Legal challenge issued in response to Governor Ritter’s CRNA opt-out

The Denver Post featured an article today about the Colorado Society of Anesthesiologists and the Colorado Medical Society filing a suit in Denver District Court on Tuesday, September 28 to block Governor Ritter’s decision to opt-out of the certified registered nurse anesthetist Medicare supervision requirement in rural and Critical Access Hospitals. 

Colorado awarded over $6.7 million to strengthen healthcare workforce

Congratulations to the Colorado recipients of recently-announced HHS grant awards to expand and support the state's healthcare workforce. Below is a listing of Colorado grantees, programs, and amounts awarded.

Expansion of Physician Assistant Training Program

University of Colorado Denver – Aurora: $855,360

State of Colorado for Red Rocks Community College – Lakewood: $399,495

Nurse Managed Health Clinics

University of Colorado Denver – Aurora: $1,498,206

Primary Care Residency Expansion

Regents of the University of Colorado – Aurora: $1,920,000

University of Colorado Denver – Aurora: $1,920,000

State Health Care Workforce Grants: Planning

Colorado Department of Public Health and Environment – Denver: $150,000

Governor Ritter Signs Opt-Out for CRNA Supervision

Today Governor Ritter took an important step in preserving and improving access to quality, safe, and affordable healthcare services in Colorado by opting-out of the certified registered nurse anesthetist (CRNA) Medicare supervision requirement in rural and Critical Access Hospitals. Read the Governor's press release.

CRHC has long supported the opt-out of the Medicare requirement for CRNAs to be directly supervised by the attending physician, dentist or podiatrist, which adds another barrier to accessing healthcare for rural residents. Opting-out also gives hospitals the flexibility to structure their anesthesia services around the needs of their communities and patients. With today’s action, Colorado joins 15 other states that have already opted-out of this requirement. CRHC applauds Governor Ritter for helping increase access to care for rural Coloradans. Thanks to everyone who took action in support of this important issue.

Getting Started...

Hello from CRHC's new Policy Analyst! A big thanks goes to Terri Hurst for her expert guidance and leadership in this role and I wish her well in her new position.

A little bit about myself...I came to CRHC in May as a recruitment coordinator with Colorado Provider Recruitment, assisting rural and underserved communities in recruiting and retaining healthcare professionals. Prior to relocating to Colorado with my family and joining CRHC, I worked in managed care and program planning at the University of Chicago Medical Center and earned my Master’s Degree in health administration and policy from the University of Chicago. I also served as policy/advocacy coordinator for several years with the AIDS Foundation of Chicago.

I welcome your feedback and input on The Rural Voice and look forward to working with you to ensure that every Coloradan has access to quality healthcare services. We have much to do in the year ahead and I'm excited to get started!

Are Rural Health Clinics Part of the Rural Safety Net?

A report that highlights the importance of Rural Health Clinics (RHCs) to the healthcare safety net was just released today. Published by the Maine Rural Health Research Center, this policy breif entitled, Are Rural Health Clinics Part of the Rural Safety Net? highlights the importance of RHCs in providing primary care services in rural areas. In particular, in communities without a Community Health Center (CHC), RHCs provide a majority of care to those insured by Medicaid & CHP. The report also highlights the lack of funding and resources for RHCs, as they have been left out of funding from both the stimulus bill and federal health reform. While there are measures in the federal health reform law to incentivize RHCs to collaborate with CHCs, RHCs in and of themselves have been largely overlooked as part of the healthcare safety net. Read the full report by clicking HERE.

September Revenue Forecast

The September Revenue Forecast was released today by both the Office of State Planning & Budgeting and the Colorado Legislative Council Staff. While the numbers vary slightly in both of the forecasts, one thing is certain.......Colorado state services will continue to experience cuts as the state is facing a shortfall from projected revenue. For our current fiscal year, FY10-11, Colorado is upwards of $257 million short, which means future cuts are on the horizon. The cuts may not tally as high as $257 million as there are many factors at play, though $257 million appears to be the ceiling, at least for now. For FY11-12, which doesn't even start until July 1, 2011, and for which the budget hasn't even been created yet; the state is expected to be upwards of $1.1 billion short. FY11-12 is going to be tough fiscally for the state as federal assistance through the stimulus package & FMAP extension will not be available anymore.

The next budget revenue forecast will be released in December. Even though it's only September, my wish for the upcoming holiday season (and next revenue forecast) is that our state does not have to continue cutting an already meager budget.

CRHC Opposes Amendment 63!

Coloradans will have 9 state ballot measures to vote on this November. CRHC has already taken a position of opposition and urges you to vote no on Amendment 60, Amendment 61, and Proposition 101. These anti-tax measures would end state funding for public schools, diminish funding for EMTS services, and basically stop any future infrastructure (roads, bridges, schools, etc) from happening. For more information on these measures, please visit Don't Hurt Colorado.

CRHC has now officially taken a position of opposition on Amendment 63, which is entitled Health Care Choice. This amendment would amend the state constitution to block Colorado from adopting federal legislation passed earlier this year through the Patient Protection and Affordable Care Act to require all U.S. citizens to get health insurance coverage. CRHC does not believe that a constitutional amendment is the appropriate solution to this issue. Colorado's constitution is four times longer than the U.S. Constitution and adding an amendment like Amendment 63 will not actually impact or override the federal law. CRHC has not taken a position of opposition or support regarding the individual insurance coverage mandate, but urges you to vote NO on Amendment 63 as it is not a substantive and constructive alternative!!!

The Colorado Legislative Council has published The Blue Book, where you can read each of the ballot initiatives, read the pros & cons of each side, and educate yourself on these issues prior to arriving at the voting booth in November. CRHC will be posting more information about these ballot measures and more as we get closer to the elections. Stay tuned......

My Aloha from CRHC......

It is with much sadness and excitement that this issue of The Rural Voice will be the last that is published by yours truly. After two and a half years, I am leaving CRHC and will be the Director of Public Policy at the Colorado Behavioral Healthcare Council. It has been an absolute pleasure working at CRHC and for all of you, as we have worked hard to improve access to healthcare services for those who call rural Colorado home. CRHC will continue to be the voice for rural Colorado to ensure that every Coloradan has access to quality healthcare services.

If you need further assistance or have any policy questions, please contact Cari Fouts, Director of Communication & Development, at cf@coruralhealth.org

Denver Post Supports CRNA Opt-Out

The Denver Post published an editorial today that supports Colorado opting-out of the CRNA Medicare supervision requirement. My previous two blog posts provide more information on this issue and I encourage you to read them if you are not familiar with this issue. In the meantime, we are anxiously awaiting Governor Ritter's decision, which will hopefully come in the next week or so.

NY Times Editorial: Who Should Provide Anesthesia Care?

Is this perfect timing or what!? The New York Times featured an editorial yesterday discussing the Certified Registered Nurse Anesthetist (CRNA) supervision opt-out issue (see my Sept. 2nd post for more information). The editorial highlights two reports that have concluded patient safety and quality has not been compromised in the 14 states that have opted-out of the Medicare supervision requirement (California chose to opt-out last year, making it 15 states altogether). In fact using CRNA's to deliver anesthsia services is more cost-effective and is a more feasible option for rural hospitals.

Let's hope Governor Ritter makes Colorado the 16th state to opt-out.

Urge Governor Ritter to Improve Access to Healthcare Services in Rural Colorado!

Governor Ritter needs to hear from you about opting-out of the certified registered nurse anesthetist (CRNA) Medicare supervision requirement. As you know, CRHC has long supported the opt-out of the Medicare requirement for CRNAs to be directly supervised by the attending physician, dentist or podiatrist, which adds another barrier for rural residents in accessing quality healthcare services. A recent study published in Health Affaris showed that there was no diminished quality of care or threat to patient safety in the 14 states (2005) that had opted-out of the supervision requirement. In fact, the study recommends that CRNA's in every state be allowed to work without the supervision requirement. As of July 2009, 15 states had chosen to opt-out of the supervision requirement.

Recently, both the state Board of Nursing and the Colorado Medical Board voted on and supported the CRNA opt-out. Both respective entities stated that opting-out is consistent with the Nurse Practice Act and the Medical Practice Act. It is now up to Governor Ritter to submit a letter to the Center for Medicare & Medicaid Services (CMS) requesting Colorado be exempted from the supervision requirement.

If you have minute, please call the Governor at (303) 866-2471 and urge him to opt-out of the CRNA supervision requirement.

There are 42 rural hospitals in Colorado. Of those 4 do not provide anesthesia services at all. Of the remaining 38 that provide anesthesia services:
• 5 provide anesthesia services using physician anesthesiologists ONLY
• 9 provide anesthesia services using a combination of part time anesthesiologists and part time CRNAs
• 24 provide anesthesia services using CRNA’s ONLY and do not have anesthesiologists on staff.

Opting-out of CRNA supervision will not harm patient safety. It will not diminish the need for physicians and anesthesiologists in the healthcare arena. It WILL help increase access to care for the 700,000 plus residents of our state that call rural Colorado home. Tell Governor Ritter to increase healthcare access for rural residents by opting-out of the CRNA supervision requirement!

Rural Community Hospital Demonstration Program

Health & Human Services Secretary Kathleen Sebelius has announced the expansion of the Rural Community Hospital Demonstration Program. The Demonstration Program began in 2005 as per the Medicare Modernization Act. The pilot originally funded 13 hospitals that were located in 8 sparsely populated states. There are currently ten hospitals still participating in the program. With the passage of the Affordable Care Act, 20 additional hospitals (in 20 additional states, which includes Colorado) may be eligible to participate in the Program. In order for a hospital to be eligible to apply and participate in the Program they must be located in a rural area, have fewer than 51 acute care beds, provide 24-hour emergency care, and not be eligible for nor currently be designated as a Critical Access Hospital. Approximately 3 hospitals in Colorado may have the potential to apply to participate in this Program.

The Demonstration Program tests the feasibility and advisability of providing reasonable cost reimbursement for small rural hospitals. Hospitals selected for participation in the Program will receive payment for inpatient services, with the exclusion of services furnished in a psychiatric or rehabilitation unit that is a distinct part of the hospital, using the following rules:
1. Reasonable cost for covered inpatient services, for discharges occurring in the first cost reporting period on or after the implementation of the program;
2. For subsequent cost reporting periods, the lesser amount of reasonable cost or the previous year’s amount updated by the inpatient prospective payment update factor for that particular cost reporting period.

Mental Health First Aid for Suicide Prevention Webcast 9.10

Did you know that the rate of suicide among rural men is significantly higher than urban men? The rate of suicide among rural women has also been increasing the past few years and research has shown that rural residents are more successful in their suicide attempts due to the prevelance of the use of guns. Join the National Council for Community Behavioral Healthcare on World Suicide Prevention Day for a Mental Health First Aid webinar geared toward suicide prevention on Friday, September 10th from 11a - 12p MST. Learn how you can recognize the symptoms and risk factors that can lead to suicide and tools that can be used to help prevent suicide from happening.

Open Meeting 9.14: CoverColorado Provider Fee Schedule Meeting

CoverColorado, one of Colorado's high risk insurance pools, is restructuring its fee schedule for providers. CoverColorado currently insures approximately 12,000 Coloradans who are unable to obtain insurance from other avenues. In order to ease some of the financial strain CoverColorado has been experiencing, legislation was passed during the 2010 session that allows CoverColorado to create a new fee schedule for reimbursing providers who provide services to those insured through CoverColorado.

CoverColorado is seeking input from providers in regards to the new fee schedule. A meeting is scheduled for Tuesday, September 14th from 4-6pm at the Molly Blank Auditorium at National Jewish Hospital in Denver. Interested individuals who cannot attend the meeting in person may also submit written comments to sbgamble@covercolorado.org.

Please visit the highlighted links for more information on CoverColorado or the Public Meeting set for September 14th.