Minnesota Hospital Association


September 10, 2013

MHA Newsline

In this issue:

Hospital spotlight: Fairview Southdale a Minnesota best hospital workplace

Fairview Southdale Hospital in Edina has implemented a variety of strategies and tactics to transform workplace culture and improve employee engagement and retention. A positive side benefit is the reduction of employee injuries and increasing patient satisfaction scores. These programs included the “Healthy Environment Initiative,” which focuses on transforming workplace culture and the “Going the Extra Mile Awards Program” that last year recognized more than 110 employees, volunteers and physicians who have made a significant achievement that supports Fairview Southdale’s vision and strategic goals. Read more about how Fairview Southdale earned the large hospital award for MHA’s Best Minnesota Hospital Workplace. return to top

MHA responds to proposed outpatient payment and physician fee schedule rules

Emphasizing its continuing opposition to enforcement of new direct physician supervision requirements and imposition of cuts to physician payments due to the Sustainable Growth Rate (SGR) legislation, MHA sent two comment letters to the Centers for Medicare and Medicaid Services (CMS) on behalf of its members. The first letter addressed issues in the proposed 2014 physician fee schedule rule, and the other addressed issues in the proposed 2014 outpatient prospective payment system rule.

Each letter addressed aspects of the proposed rules that would have the greatest impact on Minnesota’s health care delivery system and support positions taken by the American Hospital Association.

In addition, MHA is working with Minnesota’s congressional delegation to build support for legislation that would replace CMS’s direct supervision policy for outpatient therapeutic services with a general supervision standard and to extend or eliminate implementation of SGR cuts.

For more information, contact Matt Anderson, MHA vice president of regulatory and strategic affairs, 651-659-1421. return to top

MHA pushes for greater Medicare claims and payment transparency

In response to a request for comments from the Centers for Medicare and Medicaid Services (CMS), MHA offered support for making Medicare physician claims and payment data more available for health care cost and quality improvement efforts. Read the comments here.

A recent court decision overturned a long-standing CMS policy that kept physician claims and reimbursements from being publicly available. Before moving forward with making that information more accessible, CMS requested input on whether physicians had a privacy interest in such data and what format(s) the agency should use when disclosing the information.

MHA highlighted the transparency and accountability processes that Minnesota’s hospitals and health systems have championed over the years, including Adverse Health Event reporting, as well as charge information for the most common inpatient and outpatient services. MHA stated that these processes have demonstrated that making information more available for analysis, comparisons and improvement are appropriate, especially when they pertain to government programs and spending.

MHA welcomed the release of the data for research and other initiatives aimed at improving health care quality and reducing the rate of health care cost growth. However, the Association emphasized that CMS should strive to place the data in a larger context of the overall value of healthcare services as measured by cost and quality of care, and to impose appropriate safeguards to ensure that patient-identifying information remains protected from public disclosure. 

For more information, contact Matt Anderson, MHA vice president of regulatory and strategic affairs, 651-659-1421. return to top  

MHA supports legislation to require Medicare to pay for follow-up treatment in a nursing home after observation status

MHA appreciates the support of Sen. Amy Klobuchar and Reps. Tim Walz, Betty McCollum, Keith Ellison, Collin Peterson and Rick Nolan on legislation to count a period of observation services in a hospital toward satisfying the three-day inpatient hospital requirement for coverage of skilled nursing services under Medicare.  

When a patient visits the hospital, physicians and caregivers are required to follow Medicare’s specific rules and protocols for designating their status as inpatient or observation. Follow-up treatment in a nursing home is not covered by Medicare unless someone has been an inpatient for at least three days. To help hospitals inform patients of their status, MHA partnered with other key stakeholders to develop a standard consumer-friendly document. However, MHA believes that these regulations need to be changed to get to the root of the problem.  

H.R. 1179 and S.569, the Improving Access to Medicare Coverage Act of 2013 would resolve the frustrations and hardships that the current outdated Medicare regulations cause seniors. The bills have support from both political parties.  

Members of the MHA staff will be in Washington D.C. this week to meet with health care staff and will request that remaining Minnesota members of Congress sign onto the bills. return to top 

Choice, affordability featured in MNsure plans

Last Friday, the Minnesota Department of Commerce released information about the health plans that will be offered on MNsure, Minnesota’s health insurance exchange, beginning Oct. 1. Proponents of MNsure quickly pointed to the number of products being offered and the lower-than-expected premium costs as early signs of that the exchange will be successful.

Five Minnesota-based health plans — Blue Cross Blue Shield, HealthPartners, Medica, Preferred One and UCare — will offer approximately 140 different insurance products. Although residents in Hennepin and Ramsey counties will have the greatest number of products to choose from, MNsure officials emphasized that there will be choices and competition throughout the state.

As expected, the premiums for the new plans vary based on nine different regions of the state. However, the net costs to consumers after factoring in federal premium subsidies available through MNsure were lower and more affordable than many had expected.

More information about MNsure, available plans and premium costs can be found at www.mnsure.org. return to top  

MCHA transition plan announced       

The Minnesota Department of Commerce has released its plan for transitioning enrollees in the state’s high-risk insurance pool, MCHA (Minnesota Comprehensive Health Association), to other insurance. The transition is occurring because in 2014 insurance plans will no longer exclude people with pre-existing conditions, making a separate pool for hard-to-insure individuals unnecessary.  

Current enrollees are encouraged to find new coverage through MNsure, the state’s health insurance marketplace, or a private broker. Open enrollment begins Oct. 1, 2013, and MCHA enrollees who choose a plan by Dec. 15, 2013 will see their new coverage begin Jan. 1, 2014. Current MCHA enrollees who have trouble finding a new plan that meets their needs will be able to appeal to MCHA and also seek assistance from the Dept. of Commerce and MNsure. MCHA coverage will close for all enrollees at the end of 2014. For more information, click here. return to top 

MNsure, DHS officials address members’ questions at MHA seminar

Just weeks before the launch of MNsure, Minnesota’s health insurance exchange, hospitals and health systems have many outstanding questions about the details associated with upcoming changes to state public programs and new health coverage enrollment activities. Last Friday, MHA members had raised those questions with the state officials responsible for implementing the new policies. The seminar was underwritten in part with funds from a grant provided to MHA by the American Hospital Association.

Susan Hammersten, health care reform implementation manager for the Minnesota Department of Human Services (DHS), presented information about key elements of Medical Assistance and MinnesotaCare that will change in 2014. Most specifically, she discussed new authority for hospitals to presumptively enroll patients into Medical Assistance, thereby ensuring that they will have coverage through the following month pending a final eligibility determination.

David Van Sant, navigator broker manager for MNsure, discussed the exchange’s Consumer Assistance Partners (CAP) program and the roles hospitals and health systems can play to help patients enroll in health coverage through MNsure. Van Sant emphasized that the CAP program remains open for organizations interested in becoming trained and certified navigators or consumer assistance counselors. He predicted that the online training and certification process for CAP participants would begin this week.

For more information about MNsure, state public program changes or other health care reform issues, contact Matt Anderson, MHA vice president of regulatory and strategic affairs, 651-659-1421 or JenMcNertney, MHA policy analyst, 651-659-1405. return to top  

Hospital inpatient admission order clarification issued

The Centers for Medicare and Medicaid Services (CMS) have issued a clarification regarding Medicare Part A payment for admission orders given by non-physicians. Admissions made from an order documented by a physician assistant (PA) or other qualified non-physician will be covered.  

Some members have expressed concern that the recent CMS inpatient payment rule prohibits Medicare Part A coverage for admissions ordered by a physician assistant. A Sept. 5 memo from CMS clarifies that Medicare Part A will reimburse for admissions when the order is documented by an individual who is not a physician — such as physician assistants, residents or registered nurses — provided the documentation is consistent with state law, hospital policies, and medical staff bylaws and rules. MHA believes this rule does not change current Minnesota law or practice regarding use of PAs in admitting patients. return to top 

Mental health resource sheet available

MHA and the National Alliance for Mental Illness (NAMI) Minnesota have produced a resource sheet for raising awareness of or addressing mental illnesses and behavioral health in their communities. Many hospitals have found through their community health needs assessments that mental health and mental illnesses are growing areas of concern. Members are encouraged to use the resource sheet as a guide for raising awareness within their communities and hospital settings. The sheet provides helpful tips such as bringing NAMI MN members into the hospital to raise awareness among staff; offering patients with a mental illness a “welcome packet” that provides basic information on what to expect during a mental health stay; and links to free brochures and booklets that can be downloaded and printed for hospital visitors and patients.  

For more information contact Jen McNertney, MHA policy analyst, 651-659-1405. return to top  

IRS issues large employer insurance reporting requirements proposed rule

The Internal Revenue Service (IRS) has issued proposed rules implementing the Patient Protection and Affordable Care Act’s information reporting requirements for minimum essential coverage and for large employers coverage subject to the law’s shared responsibility provisions, which were recently delayed until 2015. The ACA requires insurers, self-insuring employers including hospitals that self-insure for their employees, and others that provide health coverage to provide a list of covered individuals and the months they were covered. It also requires employers with more than 50 full-time workers to provide information about the coverage offered to each, by month, including the cost of self-only coverage. Among other provisions, IRS said the rules would eliminate the need to determine whether particular employees are full-time if adequate coverage is offered to all potentially full-time employees, and allow employers to report the specific cost to an employee of purchasing employer-sponsored coverage only if the cost is above a specified dollar amount. The agency is encouraging covered entities to voluntarily implement information reporting in 2014, when reporting will be optional, to enable real-world testing of reporting systems before the provisions are fully implemented in 2015. return to top  

LPN and rural birth hospital representatives needed for statewide boards

The Minnesota Board of Nursing has a vacancy for one licensed practical nurse member for a term ending Jan. 6, 2014. The board licenses professional and practical nurses; registers public health nurses; renews licenses; regulates advanced practice registered nurses (certified nurse midwives, certified nurse practitioners, certified clinical nurse specialists, and certified registered nurse anesthetists); provides data services; approves nursing education programs; processes complaints about nurses; and imposes disciplinary action against nurse licenses.   

There is also a vacancy on the Newborn Hearing Screening Advisory Committee for a rural birth hospital representative.  

View the vacancy announcements here. Application forms are available on the secretary of state website or may be obtained from the Office of the Secretary of State, Open Appointments, 180 State Office Building, 100 Rev. Dr. Martin Luther King, Jr. Blvd., St. Paul, MN 55155-1299, or in person at Room 180 of the State Office Building. return to top  

Webinar will discuss coordination of health insurance exchange messages

Enroll America, a non-partisan organization aiming to maximize the number of uninsured Americans who enroll in health coverage made available by the Affordable Care Act, is hosting a webinar this Thursday, Sept. 12 to discuss how navigators, assistors and other enrollment stakeholders can coordinate to ensure consumers get the information they need to enroll. “We’ve got Navigators, Now What?” will address how groups in different kinds of states and with different roles can work together. Participants will hear from consortia in different states about how they’re planning for the coming months, and will offer concrete ways for all kinds of organizations to get engaged, both with Enroll America and with other stakeholders. Click here to learn more or to register for this free event. A recording of the webinar will be available if you are unable to attend the live event from 12-1:15 p.m. return to top

Choosing Wisely webinar to address appropriate use of early induction and C-Sections

The Institute for Clinical Systems Improvement (ICSI) is holding a free webinar on two procedures — early induction of labor and C-sections — that the ABIM Foundation’s national Choosing Wisely campaign have indicated are overused and, at times, may be harmful.  

Penny Wheeler, MD, Chief Clinical Officer at Allina Health, will discuss Allina’s quality improvement strategies and patient engagement efforts that have achieved dramatic improvements in the rates of these two procedures.  

This is the first in a series of webinars on 11 Choosing Wisely recommendations that ICSI is initially focusing on. The goal of Choosing Wisely is to help providers and patients engage in conversations to ensure appropriate care on numerous medical conditions. As part of Choosing Wisely, the American College of Obstetricians and Gynecologists and the American Academy of Family Physicians have both indicated that these two procedures are not being used appropriately.  

The webinar will take place Wednesday, Sept. 18 from noon-1 p.m. Registration closes Sept. 16; sign up today. Contact Emily Mallen, ICSI, 952-814-7079 with any questions. return to top