Minnesota Hospital Association


March 31, 2014

MHA Newsline: March 31, 2014

In this issue

Hospital spotlight: Abbott Northwestern again earns Magnet® status

Abbott Northwestern Hospital in Minneapolis has again attained Magnet® recognition as part of the American Nurses Credentialing Center’s Magnet Recognition Program®. This voluntary credentialing program for hospitals recognizes excellence in nursing and is the highest honor an organization can receive for professional nursing practice. The Magnet program promotes high standards based on 14 Forces of Magnetism, including:

  • Quality of nursing leadership (strong, visionary leaders)
  • Organizational structure (decentralized with care decisions made at the unit level)
  • Management style (staff members are involved at all levels)
  • Personnel policies and programs (competitive salaries and benefits)
  • Professional models of care (number and type of staff needed to care for patients)
  • Quality of care (always striving for better patient outcomes)
  • Quality improvement (always learning and a non-punitive environment)
  • Consultation and resources (staff have access to experts and evidence)
  • Autonomy (staff practice at the highest level allowed by their education and licensure)
  • Community and the hospital (staff members make a positive impact on the community)
  • Nurses as teachers (teaching is an important nursing role)
  • Image of nursing (viewed as integral to the hospital mission)
  • Collegial interdisciplinary relationships (team members work together for the patients)
  • Professional development (personal growth and development are valued and are a part of the mission).

Congratulations to staff and leadership at Abbott Northwestern on this prestigious honor. Learn more about the Magnet Recognition Program® or find a Magnet hospital. return to top  

28 more hospitals recognized for reducing early elective deliveries

MHA and the March of Dimes have recognized 28 additional Minnesota hospitals for reducing the number of elective inductions and Cesarean deliveries performed before 39 completed weeks of pregnancy. Babies delivered before full term are at increased risk of serious health problems and death in their first year of life. Each hospital will receive a banner to display that spreads the message that “Healthy Babies are Worth the Wait.”  

Banner recipients were determined by reviewing the MHA Perinatal Safety Roadmap and early elective delivery outcome data submitted to the Patient Safety Registry. All recipients had less than a 5 percent early elective delivery rate for four quarters, a hard stop policy with clearly defined medical indications for deliveries less than 39 weeks, and a process to monitor the scheduling of Cesarean sections and inductions of labor prior to 39 weeks gestational age.  

The 28 hospitals join 35 others that were recognized in late 2013. For a complete list of banner recipients, visit the MHA website. For questions, contact Kattie Bear-Pfaffendorf, MHA patient safety and quality specialist, 651-659-1404. return to top  

Rebasing legislation affecting future Medicaid payments

The Minnesota Department of Human Services (DHS) is proposing an overhaul of the fee-for-service (FFS) payment system for inpatient hospital services provided to Medical Assistance (Medicaid) beneficiaries. This is an important and complex proposal that is moving quickly at the Legislature. Following are the Minnesota Hospital Association's (MHA) key messages for its members to convey to legislators:

  • Ending the most recent 10 percent cut to hospital payments on Sept. 1, 2014 is the most significant thing the legislature can do to mitigate the potentially destabilizing changes in hospital payments. Current law calls for this rate cut to end on July 1, 2015, but MHA is urging legislators to go beyond the DHS proposal by accelerating the end of this cut to align with the other required payment system changes in Sept. to help ensure that no hospital sustains dramatic losses.
  • It is critical that the legislature enact some protections and safeguards for hospitals as the state makes multiple, complex changes to the Medical Assistance program's payment system. While hospitals recognize that these changes are necessary when federal ICD-10 requirements are enforced, they present tremendous uncertainty for hospitals because no one knows how much more or less hospitals will be paid for the same services after the changes are implemented.
  • Minnesota needs to move forward with updating hospital payment rates because our current system is based on hospitals’ costs in 2002. By updating payment rates and the grouper software used by the state, hospital payments would better reflect the services MHA members provide to Medical Assistance beneficiaries.

At this time, it is impossible for MHA or DHS to predict how these interconnected changes will impact individual hospitals. MHA hopes to have the ability to model some of the changes when DHS has developed a rebasing formula. Understandably, this legislation is accompanied by a high degree of apprehension.  

Adding to the uncertainty are developments at the federal level. This evening the U.S. Senate will vote on a bill to delay implementation of the Sustainable Growth Rate for physician payments. Among the bill's provisions is a one-year delay in the requirement to convert to ICD-10, thereby creating greater ambiguity around the timing and sequencing of the interrelated changes proposed by DHS.  

For questions, contact Joe Schindler, MHA vice president of finance or Matt Anderson, MHA vice president of regulatory and strategic affairs. If you talk with legislators about this issue, please provide a brief summary of your conversation and the legislators' reactions to Mary Krinkie, MHA vice president of government relations or Kristin Loncorich, MHA director of government relations. return to top  

CDC report shows improvements in hospital-acquired infections, more work to be done

A report from the Centers for Disease Control and Prevention (CDC) details the nation’s progress toward eliminating healthcare-associated infections (HAIs). The National and State Healthcare-Associated Infections Progress Report finds that nationally significant reductions were reported in 2012 for nearly all infections, with decreases in central line-associated bloodstream infections (CLABSI) and surgical site infections (SSI) leading the way. Hospital-onset C. difficile and MRSA bloodstream infections saw minimal decreases while catheter-associated urinary tract infections (CAUTI) increased by 3 percent nationally.  

In Minnesota, infection rates are below the national standardized infection ratio (SIR) for CLABSI and SSI, colon surgery, while CAUTI and SSI, abdominal hysterectomy continue to present challenges for hospitals. Minnesota hospitals are involved in a number of efforts to reduce healthcare-associated infections.

  • Minnesota is one of 10 state health departments participating in CDC’s Emerging Infections Program, which allows for extra surveillance and research of HAIs.
  • Through the Collaborative Healthcare-Associated Infections Network (CHAIN), hospitals across the state are implementing a road map of best practices for effective HAI prevention focused on hand hygiene, transmission precautions, injection practices, antimicrobial stewardship and environmental cleaning. A gap analysis for CAUTI, CLABSI, SSI, ventilator-associated events and C. difficile accompany the HAI road map.
  • As a Hospital Engagement Network, MHA keeps hospitals appraised of state level HAI data and provides resources on HAI specific prevention best practices.  
  • Hospitals are engaged in the national On the Cusp: Stop CAUTI project.
  • Hospitals in the Leading Edge Advanced Practice Topics (LEAPT) project are targeting hand hygiene compliance and environmental services best practices in order to reduce the spread of C. difficile infection. 

While there is still much work to be done, the efforts appear to be paying off. Data available through the MHA Hospital Engagement Network show an 11 percent reduction in CAUTI and a 61 percent reduction in CLABSI. return to top  

Rep. Paulsen supports legislation to establish equity in the Medicare Hospital Readmissions Reduction Program

MHA appreciates Rep. Erik Paulsen’s (R) recent co-sponsorship of H.R. 4188, the Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2014.  

This legislation would adjust the Medicare Hospital Readmissions Reduction Program to account for certain socioeconomic and health factors that can increase the risk of a patient’s readmission.  

Some of the specific requirements of the bill include requiring an analysis (effective in Fiscal Year 2015) of each hospital’s dual-eligible population to ensure that hospitals are not unfairly penalized for treating the most vulnerable patients; and exclude from the program certain readmissions that are classified as transplant, end-stage renal disease, burns, trauma, psychosis or substance abuse. The legislation would also require the Medicare Payment Advisory Commission to study whether the program’s 30-day readmission threshold is appropriate.  

MHA has requests pending with the remaining House offices of the Minnesota congressional delegation to sign onto the bill. A Senate counterpart for this legislation has not been introduced at this time.  

For more information, contact Ann Gibson, MHA vice president of federal relations and workforce, 651-603-3527. return to top  

Sens. Klobuchar and Franken sign onto legislation supporting a fix to the two-midnight requirement

Minnesota Sens. Amy Klobuchar (D) and Al Franken (D) recently signed on as cosponsors to S. 2082, the Two-Midnight Rule Coordination and Improvement Act of 2014. This legislation would support delaying enforcement of the two-midnight policy and direct the Centers for Medicare and Medicaid Services to take a more thoughtful approach by developing a new standard that will provide clarity on whether a patient should be billed as an inpatient or outpatient.  

Under the current requirement, Medicare beneficiaries must stay at least two midnights in a hospital to be presumed to be appropriately paid for by Medicare as an inpatient admission. There are some exceptions to hospital stays of a shorter duration with proper physician documentation, but MHA is concerned about the precarious position this puts physicians in at the time of admission. The requirement is administratively burdensome and gets in the way of the best medical judgment.  

Minnesota Reps. Bachmann (R) and Peterson (D) have signed onto the House version of this legislation, H.R. 3698, the Two Midnight Rule Delay Act. The Senate and House bill are supported by MHA and the American Hospital Association.  

For more information, contact Ann Gibson, MHA vice president of federal relations and workforce, 651-603-3527. return to top  

U.S. House passes legislation to hold off scheduled cuts to Medicare physician payment cuts

On Thursday, March 27, the U.S. House passed by voice vote legislation that would hold off scheduled cuts to Medicare physician payments through April 1, 2015. Medicare physician payments are scheduled to be cut by 24 percent on April 1 without final congressional action. The Senate will still need to take up this measure. Some of the other hospital-related provisions in the bill include:

  • Two-midnight requirement - extends the delay in enforcement of the two-midnight requirement through March 31, 2015.
  • ICD-10 - delays implementation of the ICD-10 coding system until Oct. 1, 2015.
  • Medicare extenders - extends the Medicare-Dependent Hospital Program, low-volume adjustment and ambulance add-on payments through April 1, 2015.
  • Sequester - doubles the Medicare sequester cuts (4 percent) for the first six months of 2024, but eliminates the sequester cuts for the last six months of 2024.
  • DSH - delays the start of Medicaid disproportionate share hospital payments cuts for one year, until 2017, but extends cuts for an additional year through 2024. 

For more information, contact Ann Gibson, MHA vice president of federal relations and workforce, 651-603-3527. return to top  

DHS requesting proposals for children’s mental health grant contracts

The Minnesota Department of Human Services (DHS) is requesting proposals to enter into grant contracts with children’s mental health providers enrolled in Minnesota Health Care Programs (MHCP) to develop clinical capacity to provide evidence-based treatment to children and adolescents, specifically Trauma-Focused Cognitive Behavioral Therapy. The objective is to strengthen the clinical infrastructure by providing training and consultation to practicing mental health professionals, particularly across the central region of the state. The training and consultation will be provided in collaboration with the Ambit Network. Proposals are due by 4 p.m., Friday, April 28; work is proposed to start June 1, 2014. The full RFP is available online. For more information contact Patricia Nygaard at DHS. return to top  

April is National Donate Life Month

Currently, nearly 120,000 men, women and children are awaiting organ transplants in the U.S. Each year more than 28,000 of them begin new lives after receiving their transplant. Sadly, an average of 18 people die a day before getting their second chance due to a lack of organs.

During the month of April, individuals, organizations and communities are encouraged to support National Donate Life Month and consider the need for organ, tissue and eye donations. MHA has worked closely with LifeSource, a federally-designated organization that manages organ and tissue donation in the Upper Midwest, to increase the number of registered donors in the state and to strengthen the culture of donation in Minnesota. As a result, more than 3 million people have registered to be an organ and tissue donor in Minnesota, North Dakota and South Dakota. In addition, hospitals have had great success partnering with LifeSource to honor patients’ end-of-life decisions to donate.

To learn more about how your hospital can get involved with organ and tissue donation, visit the Life Source website. return to top  

More opportunities to attend mental health workforce community forums

Community forums focused on gathering input on the state of Minnesota’s mental health workforce continue to be held around the state. HealthForce Minnesota, in conjunction with Minnesota State Colleges and Universities (MnSCU), is holding these forums to gather information ahead of a statewide mental health workforce summit, scheduled for May 28 at Hennepin Technical College.  

Many MHA members have attended their local forums and taken the opportunity to outline their concerns and ideas about Minnesota’s mental health workforce. MHA members are encouraged to attend upcoming local forums and provide input. HealthForce is seeking specific examples of what barriers exist to recruiting and retaining mental and behavioral health staff, as well as possible solutions to these barriers.  

The scheduled community forums are as follows:  

Visit the HealthForce Minnesota website for more information, or contact Jen McNertney, MHA policy analyst, 651-659-1405. return to top  

Honoring Choices Minnesota sponsoring advanced care planning facilitator certification course

This “must have” advanced care planning (ACP) facilitator training course is offered to interdisciplinary healthcare providers, caregivers, community members, interdisciplinary healthcare students, and other interested individuals. The course is designed for individuals who want to learn how to lead effective in-depth ACP conversations. It utilizes the Respecting Choices® curriculum and certification process to provide the needed skills to lead conversations on future health care wishes and preferences.   

Course objectives:

  • Describe interview skills for basic ACP, planning for adults with chronic, progressive illness and those living in long-term care
  • Demonstrate beginning competency in facilitating basic ACP discussions
  • Demonstrate competency in completing a health care directive
  • List a variety of educational materials and tools available for promoting and assisting with ACP
  • Identify key strategies for community engagement
  • Identify key principles and strategies to develop an effective ACP program

The training takes place Friday, May 9 from 8 a.m. – 4:30 p.m. at the Broadway Ridge Building in Minneapolis. Registration and additional details are available online. CEUs available for nursing and social work. Space is limited so early registration is recommended. return to top