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