In this issue
MHA,
hospital leaders meet with Sens. Klobuchar, Smith, House delegation
In May, MHA members
and staff traveled to Washington, D.C., for the American Hospital Association
annual conference and met with most of the Minnesota congressional
delegation.
Congressional meetings focused on the innovations that Minnesota’s hospitals
and health systems are undertaking to ensure high-quality health care and to
reduce health care costs. Additionally, members discussed the importance of the
340B Drug Discount Program, adequate Medicare payments for telehealth services
and hospital and health system programs to combat the opioid epidemic.
Many of the hospital industry’s federal priorities were passed into law earlier
this year. Congress and the president extended the so-called Medicare extenders
through 2022, provided two years of funding for community health centers,
reauthorized the Children’s Health Insurance Program (CHIP) through 2027,
eliminated Medicaid disproportionate share hospital (DSH) cuts for two years
and adopted other measures to reduce regulations on Critical Access Hospitals
(CAH).
A significant health
care issue that remains unresolved this year is a legislative package to help
battle opioid abuse. During the meetings with Congress, MHA members highlighted
work already underway in Minnesota and outlined areas where congressional action
would help. Potential federal efforts could include expanding access to
medication-assisted treatment (MAT); repealing the Institutions for Mental
Disease (IMD) exclusion, which restricts federal payments for some Medicaid
patients hospitalized in inpatient psychiatric treatment facilities; and
aligning substance use disorder patient record confidentially with the Health
Insurance Portability and Accountability Act (HIPPA) privacy standards.
Opioid legislation has
passed both the Health, Education, Labor and Pensions (HELP) Committee, of
which Sen. Smith is a member, and a key health subcommittee of the House Energy
and Commerce Committee. While the House and Senate packages vary, both include
MHA priority issues.
For example, the Senate legislation would improve access to MAT by making
permanent the ability of nurse practitioners and physician assistants to
prescribe MAT and codifying physicians’ ability to prescribe MAT for up to 275
patients, up from 100. It would authorize Department of Health and Human
Services (HHS) grants to medical schools and teaching hospitals to support MAT
training and to hospitals and other acute care settings to develop and
implement strategies on alternatives to opioids for pain management.
In the House, the Energy and Commerce Health Subcommittee has approved 56
separate bills aimed at combating the opioid epidemic. The subcommittee adopted
proposals to expand access to MAT, improve health provider education related to
opioid prescribing, reduce statutory restrictions on Medicare reimbursement for
telehealth services and amend the IMD exclusion to allow states to receive
limited federal Medicaid matching dollars for services in an IMD for Medicaid
beneficiaries with a substance use disorder. The full House and Senate are
expected to continue consideration of opioid legislation in early summer.
For additional information about MHA federal priorities, contact Briana Nord Parish, policy analyst, MHA,
651-603-3498, or Ben Peltier, vice president, legal and federal
affairs, MHA, 651-603-3513. return to top
Leadership development expert Jonathan Fanning to present
closing session at Summer Trustee Conference
The MHA annual Summer
Trustee Conference, themed “Strategies for Effective Governance,” will be held
July 13-15 at the Arrowwood Resort and Conference Center in Alexandria. A total
of six general sessions and nine breakout sessions at the conference will focus
on areas such as transformation, reform, patient safety and the future of
health care.
New York-based speaker, author and leadership development expert Jonathan
Fanning will present the conference’s closing session on July 14. During the
presentation, “They Serve: The True Essence of Authentic Leadership,” Fanning
will explore the most effective, time-tested leadership principles and
paradoxes, as well as the four things servant leaders must do and the ways many
organizations that teach servant leadership violate at least two of those
building blocks.
Fanning will also present an afternoon session, “Developing Emotional
Intelligence.” During the session, Fanning will discuss the demise of emotional
intelligence in our text-obsessed culture and what that means to leaders,
parents, teachers, coaches and you. He will share a four-part process to take
your emotional intelligence quotient to the next level.
For more information or to register, download the conference brochure or
visit the MHA website. return to top
Minnesota hospitals’ board members embrace certification
Since its inception in
January 2008, interest in the MHA board certification program has steadily
grown. Currently, more than 260 board members from Minnesota hospitals are
actively working toward certification. There are 190 board members who have
already been certified.
The following board members were recognized for completing the certification
process at the MHA 2018 Winter Trustee Conference:
- Amy
Anderson, FirstLight Health System, Mora
- Randy
Baum, Ridgeview Le Sueur Medical Center
- Jesse
Frye, St. Luke’s Hospital, Duluth, and Lake View Hospital, Two Harbors
- John
H. Halvorson, Perham Health
- Colleen
Hoffman, Sanford Thief River Falls Medical Center
- Bob
Kovell, St. Cloud Hospital
- Jesi
Martinson, Johnson Memorial Health Services, Dawson
- Charlie
Meyer, Alomere Health, Alexandria
- David
M. Meyer, Riverwood Healthcare Center, Aitkin
- Larry
Ortloff, Alomere Health, Alexandria
- David
Petersen, CentraCare Health - Long Prairie
- Robert
Prentiss Jr., North Memorial Health, Robbinsdale
- Mark
W. Rekow, Chippewa County-Montevideo Hospital
- Jan
Rourk, M.D., Grand Itasca Clinic and Hospital, Grand Rapids
- Timothy
Wensman, St. Cloud Hospital
- Jayne
Stecker, Ortonville Area Health Services
- Mark
Van Eck, Hendricks Community Hospital Association
Another 21 trustees
have recently completed certification requirements and will be recognized for
their work at the Summer Trustee Conference in July.
The MHA Trustee Council developed the voluntary board certification program as
way to verify a trustee's efforts to improve personal health care knowledge,
leadership effectiveness and compliance with a variety of governance best
practices. Certification is a way of assuring stakeholders that Minnesota
hospitals hold themselves to high standards and are accountable for their
governing performance.
For those interested in becoming certified, information can be found in the brochure or on the trustee section of the MHA website under
“Board Certification.”
You can check your
progress toward certification at any time here or on the trustee section of the MHA website under “Board Certification.” return to top
17
trustees to be recognized for completing MHA’s Advanced Trustee Certification
program
MHA’s Advanced
Certification Program offers trustees who have completed their MHA
certification guidance to ensure excellence, innovation and accountability in
health care governance. By staying informed on pressing governance issues and
advancing governance best practices, trustees will gain the necessary continued
background and education to show stakeholders that high standards and
accountability are central to successful governance. A total of 17 trustees
have completed Advanced Certification Program and will be recognized at the
Summer Trustee Conference. This will be the first group to complete the
program.
For those working toward advanced certification, two sessions will be offered
at the Summer Trustee Conference:
- What Trustees Need to Know About Health Care Reform
- Todd Linden, FACHE,
president, Grinnell Regional Medical Center, Grinnell, IA
- Saturday, July 14, from 8 to 9 a.m.
- Strategic Planning and Positioning – Advanced
- Developing Emotional Intelligence
- Jonathan Fanning,
speaker, author, leadership development expert, New York, NY
- Saturday, July 14, from 1:45 to 2:45 p.m.
- Board Development and Self-Assessment – Advanced
Board members who have
completed the MHA Trustee Certification Program are eligible for enrolling in
the Advanced Certification Program. To participate, you must complete the
advanced enrollment form and receive approval from MHA. A total of eight
credits is needed to complete the advanced certification. Two credits are
needed in each of the following categories: effective governance, strategic
planning, quality and patient safety, and board development. The eight credits
can only be received by attending MHA education programs. Advanced education
programs will be provided at both Winter and Summer Trustee Conferences.
Click here for more
information on the MHA Advanced Certification Program. Complete this form to
let MHA know of your intention to complete the advanced board certification process.
You can check your
progress toward advanced certification at any time here or on the trustee section of the MHA website under “Board Certification.”
return to top
Minnesota
Hospital PAC golf tournament scheduled for July 30 in St. Cloud
Registration is now
open for the Minnesota Hospital Political Action Committee (PAC) golf
tournament. The tournament will be held on July 30 at Territory Golf Club in
St. Cloud. Lunch will be served at 11:30 a.m., shotgun start at 12:30
p.m., with a dinner buffet and awards to follow at 5 p.m. Trustees are welcome
to attend. Registration is $200.
For more information
or to register, download the registration form or contact Kristin Loncorich, director of state
government relations, MHA, 651-603-3526. If you are not able to attend the golf
tournament, but still wish to make a contribution to the PAC, you may also use
the linked form. Any contribution is greatly appreciated! return to top
3
things nonprofits should understand about federal income tax reform
By Michael Haines,
vice president, First American Healthcare Finance, Fairport, NY
1) The reduction in the
corporate income tax rate will make tax-exempt financing more expensive for
borrowers.
When financial institutions write a “tax-exempt” loan, interest income from
that loan is not subject to income taxes. Because of that exemption, lenders
are willing to offer lower interest rates compared to taxable loans. When the
corporate income tax rate was reduced from 35 percent to 21 percent, the tax
benefit from “tax-free interest income” was also reduced by the same
proportion. Financial institutions will raise their tax-exempt rates to make up
for that lost benefit. In addition, many will raise the rate on existing tax
leases in the middle of their term.
Plan of action:
Talk to your financing partner(s) about how your tax-exempt rates will be
impacted.
Question(s) to ask:
How will our use of tax-exempt financing be affected by the reduction in the
corporate tax rate?
2) The reduction in the
corporate income tax rate may cause lessors to increase rates on existing tax
leases.
Like tax-exempt financing, the income tax benefit for various lease products
has been reduced. Some lessors, especially vendor-lessors, rely heavily on that
benefit to subsidize pricing, and as such, include an “income tax
indemnification” clause in their contract that allows them to adjust their client’s
rate accordingly.
Plan of action: Review
your current lease agreement(s) or speak with your leasing partner(s) to
understand if this impacts you.
Question(s) to ask:
Which of our leases are subject to income tax indemnification? How will this
impact our current rate and rental payment?
3) The increase in the
standard deduction for personal tax returns may reduce charitable giving in
2018.
The new law raises the standard deduction on personal income taxes to $12,000
for individuals (up from $6,350) and to $24,000 for couples (up from $12,700).
For millions of Americans, it will no longer make sense to itemize deductions
on their tax return and charitable donations will not reduce their tax
liability.
Plan of action:
If charitable giving is reduced in 2018, you will need to find alternative ways
to fund operations or capital initiatives.
Question(s) to ask: What
impact will the increase to the standard deduction have on our fundraising?
What alternatives do we have to offset a reduction in donations? return to top
Barriers
to effective communication
By Mallory Earley,
J.D., senior risk resource advisor, ProAssurance, Madison, WI
To ensure an effective physician-patient relationship and provide quality care,
you must be able to communicate with your patients.
Physicians may encounter difficulties in three situations: when a patient is
hard of hearing, has limited English proficiency or is illiterate. Federal law
requires physicians to make reasonable accommodations for hard of hearing and
Limited English Proficiency (LEP) patients. If proper accommodations are not
afforded to these individuals, serious consequences, including medical
professional liability lawsuits, can occur. Here are some risk management strategies
that can be applied to reduce miscommunication with hard of hearing, LEP and
illiterate patients.
Hard of hearing patients
The Americans with Disabilities Act (ADA) strictly prohibits any discrimination
against individuals who are hard of hearing in places of public accommodation.
Under Title III of the Act, a physician’s office is defined as a place of
public accommodation.1 As such, it is required to make reasonable
accommodations for hard of hearing patients. Since the standard is reasonable
accommodation, there is not a bright-line rule that states what each practice
must do for each patient. Appropriate accommodations will vary based on the
circumstances of each patient’s case and his or her needs. For example, one
patient may want to write notes to facilitate communication with the provider
while another may require a qualified sign language interpreter for every
visit.
Discuss communication preferences with hard of hearing patients in advance.
Their options can include: a qualified interpreter on-site, note-taking,
computer-aided transcription services or devices such as telephone handset
amplifiers and Telecommunications Devices for the Deaf (TDDs). If you have a
large number of hard of hearing patients it may be effective to hire an interpreter.
Then set aside a block of time when the interpreter will be present to
accommodate these patients.
Regardless of the method of assistance your patient chooses, ensure the type of
aid to facilitate communication is accurate, effectively conveys medical
terminology and maintains the patient’s confidentiality of protected health
information.
Limited English
Proficiency (LEP) patients
Another breakdown in communication can occur with LEP patients. Title VI of the
Civil Rights Act prohibits discrimination on the basis of race, color or
national origin. This Act requires physicians to ensure that non-English
speaking patients have equal access to health care.2 You and your office staff
need to take reasonable steps to make sure LEP patients have meaningful access
to care.
Once you determine your office’s need for language or interpreting services,
choose the services that best meet your patient’s needs and office’s resources.
Your practice may also want to include a preferred language section on office
intake forms so patients can tell your practice if they require accommodation.
Your options for communicating with LEP patients can include: hiring bilingual
staff if English is not the dominant language in your area, using a telephone
or video conferencing interpretation service, contracting with companies to
provide qualified interpreters who will come to your office, or written
translation services.
Some patients ask their family or friends to translate, which can be helpful.
However, it remains the physician’s responsibility to ensure that the
communication is accurate and effective. For example, if minor children
translate for a parent, they may lack the knowledge or maturity to effectively
convey the medical information. An adult family member or friend may not be
comfortable telling the patient certain information or could fail to tell the
patient important items. In certain circumstances, referring the patient to a
physician better suited to communicate with the LEP patient could be an option.
However, this does not need to be the sole method for accommodating LEP
patients in your practice.
As with any patient, the doctor must ensure accurate communication of any
medical terminology. When using an interpreter, the physician should stress the
importance of confidentiality and document in the medical record the type of
interpretive services used.
Minimally literate
patients
Minimally literate patients may be difficult to identify in your practice. One
article defines health literacy as “the degree to which individuals can obtain,
process and understand the basic health information and services they need to
make appropriate health decisions.”3 If patients cannot understand their
medical information, they may be unable to follow their treatment plans, take
medications as prescribed or make educated decisions about their care. Some may
turn to litigation to resolve their issues.
According to one estimate, nearly half of Americans have some type of limited
ability to understand medical terminology and have difficulty understanding and
acting on health information. Nearly 40 million Americans cannot read complex
medical texts and 90 million have difficulty understanding them.4 With
training, your front office staff may be able to help identify and assist
minimally literate patients at check-in. Patients who avoid filling out new
patient information, miss appointments or mishandle medications may have
literacy challenges. They also may bring a family member along to read their
paperwork or say they have poor eyesight and forgot their glasses.
There are a few risk management tips when caring for minimally literate
patients. Physicians and medical staff should avoid using complex medical
terms. Instead of assuming a patient understands what has been said, physicians
can ask questions and have the patient explain the instructions or care plan.
Physicians can help minimally literate patients by using pictures or
illustrations to assist patients in understanding treatment plans. If a patient
brings a family member or friend to the appointment, enlist the help of the
other person to aid in the patient’s comprehension. As with any patient, ask if
he or she has questions at the end of the appointment. A little bit of extra
time during the appointment could help prevent follow-up appointments or
subsequent treatments and improve the health of the patient. Ensure that your
educational materials and forms are easy to read and understand. Use plain
language in short sentences and avoid medical jargon.
Noncompliant patients
Noncompliant patients also can pose a risk management risk to a physician
practice. These patients may miss scheduled appointments, not follow treatment
guidelines or ignore medical recommendations for further testing or scans.
Although there can be many reasons for noncompliance, open and honest
communication with the patient may help you reach a compromise.
Some patients may not follow through due to financial limitations.5 Others may
not understand the importance of compliance in their treatment goals.
Regardless of the reasons, physicians and office staff must document any
noncompliance in the medical record. Proper tracking and follow-up procedures
for missed appointments will indicate a potential problem with a patient that
must be addressed. If the patient continues to be noncompliant with
appointments or treatment options, the practice may consider dismissing the
patient.
Sources:
- Americans
with Disabilities Act of 1990, Pub. L. No. 101-336, 104 Stat. 328 (1990).
- Civil
Rights Act of 1964, Pub. L. 88-352, 78 Stat. 241 (1964).
- Nielsen-Bohlman
et al., Health Literacy: A Prescription to End Confusion, Institute of
Medicine (Eds. National Academies Press 2004).
- Ibid.
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2912714/
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