Minnesota Hospital Association

Newsroom

May 22, 2018

Health Care Leader: May 22, 2018

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.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: 

  1. Americans with Disabilities Act of 1990, Pub. L. No. 101-336, 104 Stat. 328 (1990). 
  2. Civil Rights Act of 1964, Pub. L. 88-352, 78 Stat. 241 (1964). 
  3. Nielsen-Bohlman et al., Health Literacy: A Prescription to End Confusion, Institute of Medicine (Eds. National Academies Press 2004). 
  4. Ibid. 
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2912714/ 

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