Five things to know from Phelps Health’s board meeting

Aug. 12--1. Appropriations

Phelps Health's Senior Vice President on Research and Governmental Affairs, Donald James, D.O., briefed the board on the recent legislative session. James highlighted the outcomes of various legislative proposals affecting hospitals and health care. James said there was over 140 health-related bills introduced during the 2019 session.

During the 2019 legislative session, Missouri Gov. Mike Parson signed both budgetary bills, House Bill 11 and House Bill 14. House Bill 11 appropriates funding to support the expected increase in payments to hospitals for Medicaid services in fiscal year 2020, James said. The bill specifically appropriates $20 million in federal and state funding to enhance the use of Admission Discharge Transfer technology by hospitals and health information exchanges.

The Missouri Hospital Association prepared a federal application to earmark $10 million for hospital projects, according to James, using $1 million in hospital provider tax to generate $9 million in federal matching funds under HB 11. The bill further provides $34 million to fund the costs of a planned Medicaid transformation initiative, while HB 14 authorizes $133.5 million in additional funding, including $11 million of general revenue, for unforeseen Medicaid hospital services provided in the current state fiscal year.

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2. Senate Bill 514

Another piece of legislation, which was signed by the Governor, was Senate Bill 514, which modifies provisions relating to health care. In the past, insurers could deny an authorization and not give the physician their clinical reasons. Now, with the passage of SB 514, insurers have to send a written statement of clinical rationale.

Insurance prior authorization under SB 514 defines an insurer's certification of medical appropriateness to include authorization of payment for the services, applies the deadlines for insurers to make and provide notice of utilization review decisions to all determinations and certifications; when they applied only to initial determinations and certifications. The bill also mandates that health insurers electronically post their procedures for addressing a provider's failure or inability to provide information needed for utilization review and prohibits a prior authorization decision from being revoked or restricted within 45 working days of a provider receiving it.

SB 514 further modifies surprise billing, by requiring an out-of-network practitioner to bill the patient's insurer, invoking the billing and payments standards for unanticipated out-of-network treatment created by a 2018 state law. The process had been optional.

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3. Electronic Medical Record System

Following James legislative brief, Phelps Health's Senior Vice President and Chief Operating Officer Jason Shenefield, said Phelps Health's new electronic medical record system's implementation is on target.

The majority of positions needed to begin the implementation of Epic have been filed, and the process of backfilling these positions has begun as many of the Epic positions were filled with internal applicants, Shenefield, said.

The project is on target, and training for the entire Epic team has plans to begin mid-September 2019.

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4. Phelps Health 2019 Mission Lifeline STEMI Award

Phelps Health's board was also presented with good news through an announcement by Senior Vice President and Chief Nursing Officer Keri Brookshire-Heavin, who said that Phelps Health was awarded the 2019 Mission Lifeline STEMI Silver Achievement Award from the American Heart Association.

The award is based on the quality and patient safety of Phelps Health's STEMI program, Brookshire-Heavin said. The American Heart Association looks at outcomes such as the amount of time elapsed from when a patient arrives at Phelps Health to the time when the patient receives intervention or treatment with medications, and the education and counseling Phelps Health staff provides its patients.

Phelps Health's emergency room staff can get someone who walks in the door with an acute time critical heart attack on a helicopter and up in the air in less than 30 minutes, Brookshire-Heavin said.

The Silver Award recognizes the treatment of a specific volume of patients, and Phelps Health has met the criteria for the last two quarters, Brookshire-Heavin said, and as the cardiology department continues to grow and meet these indicators, Phelps Health will progress to the Gold Level within a couple quarters.

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5. Time Critical Diagnosis STEMI Program

Brookshire-Heavin also gave an update on the July 16 Time Critical Diagnosis STEMI program certification survey. The survey team consisted of four surveyors, an emergency department medical director from Barnes Jewish Hospital, an interventional cardiologist, a registered nurse and a state surveyor.

The survey went well with the program receiving high praise from the survey team, Brookshire-Heavin said. The Phelps Health Time Critical Diagnosis Team is led by the Time Critical Diagnosis and Staff Development Coordinator Suzanne Weckman and the STEMI Medical Director James Spadaro.

"We could not achieve these high results without the support of our physicians, nurses and support staff," Brookshire-Heavin said. "These individuals work diligently to consistently improve the care we provide at Phelps Health."

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