Jube 2020, Volume XXXIV, Number 3

  CAPSULES

State updates law on prior authorization

A bill modifying the utilization review and prior authorization requirements used by Minnesota’s health insurance companies to medically manage health care benefits has been signed into law by Gov. Tim Walz. The revised Chapter 114 (https://tinyurl.com/hcn-chapter-114) follows passage of House File 3398, authored by Rep. Kelly Morrison, MD, and Senate File 3204, authored by Sen. Julie Rosen.

Most sections of the new law are effective Jan. 1, 2021. Highlights:

  • Standard review authorizing decisions will be due within five business days for electronic submissions and six business days for paper submissions (previously 10 business days). Expedited review decisions will be due within 48 hours, including at least one business day (previously 72 hours). Standard review determination on all requests for utilization review must be communicated to the provider and enrollee within five days for requests received electronically or within six days for requests received nonelectronically (previously 10 days).
  • Utilization review organizations will not be able to revoke or change a prior authorization, unless there is evidence that the prior authorization was authorized based on fraud or misinformation or a previously approved prior authorization conflicts with state or federal law. Application of a deductible, coinsurance, or other cost-sharing requirement does not constitute a limit, condition, or restriction.
  • The new law also requires the review to be done by a physician within the same or similar specialty; online posting of prior authorization criteria; a 45-day notice of all new prior authorization requirements; a continuity of care of 60 days if the individual changes health plans; and an annual posting on the health plans’ public website of the number of prior authorizations that were authorized or denied.

For a summary of the issues and recent legislative history, see “Prior authorization: We need a better law” by Sheldon Berkowitz, MD, FAAP in the April 2020 edition of Minnesota Physician: https://tinyurl.com/mp-berkowitz.

Reports show continued disparities in health care

MN Community Measurement (MNCM) has released two new reports highlighting disparities in health care quality in Minnesota.

The reports examine disparities in quality measures for preventive care and care for chronic conditions such diabetes, heart disease, and depression. MNCM expressed concerns that disruptions to health care services and access will affect future health for groups that are already at risk for worse outcomes.

“2019 Minnesota Health Care Disparities by Insurance Type” examines differences in nine quality indicators between patients covered by Minnesota Health Care Programs (MHCP) managed care plans and other types of health insurance. Although large gaps exist between quality measures for MHCP enrollees and other types of insurance, performance improved in 2019 for six of the nine measures included in the analysis. In addition, the gap between MCHP and other insurance types has narrowed over time for seven of the nine measures, but the report documents wide disparities by race and ethnicity within MHCP, especially for American Indian/Alaska Natives and for Black/African American MHCP enrollees.

There is significant variation across health care providers in quality measures for MHCP enrollees. The report recognizes eight medical groups that achieved performance above the MHCP average on at least five of the nine measures included in the report: Allina Health, Essentia Health, Fairview Health Services, HealthEast Clinics, HealthPartners Clinics, Lakewood Health System, Mankato Clinic, and Park Nicollet Health Services.

“Minnesota Health Care Disparities by Race, Ethnicity, Language and Country of Origin” analyzes disparities in quality measures for colorectal cancer screening, diabetes, vascular care, asthma, and depression. It includes summary information on separate components of the diabetes and vascular care measures, and more in-depth analysis within race/ethnicity/language/country of origin categories (for example, combinations of race and language or race and sex).

Across all measures included in the report, American Indian/Alaska Native, Black/African American, and Hispanic Minnesotans experienced the largest disparities. Results by language and country of origin are more mixed, with non-English speaking patients and patients born outside of the U.S. sometimes experiencing better outcomes.

Stay-at-home orders may decrease COVID-19 hospitalizations

New research from the University of Minnesota’s Carlson School of Management illustrates an association between the implementation of statewide stay-at-home orders and a reduction in the number of people hospitalized for COVID-19.

The research, published in JAMA, analyzed hospitalization rates before and after stay-at-home orders were issued in Colorado, Minnesota, Ohio, and Virginia.

“What we found is that about 12 days after the stay-at-home order was implemented, the growth in hospitalizations began to deviate favorably from the initial, projected trajectory,” said Soumya Sen, PhD, MS, associate professor in the Carlson School and the study’s lead author. “In all the states we examined, growth in the total number of patients being hospitalized due to COVID-19 symptoms appeared to slow down from the initial, exponential trend.”

The four states examined were the only states that met the study criteria:

  • Issuance of a statewide stay-at-home order;
  • At least seven consecutive days of cumulative hospitalization data for COVID-19 patients (i.e., those currently hospitalized and those released) before the stay-at-home order was implemented; and
  • At least 17 days of cumulative hospitalization data following the order date.

Researchers estimated how many total Minnesota hospitalizations might have occurred if the initial growth trend continued in the absence of a stay-at-home order. By April 13, 2020, five days after the end of the incubation period, projected hospitalizations were 988 while the actual hospitalizations were 361. Similar results were found in the other states.

A variety of additional factors may have contributed to the slowing hospitalization rate, including a declaration of national emergency; school closures; a growing, general awareness about social distancing; and good hand hygiene practices. However, some of these measures were already in place before the study’s designated period.

Essentia Health trims staff due to pandemic

Some 900 Essentia employees—about 6% of the health care system’s workforce—will be laid off due to the financial impacts of the COVID-19 pandemic. Essentia will continue to provide health insurance for non-contract employees for the next three months. Staff covered by collective bargaining agreements have other protections, including the right of recall. Additionally, there are about 850 Essentia colleagues on administrative leave with benefits through July 31, with the intention of being called back to work as needed.

Minnesota hospitals and health systems expect to lose almost $3 billion in the first three months responding to COVID-19. In Essentia’s case, operational losses due to pandemic-related declines in patient volumes since the beginning of March have totaled nearly $100 million, with more losses on the horizon.

To offset its significant decline in revenue while prioritizing patient and staff safety, Essentia has placed some employees on administrative leave, offered flexible hours, reduced physician and executive leader compensation, restructured and eliminated leadership roles, limited capital expenditures, and reduced services and discretionary spending.

“Despite our best efforts, the many cost-reduction measures we’ve taken over the last several weeks are not sufficient to preserve our mission and the health of the organization,” Essentia Health CEO David C. Herman, MD, said in a message posted at the Essentia website. “This has prompted our leadership team to carefully consider the most difficult decision we’ve faced.”

State’s COVID-19 cases in skilled nursing facilities lower than national average, data shows

Minnesota’s rates of COVID-19 cases and deaths in skilled nursing facilities are lower than the national average, according to a state-by-state comparison from the Centers for Medicare and Medicaid Services (CMS) presented by Minnesota Department of Health (MDH) Commissioner Jan Malcolm before a recent House Health and Human Services Finance Division hearing.

The CMS data shows the national rate of COVID-19 cases at 62 per 1,000 residents in skilled nursing facilities, compared to 39.9 cases per 1,000 residents in Minnesota. Across the nation, deaths total 27.5 per 1,000 skilled nursing residents, compared to 12.7 in Minnesota.

Previous reports issued by MDH and reported in the media included all senior congregate living settings, not just skilled nursing facilities. Case rates and death rates are higher when these additional types of facilities are included. Larger facility sizes and higher prevalence rates within a county are primary drivers of higher infection rates, according to national studies.

In her presentation, Malcolm updated legislators on progress in COVID-19 testing of long-term care residents and workers, efforts to provide PPE to long-term care settings, and onsite visits to provide technical support addressing infection control improvements.

Malcom also discussed hospital discharges and transfers to long-term care. “We are not aware of any facilities whose outbreak started because they accepted a COVID positive patient from a hospital,” she said. “It is much more likely transmission from workers and others coming and going from facilities.” 

 

  Medicus

Timothy A. Lander, MD, is the new medical director for the ENT and facial plastic surgery program at Children’s Minnesota. Dr. Landers had previously served as vice chief of surgery and as a member at large on the credentials committee. He is an assistant professor of pediatric otolaryngology at the University of Minnesota.

 

St. Luke’s Advanced Wound Care & Hyperbaric Center, directed by Tania McVean, has received the President’s Circle award from Healogics. The award cited exceptional clinical outcomes for 12 consecutive months, patient satisfaction higher than 92 percent, and a minimum wound healing rate of at least 91 percent within 28 median days.

 

David Boulware, MD, professor of medicine at the University of Minnesota, recently led the nation’s first randomized trial testing the effectiveness of hydroxychloroquine in preventing COVID-19. The study showed little difference between those who took hydroxychloroquine and a comparison group who took only folic acid vitamins.

 

Steve Wigginton has joined NovuHealth, succeeding company co-founder Tom Wicka, who will move to the role of executive chairman. Before joining the health care industry consumer engagement company, Wigginton had served in leadership roles in both payer and provider markets, including Sutter Health|Aetna,

Scott Stayner, MD, has joined Nura Pain Clinic. Board-certified in anesthesiology and pain management, he previously served as a member of the Montana Medical Association’s committee addressing the state’s opioid crisis, educating primary care physicians on best practices for managing chronic pain, as well as the role of opioid medications. Dr. Stayner has published book chapters and journal articles on safe practices for opioid prescribing.  

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  CAPSULES

State updates law on prior authorization

A bill modifying the utilization review and prior authorization requirements used by Minnesota’s health insurance companies to medically manage health care benefits has been signed into law by Gov. Tim Walz. The revised Chapter 114 (https://tinyurl.com/hcn-chapter-114) follows passage of House File 3398, authored by Rep. Kelly Morrison, MD, and Senate File 3204, authored by Sen. Julie Rosen.

Most sections of the new law are effective Jan. 1, 2021. Highlights:

  • Standard review authorizing decisions will be due within five business days for electronic submissions and six business days for paper submissions (previously 10 business days). Expedited review decisions will be due within 48 hours, including at least one business day (previously 72 hours). Standard review determination on all requests for utilization review must be communicated to the provider and enrollee within five days for requests received electronically or within six days for requests received nonelectronically (previously 10 days).
  • Utilization review organizations will not be able to revoke or change a prior authorization, unless there is evidence that the prior authorization was authorized based on fraud or misinformation or a previously approved prior authorization conflicts with state or federal law. Application of a deductible, coinsurance, or other cost-sharing requirement does not constitute a limit, condition, or restriction.
  • The new law also requires the review to be done by a physician within the same or similar specialty; online posting of prior authorization criteria; a 45-day notice of all new prior authorization requirements; a continuity of care of 60 days if the individual changes health plans; and an annual posting on the health plans’ public website of the number of prior authorizations that were authorized or denied.

For a summary of the issues and recent legislative history, see “Prior authorization: We need a better law” by Sheldon Berkowitz, MD, FAAP in the April 2020 edition of Minnesota Physician: https://tinyurl.com/mp-berkowitz.

Reports show continued disparities in health care

MN Community Measurement (MNCM) has released two new reports highlighting disparities in health care quality in Minnesota.

The reports examine disparities in quality measures for preventive care and care for chronic conditions such diabetes, heart disease, and depression. MNCM expressed concerns that disruptions to health care services and access will affect future health for groups that are already at risk for worse outcomes.

“2019 Minnesota Health Care Disparities by Insurance Type” examines differences in nine quality indicators between patients covered by Minnesota Health Care Programs (MHCP) managed care plans and other types of health insurance. Although large gaps exist between quality measures for MHCP enrollees and other types of insurance, performance improved in 2019 for six of the nine measures included in the analysis. In addition, the gap between MCHP and other insurance types has narrowed over time for seven of the nine measures, but the report documents wide disparities by race and ethnicity within MHCP, especially for American Indian/Alaska Natives and for Black/African American MHCP enrollees.

There is significant variation across health care providers in quality measures for MHCP enrollees. The report recognizes eight medical groups that achieved performance above the MHCP average on at least five of the nine measures included in the report: Allina Health, Essentia Health, Fairview Health Services, HealthEast Clinics, HealthPartners Clinics, Lakewood Health System, Mankato Clinic, and Park Nicollet Health Services.

“Minnesota Health Care Disparities by Race, Ethnicity, Language and Country of Origin” analyzes disparities in quality measures for colorectal cancer screening, diabetes, vascular care, asthma, and depression. It includes summary information on separate components of the diabetes and vascular care measures, and more in-depth analysis within race/ethnicity/language/country of origin categories (for example, combinations of race and language or race and sex).

Across all measures included in the report, American Indian/Alaska Native, Black/African American, and Hispanic Minnesotans experienced the largest disparities. Results by language and country of origin are more mixed, with non-English speaking patients and patients born outside of the U.S. sometimes experiencing better outcomes.

Stay-at-home orders may decrease COVID-19 hospitalizations

New research from the University of Minnesota’s Carlson School of Management illustrates an association between the implementation of statewide stay-at-home orders and a reduction in the number of people hospitalized for COVID-19.

The research, published in JAMA, analyzed hospitalization rates before and after stay-at-home orders were issued in Colorado, Minnesota, Ohio, and Virginia.

“What we found is that about 12 days after the stay-at-home order was implemented, the growth in hospitalizations began to deviate favorably from the initial, projected trajectory,” said Soumya Sen, PhD, MS, associate professor in the Carlson School and the study’s lead author. “In all the states we examined, growth in the total number of patients being hospitalized due to COVID-19 symptoms appeared to slow down from the initial, exponential trend.”

The four states examined were the only states that met the study criteria:

  • Issuance of a statewide stay-at-home order;
  • At least seven consecutive days of cumulative hospitalization data for COVID-19 patients (i.e., those currently hospitalized and those released) before the stay-at-home order was implemented; and
  • At least 17 days of cumulative hospitalization data following the order date.

Researchers estimated how many total Minnesota hospitalizations might have occurred if the initial growth trend continued in the absence of a stay-at-home order. By April 13, 2020, five days after the end of the incubation period, projected hospitalizations were 988 while the actual hospitalizations were 361. Similar results were found in the other states.

A variety of additional factors may have contributed to the slowing hospitalization rate, including a declaration of national emergency; school closures; a growing, general awareness about social distancing; and good hand hygiene practices. However, some of these measures were already in place before the study’s designated period.

Essentia Health trims staff due to pandemic

Some 900 Essentia employees—about 6% of the health care system’s workforce—will be laid off due to the financial impacts of the COVID-19 pandemic. Essentia will continue to provide health insurance for non-contract employees for the next three months. Staff covered by collective bargaining agreements have other protections, including the right of recall. Additionally, there are about 850 Essentia colleagues on administrative leave with benefits through July 31, with the intention of being called back to work as needed.

Minnesota hospitals and health systems expect to lose almost $3 billion in the first three months responding to COVID-19. In Essentia’s case, operational losses due to pandemic-related declines in patient volumes since the beginning of March have totaled nearly $100 million, with more losses on the horizon.

To offset its significant decline in revenue while prioritizing patient and staff safety, Essentia has placed some employees on administrative leave, offered flexible hours, reduced physician and executive leader compensation, restructured and eliminated leadership roles, limited capital expenditures, and reduced services and discretionary spending.

“Despite our best efforts, the many cost-reduction measures we’ve taken over the last several weeks are not sufficient to preserve our mission and the health of the organization,” Essentia Health CEO David C. Herman, MD, said in a message posted at the Essentia website. “This has prompted our leadership team to carefully consider the most difficult decision we’ve faced.”

State’s COVID-19 cases in skilled nursing facilities lower than national average, data shows

Minnesota’s rates of COVID-19 cases and deaths in skilled nursing facilities are lower than the national average, according to a state-by-state comparison from the Centers for Medicare and Medicaid Services (CMS) presented by Minnesota Department of Health (MDH) Commissioner Jan Malcolm before a recent House Health and Human Services Finance Division hearing.

The CMS data shows the national rate of COVID-19 cases at 62 per 1,000 residents in skilled nursing facilities, compared to 39.9 cases per 1,000 residents in Minnesota. Across the nation, deaths total 27.5 per 1,000 skilled nursing residents, compared to 12.7 in Minnesota.

Previous reports issued by MDH and reported in the media included all senior congregate living settings, not just skilled nursing facilities. Case rates and death rates are higher when these additional types of facilities are included. Larger facility sizes and higher prevalence rates within a county are primary drivers of higher infection rates, according to national studies.

In her presentation, Malcolm updated legislators on progress in COVID-19 testing of long-term care residents and workers, efforts to provide PPE to long-term care settings, and onsite visits to provide technical support addressing infection control improvements.

Malcom also discussed hospital discharges and transfers to long-term care. “We are not aware of any facilities whose outbreak started because they accepted a COVID positive patient from a hospital,” she said. “It is much more likely transmission from workers and others coming and going from facilities.” 

 

  Medicus

Timothy A. Lander, MD, is the new medical director for the ENT and facial plastic surgery program at Children’s Minnesota. Dr. Landers had previously served as vice chief of surgery and as a member at large on the credentials committee. He is an assistant professor of pediatric otolaryngology at the University of Minnesota.

 

St. Luke’s Advanced Wound Care & Hyperbaric Center, directed by Tania McVean, has received the President’s Circle award from Healogics. The award cited exceptional clinical outcomes for 12 consecutive months, patient satisfaction higher than 92 percent, and a minimum wound healing rate of at least 91 percent within 28 median days.

 

David Boulware, MD, professor of medicine at the University of Minnesota, recently led the nation’s first randomized trial testing the effectiveness of hydroxychloroquine in preventing COVID-19. The study showed little difference between those who took hydroxychloroquine and a comparison group who took only folic acid vitamins.

 

Steve Wigginton has joined NovuHealth, succeeding company co-founder Tom Wicka, who will move to the role of executive chairman. Before joining the health care industry consumer engagement company, Wigginton had served in leadership roles in both payer and provider markets, including Sutter Health|Aetna,

Scott Stayner, MD, has joined Nura Pain Clinic. Board-certified in anesthesiology and pain management, he previously served as a member of the Montana Medical Association’s committee addressing the state’s opioid crisis, educating primary care physicians on best practices for managing chronic pain, as well as the role of opioid medications. Dr. Stayner has published book chapters and journal articles on safe practices for opioid prescribing.  

Malcom also discussed hospital discharges and transfers to long-term care. “We are not aware of any facilities whose outbreak started because they accepted a COVID positive patient from a hospital,” she said. “It is much more likely transmission from workers and others coming and going from facilities.” 

Scott Stayner, MD, has joined Nura Pain Clinic. Board-certified in anesthesiology and pain management, he previously served as a member of the Montana Medical Association’s committee addressing the state’s opioid crisis, educating primary care physicians on best practices for managing chronic pain, as well as the role of opioid medications. Dr. Stayner has published book chapters and journal articles on safe practices for opioid prescribing.