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August 15, 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’s been a hard week for Missouri. The news from Ferguson — an otherwise non-descript suburb in St. Louis County — has placed Missouri and the state’s eastern metro area on the world stage.

How we see ourselves, or how we fail to see, matters.

A news report about Ferguson in today’s Washington Post has lessons for citizens, leaders and our health care system — both here and beyond. Former St. Louis Post-Dispatch reporter and current Washington Post writer Todd C. Frankel explains.

“Ask people who live in Ferguson where they’re from, and most likely they’ll say St. Louis. It’s a quirk of the region. People identify with the St. Louis metro area. Ferguson, a city of 21,000 residents, is a place distinct from St. Louis City, which is different from Affton or Clayton or Ballwin. But these are mostly neighborhood distinctions. The residents all live in the same St. Louis County, which is packed with 91 different municipalities. Some have quaint downtowns. Others have just 12 residents. But at the center of all of them is St. Louis City.”
St. Louisans ask each other where they went to high school. It’s a running joke in Missouri. But there’s a reason that it’s not particularly funny. That’s because the question is as much about socio-economic status as it is geography. It says a lot whether you are part of the private or parochial school set or from a public school. And, it’s just as telling whether you went to the public school district in Ferguson or in Ladue — two districts separated by less than 10 miles along Highway 170. These St. Louis burbs have vastly different resources and produce significantly different student proficiency in language, mathematics, science and social studies. The Ferguson-Florissant district scores for proficiency were 30 percent while the Ladue school district was more than 75 percent. The median — I stress median — household income in Ladue is $154,000. In Ferguson it’s $36,000.

We’re finding that geography matters in health care, too. A recent release from the Harvard School of Public Health argues — using a Missouri community as an example — that ZIP code is a better predictor of health than genetic code. The linkage of health and education starts pre-K. Educational attainment is the key driver of socioeconomic status which is the key driver of health outcomes.

We know this to be true. Our research on socio-economic status was recently published in Health Affairs.

As a hospital community we’re working to understand the socio-economic and demographic links — lack of access, health insurance or community support — that lead to readmissions. These factors aren’t exclusively related to Medicare, or the state’s debate over Medicaid reform. They are fundamental to improving the quality and delivery of care in a state that ranks 39th in health status.

This month’s HIDI HealthStats reviews pediatric emergency department utilization. As with analysis of other population and utilization trends, there are outliers that use significantly more services than would be expected. Children who have between four and ten ED visits are more likely to have conditions and comorbidities including psychiatric disorders, diabetes, asthma and chronic obstructive pulmonary disease. They are also more than twice as likely to be pediatric ED super utilizers.

Our ability to identify problems, and use data to marshal resources to address health issues, grows daily. Eventually, with support from public policy, these tools could allow hospitals and health care stakeholders to develop a system that better reflects the diversity of our patients. That’s the path to the Triple Aim of better care, better health and lower cost.

Ferguson isn’t St. Louis, it’s Ferguson — with all of the opportunities and challenges presented in being so. Recognizing this is essential to building a better system. And, it is as true for Albany, Cape Girardeau, Macon and Springfield as it is for the municipalities of St. Louis County. Where you live shouldn’t be reflected in health status. Too often, it is.

One size seldom fits all.

Let me know what you are thinking.


Herb B. Kuhn

MHA President and CEO

In This Issue
MHD Adopts No Payment Rule For Early Elective Deliveries
Missouri HEN Report Available On Analytic Advantage Plus®
CMS Outlines Testing Approach For ICD-10 Implementation

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

MHD Adopts No Payment Rule For Early Elective Deliveries
MHA Staff Contact: Sharon Burnett

The MO HealthNet Division published a final rule, 13 CSR 70-3.250, Payment Policy for Early Elective Delivery in the Aug. 15 Missouri Register. The rule becomes effective Sept. 30.

EED-related services for deliveries before 39 weeks gestation, without a specific medical indication, will not be reimbursed by the MHD. Non-payment includes services billed by the delivering physicians/provider and the delivering institution, and non-routine newborn services provided during the initial delivery-related stay billed by the delivering facility. A MHD provider bulletin with additional guidance will be issued at a later date.

The 44 birthing hospitals that have been participating in the Missouri Hospital Engagement Network since 2012 have an average EED rate of 1.7 percent for the last six months of reported data, below the national benchmark of 2 percent.


Missouri HEN Report Available On Analytic Advantage Plus®
MHA Staff Contact: Jessica Rowden

The Missouri Measure Reporting Snapshot is a Missouri Hospital Engagement Network report offered on Analytic Advantage Plus®. The report summarizes, via a point system, the degree to which hospitals are currently reporting the preferred Missouri HEN measures to the comprehensive data system. The report is designed to reduce variation in reporting and ensure comparability and benchmarks for statewide quality topics.


CMS Outlines Testing Approach For ICD-10 Implementation
MHA Staff Contact: Cerise Seifert

The Centers for Medicare & Medicaid Services recently provided updated information for the testing approach for ICD-10 implementation. Included in the plan are updated dates for acknowledgement and end-to-end testing. The newly announced deadline is Oct. 1, 2015.

End-to-end testing will be offered to approximately 2,550 volunteer submitters during three testing opportunities in 2015. CMS will be providing registration information at a later date.


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.

August 14, 2014
GAO Report Calls For Better Oversight Tools To Reduce Duplicate Post-Payment Reviews
MHA Distributes Analysis For Proposed CY 2015 Medicare Outpatient PPS
MHA Distributes Analysis For Proposed Updates To CY 2015 Home Health PPS
MLN Connects Provider eNews Available

August 13, 2014
CMS Requests Citizenship, Immigration Documents For Keeping Marketplace Coverage
HIDI Releases First Quarter 2014 VBP Payments Model

August 12, 2014
Study Reveals Missouri Hospitals To Lose Billions Over Medicaid Nonexpansion
CMS Revises List Of Certain Preventive Screening Eligible For AIR Payment
CMS Details Equipment Maintenance Standards For CAHs
Missouri Rehabilitation Center To Close
Sac-Osage Hospital To Close

August 11, 2014
HIDI HealthStats — Pediatric ED Super Utilizers
CMS Reports Medicaid, CHIP Eligibility Activity For June
Health Insurance Premium Expected To Increase For 2015


MHA Consider This Consider This ...

Vaccinations matter. Between January and June, nearly 10,000 cases of whooping cough were reported to the Centers for Disease Control and Prevention — a 24 percent increase compared with the same time period last year.

Source: Centers for Disease Control and Prevention

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