However, for those with acute cases, models of disease progression, future options for care or a vaccine are academic. Caregivers share this challenge. In addition to the extreme burden of care delivery, there is the heart-rendering challenge of — when resources move from scarce to unavailable — what clinicians will do to evaluate which patients will receive additional care and resources, and which will not.

Whether we meet or exceed care capacity or not, we’re already beginning to make difficult decisions about the very human aspects of care. Babies will be born without a full complement of family around them, and Missourians will die without a room full of family. These disruptions will change our expectations. However, they pale in comparison to the complicated decisions of rationing resources.

Despite hospitals’ goal of providing care for all, there is a possibility that hospital resources will be inadequate to meet demand — despite the influx of new resources. The good news is that state planners, working alongside MHA and our member hospitals, are building that surge capacity to eliminate — or drastically mitigate — possible shortages during the surge. And hospitals across the state are flexing and reconfiguring their operations to expand existing capacity.

There has been a vigorous attempt to boil these issues down to beds and vents. That assumes that COVID-19 is a clinical problem, when it first is a public health problem. Nonetheless, the fact that COVID-19 is manifesting in hospitals and the clinical system means every hospital must have a plan for resource allocation.

MHA is working with clinicians, ethicists, clergy and others to establish systems to help hospitals make the difficult decisions if needed. Asking our clinicians to make these decisions without adequate tools and a system is unfair. Deciding how to allocate life-or-death resources shouldn’t be arbitrary or under the auspices of front-line caregivers exclusively.

It isn’t clear that Missouri will exceed our capacity to care for critically ill COVID-19 patients. However, we must plan for the worst-case scenario. The worst case envisions choices — decisions resulting in some Missourians getting care and others not.

These are questions for the best clinical and academic minds. MHA is bringing these individuals together to address the challenge — whether we meet the threshold or not.

Let me know what you’re thinking.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
Governor Orders $180 Million In Expenditure Restrictions
MACPAC Recommends Changes To Promote Dual Eligible Assistance And Care Coordination
MLN Connects Provider eNews Available
MHA Updates Hospital Quality Reporting Guides

state and federal health policy developments

Governor Orders $180 Million In Expenditure Restrictions

Staff Contact: Daniel Landon

Gov. Parson halted $180 million in state government spending due to the effect on the Missouri economy and revenues of the COVID-19 public health emergency. The spending restrictions are for the current state fiscal year, which ends June 30, 2020. Most of them involve the state’s higher education institutions. In his press release, the governor noted that he anticipates $315 million in federal funding to help with the budget shortfall.

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Regulatory News
the latest actions of agencies monitoring health care

MACPAC Recommends Changes To Promote Dual Eligible Assistance And Care Coordination

Staff Contact: Brian Kinkade

The Medicaid and CHIP Payment and Access Commission adopted two recommendations for its June 2020 report to Congress regarding qualification for care under the Medicare and Medicaid programs. Participants who qualify for both programs are commonly referred to as “dual eligibles.”

MACPAC recommends that Congress simplify the so-called Medicare Savings Programs, under which participants’ Medicare premiums and copayments are paid, in part or in full, by Medicaid. MACPAC recommends that the definitions of income used to determine eligibility for Medicaid assistance be simplified and that the Social Security Administration expand its data sharing with the states to promote higher MSP participation.

The commission also recommends the Centers for Medicare & Medicaid Services promote coordinated care for dual eligibles by expanding opportunities for beneficiaries to enroll in integrated care plans and to increase funding to states to develop and implement integrated care models.

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MLN Connects Provider eNews Available

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services issues 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.

  • Provider preview report: review your data by April 13
    • IRF
    • LTCH
    • Hospice
  • MLN catalog – April 2020 edition
  • Interoperability and patient access final rule call – April 7

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Quality and Population Health

MHA Updates Hospital Quality Reporting Guides

Staff Contact: Sherry Buschjost

MHA has updated the acute care, critical access hospital and specialty services quality reporting guides to reflect requirements effective with Jan. 1, 2020, dates of service. The guides support hospitals with reporting quality measures through various reporting programs. Download the updated guides to access direct sources of information and to stay up-to-date on measure specifics.

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Consider This ...

To avoid contamination, always remove a face mask by the ear loops or the tie — never the part that covers your face.

Source: The New York Times