Minnesota Hospital Association


December 09, 2013

MHA Newsline

In this issue

Hospital spotlight: Teamwork and communication help Allina Health reduce newborn complications

Allina Health delivers more than 14,000 infants annually. While only a small percentage of these births result in complications, Allina Health recognized that in cases of shoulder dystocia (when an infant’s shoulders get stuck behind the mother’s pubic bone) the hospital was seeing a greater need for infant resuscitation and long-term care of the infant, as well as injuries to the mother. Allina Health set goals to improve measures to greatly reduce the incidence of infant resuscitation occurring at their hospitals. Read more about Allina Health’s work to reduce newborn complications. return to top  

MHA receives additional year of funding for Partnership for Patients contract

The MHA Hospital Engagement Network (HEN) has been selected to receive a third year of funding for the Partnership for Patients contract from the Centers for Medicare and Medicaid Services (CMS), extending the work through December 2014. Minnesota hospitals have made tremendous strides toward the Partnership’s goals of reducing hospital-acquired conditions by 40 percent and readmissions by 20 percent. With this additional year of funding, Minnesota hospitals will be able to continue those advances.  

To date, 58 participating hospitals have met this benchmark on three or more hospital-acquired conditions. MHA is committed to providing technical assistance and onsite expert consultation to hospitals to achieve the Partnership’s aims. MHA is asking CEOs to recommit to the Partnership for Patients goals, especially addressing catheter-associated urinary tract infections (CAUTI), readmissions, and engaging patients and families.  

CAUTIs are the most common type of health care-associated infection and data shows that Minnesota’s CAUTI rates are higher than the national average. MHA encourages all members to join On the Cusp: Stop CAUTI Cohort 7. This groundbreaking national initiative uses the Comprehensive Unit-based Safety Program (CUSP) and evidence-based interventions to reduce CAUTI. The deadline to sign up is Friday, Dec. 13.  

CMS has also placed an increased focus on patient and family engagement for the third year of the contract. MHA has convened a Patient and Family Advisory Committee to help hospitals further engage patients and families and to oversee the patient and family engagement efforts on a statewide level. Thank you to all the hospitals that have verified your status of participation with the five patient and family engagement criteria provided in the weekly Partnership for Patients email. Hospitals that still need to verify their patient and family engagement status or wish to sign up for On the Cusp: Stop CAUTI should contact Karen Olson, MHA HEN patient safety and quality coordinator, 651-603-3521. return to top  

Final rule increases interest in direct supervision toolkit

In November, MHA released a whitepaper for members seeking to better understand and adapt to Medicare’s requirements for direct supervision of outpatient therapeutic services delivered in a hospital. Although the Centers for Medicare and Medicaid Services (CMS) stated that the new policy is merely a clarification of long-standing requirements, the agency placed a moratorium on enforcement of the policy through 2013. In its recently released final outpatient payment rule for 2014, CMS confirmed that the enforcement moratorium will end after this month.  

The whitepaper provides a detailed flow chart to help hospital staff walk through the various elements of the direct supervision standard to determine if it applies to a particular service and, if so, what kind of staffing is required by Medicare.  

MHA and the American Hospital Association continue to seek congressional interventions to change the direct supervision standard to a more practical, real-world approach that protects patient safety while recognizing the need for hospitals to innovate how care teams provide services to patients, or in the alternative, to extend the moratorium on enforcement that has been in place for several years.  

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

Dec. 8-14 is National Influenza Vaccination Week

This week is National Influenza Vaccination Week, a time to remind people it’s not too late to get vaccinated against the flu. Health care workers are especially encouraged to get vaccinated as they can pass highly contagious influenza to their patients, many of whom are at high risk for complications of influenza. Resources are available on the Minnesota Department of Health’s National Influenza Vaccination Week website. return to top  

CMS’ enforcement of CAH 96-hour rule could be problematic

In the fiscal year 2014 hospital inpatient prospective payment system (IPPS) final rule, the Centers for Medicare and Medicaid Services (CMS) clarified and finalized that as a condition of payment, physicians at critical access hospitals (CAHs) must certify that a Medicare beneficiary may reasonably be expected to be discharged or transferred to another hospital within 96 hours after admission to a CAH. If something unforeseen occurs and the beneficiary stays for longer than 96 hours, the physician may document and certify complications to still meet the condition of payment. Alternatively, if no such certified documentation is found upon review of the medical record, payment will be denied.  

The greatest concern remains for CAHs that have surgical patients or programs such as orthopedics where they are staffed and equipped to safely deliver quality care for beneficiaries and physicians know up front may be in the hospital for longer than 96 hours. CAHs would potentially have to discontinue these services and beneficiaries would have to travel longer distances to obtain access to care.  

This provision was originally set forth in 1997 in 42 CFR Chapter IV, Subchapter B – Medicare program, Part 424 – Conditions for Medicare Payment, Section 424.15, but has not been enforced until now. Changing the rule would require legislation to modify or remove it. The American Hospital Association (AHA) has legislation drafted and is currently looking for legislative sponsors.  

There is a separate condition of participation requirement that a CAH provides acute inpatient care for a period that does not exceed, on an annual basis, 96 hours per patient. This is the requirement that is more familiar to the hospital field.  

The 96 hour requirement also ties into a previously discussed issue, the two-midnight rule. This CMS clarification, also found in the 2014 IPPS final rule, requires physicians to document they expect a beneficiary to require a hospital stay that crosses at least two midnights with limited exceptions, in order to consider the beneficiary an inpatient. Hospitals had asked CMS to streamline its medical necessity requirements for inpatient status to avoid some of the unnecessary recovery audit activities that are administratively burdensome. A patient expected to stay less than two midnights should generally be considered for outpatient observation status. 

As you can imagine, there is a lot of confusion with these requirements, especially for CAHs, where it appears that inpatient care must be longer than two midnights but shorter than 96 hours. MHA is very concerned about the impact that this will have on patients, the additional administrative burden this is putting on physicians, and meeting these requirements with the level of complexity of patients often seen in a hospital setting.  For more information, contact Ann Gibson, MHA vice president of federal relations and workforce, 651-603-3527 or Joe Schindler, MHA vice president of finance, 651-659-1415. return to top  

CMS proposes to significantly delay PSO requirement

The Centers for Medicare and Medicaid Services (CMS) recently issued a proposed rule to implement a little understood provision of the Affordable Care Act (ACA) related to hospital use of a Patient Safety Organization (PSO). The language, contained at Section 1311(h) of the ACA, was ambiguous but could have been interpreted as requiring hospitals with 50 or more beds to contract with a certified PSO.   

The proposed rule, released by CMS just prior to Thanksgiving, would impose new restrictions on a qualified health plan (QHP) beginning in 2015 and continuing through at least 2017. Under the proposed rule, a QHP could only contract with a hospital with more than 50 licensed beds if the hospital certified compliance with certain conditions of participation related to quality assessment and performance improvement (QAPI) and discharge planning. A hospital could meet these conditions of participation without contracting with a PSO.  

CMS has not specified whether additional requirements may be imposed after 2017 but has asked for comments on whether a mandated PSO arrangement might be appropriate.  

The rule is not yet final and MHA members have an opportunity to submit comments to CMS regarding the proposed rule. Comments are due by Dec. 26. If you would like MHA to submit comments on your behalf, email them to Tania Daniels by close of business Wednesday, Dec. 18.    

MHA will continue to work with the American Hospital Association (AHA) and the Minnesota Congressional delegation to ensure that any PSO-related requirements do not impose a duplicative burden on Minnesota hospitals. MHA is also committed to providing Minnesota hospitals with the tools necessary to ensure compliance with any requirements contained in the final rule. For more information, contact Tania Daniels, MHA vice president of patient safety, 651-603-3517. return to top  

Presumptive eligibility process delayed

The Minnesota Department of Human Services (DHS) informed MHA that its efforts to do the systems modifications needed to allow hospitals to presumptively enroll patients into Medical Assistance will not be available by Jan. 1, 2014, as previously planned.  

The Affordable Care Act (ACA) creates a unique PE role for hospitals beginning in 2014. MHA and hospitals around the country applauded this provision of the ACA because it would create a streamlined process for getting the most economically vulnerable patients covered by Medicaid at the point of service, often the emergency room, even if the individual patient is unable to complete the entire enrollment process while at the hospital. Federal law requires that hospital staff receive training and certification by the state before being authorized to complete PE enrollment for patients.  

DHS reiterated its commitment to getting the PE process up and running as quickly as possible, and emphasized that it has considered alternative interim approaches but has not found any that offer practical, timely solutions. Unless other options are created, hospitals with MNsure-certified consumer assistance counselors, navigators or in-person assisters can help patients complete the Medical Assistance enrollment process through MNsure.   

MHA will continue to work with DHS to limit delays as much as possible and to develop more advantageous interim solutions that hospitals can use to help otherwise uninsured but potentially eligible patients get coverage. MHA will communicate to members as it learns more details, including a projected timeline for when the PE process will begin.     

For more information about presumptive eligibility, contact Joe Schindler, MHA vice president of finance, 651-659-1415 or Matt Anderson, MHA vice president of regulatory and strategic affairs, 651-659-1421. return to top  

Members encouraged to submit community needs assessments to MHA

MHA is compiling the results from its members' community health needs assessments (CHNAs) and preparing to post those assessments and analysis of their findings on its website. Accordingly, MHA is encouraging members who have not already submitted their CHNAs to MHA to send an electronic copy or hyperlink to Matt Anderson.  

Because charitable hospitals are required to demonstrate that they have made their CHNAs widely available to the public, MHA's posting of its members' assessments will provide an additional example of how hospitals have met and exceeded this new requirement.  

MHA hopes to release its preliminary analysis of members' CHNAs by the end of December. So far, common themes across communities include the need to address obesity and mental health concerns. Community-specific needs range from access to certain specialty care services to improving residents' awareness of resources already available in their area.

In addition to its evaluation of members' CHNAs, MHA has joined with the Local Public Health Association (LPHA) of Minnesota to offer a half-day program for hospital and local public health staff to learn more about successfully collaborating to leverage local resources to improve community health (see Dec. 2 Newsline). The event will be held on Feb. 20 at the Dakota Lodge in West St. Paul. Further details including the agenda and registration instructions will be available soon. return to top  

SAMHSA offering online training sessions for establishing telebehavioral health programs

The Substance Abuse and Mental Health Services Administration (SAMHSA) is offering six free online training sessions to help providers establish telebehavioral health programs. The training offers providers the tools and resources necessary to identify and implement a telebehavioral health program. Each educational session includes a Q&A session with telebehavioral health experts and associated resources for further exploration and information.  

The one-hour training sessions can be found online. return to top  

Trustee Conference helps hospital trustees set strategies for efficiency and quality in health care transformation

This year’s Winter Trustee Conference will feature a presentation from the American Hospital Association’s Maulik S. Joshi, DrPH on performance initiatives essential to successfully transforming health care delivery and financing. He will provide trustees with a framework of “must-do strategies” and practical implementation steps to improve their organizations’ efficiency and quality.   

Joshi is president of the Health Research & Educational Trust (HRET) and senior vice president at the American Hospital Association (AHA). HRET conducts applied research in critical areas of the health care system and leads Hospitals in Pursuit of Excellence, AHA’s strategy to accelerate performance improvement. He is editor-in-chief for the Journal for Healthcare Quality, co-edited The Healthcare Quality Book: Vision, Strategy and Tools and authored Healthcare Transformation: A guide for the Hospital Board Member.  

The Winter Trustee Conference takes place Jan. 10-12, 2014 at the Minneapolis Marriott Northwest in Brooklyn Park. Click here to learn more about the conference sessions or to register.  

The deadline for accommodations at the Marriott is Dec. 19. Click here to reserve your room online. return to top  

March of Dimes recognizes nurses of the year

The March of Dimes recently recognized nurses in 15 categories who have displayed great leadership and have made significant contributions to their community and to the profession of nursing. Several of the winners represent MHA member hospitals:

  • Advanced Practice – Samantha Sommerness, Fairview Southdale Hospital, Edina
  • Leadership – Lynn Choromanski, Gillette Children’s Specialty Healthcare, St. Paul
  • Mental Health – Wendy Waddell, Regions Hospital, St. Paul
  • Neonatal – Natalie Wilson, Children's Hospitals and Clinics of Minnesota, Minneapolis
  • Pediatric – Karen Johnson, Children's Hospitals and Clinics of Minnesota, Minneapolis
  • Perioperative – Darin Prescott, Mayo Clinic Health System Mankato
  • Rising Star – Elizabeth Cantrell, St. Francis Regional Medical Center, Shakopee
  • Rural Health – Katherine Galliger, Riverwood Healthcare Center, Aitkin
  • Staff Nurse - Critical Care – MaryEllen Swanson, Hennepin County Medical Center, Minneapolis
  • Staff Nurse - General Care – Sher Stiles, St. Francis Regional Medical Center, Shakopee
  • Women's Health – Nanette Mastain, Park Nicollet Methodist Hospital, St. Louis Park

MHA extends its congratulations and thanks to each of this year’s winners. For a complete list of winners, visit the March of Dimes’ website. return to top