IHA Daily Briefing: April 16
In Today's Issue
Crain’s: Hospital Association Pushes for Prior Authorization Reform
Registration Open: CMS Health Equity Conference
Survey: One and Five Disenrolled from Medicaid in Last Year
CDC: Counterfeit, Mishandled Botox Injections in Nine States
COVID-19 Information
Briefly Noted
Leading the News
Crain’s: Hospital Association Pushes for Prior Authorization Reform
An April 15 Crain’s Health Pulse article highlighted the recent April 11 meeting between IHA, hospital chief medical officers and members of the Medicaid Legislative Working Group. In a media statement shared with Crain’s, IHA said the meeting offered a forum to share patient stories and updates on IHA’s legislative reform package targeting Managed Care Organization (MCO) prior authorization practices, which are negatively impacting access to critical healthcare services for Medicaid patients across Illinois.
Crain’s wrote, “They are advocating for House Bill 4977 and Senate Bill 3372, which permit emergency physicians to admit a patient in need of inpatient care without seeking authorization from the MCO, with inpatient coverage provided for 72 hours.” The news outlet also pointed out IHA’s House Bill 3979 and Senate Bill 3373, “would give doctors and hospitals a ‘gold card’…that would exempt them from the prior authorization process for one year. The gold card determinations would not be provided across the board, but would be based on a previous history of a high percentage of prior authorization approvals.” The article said, “IHA said such measures have been passed in several other states, eliminating delays in patient care and reducing administrative burden on providers.”
A.J. Wilhelmi, IHA’s president and CEO, was quoted in Crain’s, saying, “We are not opposed to appropriate prior authorization practices, but we are opposed to for-profit companies overriding medical decisions that have been made by a doctor in caring for their patient….We are also opposed to clinicians spending more time on administrative paperwork than providing care.”
Crain’s said, “The IHA argues the bills also incentivize MCOs by increasing and expanding reimbursement for stays that are beyond medical necessity,” pointing to IHA’s press statement which emphasized, “Costs can be avoided if MCOs simply authorize post-acute placement requests in a timely manner.”
Virtual Registration Open: CMS Health Equity Conference
Virtual registration for the 2024 Centers for Medicare & Medicaid Services (CMS) Health Equity Conference remains open. The free, hybrid event will take place May 29-30, convening health equity leaders from federal and local agencies, health provider organizations, academia, community-based organizations, and others seeking to sustain health equity through action. Conference attendees will have the opportunity to hear from CMS leadership on recent developments and updates to CMS programs; explore the latest health equity research; discuss promising practices and creative solutions; and collaborate on community engagement strategies.
While CMS has reached capacity for in-person participation, virtual participation is still open. Click here to register for virtual attendance, which includes all keynotes, all plenaries and the ability to join your choice of breakout sessions. Those interested in attending the event at the Hyatt Regency in Bethesda, Maryland can join the in-person waitlist. Click here for additional information about the conference.
Survey: One and Five Disenrolled from Medicaid in Last Year
One in five Medicaid enrollees have been disenrolled, and about a quarter (23%) of those who were disenrolled remain uninsured, since continuous coverage ended last March, according to a recent Kaiser Family Foundation (KFF) report. Of those who were disenrolled, 75% said they were worried about their physical health, 60% were worried about their mental health and 56% said they have skipped or delayed healthcare services or getting prescription medications. The survey found that more than one-third of those who are currently uninsured are trying to get Medicaid coverage, with more than half (54%) citing cost as prohibitive to obtaining coverage from somewhere else. Approximately six in 10 of those who tried to reenroll cited at least one problem during the process, with long call center wait times identified as the most common obstacle. Other problems encountered include not knowing what documents were needed; trying to submit documents and being told they were incomplete, not received, or not processed; or having unreliable internet access to complete forms online.
According to KFF state tracking, more than 20 million people have been disenrolled since the start of the Medicaid unwinding, with states reported renewal outcomes for two-thirds of enrollees. IHA has created a COVID-19 Public Health Emergency sunset webpage that includes numerous resources to assist hospitals with informing patients on Medicaid redeterminations. To view the resource page, click here. To view the Dept. of Healthcare and Family Services Medicaid renewal toolkit, click here.
CDC: Counterfeit, Mishandled Botox Injections in Nine States
In a Centers for Disease Control and Prevention (CDC) update issued yesterday, the CDC reported it continues to collaborate with state and local health departments and the U.S. Food and Drug Administration (FDA) as part of an ongoing investigation into reports of harmful reactions among people who received injections of counterfeit or mishandled botulinum toxin, commonly called “botox.”
As of April 12, a total of 19 people from nine states—including Illinois—have reported harmful reactions after receiving botox injections from unlicensed or untrained individuals or in non-healthcare settings, such as homes and spas. All reports came from people identifying as females, ranging in age from 25 to 59 years, with a median age of 39 years. Eighteen (95%) people reported receiving botulinum toxin injections for cosmetic purposes.
The CDC is recommending healthcare providers consider the possibility of adverse effects from botulinum toxin injection, including for cosmetic reasons, when patients present with signs and symptoms consistent with botulism near the injection site. If systemic botulism is suspected, call your health department immediately for consultation and antitoxin release. If no one answers, contact the CDC clinical botulism service 24/7 at 770-488-7100. Refer to your state or local health department for guidance on reporting adverse effects.
COVID-19 Information
The Illinois Dept. of Public Health (IDPH) has launched a weekly Infectious Respiratory Disease Surveillance Dashboard that will be updated weekly on Friday. This report provides the public with the latest data on hospital visits, seasonal trends, lab test positivity and demographic data.
Click here to visit the IDPH COVID-19 resources webpage. IDPH will continue to report the weekly number of people with COVID-19 admitted to hospitals from emergency departments, deaths and vaccinations, with COVID-19, influenza and respiratory syncytial virus information also reported through the dashboard of the Illinois Wastewater Surveillance System.
Briefly Noted
New data released yesterday by the American Association of Colleges of Nursing (AACN) show that sustaining student enrollment in baccalaureate and graduate programs continues to be a challenge at U.S. schools of nursing. Though enrollment in programs designed to prepare entry-level registered nurses held steady (up 0.3%), fewer students are entering baccalaureate degree-completion, master’s and PhD programs. The organization said that even though enrollments were down across program levels last year, thousands of qualified applications were turned away from four-year colleges and universities. The primary barriers to accepting all qualified students at nursing schools continue to be insufficient clinical placement sites, faculty, preceptors and classroom space, as well as budget cuts.
Hackers leak Change Healthcare contracts, patient data
Becker’s Hospital Review reported (4/15) that, “Hackers leaked contracts and patient records purportedly stolen in the Change Healthcare cyberattack, TechCrunch reported April 15.”
US healthcare's ‘mind-numbing burden’: Advocate CEO
Becker’s Hospital Review reported (4/15) that, “The biggest challenges American health systems face are largely out of their control, according to Eugene Woods, CEO of Charlotte, N.C.-based Advocate Health.”
27 critical access hospitals to know | 2024
Becker’s Hospital Review reported (4/12) that, “Becker's Healthcare is pleased to name 27 critical access hospitals to know. These hospitals are vital components of the overall healthcare delivery system, providing quality care to the residents and visitors of rural areas.”