Minnesota Hospital Association

Newsroom

November 14, 2018

MHA Health Care Leader: Nov. 14, 2018

In this issue 

MHA leader Peggy Westby to retire in December

Peggy Westby, vice president of education and membership services, MHA, has announced her upcoming retirement from MHA at the end of 2018 after 30 years of service to the association and its members statewide.   

“Peggy is renowned in her field, with many national awards and recognitions, and is regarded as one of the best in the country for designing top-quality educational events,” said Lorry Massa, president and CEO, MHA. “She has also nurtured MHA’s trustee development program, providing strong leadership to the Trustee Council and developing a nation-leading trustee certification program that continues to grow.”

MHA congratulates Westby on her outstanding career and wishes her the best in retirement. return to top     

MHA selects Kristin Loncorich as vice president, education and member relations

MHA has selected Kristin Loncorich as its new vice president, education and member relations, effective at the end of 2018 upon the retirement of Peggy Westby, vice president, education and membership services.   

Loncorich joined MHA in 2011 as director of state government relations. In addition to working to advance MHA’s policy agenda at the Capitol, she also serves as a staff liaison to the MHA Policy and Advocacy Committee and the Minnesota Hospital PAC Board. Previous staff liaison roles have included the MHA Workforce Development Committee and the Health Care Reform Task Force.   

“Kristin demonstrates exceptional knowledge of and dedication to MHA’s members,” said Lorry Massa, president and CEO, MHA. “Our members and staff have all observed her work ethic and her ability to collaborate to address the significant challenges facing the health care delivery system. Kristin will allow us to not skip a beat in transitioning from Peggy’s tenure with MHA and she will be well-positioned to use her unique expertise to help us build on MHA’s nationally recognized educational and trustee program.” return to top   

As political power shifts, so will congressional focus on health care

The Nov. 6 elections brought changes to the U.S. Congress and Minnesota’s delegation to the U.S. House of Representatives. At the time of publication, Democrats will take control of the House with a majority of at least 225 seats. Minnesota will be represented by five new Representatives. 

  • Jim Hagedorn (R) will replace Governor-elect Tim Walz (D) representing the 1st District. 
  • Angie Craig (D) defeated Congressman Jason Lewis (R) in the 2nd District. Craig spent most of her professional career in health care manufacturing. 
  • Dean Phillips (D), a former Allina Health board chair, defeated Erik Paulsen (R) to represent the 3rd District. 
  • Former State Rep. Ilhan Omar (D) will replace Keith Ellison (D) in the 5th District. 
  • Pete Stauber (R), a St. Louis County Commissioner and police veteran, will replace Rick Nolan (D) to represent the 8th District. 

Reps. Betty McCollum (D), Tom Emmer (R) and Colin Peterson (D) will continue to represent Minnesota and can be expected to take on larger roles in the new Congress.   

Republicans will increase their Senate majority from 51 to as many as 54 (depending on the outcome of some undecided races). Minnesota Sens. Amy Klobuchar (D) and Tina Smith (D) were both re-elected by comfortable margins.   

Focus on health care shifts in new Congress  
While “Medicare for All” and health care coverage for pre-existing conditions were campaign issues, they are unlikely to get much congressional attention given Congress’s partisan divide.   

The new Congress must address federal spending levels and the national debt. Health care funding may be under threat. Proposals to cut to Medicare payments may be considered as Congress looks for ways to reduce federal spending.   

The new House Democratic majority reduces the likelihood that legislation limiting the 340B Drug Pricing Program will move through Congress. There is little support among House Democrats and senators in both parties to create barriers for eligible providers to participate in the program.   

Still work to be done  
While the election determined who will be in Congress starting in 2019, the current Congress has several issues left unresolved. In November and December, Congress will meet (in what is commonly referred to as a “lame duck session”) and will need to pass legislation to fund parts of the government for the remainder of the fiscal year.   

In addition, Congress may consider several health care bills including legislation affecting pharmaceutical prices. Provisions related to the 340B program could also be included in such legislation. Other potential topics may include a focus on rural health care, including alternative payment models, providing regulatory relief for critical access hospitals (CAHs) and expanding access to telehealth services.   

In addition, hospital advocates will seek to use the lame duck session to address a recent CMS decision to reduce hospital outpatient department payments in some facilities.   

MHA federal priorities  
As representatives and senators convene for the new Congress, MHA’s policy positions remain the same:  

  • Minnesota hospitals and health systems will continue to advocate for coverage for all Minnesotans 
  • Mental health is the top public health problem facing Minnesota families 
  • Health care payment reforms should reward high-quality, highly efficient providers 
  • The federal government should reduce barriers to access and other administrative burdens on health care providers 

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Minnesota’s political pendulum swings to the left

Minnesota’s political pendulum has swung once again. On a national level, it was not a blue tsunami. However, here in Minnesota, Democrats did have a big blue wave, winning every statewide race, including two U.S. Senate seats, the governor’s race and all of the constitutional offices, including a hotly contested attorney general’s race. U.S. Rep. Tim Walz will become Minnesota’s 41st governor by a comfortable margin of victory.   

Perhaps the biggest surprise in Minnesota was the margin of victory for DFLers in the House of Representatives. House DFLers gained 18 legislative seats, flipping the House to a new DFL majority of 75 seats to the Republicans’ 59 seats. (While majority control will not be impacted, one automatic recount could potentially change the outcome in a state legislative race. DFL challenger Rep. John Persell defeated Republican freshman incumbent Rep. Matt Bliss in the Bemidji area by four votes, proving once again that every vote really does matter.)   

The battle for the House was fought primarily in the suburbs, with the DFL winning all 12 of its targeted districts that currently have a Republican legislator but were won by Hillary Clinton in 2016. These 12 districts were inundated with outside, independent expenditures. The suburban strategy proved to be successful.   

Health care was a pivotal issue in many of these races. Of particular note, two DFL physicians were elected to the House: Rep. Kelly Morrison (District 33B) and Rep. Alice Mann (District 56B). Two physicians currently serve in the Senate: Republican Sen. Scott Jensen (District 47) and DFL Sen. Matt Klein (District 52).   

House leadership  
In the House, current Minority Leader Melissa Hortman (DFL-Brooklyn Park) was selected by her caucus to be the new speaker of the house when the Legislature convenes in January. Former Rep. Ryan Winkler (DFL-Golden Valley) is coming back to the seat he previously represented and has been selected by his DFL colleagues to be the new majority leader.   

Despite significant election losses, current Speaker Kurt Daudt (R-Crown) was selected by his colleagues to stay as the head of their Republican caucus and serve in the role of minority leader. Many Republican legislators blame an anti-Trump sentiment prevalent particularly within the suburbs for their election losses and not the leadership style of Daudt. There is not an apparent successor for retiring Majority Leader Joyce Peppin (R-Rogers).   

MHA is eager to see who will be named to the committee chair positions, particularly the Health and Human Services Finance Committee and the Health and Human Services Policy Committee.   

Senate leadership  
In the Senate, Republican Majority Leader Paul Gazelka (R-Nisswa) was re-elected to his post. Republicans kept their narrow majority of 34 seats to the DFL’s 33 seats, with the election of current state Rep. Jeff Howe to fill the open Senate District 13 seat. Sen. Jeremy Miller (R-Winona) was selected to be the new president of the Senate. Sen. Tom Bakk (DFL-Cook) will continue in his role as the Senate minority leader.   

Issue preview  
While MHA’s proactive legislative agenda for 2019 is still taking shape, some issues will be top concerns for the hospital community. Below you will find five areas for our legislative work this upcoming session: 

  • Preserve meaningful health care coverage for low-income Minnesotans. 
  • Protect hospital reimbursements in a budget-setting year, recognizing that the state’s Medicaid program consistently pays providers below the costs of providing care.
  • Improve access to appropriate, high-quality mental and behavioral health services throughout the state. 
  • Modernize Minnesota’s Health Records Act to improve coordination of patient care. 
  • Reject government-mandated nurse-to-patient staffing ratios. 

Help with grassroots advocacy  
There will be many new faces at the Capitol, including 39 new House members (34 DFL members [pending the recount] and five Republican members). This creates both challenges as well as opportunities for the hospital community.   

Health care was viewed as the top election issue and new legislators will be anxious to learn more from health care providers. We encourage trustee leaders to work with hospital CEOs and schedule your legislative visits now, before the session starts on Jan. 8, 2019. MHA is preparing new legislative matching information as well as a new issue brief that you can use in legislative visits.   

As a trustee of your local hospital, you could also write a congratulatory note to your legislator. Campaigns are hard work and holding elective office is a big commitment. Thank them for stepping up to serve!   

With questions, contact Mary Krinkie, vice president of government relations, MHA, 651-659-1465. return to top   

Winter Trustee Conference scheduled for Jan. 11-13

The MHA Annual Winter Trustee Conference, themed “Connecting Care and Communities,” will be held Jan. 11-13 at the Marriott Minneapolis Northwest in Brooklyn Park. Conference highlights include presentations from best-selling author, documentarian and mental health advocate Kevin Hines and “Survivor” alumna Holly Hoffman. 

Two years after he was diagnosed with bipolar disorder at 19 years of age, Kevin Hines attempted to take his own life by jumping from the Golden Gate Bridge. One of only 34 people to survive the fall, Hines shares the story of his unlikely survival and strong will to live and spreads the message of living mentally healthy around the globe. 

Holly Hoffman will share her experience of being on the reality TV show “Survivor” and encourage you to think about how to decide to survive daily. She will share how adversity is not so much contending with problems as it is learning more about who you really are and what is inside of each of us. 

Seven general sessions and 17 breakout sessions will focus on issues of mental and behavioral health, finance, patient safety and the future of health care. For more information or to register, download the conference brochure or visit the MHA website. The Marriott sells out quickly so reserve your room online now. return to top   

Six Minnesota trustees receive MHA board certification and 16 receive advanced certification

Six Minnesota hospital trustees were recognized for completing the MHA board certification process at the Summer Trustee Conference on Friday, July 13. They are:  

  • Phil Gravel, Mille Lacs Health System, Onamia 
  • Kelly A. Johnson, Community Memorial Hospital, Cloquet 
  • Mary Klimp, Mayo Clinic Health System in St. James 
  • Irene Manke, Ridgeview Le Sueur Medical Center 
  • Lisa Pfarr, Ridgeview Sibley Medical Center, Arlington 
  • Julie Turnberg, Johnson Memorial Health Services, Dawson 

Additionally, 16 trustees were recognized for completing the MHA Advanced Trustee Certification program. This is the first class of trustees to receive advanced certification.  

  • Larry Anderson, United Hospital District, Blue Earth 
  • Judith Bjerga, Lakewood Health System, Staples 
  • Shirley Conaway, Cook Hospital & Care Center 
  • Pam Grover, Community Memorial Hospital, Cloquet 
  • Lana Hansen, Lakewood Health System, Staples 
  • Bev Hoemberg, Lakewood Health System, Staples 
  • James Hofer, Lakewood Health System, Staples 
  • Melanie Humburg, United Hospital District, Blue Earth 
  • Barbara Johnson, Cook Hospital & Care Center 
  • Luke Johnson, Pipestone County Medical Center 
  • Paul Kent, FirstLight Health System, Mora 
  • Norma Krumwiede, Madelia Community Hospital 
  • Gail Langhorst, Mercy Hospital, Moose Lake 
  • Loren Morey, Lakewood Health System, Staples 
  • Nancy Moritz, Cuyuna Regional Medical Center, Crosby 
  • Mary Theurer, Lakewood Health System, Staples  

MHA’s website provides information on board certification and advanced certification. Complete this form to let MHA know of your intention to complete the advanced board certification process. You can also check your progress toward certification online. return to top   

New educational videos for board meetings available on MHA’s website

MHA has developed a series of board education videos designed as short introductions on specific health care topics to be shared during hospitals’ board meetings or for individual use. MHA recently filmed nine new videos. These videos, as well as previously recorded videos, are available on MHA’s website. Topics and speakers include: 

  • Patient and Family Engagement in Action
    Joy Benn, MBA, CPXP, quality and process improvement specialist, Minnesota Hospital Association, St. Paul, MN 
  • MHA Workforce Planning Tool
    Mark Sonneborn, vice president, health information and analytics, Minnesota Hospital Association, St. Paul, MN 
  • Board Minutes and Documentation Best Practices
    Laura Leitch, attorney, Hall, Render, Killian, Heath & Lyman, Milwaukee, WI 
  • MHA’s New Analytics Platform
    Mark Sonneborn, vice president, health information and analytics, Minnesota Hospital Association, St. Paul, MN 
  • Designing Your Facility with Brand Experiences in Mind
    Jon Buggy, principal, RSP Architects, Minneapolis, MN 
  • A 2019 Legislative Session Preview
    Mary Krinkie, vice president, government relations, Minnesota Hospital Association, St. Paul, MN 
  • Addressing the Opioid Epidemic
    Jennifer Schoenecker, senior director, quality and patient safety, Minnesota Hospital Association, St. Paul, MN 
  • The Importance of Strategic Planning for Hospital Trustees
    Kari Larsen, area sr. vice president/consulting practice leader, health & welfare consulting practice, Gallagher, Bloomington, MN 
  • Cyber Risk Management
    Dave Wasson, vice president, cyber liability, Hays Companies, Minneapolis, MN 

MHA adds additional videos annually. If you find other topics that you would like MHA to explore, please contact Christy Hammer, MHA education specialist, 651-659-1412. return to top   

Minnesota’s Hospitals: Strengthening Healthy Communities campaign update

Minnesota’s hospitals and health systems are the centerpieces of their communities, working beyond physical walls to strengthen the health of Minnesotans. Minnesota’s Hospitals: Strengthening Healthy Communities is a multiyear online and social media campaign designed to help our hospitals and health systems tell their stories of how they work beyond their walls to keep their communities healthy. The campaign features topic areas that resonate strongly with Minnesotans, including mental health, responding to the opioid epidemic and ensuring that low-income Minnesotans have health coverage. 

This fall, the campaign initiated a new series that emphasizes advocacy around issues that matter to Minnesotans. The Speak Up Minnesota series focuses attention on two main issues – creating a better mental health system and ensuring meaningful health care coverage, including coverage for pre-existing conditions. The series’ goal is to refine public attention on these health care issues and demonstrate how Minnesota’s hospitals are working to support patients and families. 

To view campaign videos and read about how hospitals are strengthening healthy communities across Minnesota every day, please visit our campaign website, www.mnhealthycommunities.org. You can also find the campaign on Facebook at www.facebook.com/minnesotashospitals

What are MHA members and trustees being asked to do? 

  • Members are asked to “like” the Facebook page and help share our posts from their personal pages as well as their organization pages. 
  • MHA members are encouraged to contribute examples and stories to be featured in the campaign and shared across the state. 
  • Invite legislators to your hospital between now and the start of the 2019 legislative session for discussions on these issues. 
  • Finally, MHA members are being asked to reach out to their employees to mobilize those who would like to be involved in a grassroots advocacy network and public policy advocacy on behalf of their own hospital. 

Details on the campaign and additional campaign resources are available on the MHA Member Center. Together, we can all help highlight how Minnesota’s hospitals and health systems reach beyond their walls to strengthen and care for their communities across the state every day. With questions, contact Emily Lowther, communications director, MHA, 651-603-3495. return to top   

The why, what and how of physician contracting oversight

By Joe Wolfe and James Junger, attorneys, Hall, Render, Killian, Heath & Lyman, P.C., Milwaukee, WI Physician contracting can be one of the most confusing topics in hospital governance. The rules in this area seem to run counter to business sense, and it can be hard to understand how to advance a hospital’s business interests without triggering the laws of health care fraud and abuse. While hospital board members do not have to be experts in the Stark Law or the Anti-Kickback Statute, they do have to know enough to ask the right questions. 

The Why
Understanding why the policy behind the fraud and abuse laws exist can help board members understand the rules. The federal government is the single largest insurer in the country, so federal policy has enormous implications in health care. As a basic principle, the federal government will not pay a Medicaid or Medicare claim unless it is for medically necessary services. Only physicians (and advanced practice practitioners such as physician assistants) are permitted to certify as to medical necessity. Physicians, therefore, are gatekeepers to Medicare payments. Recognizing this, Congress created laws strictly regulating how money flows between hospitals and physicians. 

The What
The Stark Law and the Anti-Kickback Statute act as the core of the fraud and abuse laws. The Stark Law generally prohibits payments between a hospital and a physician (including a doctor of medicine or osteopathy, a chiropractor, a dentist or a podiatrist) who makes referrals to the hospital unless an exception is met. The Stark Law is a strict-liability civil statute, so a person can be penalized for violating it even if they had no bad intent, but there are no criminal consequences (e.g., jail time) for doing so. 

In contrast, the Anti-Kickback Statute is a criminal law that prohibits offering, paying or soliciting anything of value in exchange for a referral from a federal health care program. Dealings between hospitals and physicians can be protected if they meet a safe harbor, but even without a safe harbor, a transaction is allowed if neither party intended to pay for, or be paid for, referrals. However, if even one purpose of a deal is to pay for referrals, both parties can be criminally liable. 

In most cases, there is significant overlap between a Stark Law exception and an Anti-Kickback Statute safe harbor. Most exceptions and safe harbors require that the terms of an arrangement be set in advance, documented in a signed agreement and not take into account the volume or value of Medicare or Medicaid referrals. Additionally, payments should be fair market value and the deal should be commercially reasonable. Complying with these key tenets is a good first step to ensuring compliance with the fraud and abuse laws. 

The How
While board members typically will not review every physician contract, there are many things that a board member can do to help their organization comply with the fraud and abuse laws. Most importantly, board members should ask management about the organization’s strategy for securing physician services, focusing specifically on steps designed to comply with the fraud and abuse laws. The board member should seek to understand what structures are in place to comply with the key tenets described above. 

For instance, board members should ensure that physician contracts are reviewed in advance by appropriate (and appropriately trained) personnel. Additionally, payments to physicians should be audited frequently. When potential issues are identified, they should be properly investigated. Significant penalties apply if the organization fails to return known overpayments (e.g., Medicare payments made for prohibited referrals), so board members should review the organization’s investigations and overpayments policies to ensure that identified overpayments are returned in accordance with federal law. 

This article is educational in nature and is not intended as legal advice. Always consult your legal counsel with specific legal matters. If you have any questions or would like additional information about this topic, please contact Joe Wolfe at 414-721-0482, James Junger at 414-721-0922 or your regular Hall Render attorney. return to top   

Priorities of the MHA Mental and Behavioral Health Committee

Minnesota’s hospitals and health systems collaborate with mental and behavioral health care providers, policymakers and other health care stakeholders to create an effective and accessible health care system that meets the needs of individuals, families and communities. MHA’s many committees work to advance the goals of the association’s priority issues. Each committee is comprised of individuals representing hospital members from across the state, establishing policies to advance the delivery of health care in Minnesota. The focus of MHA’s Mental and Behavioral Health (MBH) Committee is to examine and develop recommendations to improve Minnesota’s mental and behavioral health system.    

An example of the substantial work being done by the MBH Committee is its collaboration with the Minnesota Department of Human Services to create a website to help hospitals obtain quick access to mental health resources and information for available inpatient mental health treatment beds in the state. The goal of the Minnesota Mental Health Access website is to connect patients with the services they need as quickly as possible. As of July 2018, the website also offers information on available inpatient beds and services for those affected by substance use disorder.   

Minnesota is one of eight states chosen to participate in the federal pilot project to create Certified Community Behavioral Health Clinics (CCBHCs) as part of the Excellence in Mental Health Act. As a participating state, Minnesota has established a network of CCBHCs that provide outpatient mental health and addiction treatment services as well as coordinated and integrated care with hospitals, health systems and other medical and social service providers. A subgroup of the MBH Committee is working to improve communication and partnership between CCBHCs and health systems.    

The subgroup is creating a best practice road map for hospitals to improve their coordination of care, efficiency and effectiveness in connecting patients with the mental health services they will need once they leave the hospital. MHA has published a tip sheet to ensure the right information is communicated between caregivers to provide patients with a seamless transition between services.   

As hospitals are seeing an increase in the demand for mental health services, the MBH Committee is prioritizing mental and behavioral health educational opportunities for hospital clinicians. Hospitals and health systems also need active partnership and support from federal, state and local community organizations to build a cohesive and sustainable system of care for mental and behavioral health patients across the state. return to top