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.
Insights
This morning, I Googled “Missouri hospital pricing data” in anticipation of writing this column. In .83 seconds, Google produced nearly 84 million results, with the top four being MHA’s Focus on Hospitals website or MHAnet. Since we clearly were dominating the search engine’s pulls, I asked a member of our staff to look at the Google analytics, which one could expect to be off the charts given our ranking. In August, there only were 503 visits, and in the last 30 days, only 398.
I would hold up Missouri hospitals’ efforts on Focus on Hospitals as the nation’s premier platform for patient-accessible, hospital-inclusive and current pricing data transparency. Moreover, it has been available since 2016, combines important data on hospital quality with price to help drive good decisions and is free to the public. So, where’s the disconnect?
For the vast majority of Missourians, I suspect the disconnect is in their bag or wallet — their insurance card. Despite our commitment to providing transparent data, most Americans simply don’t shop for health care, because they aren’t looking for what an item, procedure or other billable expense might cost, they are interested in what their exposure to that cost might be. That’s why the Missouri legislature adopted legislation nine years ago requiring insurance companies to provide out-of-pocket estimates to every one of their policy holders who requests that information. When you combine the pricing and quality data on Focus on Hospitals, along with the insurer OOP information, you have the complete package in this state. And it’s been in place for several years.
Last year, President Trump issued an executive order calling for greater transparency of health care costs and prices. In response to the order, the Centers for Medicare & Medicaid Services issued a rule mandating price-related transparency requirements, including that hospitals post standard charges for all items and services in a machine-readable format on the internet, and display standard charges and certain other information for 300 “shoppable” items and services in an easy-to-understand format.
There’s an old saying, “If it was easy, someone would already be doing it.” That’s the case with meeting the standards.
Missouri and several partner states surveyed their hospital members about costs associated with the rule, level of complexity in meeting the standard and whether a vendor was supporting their efforts. The hospitals that are working to comply have found that the CMS estimates of costs to build the reporting backbone are significantly more in the short and long term. Moreover, because our health care system’s packaging of services for payment, there is complexity in separating supplies and services to deliver meaningful information for “shoppable” elements. Finally, no vendor is guaranteeing a solution that meets all the regulation requirements.
The mandate is only months away, and hospitals’ ability to both comply and produce data that could be meaningful to a customer remains an open question. It’s a classic “Catch 22” for the nation’s hospitals. Accordingly, we’re working on clarification from CMS on expectations, and the American Hospital Association continues to pursue a remedy through the courts.
Unfortunately, there’s strong evidence that despite whether this information can be developed in the time mandated, few people will use it. Focus on Hospitals is strong evidence. Just ask Google.
The ETC Model will test whether greater use of home dialysis and kidney transplantation for Medicare beneficiaries with ESRD will reduce Medicare expenditures while enhancing the quality of care. The ETC Model would adjust certain payments to nephrologists and other clinicians treating beneficiaries with ESRD. CMS is estimating the savings to be $23 million over five and a half years.
The RO Model will allow greater focus on value-based care by creating a simpler, more predictable payment that incentivize cost-effective and clinically effective treatments to improve quality and outcomes. CMS is estimating that the model will save Medicare $230 million over five years.
Both models are included in a recently published final rule on Medicare specialty care models to improve quality of care and reduce expenditures. MHA soon will publish an issue brief.
The Centers for Medicare & Medicaid Services issued 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 lessons learned and infectious disease surge annex template
participate in medical documentation interoperability pilot
new waivers for Inpatient Prospective Payment System hospitals, long-term care hospitals and inpatient rehabilitation facilities due to provisions of the CARES Act
The third quarter federal fiscal year 2020 inpatient and outpatient databases, including HIDI-reporting hospitals in Missouri and Illinois (but excluding hospitals in Kansas City, Kan., for the current quarter), now are available for download to subscribers of the Premier Data Package on HIDI Analytic Advantage®. These databases will be updated to include the Kansas City, Kan., 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.
Q3 FFY2020, Inpatient
Q3 FFY2020, Outpatient Classified
Q3 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.
The U.S. Department of Health and Human Services announced 80 organizations in 36 states and two territories who will receive nearly $25 million in grant funding through the Health Resources and Services Administration as part of the Rural Communities Opioid Response Program. HHS reported nearly $15 million will to go 30 recipients to reduce neonatal abstinence syndrome by improving care, family supports and factors related to social determinants of health. Each recipient will receive $500,000 over three years through the Federal Office of Rural Health Policy. Additionally, $10 million will go to 50 recipients to strengthen and expand substance use and opioid use disorder prevention, treatment and recovery services, funded through Rural Communities Opioid Response Program Planning.
Data from the National Health Interview Survey in 2018 was released from the National Center for Health Statistics finding that in 2018, two-thirds, or 66.3%, of adults aged 18 and over consumed alcohol in the past year. Among adults aged 18 and over, 5.1% engaged in heavy drinking. Additional key findings found adults who regularly felt worried, nervous or anxious, or who regularly felt depressed, were more likely than adults without these feelings to engage in heavy drinking in the past year.
Heavy drinking is associated with an increased risk of alcohol use disorders, suicide, interpersonal violence, traffic injuries, liver disease, certain cancers and infectious diseases, and adverse birth outcomes in pregnant women. The U.S. Preventive Service Task Force recommends screening adults for unhealthy alcohol use in primary care settings and providing brief behavioral counseling to those whose drinking exceeds certain weekly, daily or per-occasion amounts.
The Health Resources and Services Administration is accepting applications for the fiscal year 2020 National Research Service Award program. The application cycle closes on Monday, Nov. 9.
This funding opportunity will allow eligible institutions to train and provide support to postdoctoral health care professionals who are planning to pursue careers in biomedical and behavioral health research related to primary care. Grantees will train researchers to study issues facing the primary care workforce across the nation.
September 14, 2020
MHA Offers New Voting Resources For Members
Missouri U.S. Representatives Support Hospital 340B Concerns
CMS Reminds Hospitals Of HCAHPS Submission Deadline
TJC Posts Specifications Manual Version 2020B2
September 16, 2020
CMS Withdraws Troublesome Medicaid Fiscal Accountability Rule
CMS Announces ACO Investment Model Report
CMS Releases NOFO For CHART Model
CMS Releases 2022 MA Advance Notice
CMS Selects Hospitals For OQR CY 2022 Validation
MDHEWD Opens Application For Fast Track Workforce Incentive Grant
Consider This …
New data from the Centers for Disease Control and Prevention show that adult obesity prevalence is increasing and racial and ethnic disparities persist. And, all states and territories had more than 20% of adults with obesity.
