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July 18, 2014

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 & CEO

It is said that “an apple a day keeps the doctor away.” The healing powers of apples aside, even apple lovers who take care of themselves need primary and preventive care. And in Missouri, we have too few of these practitioners — right now and to meet future projected needs.

MHA recently released a report on the status of the primary care workforce in Missouri. The report follows up on our initial look at the subject in 2011. Since then, the difficulties have multiplied. More troubling perhaps is that while limited initiatives have been launched to address the problem, the situation on the ground continues to deteriorate. These initiatives are laudable, but they tend to work around the periphery of the issue rather than address key solutions. Statewide, 40 percent of practicing physicians are older than 55, and about one-third of the nursing workforce is older than 50. Physicians in rural Missouri are older than their urban counterparts by at least two years. Of all physicians practicing in rural Missouri, nearly 70 percent are 50 or older. None of this bodes well for the future, especially for rural communities. And although Missouri comprises 19 percent of the country’s population and produces 2.7 percent of the nation’s medical school graduates, we rank second in the nation for exporting the doctors we train to other states.

Of the more than 6 million Missourians, 2.23 million — 37 percent — live in a rural areas. Demographically, rural Missouri is older, sicker and poorer than urban Missouri. Rural areas have higher rates of smoking, obesity diagnosed rates of high blood pressure and high cholesterol. At the same time, rural areas have lower rates of preventive screenings, including mammograms and colonoscopies.

Better access to primary care is part of the solution. Missouri has made strides in some areas, like improving the climate for telemedicine, but it isn’t keeping pace with other states in addressing other issues that could increase access to primary care. First, we have failed to adopt a Medicaid reform plan. Second, we need to do a better job of retaining the physicians we’re producing in our medical schools and creating a more attractive environment for advanced practice nurses and physician assistants. Finally, lawmakers need to restore a cap on noneconomic damages in medical malpractice liability lawsuits.

As I said in a February column, without action, Missouri could end up in the second-tier of the second-tier states. We don’t have mountains or beaches and our weather is — this week notwithstanding — not a selling point. In the absence of these natural amenities, we could be putting out the welcome mat. We have not. And, the long-term implications are troubling.

An orchard full of apples won’t negate the anticipated demand for primary care. What is “keeping the doctor away” from Missouri is not apples but policies. That’s bad news for hospitals and for Missourians. We must make the changes necessary to address the workforce issues included in the report.

Our communities deserve better.

Send me a note to let me know what you are thinking.



Herb B. Kuhn
MHA President and CEO

In This Issue
CMS Launches Next Phase Of New QIO Program

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

CMS Launches Next Phase Of New QIO Program
MHA Staff Contact: Sharon Burnett

The Centers for Medicare & Medicaid Services today awarded additional contracts as part of a restructuring of the Quality Improvement Organization Program to create a new approach to improve care for beneficiaries, families and caregivers. The new contracts being awarded to 14 organizations represent the second phase of QIO restructuring. The awardees will work with providers and communities nationwide on data-driven quality initiatives. These QIOs will be known as Quality Innovation Network (QIN)-QIOs. Missouri will now be part of the Texas QIO, TMF.

The first phase of the restructuring that CMS announced in May allows two beneficiary and family-centered care (BFCC)-QIO contractors to perform the program’s case review and monitoring activities separate from the quality improvement activities performed by QIN-QIOs. The two BFCC-QIO contractors are Livanta LLC and KePRO. They will be responsible for ensuring consistency in the review process, with consideration of local factors important to beneficiaries.

CMS is hosting a webinar from 10 to 11 a.m. Wednesday, July 23, on the QIO restructuring that is effective Aug. 1. The purpose of the webinar is to provide an overview of the QIO program change and an update on the transition process. Presenters also will discuss the impact of the changes on the provider community, share critical resources and answer any questions. Pre-registration is not required for this program. To participate, go to To join the audio portion, call 877/267-1577 and give the meeting ID 993 182 797.


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.

July 17, 2014
MLN Connects Provider eNews Available
Resources Offer Guidance For Improving Health Literacy

July 16, 2014
CBO Projects Slower Cost Growth
MHA Comments On Federal EHR Incentives For 2014

July 15, 2014
Governor Vetoes Legislation On Firearms Data In Medical Records
Unemployment Compensation Legislation Becomes Law
HHS Announces $11 Million Available To Better Integrate HIV Services Into Primary Care

July 14, 2014
HIDI HealthStats — Economic and Financial Stresses: Payer Mix Ratio
Governor Approves Legislation On Use Of Investigational Drugs
Governor Vetoes Legislation On Regulation Of E-Cigarettes
Nixon Approves Legislation Authorizing Hemp Oil For Seizure Treatment
Final Rule Revising Certain CoPs for Hospitals, CAHs Now Effective

MHA Consider This Consider This ...

This year, the United States is experiencing a record number of measles cases. There have been 566 confirmed measles cases reported, the highest number of cases since measles elimination was documented in the United States in 2000.

2014 Measles Cases and Outbreaks

Source: Centers for Disease Control and Prevention

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