Minnesota Hospital Association


July 29, 2013

MHA Newsline

In this issue:

Hospital spotlight: Allina Health helps build healthy communities with free bikes for kids

Allina Health is working with the community to encourage physical activity, support healthful eating, and maintain a balanced life. Its efforts earned it the MHA Community Benefit Award for a large hospital earlier this year. Allina Health partnered with the non-profit organization Free Bikes 4 Kidz to give 5,000 free bikes, helmets and concussion prevention information to under-served children throughout its service area. A core team of Allina Health employees planned and implemented two community events: a community-wide bike collection day and a bike distribution event. At the collection day events, community members dropped off new and used bikes at 48 Allina Health sites across the state. Allina Health employees and volunteers from the community then cleaned and fixed up the bikes so they were ready to be matched with a child. At the giveaway events, each bike was matched with the age and size appropriate for each child. Thousands of kids learned about bike safety, were fitted for a helmet and selected a bike. For many, it was the first bike they ever had. ^top of page

MHA disappointed with IOM’s recommendation against Medicare payment incentives for providers in high-value areas

The Institute of Medicine (IOM) released a long-awaited report exploring vexing variations in the cost of care for Medicare beneficiaries in different regions throughout the country. The IOM report provided further confirmation of repeated studies, such as those completed by the well-respected Dartmouth Atlas, showing that some areas of the country provided higher quality care at less cost and other regions receive much more revenue from Medicare per-beneficiary and deliver lower quality care.

However, the IOM recommended against Medicare reforms that would vary or index providers' payments on a geographic basis as a way of addressing the misaligned incentives in the current system. Instead, the IOM stated that payment incentives should be designed in ways that are tailored to individual providers rather than groups of providers in a regional area. The IOM argued that geographic incentives would end up rewarding some low-quality, high-cost providers who happen to be in an otherwise high-value geographic area and, conversely, penalize high-quality, low-cost providers located in a region that delivers low-value care in the aggregate.

Because MHA has been a long and loud champion for Medicare payment reforms that reward high-value care delivery systems, the Association had mixed reactions to the IOM report.

On one hand, MHA was pleased with the analysis and findings in the report. The IOM confirmed (1) that geographic disparities in the quality and cost of care exist; (2) that those disparities cannot be explained away by accounting for the population's age, gender, income, race or health status; (3) that the increased spending in some regions has no correlation whatsoever to higher quality care; and (4) that these variations are substantial and result in large amounts of wasted or unnecessary Medicare spending.

MHA is frustrated, however, that the IOM opposed using geography as a basis for making adjustments to Medicare payments to mitigate these disparities. Lawrence Massa, president and CEO of MHA, noted that Medicare already uses geography as a basis for differentiating payment amounts for Medicare Advantage plans, physician payments and the hospital wage index. He said, “This is a textbook case of the perfect being the enemy of the good. It is as if the IOM is saying that we shouldn't approve a cure for some forms of cancer because it doesn't cure all cancer. Continuing to use a flawed and unfair payment system that, by the IOM's own analysis, results in misaligned incentives, wastes billions of dollars and prolongs the delivery of lower quality care for millions of Americans is an unacceptable option. Instead, if we know the payment system is flawed and we can make it more fair for more providers, we should do so while we keep searching for ways to design more precise provider-specific incentives.”

Massa said that MHA will continue its push for reforms that differentiate payments based on providers' quality and efficiency of care. “The fundamental premise remains undisputed: if we truly want to improve patient care and make it more affordable, Medicare needs to stop paying more for worse outcomes. Will this report prolong the status quo? Maybe a little. Does it make the need to reform the payment system less important, less urgent or less possible? Absolutely not.”

The IOM report can be found here. ^top of page

MHA pressing for MNsure details

Minnesota's new health insurance exchange, MNsure, will open for business on Oct. 1, and is counting on an active and robust group of "Consumer Assistance Partners" (CAPs) to help individuals use the exchange and enroll in coverage. Many Minnesota hospitals and health systems submitted applications to become CAPs, even though MNsure has not yet released details or timelines about the staff training, organizational obligations, partnership contracting process, or other questions about the process.

MHA has reached out to MNsure staff for information and details. Some of our questions are awaiting answers, because we have been told that MNsure does not currently have the capacity to participate in joint efforts for hospital and health system education. Based on lengthy conversations with MNsure's CAP director, MNsure is focused on staff hiring and the CAP program remains largely undeveloped at this time. Consequently, the organization cannot provide information about training and testing for CAP certification, timelines for the CAP program participants, consumer information materials, or other resources many hospitals are eager to use as they address questions from patients and community members.

Matt Anderson, MHA's vice president of regulatory and strategic affairs, said he has conveyed that MHA members are anxious for information so they can assist with this important enrollment function. “MNsure's response has been to ask for patience and trust while they work on the numerous steps in the implementation of the exchange,” Anderson said. “For our members who will be on the front lines as patients look for information and help with enrollment, 'hurry up and wait' is concerning.”

MHA continues its efforts to get more information from MNsure and to pass it along as quickly as possible to members. In the meantime, MHA members are encouraged to direct their questions to Anderson at manderson@mnhospitals.org or 651-659-1421. You can also click here for answers to the questions MHA is receiving most frequently from members. ^top of page

MHA encourages members to serve on MNsure advisory groups, respond to proposed rule

Last week, Minnesota's health insurance exchange, MNsure, opened an application process for positions to serve on two new advisory groups: the Health Industry Advisory Committee and the Consumer and Small Employer Advisory Committee. In addition, MNsure released a draft rule that would govern its appeals processes.

MHA encourages members to submit applications to serve on the advisory groups to ensure that hospitals and health systems are well represented in discussions of MNsure's policies, operations and initiatives. Applications are due by 3 p.m. on Aug. 15 and can be found here.

MHA also hopes that its members will review and provide feedback on MNsure's proposed appeals process rule. Comments are due Aug. 12. MHA members can submit their own comments directly to MNsure or provide them to MHA to include in its comments letter. The proposed rule can be found here.

Contact Matt Anderson, MHA vice president of strategic and regulatory affairs, 651-659-1421 with questions about the MNsure advisory committee application process or on its recently proposed rule.^top of page

Longtime MHA staff member retiring

It is with mixed emotions that we ask you to join us in bidding farewell to Lynette Virnig, a member of the communications team at MHA. Lynette has decided to embark on early retirement after more than 32 years with MHA. Lynette has worn many hats throughout her tenure with MHA, and takes with her an extensive historical knowledge about MHA member hospitals across the state that will be greatly missed. She has been instrumental in maintaining our website and keeping our database up-to-date; performing the work “behind the scenes” to ensure members receive timely and important health care related information. Lynette’s last day is Friday, Aug. 2, so please take a moment to drop her a note to wish her well. Best wishes, Lynette. Enjoy your retirement!  ^top of page

MDH reminds hospitals to verify practitioner licenses

The Minnesota Department of Health (MDH) is encouraging Minnesota hospitals to use an MDH website to systematically check the licensure status of health care professionals. MDH indicates that surveyors have encountered several instances where practitioners — especially audiologists, speech-language pathologists and occupational therapists — are working for extended periods of time without a current Minnesota license. Federal law and Minnesota law require hospitals to ensure proper licensure of employees.

The MDH Health Occupations Program Credential Lookup is available online at: https://pqc.health.state.mn.us/hopVerify/loginAction.do

For questions about professional licensure, please contact Ben Peltier, MHA vice president of legal affairs, 651-603-3513.  ^top of page

CMS releases presumptive eligibility rule

The Centers for Medicare and Medicaid Services (CMS) has released a final rule that includes regulations for hospital presumptive eligibility determination. MHA has also been in conversation with the Minnesota Department of Human Services (DHS) for further clarification of state options.

Beginning Jan. 1, 2014, qualified hospitals can assume a patient meeting minimum eligibility standards for Medicaid under modified adjusted gross income (MAGI) will be found eligible for Medicaid by the state. Qualified hospitals can then bill the state agency (DHS) for reimbursement under Medicaid. For Minnesota, that means the following populations and income levels (before converted to a MAGI equivalent standard) are covered under presumptive eligibility:

  • Pregnant women to 275 percent of federal poverty level (FPL)
  • Infants 0-2 to 280 percent FPL
  • Children 2-18 to 275 percent FPL
  • Children 19-20 to 133 percent FPL
  • Parents to 133 percent FPL
  • Adults without children to 133 percent FPL
  • Family planning and women with breast and/or cervical cancer (current presumptive eligibility will remain in place for the time being)

Not included are MinnesotaCare (for parents and adults over 133 percent FPL) or children aging out of foster care. Although DHS is looking into presumptive eligibility for former foster care children, they will most likely transition automatically to Medicaid before becoming uninsured.

Qualified hospitals may not be held liable for the Medicaid payment if an individual found presumptively eligible for Medicaid is later found by DHS to be ineligible.

Other provisions of the rule that affect Minnesota hospitals include:

  • DHS will require training for qualified hospitals determining presumptive eligibility. DHS is considering additional proficiency standards and quality measures; however, it will be some time before a decision regarding the additional standards and measures is made.
  • Payment of cost-sharing is not exempt under presumptive eligibility.

DHS will convene a presumptive eligibility stakeholder group to work out details. MHA and our members have been invited to participate. We will provide additional information when it is available. ^top of page

Gillette Specialty Healthcare names new CEO

photo of Barbara JoersGillette Children’s Specialty Healthcare announced that Barbara Joers, most recently from the Children’s Hospital of Wisconsin, will succeed CEO Margaret Perryman, who is retiring later this year. 

Joers served as vice president at Children’s Hospital of Wisconsin since June 2010. She oversaw surgical services, ancilphoto of Margaret Perrymanlary services, supply chain management and environment of care (includes real estate and facilities). She also worked in various leadership roles at Vanderbilt University Medical Center, most recently as chief operating officer at the Monroe Carell Jr. Children’s Hospital at Vanderbilt. She earned her bachelor’s degree from Marymount University in Arlington, VA, and her master’s degree from George Washington University in Washington, D.C.

Perryman announced last December that she was retiring after serving in Gillette’s top post for 26 years.^top of page

Forward-thinking speakers lead-off MHA’s Annual Meeting

Former CMS Administrator and former Institute for Healthcare Improvement President and CEO Don Berwick, M.D.; author, CNN and Fox News medical commentator and Professor Marty Makary, M.D.; and former U.S. Assistant Secretary of Health and Human Services Benjamin Sasse, Ph.D., will lead off MHA’s annual meeting.

Berwick’s session, “Health Care New Rules — Quality Health Care for Every American,” will present a vision of how, through continual improvement, innovations in health care delivery, stronger leadership and smarter policy, America can forge a system that satisfies our patients, achieves better outcomes, respects our limited resources and honors our moral imperative to care for the disadvantaged.

During his presentation, “Modern Medicine’s Transparency Revolution,” Makary will address some of the health care industry’s main challenges, suggest simple solutions and provide an optimistic and passionate view about the future of new leadership and management styles emerging from the growing transparency movement.

Sasse’s presentation, “American Health Care: Navigating through Crisis,” will help participants think about the implementation of health reform and beyond — and about the decisions that must be made at each moment. He’ll cover the remaining months of implementation, the first two years of exchange operations and the election of 2016 and the next round of health reform.

The MHA Annual Meeting will be held Sept. 18-20 at Madden’s on Gull Lake in Brainerd.

For more information, view the full brochure or visit our Events page and log-in to register. Room reservations can be made online at www.maddens.com/mha.html. The deadline to secure accommodations at Madden’s is Aug. 20.

Continuing Education
The Minnesota Board of Examiners for Nursing Home Administrators has approved the conference content for a total of 9.5 clock hours. ^top of page

Outpatient supervision bill introduced in the House

MHA thanks Rep. Collin Peterson and Sen. Al Franken for their leadership on this issue

Last week, Reps. Collin Peterson (D-MN) and Kristi Noem (R-SD) introduced a House companion to the Protecting Access to Rural Therapy Services Act (H.R. 2801).

H.R. 2801 would allow general supervision by a physician or non-physician practitioner for many outpatient therapy services. The bill would require the Centers for Medicare and Medicaid Services (CMS) to allow a default setting of general supervision, rather than direct supervision, for outpatient therapy services and would create an advisory panel to establish an exceptions process for risky and complex outpatient services. H.R. 2801 also would create a special rule for critical access hospitals (CAH) that recognizes their unique size and Medicare conditions of participation; and would hold hospitals and CAHs harmless from civil or criminal action for failing to meet the “direct supervision” requirements applied to services furnished since 2001. The legislation is supported by the American Hospital Association.

Sen. Al Franken (D) is a co-sponsor of the Senate version (S.1143). If you have any questions, please contact Ann Gibson, MHA vice president of federal relations and workforce, 651-603-3527.^top of page

MHA’s Sonneborn appointed to AHRQ workgroup

Mark Sonneborn, MHA’s vice president of information services, has been appointed to the federal Agency for Healthcare Research and Quality (AHRQ) standing workgroup on the AHRQ Quality Indicator (QI) project. The AHRQ QI project provides free software that utilizes inpatient claims data to produce patient safety and quality measures. These measures are widely used for quality improvement as well as public reporting, including in Minnesota’s mandated Statewide Quality Reporting and Measurement System.

The workgroup is tasked with advising AHRQ and helping to evaluate proposed changes to the indicators. This is a well-respected and influential agency, and MHA is honored to be represented on this committee.^top of page

Golf in support of the Minnesota Hospital PAC Monday, Aug. 19 in St. Cloud Register by Tuesday, July 30

Registrations for the Minnesota Hospital Political Action Committee’s (PAC) premiere fundraising event, the golf open, are filling quickly. The deadline to register for the annual day of golfing, food, networking and fun is Tuesday, July 30.

This year’s golf event will take place Monday, Aug. 19 in St. Cloud at Territory Golf Club.

Hospital CEOs are asked to contribute at a club level to participate. Hospital employees, trustees and other guests can attend for $200 per person. Please contact Carol Eshelman, MHA PAC coordinator, at 651-603-3539 or ceshelman@mnhospitals.org for a registration form by July 30.

Members who have already contributed at a club level in 2013 are invited to participate at no extra charge, but please register.

The Minnesota Hospital PAC thanks the following members who have already contributed $350 or more in 2013 as of July 25:

Ben Franklin Club – individuals giving $1,000 or more

Bradley Beard, Fairview Southdale Hospital, Edina
Craig Broman, St. Cloud Hospital
Ty Erickson, Regina Medical Center, Hastings
Alan Goldbloom, M.D., Children’s Hospitals and Clinics of Minnesota
Ben Koppelman, St. Joseph's Area Health Services Inc., Park Rapids
Mary Maertens, Avera Marshall
Charles Mooty, Fairview Health Services, Minneapolis
Ken Paulus, Allina Health, Minneapolis
Margaret Perryman, Gillette Children’s Specialty Healthcare, St. Paul
Terence Pladson, M.D., CentraCare Health, St. Cloud
Matt Anderson, Minnesota Hospital Association, St. Paul
Lorry Massa, Minnesota Hospital Association, St. Paul
Ben Peltier, Minnesota Hospital Association, St. Paul

Chairman's Circle – individuals giving $500 or more

David Albrecht, Owatonna Hospital
Daniel Anderson, Fairview Health Services, Minneapolis
Michael Baumgartner, St. Francis Regional Medical Center
Debra Boardman, Range Regional Health Services, Hibbing
Bill Fenske, Rice Memorial Hospital, Willmar
John Herman, Fairview Northland Medical Center, Princeton
Peter Jacobson, Essentia Health St. Mary’s Hospital-Detroit Lakes
Mark Koch, Mayo Clinic Rochester
Daniel McGinty, Essentia Health–St. Mary’s Medical Center, Duluth
Steven Mulder, M.D., Hutchinson Health
Bill Nelson, Mille Lacs Health System, Onamia
Keith Okeson, LifeCare Medical Center, Roseau
John Porter, Avera, Sioux Falls, S.D.
Steve Pribyl, District One Hospital, Faribault
Tim Rice, Lakewood Health System, Staples
Carl Vaagenes, Douglas County Hospital, Alexandria
Mary Ellen Wells, CentraCare Health – Monticello
Jani Wiebolt, Essentia Health-St. Joseph’s Medical Center, Brainerd
Wendy Burt, Minnesota Hospital Association, St. Paul
Tania Daniels, Minnesota Hospital Association, St. Paul
Ann Gibson, Minnesota Hospital Association, St. Paul
Mary Krinkie, Minnesota Hospital Association, St. Paul
Kristin Loncorich, Minnesota Hospital Association, St. Paul
Joe Schindler, Minnesota Hospital Association, St. Paul
Mark Sonneborn, Minnesota Hospital Association, St. Paul
Peggy Westby, Minnesota Hospital Association, St. Paul

Capitol Club – individuals giving $350 or more

Nathan Blad, RC Hospital & Clinics, Olivia
David Borgert, CentraCare Health, St. Cloud
Andrew Cochrane, Maple Grove Hospital
Thomas Crowley, Saint Elizabeth’s Medical Center, Wabasha
James Davis, CentraCare Health, St. Cloud
Deb Fischer-Clemens, Avera, Sioux Falls, S.D.
George Gerlach, Granite Falls Municipal Hospital & Manor
Gerry Gilbertson, CentraCare Health – Melrose
Steven Housh, Fairview Lakes Health Services, Wyoming
Dale Hustedt, Rice Memorial Hospital, Willmar
Kathy Johnson, Johnson Memorial Health Services, Dawson
Richard Korman, Avera, Sioux Falls, S.D.
Beth Krehbiel, Fairview Ridges Hospital, Burnsville
Daniel Milbridge, Essentia Health-Virginia
Fred Slunecka, Avera, Sioux Falls, S.D.
John Rau, Stevens Community Medical Center, Morris
Mary Ruyter, Sanford Jackson Medical Center
John Solheim, Cuyuna Regional Medical Center, Crosby   ^top of page