Minnesota Hospital Association


March 25, 2013

MHA Newsline

In this issue:

Agreement reached that forgoes mandated staffing quotas

Hospitals and the Minnesota Nurses Association (MNA) have come to an agreement on the nurse staffing issue. Mandated staffing ratios are off the table in both the House (H.F. 588) and Senate (S.F. 471) in favor of requiring reporting of staffing plans as well as study on the correlation between nurse staffing levels and patient outcomes. Hospitals have supported greater transparency and we are confident that Minnesota hospitals will measure up well in these new reports and studies. The main provisions are:

  • MHA will publish hospital core staffing plans on our Minnesota Hospital Quality Report website. This reporting will be both prospective and retrospective and “any substantial changes to the core staffing plan shall be updated.” We were successful at preventing MNA from including “per shift” language.
  • In addition, MHA agreed to a study to be conducted by the Minnesota Department of Health on the “correlation between nurse staffing levels and patient outcomes.” We were successful at preventing a committee of appointees or unbalanced committees of MNA members. We also prevented the addition of numerous new reporting requirements sought by the MNA.

This agreement has been reached after significant negotiation and with input from our members along the way. MHA members are asked to reiterate with your legislators that we have reached a deal and warn them against attempts by MNA to amend the bills as it moves through the legislative process. We have reached an agreement that hospitals will honor, even though there are some provisions that could be improved.

Your outreach to legislators made a significant impact in moving away from mandated ratios. Several legislators expressed their opposition to ratios, including two of the authors who said they would not support ratios. ^top of page

$150 million cut for HHS in House and Senate DFL budget targets

The Minnesota House and Senate DFL leaders both released their new budget targets last week. Each body increases overall spending by over $1 billion with the exception of health and human services (HHS), which is cut in both proposals.

The House HHS target is a $150 million cut, while the Senate goes slightly deeper at $153 million. These targets are despite the fact that the HHS budget area has consistently come in under the budget forecast and has contributed to the reduced state deficit through efficiencies and innovation in health care purchasing and delivery. In addition, HHS has been subject to years of budget cutting due to continuing deficits, including the $1.2 billion cut from health and human services in 2011. These targets will be very hard to reach without additional damage to people receiving public services and providers.

In contrast, Gov. Dayton has increased HHS general fund spending in his budget by $170 million for FY 2014-15, investing in provider rate increases, new mental health services, and implementing health care reform. Additional money from the Health Care Access Fund is used to continue MinnesotaCare for Minnesota’s working poor.

The governor, House and Senate are each calling for $2 billion in new revenue to balance the state budget and increase spending chiefly in education and property tax relief. MHA has assembled a broad coalition of 50 other health care stakeholders, and we have sent a letter to legislative leadership expressing our concern with the budget targets. Please reach out to your legislators when they are home for Easter/Passover break this week and at their upcoming town hall meetings and reiterate these messages. ^top of page

Governor signs health insurance exchange legislation

Gov. Dayton has signed legislation creating Minnesota’s health insurance exchange, MNsure. The state was under a federal deadline to pass legislation by March 31, or risk the federal government setting up a federally-run exchange. It is expected that more than 1 million Minnesotans will use the exchange to purchase health care insurance, as well as apply for subsidies and for public programs. Highlights of the legislation include:

  • Funding is from a premium withhold of 1.5 percent in 2014 and 3.5 percent starting 2015.
  • The exchange will be governed by a 7-member governor-appointed board, with conflict of interest language that bars current providers and others from serving; however, there is an exemption for providers at academic institutions.
  • For 2014, the marketplace will follow a clearing house model where all qualified plans are allowed to be sold. In 2015, the “active selector” model kicks in with the plans sold being selected by the exchange board.

Work continues in the Legislature on the insurance market rules that will regulate plans inside and outside of the exchange and MHA is working to ensure provider networks in the products are adequate.

MNsure enrollment will open Oct. 1, 2013 with coverage beginning Jan. 1, 2014. ^top of page

MHA seeks members’ input in strategic planning

MHA has begun a process to develop a new strategic plan for the Association and is seeking its members’ input through multiple avenues.

Lawrence Massa, MHA’s president and CEO, said that MHA’s current strategic plan has served the Association well since its adoption in 2009. “Our strategic plan really positioned us well to take a leading role in pushing for payment reforms that reward the value of care we provide, resulted in launching our Physician Leadership Council, and reiterated our steadfast commitments to longstanding priorities like patient safety and extending health coverage to all Minnesotans.” Now we need to look ahead to the implementation of health care reform, changing care delivery and the impact of federal and state budget pressures on health and human services.

Over the next several months, the Association will undertake an extensive effort to collect information from its members in preparation for the Board’s strategic planning discussion in August. In addition to holding a strategic planning brainstorming exercise in each of its standing committees and during upcoming region meetings, the Association will conduct a needs assessment survey of hospital trustees, a member satisfaction survey, and an environmental assessment survey. In addition, MHA will convene six focus groups to hold more thorough discussions of the most significant trends, challenges and needs members see on the horizon.

MHA encourages its members to watch for these surveys and focus group invitations, and to provide as much feedback as practical. If you have questions about the strategic planning process or have specific ideas or concerns that you would like to make sure the Board of Directors considers, please contact Matt Anderson, MHA vice president for strategic and regulatory affairs, 651-659-1421. ^top of page

NGS meets with MHA to plan outreach regarding MAC contract change

In preparation of the Medicare Administrative Contractor (MAC) switchover that will occur in August and September of this year, National Government Service (NGS) leaders met with MHA staff to plan for outreach initiatives. The Centers for Medicare and Medicaid Services (CMS) awarded its MAC contract for Jurisdiction 6 (Minnesota, Wisconsin and Illinois) to NGS on Sept. 27, 2012.

The dates posted on the CMS website indicate Medicare Part A will be transitioned by Aug. 10, 2013 and Medicare Part B claims transition will be Sept. 7, 2013.

MHA will be working with NGS to schedule outreach meetings to providers to ensure a smooth transition. NGS encourages hospitals to initiate receiving updates by going to their website www.ngsmedicare.com and registering for email updates. More information related to the transition may be found here. ^top of page

SAFE Care road map streamlines safety initiatives for hospitals

Minnesota hospitals have committed significant resources to keep patients safe across all areas of hospital care. However, MHA recognizes it can be a challenge to implement all of the SAFE campaigns, particularly for small hospitals with limited resources. In working with an advisory group of rural hospitals and topic experts, MHA has developed the SAFE Care road map to make it more feasible for hospitals to make progress in multiple areas of harm prevention simultaneously.

The SAFE Care road map combines the key foundational interventions from eight of MHA’s Call to Action road maps. It builds on the SAFE component that is consistent across all road maps to develop an infrastructure supportive of harm prevention and includes safety culture components such as teamwork and Just Culture.

The goal is for hospitals to implement the full road map of best practices. If you are already making good progress in topic-specific road maps you should continue with that work. The SAFE Care road map is designed to help you get started in areas where you have been unable to focus your resources.

Initially the SAFE Care road map will be rolled out to critical access hospitals, but will expand to all hospitals in the coming months. The SAFE Care road map has been sent to your primary HEN and patient safety contact. If you have questions or want to learn more about the SAFE Care road map, contact Karen Olson, MHA patient safety coordinator, 651-603-3521. ^top of page

Hospitals to receive dashboard outlining progress on safety initiatives

Last week, CEOs of hospitals participating in MHA’s Hospital Engagement Network were mailed a letter and dashboard overview of your hospital’s progress toward the ambitious goals of the Partnership for Patient work. Hospitals in the MHA HEN are working toward a 40 percent reduction in 10 hospital acquired conditions and a 20 percent reduction in readmissions by the end of 2013. The dashboard provides an overview of the hospital’s progress on process and outcome measures along with comparisons to state averages and established thresholds.

MHA will send these dashboard updates quarterly to HEN hospitals initially, and to all MHA members in the future. If you have questions, contact Tania Daniels, MHA vice president of patient safety, 651-603-3517. ^top of page

Save the date — Clinical Education Summit, May 29

Mark your calendars for HealthForce Minnesota’s Clinical Education Summit, May 29 at Normandale Community College in Bloomington. The Clinical Education Summit brings together health care educators — faculty, administrators, and staff — with health care providers to identify and discuss the challenges of clinical education and to begin to work toward solutions that will enable Minnesota to continue to have the high-quality health care workforce it needs now and in the future. The Summit is being designed for the wide array of health care programs/professions and is not just focused on nursing.

Learn more and register online at www.healthforceminnesota.eventbrite.com. For questions, contact Jane Foote or Valerie DeFor. ^top of page