MHA Today | April 10, 2020

April 10, 2020
MHA Today: News for Healthcare Leaders

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April 10, 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 & CEOWhen the Coronavirus Aid, Relief and Economic Security Act — known as the CARES Act — was adopted two weeks ago, there was hope that the $100 billion in relief it included for hospitals would open a financial bridge through the crisis. Today, we are hearing that the first payments from this fund are arriving. While that is good news, it looks as if the funds will be coming in a series of tranches and are based on hospitals’ historical utilization levels within Medicare, Medicaid or other programs.

MHA has been working with Missouri’s congressional delegation and federal regulatory agencies to move quickly to deliver the funds. Many hospitals are burning through their cash reserves quickly, and smaller hospitals and those on the financial margins have very little room to sustain their spending levels. Some hospitals report it only will be several days or weeks before they run out of cash.

The losses incurred by eliminating elective surgeries, and the plummet in inpatient and outpatient services, are reaching a critical stage. MHA’s estimate of the percentage loss of inpatient and outpatient revenue is worsening. We now estimate that hospitals are losing as much as $32 million each day, statewide. That’s approximately 50% of total hospital revenue. And, these losses are occurring at the same time as hospitals are challenged with new costs to respond to COVID-19 and prepare for a potential patient surge.

Approximately 2.1% of all Medicare beneficiaries live in Missouri. According to CMS, the new “bridge funding” opportunity will bring $618 million to Missouri’s providers. Hospitals are expected to receive between $350 and $400 million. Based on our current downturn, this would fund approximately 11 or 12 days of revenue losses. Moreover, this initial distribution, based on Medicare, does little to help low Medicare volume facilities such as children’s hospitals. It is essential that these hospitals be part of the second wave of relief, which CMS has promised to do.

The faster these resources arrive, the less harm will be done. Some CARES support is in place, including the 20% Medicare prospective payment system reimbursement bump for treating Medicare COVID-19 inpatients and suspension of the 2% overall Medicare sequestration. Other CARES relief — including the Medicare accelerated/advance payment program — is beginning to flow. And, as these resources begin to move, we’re engaging Missouri’s congressional delegation on the type of support we’ll need in the next COVID-19 relief package.

Unfortunately, it still is possible for the unthinkable to occur. In Missouri, we are beginning to see hospitals considering whether they will need to furlough staff. In some parts of the nation, this already is occurring. Staff are one of the largest expenses for hospitals. Absent immediate relief, hospitals could be forced to make hard staffing decisions. Worse yet, it is conceivable that the most financially challenged hospitals could have no alternative but closure.

One provision of the CARES Act allows small businesses with 500 or fewer employees to receive funding to be used for the retention of employees. The Paycheck Protection Program will provide much-needed cash flow assistance to some hospitals. However, Missouri’s public hospitals and hospital districts are not eligible for this assistance. This affects the 21 rural public hospitals that have 500 or fewer employees. We’re working with Missouri’s members of Congress to address this in the next legislation.

Leaders at all levels have been setting the expectation that the next two weeks will be very hard for the country. These warnings have been about the peaking of the virus, and hospitalization and death rates. However, these weeks also will be very hard for hospitals as we concurrently address both increasing utilization as the virus reaches peak and financial challenges.

The influx of relief funds from the federal government, and the adoption of the state’s supplemental budget this week, may generate some new flexibility and resources. How soon the next wave of support comes matters.

Keep doing what you’re doing. And, let me know what you think.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
MLN Connects Provider eNews Available
HIDI Releases First Quarter FFY 2020 Inpatient, Outpatient, Missouri Databases
CMS Announces April 2020 HQR System Release
MHA Creates Protect A Hero Digital Toolkit

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 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.

  • COVID-19
    • Dear clinician letter
    • Non-emergent, elective medical services and treatment recommendations
  • CMS approves approximately $34 billion for providers with the Accelerated/Advance Payment Program for Medicare providers in one week
  • Multi-factor authentication requirement delayed for PECOS, I&A and NPPES
  • Quality payment program: MIPS extreme and uncontrollable circumstances policy in response to COVID-19

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HIDI Tech Connect

HIDI Releases First Quarter FFY 2020 Inpatient, Outpatient, Missouri Databases

Staff Contact: Shane VanOverschelde

The first quarter federal fiscal year 2020 inpatient and outpatient databases, including HIDI-reporting hospitals in Missouri, Illinois (but excluding hospitals in Kansas City, Kansas for the current quarter), are now available for download to subscribers of the Premier Data Package on HIDI Analytic Advantage®. These databases will be updated to include the Kansas City, Kansas hospital data for the current quarter in the coming days. 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.

  • Q1 FFY2020, Inpatient
  • Q1 FFY2020, Outpatient Classified
  • Q1 FFY2020, Outpatient Unclassified

Hospitals interested in subscribing to the 2020 HIDI Premier Data Package should review the package information. Current subscribers with questions about downloading files should contact HIDI.

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Quality and Population Health

CMS Announces April 2020 HQR System Release

Staff Contact: Sherry Buschjost

The Hospital Quality Reporting system release for April 2020 has been completed and is available on QualityNet. The release consists of all applications, processes and reports necessary to support the newly added diagnosis codes effective for dates of service April 1 through Dec. 31, 2020, in the Hospital Inpatient and Outpatient Quality Reporting Programs:

  • ICD-10 code U07.0, Vaping Related Disorder
  • ICD-10 code U07.1, COVID-19

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MHA Creates Protect A Hero Digital Toolkit

Staff Contact: Kendra Hanauer Protect a Hero Toolkit

To support front-line health care staff and encourage social distancing, MHA produced a Protect A Hero digital toolkit for hospital use. Using the message, “Protect a Hero. Be a Hero. Stay Home,” the toolkit includes graphics sized for email and web, as well as two options for a Facebook photo overlay.

To add a frame to your Facebook picture, go to your profile, tap “Update” on your profile picture, then tap “Add Frame.” Search for “MHA: Protect a Hero” to see two overlay options.

Follow MHA on Facebook and Twitter, and participate with us in this campaign to protect our caregivers and slow the spread of COVID-19. Contact us if you need assistance or alternative formats of these resources.

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Did You Miss An Issue Of MHA Today?

April 6, 2020
Board Of Nursing Reports LPN Licensure Renewal Deadline Approaching
exploreMOhealth 2020 Updates Celebrate National Public Health Week

April 8, 2020
General Assembly Enacts FRA Reauthorization And Supplemental Budget
CMS Issues 2021 Medicare Advantage And Part D Rate Announcement Fact Sheet
MHA Suspends 2020 Aim For Excellence And Visionary Leadership Awards

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