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April 18, 2014

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

Insights

This week, the Missouri March of Dimes released information about hospitals’ progress in reducing early elective deliveries in the state. EEDs may be convenient for expecting families and physicians, but they have a poor track record when it comes to outcomes and cost. That’s why there’s been a movement toward a “hard stop” on early deliveries in pregnancies without a medical indication. Just this week, the Missouri Medicaid program proposed a new regulation restricting payment for EEDs done without medical justification.

Missouri hospitals have been working for two years to reduce EED rates. Among the 46 participating hospitals with birthing services, 78 percent report an EED rate of five percent or less, and 61 percent have had no EEDs in the last six months. A “hard stop” policy is now in place in 87 percent of participating hospitals, with strict medical guidelines for when a physician may schedule a delivery. Before the collaboration, only 35 percent of the participating hospitals had a hard stop policy in place.

This collaborative effort is linked to the work of the Missouri Hospital Engagement Network (MHA, March of Dimes and the Center for Patient Safety), which at its core is about finding interventions that reduce harm and improve care and delivering them to the frontlines of health care. What’s more, the EED progress is a great example of work that feeds into the Triple Aim — better care, better health and lower costs.

It’s clear that reducing EEDs results in better care. Moreover, pregnancies of 39 or more weeks help improve a newborn’s health because significant development occurs in a very short time late in pregnancy — especially brain growth and development. Finally, full term births reduce high cost neonatal intensive care stays. That’s a Triple Aim success story.

The Triple Aim strategy is demonstrating positive outcomes for many clinical conditions. The Missouri HEN is focused on improving quality while reducing both harm and readmissions. Just this week, new research was released reinforcing the evidence that community factors and access to appropriate post-discharge care have a positive effect on reducing readmissions. This report reinforces the value of collaborative partnerships, like the March of Dimes, Center for Patient Safety and MHA, working within the hospital and community to improve care and outcomes.

With penalties for Medicare readmissions in place, hospitals need to have the tools to understand readmissions and mitigate risks. In late April and early May, HIDI and MHA are collaborating on a series of webinars to roll out our readmissions toolkit. The dashboards, part of HIDI’s Analytic Advantage® platform, will provide access to key information on readmissions for AMI, congestive heart failure, pneumonia and hospital-wide readmissions. These tools are designed to help inform and drive organizational change to improve health outcomes for patients, as well as the standing of Missouri hospitals in quality-based comparatives. They also use the Centers for Medicare & Medicaid Services’ methods, but apply them to much more recent data, providing users with the opportunity to reduce potential impacts from the Hospital Readmission Reduction Program before the CMS data are even available.

In the coming weeks, MHA will issue the first report on the progress of the Missouri HEN. I’m confident that the report will show significant progress across the HEN focus areas. That means demonstrated improvements in care and savings throughout the system. Value is the new indicator; we’re moving the needle in that direction.

Hospitals are making a significant difference in improving care. And, we’re adding to our toolbox every day. That’s how we improve.

Let me know what you are thinking.

Herb B. Kuhn Signature
Herb B. Kuhn
MHA President and CEO

In This Issue
House Committee Approves Omnibus Licensure Bills With Hospital Pharmacy Language
Marketplace Enrollment Tops 8 Million
Community Health Factors Affect Readmission Rates
MLN Connects Provider eNews

Advocate Advocate state and federal health policy developments

House Committee Approves Omnibus Licensure Bills With Hospital Pharmacy Language
MHA Staff Contact: David Hale

The House Professional Registration Committee has incorporated the following health-related legislative proposals into each of two bills on licensure topics, Senate Bill 808 and Senate Bill 528. The committee then approved each bill. The added language would accomplish the following.
  • Authorize a federally-employed pharmacist to practice in Missouri without a state pharmacist license under certain conditions.
  • Make MHA-endorsed revisions to the state’s process of regulating hospital-based pharmacies.
  • Give broader authority for a pharmacist to administer childhood vaccines to a child age 7 or older under a written protocol from a physician
  • Revise the capacity of physician assistants to participate as recognized providers under the Missouri Medicaid program.
The committee also added the following provisions to Senate Bill 528.
  • the language of House Bill 1491, which creates new standards for the licensure of advanced practice registered nurses
  • authorization for a new type of provider called “Assistant Physician.” Such providers would be medical school graduates who have not completed a medical residency. They could only provide services under collaborative practice arrangements with physicians

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Marketplace Enrollment Tops 8 Million
MHA Staff Contact: Andrew Wheeler


President Obama announced that the insurance marketplace enrollment reached 8 million, of which 35 percent are under the age of 35. Obama stated that the ACA “is now covering more people at less cost than most would have predicted a few months ago.” The initial projection by the Congressional Budget Office was that 7 million individuals would sign up for coverage.

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Community Health Factors Affect Readmission Rates
MHA Staff Contact: Leslie Porth

A new report released yesterday by the Commonwealth Fund suggests a “majority of the variation seen in U.S. hospitals’ readmission rates for heart attack, heart failure, and pneumonia can be attributed to where individual hospitals are located, rather than to the quality of care they provide.” Aspects of population health status, including the number of general practitioners per capita relative to specialists and available high quality long-term care, strongly contribute to lower rates of readmissions within 30 days of discharge.

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Regulatory News Regulatory News the latest actions of agencies monitoring health care

MLN Connects Provider eNews
MHA 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.

  • hold on CAH claims for non-patient specimen analysis
  • hold on some Part B claims following April inpatient payment policy update
  • SNF consolidated billing
  • certifying physicians and the phase 2 ordering and referring denial edits for home health agencies


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Did You Miss An Issue Of MHA Today?

The following articles were published in this week’s issues of MHA Today and are available online.

April 17, 2014
MHA Today’s “Spotlight” — Carroll County Memorial Hospital, Carrollton
Report Examines Economic Impact Of Physicians In Missouri
Senate Committee Approves Conscience Protection Legislation
Senate Committee Approves Psychiatric Patient Restraints Bill
Senate Committee Approves Bill On Program for Donor Human Milk
Senate Committee Advances First Responder Bills
Measure On Investigational Drugs Advances
House Advances Bill To Study Diseases
Senate Committee Advances Bill Designating Jumping Jacks As the Official State Exercise
Hospital Compare Posts New IPF Data
IHI Issues Leadership Guide To Patient Safety
Results Available For Health Care Compensation Survey
Ray County Memorial Hospital Names Interim Administrator

April 16, 2014
MHA Today’s “Spotlight” — Fitzgibbon Hospital, Marshall
MHA Videos Highlight The Coverage Gap
House Committee Reviews Hospital Pharmacy Language
House Committee Reviews Measure Restricting State General Revenue Appropriations
Committee Reviews Measure Prohibiting Hospitals From Operating Health Insurance Entities
NHSC Accepting New Site Applications
National Healthcare Decisions Day Focuses On End-of-Life Planning

April 15, 2014
Tax Day Reinforces Medicaid Revenue Loss
CBO Reduces Estimates On People Gaining Health Insurance In 2014, 2015
Marketplace Open Enrollment Extension Ends
CMS Provides Contact Information For QualityNet Secure Portal
HIDI To Host Webinars On New Readmissions Dashboards
MIAC Issues Security Alert To Hospitals

April 14, 2014
MHA Distributes Financial Indicators Analysis
CMS Proposes To Amend Fire Safety Standards
CMS Releases Report On Use of Antipsychotics in Nursing Homes

MHA Consider This Consider This ...

Putting together an Easter basket this season? Beware of a pretty massive sugar hit. Even a modest basket has more than 250 grams of sugar, which amounts to nearly 1,000 calories from sugar alone.

Source: The Huffington Post

Missouri Hospital Association
P.O. Box 60 • Jefferson City, MO 65102
Phone: 573/893-3700 • Fax: 573/893-2809 • MHAnet
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