President's ReportPhysician RecruitmentNDHA Holiday Office ClosuresMedicare-Medicaid ACO Model Joins Growing Number of State- Based Efforts to Improve Quality of Care, Lower CostsCMS Releases 2nd Year of Home Health Utilization and Payment DataAHRQ National Scorecard: Hospital- Acquired Conditions Drop 21 Percent Over a Five Year Period

Click on link to view attachments:https://www.ndha.org/resources/publications/Burgum Cabinet AppointmentsStroke Task Force

Phone: 701-224-9732Fax: 701-224-9529Web Site: www.ndha.org

Jerry Jurena, PresidentTim Blasl, Vice PresidentCallen Cermak, Finance ManagerLori Schmautz, Executive AssistantPam Cook, Education DirectorMelissa Hauer, General Counsel

A portion of this publication is supported by The Center for Rural Health’s Medicare Rural Hospital Flexibility Program. Visit their site at http://rural-health.und.edu/projects/flex/.

The InformerPresident’s Report ~ Jerry JurenaIn This Edition:

Attachments:

NDHA Contacts

December 16, 2016

Governor Burgum takes office: On Thursday Doug Burgum assumed the office of the Governor of North Dakota. He has stated numerous times he wants to re-invent the state government. He has stated if you come asking for money the meeting will be short; if you have an idea on improving the delivery of services there will always be time for a meeting. Below are some changes to staffing made this week:

• Governor Burgum announced he will create roles for chief operating officer and chief administrative officer, which will be filled by Jodi Uecker and JoDee Hanson, respectively. - Hanson will oversee communications, office operations, the policy team, constituent services and boards and commissions.• Ron Rauschenberger, who has served as chief of staff for Govs. John Hoeven and Jack Dalrymple, “will serve as senior adviser to ... Burgum during a transition period,” • Bismarck attorney Leslie Bakken Oliver will be Burgum’s general counsel.• Other announcemnets: - Rebecca Ternes will be director of agency operations. - Robert Lauf will work as a policy adviser. - Levi Bachmeier will serve as a policy adviser. - Cassandra Torstenson will be a policy adviser. - Justin Schulz will be Burgum’s executive assistant. - Jill Schwab will serve as Burgum’s scheduler. - Research analyst Jason Nisbet. - Shelley Haugen in constituent services. - Lyndsay Witt, the executive assistant to the lieutenant governor, will continue to serve in the governor’s office.

Attached is also a summary of Cabinet appointments made earlier.

Board meeting: On Wednesday we held the final Board meeting for 2016. The fo-cus of the meeting was to have Brady Martz present the Audited report for our fiscal year completed on September 30th. There were no major findings or deficiencies. The Board also elected the Chair for this fiscal year, Dr. Craig Lambrecht and elected the Chair elect Keith Heuser. The Board also approved the Foundations recommen-dation of re-appointing Pete Antonson of Northwood Deaconess to a second 3 year term. Cody Barnhart of St. Luke’s Medical Center was appointed to the HSIsolutions Board. Alan O’Neil of Unity Medical Center was appointed to full fill the unexpired term of Greg LaFrancois who relocated to Maine.

AHA update: The Board also received updates from Paul Muraca of AHA and from John Flink in DC.

Stroke Task Force: On Thursday the Stroke Task Force met. Currently there are 26 CAHs that are designated as Stroke Ready Hospitals and three that are working on their applications. The task force is working with EMS to develop protocols and transport policies. Hospitals that are not certified as Stroke ready will be by-passed if EMS is transporting a stroke patient. At the meeting we were shown a power point on the quality criteria that is being tracked, I have attached the presentation. If you are interested in learning more about being a Stroke Ready Hospital please contact: Shila Thorson, RN-BC, BSN, State Stroke & Cardiac System CoordinatorND Department of Health, Division of Emergency Medical SystemsPhone: (701)328-4569E-mail: smthorson@nd.gov

New CEO in Harvey: Mike Zwicker is the new CEO at St. Aloisius Hospital in Harvey. His e-mail address is: mzwicker@staloisius.com

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President’s Report continued.....

Legislative Committee: The legislative Committee of NDHA will meet today at the NDHA office. A few of the major agenda items will be:

• Review of legislators and CEO’s by District • NDHA Handouts • State Optional Adjustment Requests (OARS) to the budget • Assault bill • Medical Imaging update • Compacts • Guardianship NDONE: We have added a new communications page for NDONE, it is the Clinical Placements Opportunities page. You can check it out at: https://www.ndha.org/resources/cpo/. The purpose is: • Offer hospitals the opportunity to post openings for students in any health care profession • Post requests for clinical sites for education programs.

Can you help my spouse get into a training program…?

Over the years, many physicians’ candidates have asked, “can you help my spouse get into a training program?” We can help, but the bottom line: medical school graduates matriculate to training programs on their own merits. I think phone calls, letters of recommendation etc. can influence residency review committees, however the competition for these positions is significant and formidable.

The Main Residency Match is a system for the confidential selection of applicants to core residency training programs. The 2015 Match encompassed more than 40,000 applicants, including U.S. allopathic medical school seniors and graduates of osteopathic, Canadian, and foreign medical schools, and more than 29,000 first- and second-year residency positions.

The process begins with an attempt to match an applicant to the program most preferred on that applicant’s rank order list. If the applicant cannot be matched to that first-choice program, an attempt is made to place the applicant into the second-choice program, and so on.

We can try to support their application process to a residency program, however in the end, applicants are placed on their own merits.

NDHA Holiday Office Closures The NDHA office will be closed on Friday, December 23, Monday, December 26, and Monday, January 2 giving staff time to spend the Christmas & New Year Holidays with their family and friends. The office will reopen on Tuesday, December 27 and Tuesday, January 2 at 8:00am central time.

Physician Recruitment ~ Kevin Malee

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Medicare-Medicaid ACO Model Joins Growing Number of State-Based Efforts to Improve Quality of Care, Lower Costs Today, the Centers for Medicare & Medicaid Services (CMS) announced the Medicare-Medicaid Accountable Care Organization (ACO) Model, a new initiative designed to improve the quality of care and lower costs for beneficiaries who are enrolled in both Medicare and Medicaid.

The Medicare-Medicaid ACO Model builds on the current Medicare Shared Savings Program and advances efforts to partner with states in transforming the health care delivery system.

“This model aims to provide improved care coordination for those enrolled in both Medicare and Medicaid, allowing providers to focus more on providing care for their patients rather than administrative work,” said Dr. Patrick Conway, CMS acting principal deputy administrator. “CMS continues to partner with and leverage the best ideas from states to transform our health care system to improve quality and care coordination. In the long run, this partnership will result in healthier people and smarter spending.”

In current Medicare ACO initiatives, beneficiaries who are Medicare-Medicaid enrollees may be attributed to ACOs. However, Medicare ACOs often do not have financial accountability for the Medicaid expenditures for those beneficiaries. The Medicare-Medicaid ACO Model will allow Medicare Shared Savings Program ACOs to take on accountability for the quality of care and both Medicare and Medicaid costs for Medicare-Medicaid enrollees.

CMS is accepting letters of intent from states that wish to work with CMS to design certain state-specific elements of the model. The Medicare-Medicaid ACO Model is open to all states and the District of Columbia that have a sufficient number of Medicare-Medicaid enrollees in fee-for-service Medicare and Medicaid. CMS will enter into participation agreements with up to six states with preference given to states with low Medicare ACO saturation. Once a state is approved to participate in the model, a request for application will be released to ACOs and health care providers in that state.

The Medicare Shared Savings Program and other ACO initiatives were created to change the incentives for how medical care is delivered and paid for in the United States, moving away from a system that rewards the quantity of services to one that rewards the quality of health outcomes. ACOs are groups of doctors, hospitals, and other health care providers who voluntarily come together to develop and execute a plan for a patient’s care and share information, putting the patient at the center of the health care delivery system.

The Affordable Care Act, through the creation of the Center for Medicare and Medicaid Innovation, allows for the testing of in-novative payment and service delivery models, such as the Medicare-Medicaid ACO Model. Today’s announcement is part of the Administration’s broader strategy to improve the health care system by paying providers for what works, unlocking health care data, and finding new ways to coordinate and integrate care to improve quality.

In March 2016, the Administration announced that it met the ambitious goal – eleven months ahead of schedule – of tying an es-timated 30 percent of Medicare payments to quality and value through alternative payment models by 2016. The Administration’s next goal is tying 50 percent of Medicare payments to alternative payment models by 2018. The Health Care Payment Learning and Action Network established in 2015 continues to align efforts between government, private sector payers, employers, providers, and consumers to broadly scale these efforts to achieve better care, smarter spending, and healthier people. Today’s announcement is one in a series of Innovation Center initiatives that will expand opportunities for clinicians to participate in Advanced Alternative Payment Models under MACRA. Our work in developing and expanding new payment models will continue to be guided by the following core principles:

• Supporting innovative payment and service delivery models with strong potential to improve health care quality and lower costs. • Engaging with and listening to consumers, providers, and other stakeholders allowing for open and transparent dialogue, includ-ing through the appropriate use of notice-and-comment rulemaking and ombudsmen. • Evaluating results based on appropriately scoped and sized demonstrations and advancing best practices based on their impact on quality and cost.

We look forward to continuing to work with our many stakeholders to achieve better care for patients, better health for our com-munities, and lower costs through improvement for our health care system.

For more information on the Medicare-Medicaid ACO Model, including a fact sheet, please visit: https://www.cms.gov/News-room/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-12-15-2.html

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AHRQ National Scorecard: Hospital-acquired Conditions Drop 21 Percent Over a Five Year Period The National Scorecard on Rates of Hospital-Acquired Conditions shows that about 125,000 fewer patients died and more than $28 billion in health care costs were saved from 2010 through 2015 due to a 21 percent drop in hospital-acquired conditions (HACs). In total, hospital patients experienced more than 3 million fewer HACs from 2010 through 2015. HACs include adverse drug events, catheter-associated urinary tract infections, central line associated bloodstream infections, pressure ulcers and surgical site infections, among others. Much of the evidence on how to prevent HACs was developed and tested by AHRQ. For example, one of the tools used most frequently by hospitals is AHRQ’s Comprehensive Unit-based Safety Program (CUSP), which is a proven method that combines improvement in safety culture, teamwork and communications with evidence-based practices to prevent harm and make the care patients receive safer.

Read the press release and director’s blog to learn more.

CMS Releases Second Year of Home Health Utilization and Payment Data CMS has posted the second annual release of the Home Health Agency Public Use File (Home Health Agency PUF) with data for 2014. The Home Health Agency PUF presents summarized information on services provided to Medicare beneficiaries by home health agencies. It contains information on utilization, payment (Medicare payment and Medicare standardized payment), submit-ted charges, and demographic and chronic condition indicators organized by CMS Certification Number (6-digit provider identifica-tion number), Home Health Resource Group (HHRG), and state of service.

The new 2014 PUF has information for 10,882 home health agencies (down from 11,062 in 2013), over 6 million claims, and almost $18 billion in Medicare payments for 2014. New in the 2014 data is the demographic and chronic condition information. CMS protects beneficiaries’ personal information in all public data releases.

The updated 2014 data and supplemental information can be accessed at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/HHA.html