Minnesota Hospital Association


July 18, 2016

MHA Newsline: July 18, 2016

In this issue 

Regions Hospital honored with MHA Innovation of the Year in Patient Care Award

Regions Hospital in St. Paul received the Minnesota Hospital Association (MHA) 2016 Innovation of the Year in Patient Care Award in the large hospital category, which recognizes hospitals for developing innovative ways to meet the needs of patients and ensure that they are delivering safe and high-quality care.   

Regions Hospital earned this award for its street-to-treat initiative, which is designed to get patients with stroke-like symptoms an accurate diagnosis as soon as possible, starting with the first responders who respond to the 911 call. If stroke seems likely, they give the Emergency Center at Regions Hospital a heads-up by calling a Code CVA. The code activates a team of stroke experts that meets the patient and first responders at the ambulance bay. Once the patient arrives, the EMS team gives its report and the patient and stroke team move into a nearby imaging room.   

American Stroke Association guidelines indicate that a CT scan should be initiated within 25 minutes of the patient's arrival. By partnering with more than 60 local EMS agencies to call the Code CVA ahead of time, Regions Hospital has reduced this time to less than six minutes. After implementing street-to-treat, Regions Hospital increased the percentage of stroke patients treated in less than 60 minutes from 33.6 to 62 percent of patients - compared to 14.4 percent of patients in a CDC study of 98 hospitals.   

Additional award winners will be profiled in upcoming issues of Newsline. To learn more about the award winners, visit the MHA websitereturn to top   

Two new state regulations impact hospitals

Two new regulations that will impact hospitals go into effect Aug. 1, 2016.   

The first new law can be found in Chapter 120. Authored by Sen. Ron Latz (DFL-St. Louis Park) and Rep. Nick Zerwas (R-Elk River), this legislation clarifies current law regarding the notification of local law enforcement before releasing a patient from an emergency hold or admission if law enforcement brought the patient to the hospital and if the patient is being released before the 72-hour hold has expired. If a patient leaves the facility against medical advice, this legislation expands current law to require hospitals notify the officer who brought the patient to the hospital.   

MHA was able to amend this legislation to specifically include language clarifying that this new provision of law will not be in conflict with the Minnesota Health Records Act (notwithstanding Section 144.292, Release or Disclosure of Health Records) for the release of a patient’s name under these circumstances.   

The legislation also bans a patient from being allowed to or required to consent to participation in a clinical drug trial during an emergency admission or hold. A patient may continue participation in a clinical drug trial if the patient was participating in a drug trial prior to the emergency admission or hold.   

The second new law can be found in Chapter 150. Authored by Sen. Alice Johnson (DFL-Blaine) and Rep. Brian Daniels (Faribault), this law requires all televisions in a hospital public waiting area to have the closed caption feature activated if the television includes the closed caption feature. The hospital is to make reasonable effort to ensure that members of the public do not disable the closed caption feature. If the closed caption feature if turned off, the hospitals must, as soon as practicable, turn on the closed caption feature.   

MHA was able to amend this legislation so that this new regulation is in Statute 144.611 and not in the section of law dealing with the Americans with Disabilities Act as was called for in the original bill. MHA encourages hospitals to make every effort to keep their closed captioning feature activated on all televisions in public areas of the hospital.   

For more complete information on all legislation impacting hospitals from the 2016 session, the annual MHA Legislative Report will be released soon. For more information, please contact Mary Krinkie, vice president of government relations, MHA, or Kristin Loncorich, director of state government relations, MHA. return to top   

Aug. 1 is first deadline for violence prevention training

For over a year, MHA members have been engaged in implementing the provisions of 2015 legislation regarding workplace violence prevention and making Minnesota’s hospitals a safer environment for patients, employees and visitors. One of the final components of first-year implementation specifies that by Aug. 1, all Minnesota hospitals are to have provided safety training to all health care workers and other individuals who have direct contact with hospital patients. This training is to be conducted for all health care workers upon hire and going forward provided on an annual basis.   

MHA members have been actively implementing the 2015 legislation by involving direct care workers in the formation of their workplace violence prevention plans, providing violence prevention training for direct care staff and reviewing incidences of violence. MHA members are reminded to review their violence prevention plans with their designated committee at least annually and to include a review of the plan’s effectiveness, which should include the most recent gap analysis as prepared by the Minnesota Department of Health, as well as the number of acts of violence and injuries by unit that occurred at the hospital during the previous year.   

Resources for implementing the workplace violence prevention law are available on the MHA websitereturn to top   

MDH accepting comments to proposed communicable disease reporting rule updates

The Minnesota Department of Health (MDH) has formally proposed updates to the communicable disease reporting rules through the rulemaking process and published the Notice of Intent to Adopt on July 18, 2016, in the “State Register.” MDH will be accepting comments on the proposed changes until Aug. 22, at 4:30 p.m. Comments and requests for a free copy of the rules should be sent to the agency contact person, Patricia Segal Freeman, by mail at P.O. Box 64975, St. Paul, MN 55164-00975; by fax at 651-201-5501; or by email at commdisrule@state.mn.us. All interested persons are encouraged to comment. If MDH receives 25 or more written requests for an administrative hearing, a hearing will be held on Sept. 19 at 9:30 a.m. in B144, Orville L Freeman Building, 625 N. Robert St., St. Paul, Minnesota 55155.   

Access more information on the proposed changes, such as the proposed rules, a summary of the changes, the Notice of Intent to Adopt (which outlines the comment and hearing process) and the Statement of Need and Reasonableness (SONAR), at the MDH Communicable Disease Reporting rulemaking websitereturn to top   

CMS proposes updates to hospital and CAH conditions of participation

The Centers for Medicare and Medicaid Services (CMS) on June 16 issued a proposed rule to update select Conditions of Participation (CoPs) that hospitals and Critical Access Hospitals (CAHs) must meet to participate in Medicare and Medicaid. The changes are intended to align Medicare requirements with current standards of practice, support improvements to quality of care and reduce barriers to care.   

Comments on this topic are due to CMS by Aug. 15. MHA will be submitting comments and MHA members can choose to include their comments with MHA’s letter. To participate in MHA’s submission, send comments by July 28 to Tania Daniels, vice president of quality and safety, MHA. return to top   

CMS proposes no payment for new or modified provider-based clinics

The Centers for Medicare and Medicaid Services (CMS) on July 6 published its proposed rule for the Outpatient Prospective Payment System (OPPS). One proposal would permanently end paying the hospital outpatient facility fee for designated provider-based clinics that came into existence, moved their physical address, changed their service delivery outside a family of services or changed ownership on or after Nov. 2, 2015. The payment to physicians would revert to the full physician payment rate as if they were an independent provider, including facility overhead.   

This proposal would negatively impact a number of hospital-based clinics, since the financial incentive to operate these clinics under the hospital’s outpatient department would be eliminated. MHA will be developing a comment letter to address the stresses this could place on the system, including the impact to access, ability to modernize facilities and services, and overall finances of already low- to negative-margin services.   

Comments on this topic and other aspects of the OPPS proposed rule are due to CMS by Sept. 6. With questions, contact Joe Schindler, vice president of finance, MHA. return to top   

MHA comments on proposed rules for inpatient Medicare payments

MHA submitted comments in response to the Centers for Medicare and Medicaid Services’ (CMS) fiscal year 2017 proposed rule for hospital inpatient prospective payment systems and quality reporting. Some of the issues specifically addressed by the MHA letter were concerns about the unusually high documentation and coding negative adjustment, Disproportionate Share Hospital (DSH) payment methodology changes and proposed procedures for notifying outpatient observation patients of their status. A positive item for hospitals is the reversal and payback by CMS of the two-midnight adjustment (0.2 percent) that has been in place for the last three years.   

Prospective Payment System (PPS) hospitals can expect a net positive 0.81 percent increase to the federal operating rate after taking into account various mandated adjustments. The portion of payment related to capital costs is expected to increase a net 1.73 percent.   

Comments were submitted June 17 and the final rule from CMS is expected by the first week of August. The full comment letter is available on the MHA website. With questions, contact Joe Schindler, vice president of finance, MHA. return to top   

MNCASA to offer sexual assault examination training webinars for MHA members

With support from MHA, the Minnesota Coalition Against Sexual Assault (MNCASA) is offering webinars on providing medical forensic exams for sexual assault patients. MHA encourages participation in these member-exclusive training opportunities to improve practices related to medical forensic exams for sexual assault victims.   

A three-part webinar series will provide sexual assault nurse examiner (SANE) training using medical forensic exam curriculum that was developed for emergency department nurses. The series is intended for nurses who will be performing the exams. Participants who complete this series will be better equipped to perform medical forensic exams. Sessions include: 

  • July 21, 2-3 p.m.: SANE Training 101: Part 1 – What is Sexual Assault? 
    • Part one of this series will teach context around sexual assault, best practices around hospital responses to sexual assault patients and how to document the patient’s account of the assault. Participants will have a deeper understanding of what the crime of sexual assault encompasses, the impact on victims, the importance of engaging with community partners, health care providers’ best reactions to patients who have been assaulted and how to facilitate and document the patient’s account of incident. 
  • July 28, 2-3 p.m.: SANE Training 101: Part 2 – The Exam 
    • Part two of this series will describe the aspects of a medical forensic exam and explain how to complete each component. Participants will have a better understanding of evidence collection, injury identification and the physical exam. 
  • Aug. 10, 2-3 p.m.: SANE Training 101: Part 3 – Discharge and Follow-Up 
    • Part three of this series will cover sexual assault patient discharge, follow-up and reporting to law enforcement. Topics such as sexually transmitted infection (including HIV) prophylaxis and pregnancy prevention will be discussed.   

Participants can earn one nursing contact hour CEU for each of the webinars on July 21, July 28 and Aug. 10. Instructions for requesting CEUs will be provided after each webinar.   

Webinars will be facilitated by Linda Walther, a SANE practicing in the Twin Cities and the clinical coordinator for the Statewide Medical Forensic Policy Program, and Kari Ogrodowski, the policy coordinator of the Statewide Medical Forensic Policy Program.   

With questions about webinar content, please contact Linda Walther or Kari Ogrodowski. To RSVP for a webinar, email Sarah Bohnet, visual communications specialist, MHA. return to top