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
return to top
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