Minnesota Hospital Association


January 14, 2013

MHA Newsline

In this issue:

Health insurance exchange legislation introduced

State Sen. Tony Lourey (DFL-Kerrick) and State Rep. Joe Atkins (DFL-Inver Grove Heights) introduced legislation to create a Minnesota-run health insurance exchange (Exchange). Companion bills (S.F. 1/ H.F. 5) were introduced in the first week of session to signal the importance of this issue for the 2013 legislative session.

Health insurance exchanges are a central component of the federal Affordable Care Act (ACA) and are intended to create an online marketplace for individuals and small businesses to compare, purchase and enroll in health insurance. All states are required to create an Exchange before 2014 or the federal government will run an Exchange for them. The Dayton Administration has predicted that approximately 1.3 million Minnesotans will obtain health coverage through the Exchange by 2015.

Both of the legislative authors acknowledged that they expect the bills will be substantially amended as they proceed through multiple committees. As introduced, the legislation would:

  • Create a state board of seven members to govern the Exchange, including the commissioner of Human Services and six members appointed by top ranking members in each chamber of the Legislature and the governor.
  • Empower the Exchange to act as an “active purchaser” with authority to determine which insurance products can be sold on the Exchange.
  • Fund the operations of the Exchange with a 3.5 percent withhold from the cost of premiums sold through the Exchange.
  • Leave many decisions to the Exchange’s board, including those pertaining to the criteria insurance plans must satisfy to have their products sold on the Exchange as well as the roles that insurance brokers, navigators, and in-person assistors will play.

Mary Krinkie, vice president of government relations for the Minnesota Hospital Association, described the health insurance exchange bill as one of the session’s defining pieces of legislation. Krinkie said, “Right now, the bills don’t contain a lot of the details and specifics that we expect to see before they reach either floor for a final vote.”

For more information about legislation, committee hearings or issues at the Capitol, contact Krinkie, 651-659-1465, [email protected]. For information about the health insurance exchange and related ACA policy issues, contact Matt Anderson, MHA vice president of strategic and regulatory affairs, 651-659-1421, [email protected]. ^top of page

Flu season off to an early, severe start

Data from the Minnesota Department of Health shows that Minnesota is in the midst of a very serious flu season, with a high number of cases, deaths and hospitalizations. From a statewide perspective, as of Thursday, Jan. 10 there have been 27 deaths in Minnesota and 1,121 hospitalizations.

We understand that many of you are experiencing rapid increases and are treating high numbers of patients. Guidance from MDH recommends that patients with influenza-like illness (fever greater than 100 degrees F, cough or sore throat in the absence of another known diagnosis) should be presumed to have influenza and appropriate precautions taken, including these recommendations from the Centers for Disease Control and Prevention. MDH also reminds hospitals that it is important to promote respiratory etiquette (e.g. masks, hand hygiene, Cover Your Cough) in outpatient settings, waiting rooms and lobbies.

South Central Minnesota has been a hot spot for influenza, and hospitals are part of a coalition of community partners, including representatives from regional health care organizations, public health agencies, county government, the Minnesota Department of Health, area school districts, and business leaders, all working together to prevent further the spread of influenza. Mayo Clinic Health System in Mankato has provided key step protocols, talking points and a grid describing the hierarchy of controls to prevent the spread of influenza (links below for your use).

- Key steps
- Hierarchy of controls
- Sample talking points

In addition, the MHA Patient Safety Committee, which met on Thursday, Jan. 10, has commissioned a rapid response subgroup to help identify and disseminate additional resources for hospitals. This work group will act quickly to develop resources that will help hospitals have a uniform response to such things as visitor policies.

It is important to remind your public and employees that it is not too late to get the flu vaccine, and that the vaccine is our best protection against the spread of influenza.

Please let us know how we can support you during this time. For more information about Minnesota’s flu season, visit http://www.mdhflu.com and www.cdc.gov. ^top of page

‘Method 2’ physicians eligible for Medicare electronic health record incentives

Attestation will begin in 2014

Physicians who provide services in the outpatient departments of critical access hospitals (CAHs) and for whom bills are submitted via the optional or "Method 2" billing approach are now eligible to participate in the Medicare Electronic Health Record (EHR) Incentive Program. The announcement from the Centers for Medicare & Medicaid Services (CMS) came in response to advocacy efforts by MHA, other state hospital associations with CAHs, and the American Hospital Association over the last several months.

Method 2 physicians are eligible to participate in the Medicare EHR Incentive Program this year. However, due to CMS system changes that will be implemented over the coming year, these physicians will not be able to submit attestations until January 2014.

MHA and the hospital industry greatly appreciate CMS taking action to correct this problem. However, while it provides significant financial relief in the future, it does unfairly reduce total potential payments for these physicians by about $5,000 because they will not be able to receive incentives for 2012.

Under Method 2, the CAH bills Medicare on behalf of the physician for services covered under the Medicare Physician Fee Schedule. Physician bills are submitted on the UB-04, instead of the Form 1500. Due to system constraints, CMS did not include these Method 2 claims when it identified which physicians were eligible for the incentive programs, resulting in Method 2 physicians being inappropriately excluded from the EHR incentive program because they were designated as "hospital-based" when they are not.

For more information, see the CMS fact sheet. ^top of page

Don’t miss MHA Advocacy Days at the Capitol

Join MHA in St. Paul on Wednesday, Jan. 30 and Wednesday, Feb. 20 for Advocacy Days at the Capitol.

This is a great opportunity to meet face-to-face with your legislators to discuss hospitals’ priority issues: expanding Medicaid to 133 percent of the federal poverty guideline; implementing a Minnesota-based health insurance exchange; restoring Medical Education and Research Costs funding; and opposing legislation to set government-mandated nurse staffing ratios. You can read more about these priorities on our website. Please bring any available staff to help tell the hospital story. The Minnesota Organization of Leaders in Nursing (MOLN) will also be at the Capitol on Feb. 20 so we encourage you to bring your nurse leaders for this Advocacy Day.

On Jan. 30, we’ll meet at MHA at 11 a.m. for lunch and a briefing, followed by legislator visits in the afternoon. Please contact [email protected], MHA program coordinator, 651-603-3539, to RSVP for lunch and if you need help scheduling meetings with your representative and senator. ^top of page

Senior LinkAge Line hospital discharge referral form updated

The Minnesota Board on Aging has modified forms for hospitals and certified health care home staff to use when referring individuals to the Senior LinkAge Line during discharge. The forms can be found here. These fax and online referral forms have been used since Oct. 1, 2012 to refer patients aged 60+ who are being discharged from the hospital setting or had a recent visit at their certified health care home clinic and could benefit from long-term care options counseling from the Senior LinkAge Line®. Please make sure to discard any previous fax forms and use this updated form.

The changes that were made include the following: patient address; actual/anticipated discharge date; and moving instructions to the end of the fax referral form.

Additional changes are being made regarding the vulnerable adult definition. Another updated form will be available when those changes are complete.

Finally, DHS recently released a bulletin on the referral service. ^top of page

Rural telehealth grants available

The federal Telehealth Network Grant Program (TNGP) is soliciting applications for projects that demonstrate how telehealth programs and networks can improve access to quality health care services in rural, frontier and underserved communities. Grant activities must serve rural communities, though grantees may be located in either urban or rural areas. TNGP funds are intended to fund network expansion and/or to increase the breadth of services of successful telehealth networks, not fund start up programs. Applications are due Feb. 13. ^top of page

Rural telehealth grants availableWebinar: How to organize and execute a community health needs assessment that works

The Community Health Needs Assessment (CHNA) is a federal requirement for private, nonprofit hospitals. Part of the Patient Protection and Affordable Care Act (ACA), the Community Health Needs Assessment is additional criteria for hospitals to maintain their tax-exempt, 501(c) (3) status. This requirement applies for tax years beginning after March 23, 2012. A hospital must complete a CHNA at least every three years with input from the broader community, including public health experts. Hospitals are then asked to describe how they are addressing needs identified in the community health needs assessment as well as identify any needs not being addressed and explain why not. CHNAs must be made widely available, including through information on tax forms 990.

On Thursday, Jan. 24, from noon to 1 p.m., learn how to organize and execute a CHNA that does more than just meet the letter of the tax law; it also encourages cooperation between independent health care entities. The webinar is hosted by the Minnesota Health Strategy and Communications Network. To learn more or to register, click here. ^top of page

Rural telehealth grants availableCMS names 106 new accountable care organizations

The Centers for Medicare and Medicaid Services announced new accountable care organizations (ACOs), including one in Minnesota: Community Health Network that is co-sponsored by HealthEast and expects to have about 15,000 Medicare beneficiaries. Since passage of the Affordable Care Act, more than 250 ACOs have been established, including four other Minnesota health systems: Allina Health, Essentia Health, Fairview Health Services and Park Nicollet Health Services.

ACOs must meet quality standards to ensure that savings are achieved through improving care coordination and providing care that is appropriate, safe and timely. CMS has established 33 quality measures on care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and patient and caregiver experience of care. ^top of page

Essentia Health announces new central region president

Essentia Health has selected Adam C. Rees as its central region president to lead Essentia Health-St. Joseph’s Medical Center in Brainerd and 12 Essentia clinics in north-central Minnesota.

Rees has extensive experience in an integrated health system, a strong financial background and a proven commitment to building relationships with physicians, employees and the community. He has 25 years of experience with the Mayo Clinic Health System and most recently served as chief administrative officer for Mayo Clinic Health System in Austin. When he joins Essentia Health on Feb. 25, Rees will succeed Tom Prusak, who is retiring after a 37-year career in health care. ^top of page

New hospital representative appointed to Medical Services Review Board

Buck McAlpin, government relations officer at North Memorial Medical Center, Robbinsdale, and a paramedic by training, has been appointed to serve as the hospital representative on the Medical Services Review Board (MSRB). The MSRB advises the Minnesota Department of Labor and Industry about workers' compensation medical issues; is the liaison between the department and the medical-provider community; and supports and engages in the education of the provider community about workers' compensation. ^top of page