The Direct Dispatch
A Newsletter For Healthcare Providers

June 2019

"To accomplish great things, we must not only act, but also dream; not only plan, but also believe."
- Anatole France
Industry News
Moving Forward with Medicaid Expansion

Well, the spring has sprung – literally. In January, Governor Brad Little called on the Legislature to put “spring in our safety net so that there are multiple pathways for the gap population to move off Medicaid and onto private coverage.”

However, by April, instead of the “boing” most were hoping for given the Governor’s plan, Idahoans were left with more of the “sprong” of a stretched-out spring gone awry. Far from the Governor’s desire to not only fulfill the will of the voters but to also to help those in the gap find real, long-term solutions that help them gain private coverage, the Legislature opted for a plan that will create unnecessary issues for Idaho.

With work requirements that restrict eligibility (that have been denied thus far by CMS) as well as other waiver requests that seem unlikely, we are in for a long Spring, Summer and Fall trying to determine what Idaho’s Medicaid expansion will be. Legislators sought to add more bureaucracy and cost to the program than was needed. All of which the Governor expressed concerns over.

When the much amended  Senate Bill 1204  finally came to his desk, Governor Little could have vetoed the bill, but that would have probably generated an even worse version from the Legislature – including a potential outright repeal of Medicaid expansion. He also could have let the bill become law without his signature, but then he essentially would have removed himself from the process on this legislation that certainly needs fixing.

By signing the bill and including a detailed transmittal letter back to the Legislature, he identified the problems in the bill and told the Legislature they needed to be fixed.  

In the meantime, the rest of the year leading up to enrolling 91,000 Idahoans in Medicaid coverage on January 1, 2020 will be about getting the spring recoiled and ready to do what Idaho voters and our Governor envisioned. For hospitals, it means being prepared – prepared to act, prepared to educate, and prepared to serve. A few of the hurdles we’ll be facing together include: more legislative action; being ready for an influx of new patients; and having clarity on how the expanded Medicaid program will look, operate, and be funded.

In the very near term, your Association will, with your help, be focused on the  interim Legislative committee  which will look at the long-term funding of the program. Currently, budget experts have found $18.6 million in annual savings from existing programs toward the total state cost of $42 million per year beginning in 2021. The committee will work to find what additional savings could be generated in the county indigent program and the state’s CAT Fund and how the total $42 million can be appropriated. 

We expect, based on a few shots across the bow via bills introduced that hurt hospitals – including removing tax exemptions  and  implementing a hospital tax  through an assessment – that attacks on hospital are likely to be part of those discussions. 

In anticipation, we are beginning those public discussions by sharing with Idahoans what the impact some of these legislative schemes will have on their local hospitals. A  recent news story highlighted not only a state view of the issue but also a look at several community hospitals. We will work with our members to help develop plans to meet with local legislators to help them understand that increasing the cost of healthcare through assessments or removing exemptions doesn’t bend the cost curve – at least in the direction they want to bend it.

Meanwhile, the Department of Health and Welfare will work on developing the waivers prescribed in the legislation. These are likely to result in lawsuits and/or denials by CMS based on what we’ve seen happen in other states. Additionally, it creates uncertainty for Idahoans in the gap as well as hospitals and providers about who will have coverage in January.

We will keep our members posted on this process, but in the meantime as hospitals prepare for increased demand, the Department has created  this map  which shows the estimated number of new Medicaid enrollees by county based on the “clean” expansion plan Idaho voted for in November.

Spring has sprung. We have a hard sprint ahead of us and will have to be vigilant to get that spring dialed into where it moves us forward, but not over the cliff.

~Brian Whitlock, President/CEO 
Quality Improvement
Heart failure deaths are rising in the US

Heart failure death rates in the United States declined significantly from 1999 through 2012 but then alarmingly increased through 2017, a new paper finds.

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The Leadership, Ownership, Transformation, Unity and Sustainability model, which created a new way of doing patient rounds in the ICU at Robert Wood Johnson University Hospital Hamilton, includes quality metric data assessment, according to a study in the journal Creative Nursing. The model found critical care quality control measures, such as ventilator indicators and antimicrobial stewardship, had not routinely been part of rounds, and that rounding styles varied and affected ICU team communication.
Leadership in Healthcare
For first time, US sees employed physicians outnumber...

The number of employed physicians exceeds self-employed physicians for the first time in the U.S., according to the latest American Medical Association study on physician practice arrangements. The study found that 47.4 percent of all patient...

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Lack of robust data analysis impedes care improvement...

The Renton, Wash.-based integrated health system first analyzed what drove variation across its 51-hospital network and targeted the use of antibiotic-infused bone cement.

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4 Reasons Your Health System Needs a QI-Savvy Board

IHI President Emeritus and Senior Fellow Don Berwick believes that board engagement is essential for health care system transformation. In the following interview, he explains why board education about quality improvement is a worthy investment....

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CMS Releases Proposed TAVR Medicare Coverage Changes -...

On March 26, the Centers for Medicare and Medicaid Services (CMS) released a draft national coverage determination (NCD) governing its TAVR coverage policy for Medicare fee-for-service patients. The proposed coverage includes some familiar...

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