House approves one-month Medicare payment extension

This afternoon the House approved a bill passed by the Senate earlier this month that postpones a 23 percent cut in Medicare physician payments that was scheduled to take effect December 1. The president is expected to sign the bill. The legislation freezes current rates for services provided through December 31, giving Congress additional time to craft a longer-term solution to the formula used to determine Medicare physician payments.

Colorado's rural ambulance services under pressure

Today’s Denver Post highlights ambulance services in several rural counties and how they are trying to address falling revenue and budget cuts while also providing critical emergency services for their communities. Read the article. 

Join the National Summit on Advancing Health through Nursing webcast on November 30

The Colorado Center for Nursing Excellence and AARP invite you to attend a special meeting on Tuesday, November 30 for a facilitated webcast of the National Summit on Advancing Health through Nursing. The meeting will provide more information about the Institute of Medicine and Robert Wood Johnson Foundation recommendations on the “Future of Nursing” and will allow leaders across Colorado to discuss the recommendations and their implications. The program is from 8:00-11:30am and will be held at AARP's Denver office at 303 E. 17th Avenue Suite 510. For more information and to RSVP, contact Wendy Krzeczowski at Wendy@coloradonursingcenter.org or 303.715.0343 x18.

Colorado Health Professions Workforce Policy Collaborative releases 2011 policy agenda

Read and download the recently released 2011 policy recommendations of the Colorado Health Professions Workforce Policy Collaborative. Created in 2008 through support by The Colorado Trust and convened by the Colorado Rural Health Center, the Collaborative brings together a multidisciplinary group of policy leaders, health care providers, educational institutions, economic development, and workforce planning authorities to better understand the complex nature of healthcare workforce policy and to develop and support effective changes. This year’s policy recommendations “Addressing Colorado’s Primary Care Provider Shortage” span across healthcare professions and provide evidence-based and actionable steps that state policymakers can take to ensure Colorado will have the healthcare workforce that it needs.

Senate approves one-month Medicare rate extension

On Thursday, November 18 the U.S. Senate passed a one-month extension of the current Medicare physician payment rates in an effort to avert a 23 percent cut scheduled to take effect Dec. 1. Now the U.S. House must approve the extension, which is intended to give lawmakers additional time to work out a longer-term solution. The House should take up the measure on November 29. Stay tuned for more news and thanks to all who contacted their elected officials last week on this important issue.

Challenges facing Colorado's nurse practitioners

An article in today's Denver Post highlights the challenges that Colorado's advance practice nurses face in being credentialed and reimbursed by insurance companies.

Calls needed to stop looming Medicare cuts

Congress is back in session and needs to act now to avoid a 23 percent Medicare payment cut that is scheduled for December 1 (with another 2 percent cut following on January 1). These cuts will greatly impact rural residents, as there is a larger portion of elderly living in our rural areas already dealing with provider shortages, and rural healthcare providers who are struggling to cover their costs and care for our communities. The American Medical Association (AMA) and the U.S. Health and Human Services Department are supporting a 13-month halt to any cuts while Congress works on creating a more permanent solution to Medicare funding for physicians.

Please consider contacting Senator Udall, Senator Bennett, and your 2010 member of Congress this week and ask them to avoid these Medicare cuts!

Senator Mark Udall: 202-224-5941; 303-650-7820
Senator Michael Bennett: 202-224-5852; 303-455-7600

Representative Diana DeGette: 202-225-4431; 303-844-4988
Representative Jared Polis: 202-225-2161; 303-484-9596
Representative John Salazar: 202-225-4761; 970-245-7107
Representative Betsy Markey: 202-225-4676; 970-221-7110
Representative Doug Lamborn: 202-225-4422; 719-520-0055
Representative Mike Coffman: 202-225-7882; 720-283-9772
Representative Ed Perlmutter: 202-225-2645; 303-274-7944

You can also use the AMA’s Patient Action Network by calling 888-434-6200 (you will need to submit your zip code). Not sure who represents you in Congress? Click here.

Medicare Updates: 2011 OPPS Final Rule, Physician Payments and the SGR

Earlier this month, the Centers for Medicare and Medicaid (CMS) issued final rules updating Medicare policies and rates for 2011, including several changes relating to physician supervision that impact rural providers. Read more about these changes as well as other components of the final rule. Some of the highlights include:

• Delayed the enforcement of supervision requirements for outpatient therapeutic services in both critical access hospitals (CAHs) and small rural hospitals through calendar year 2011
• Changed definition of “immediately available”
• Finalized a proposal for 16 services requiring direct supervision by a physician or non-physician practitioner during an initiation period, followed by ‘general’ supervision for the reminder of the service
• Announcement that CMS will convene a panel in 2012 to review supervision requirements for all outpatient services

While we’re on the topic of Medicare, as Rural Voice readers recall from last week’s post, Medicare physician payments will be cut by 23% beginning December 1 without congressional action. Why so high? In very oversimplified terms, the formula used to determine Medicare payments, the Sustainable Growth Rate (SGR), ties Medicare physician payments to factors related to the overall national economy. Put another way, SGR says the growth in payments per Medicare beneficiary cannot grow more than the economy as a whole…and slower economic growth requires lowering physician payments to control Medicare costs. Reimbursements were cut in 2002 but since that time payment reductions have been postponed (and been accumulating) while SGR remains in place. Many organizations and individuals will be calling on Congress next week to take action to avert these cuts and create a more stable, sustainable method for determining physician payments. Stay tuned for opportunities to contact your congressperson next week to share your concerns about potential Medicare cuts and what they will mean for rural communities and providers. 

Want to learn more about SGR and how Medicare pays physicians? Check out this policy brief by Health Affairs that summarizes the issues and possible solutions.

Share your ideas and priorities on rural public health for Rural Healthy People 2020

Complete a brief, online survey to assist rural health policy makers and researchers in identifying the most important health issues facing rural residents. The project, Rural Healthy People 2020, is designed to identify the most significant preventable threats to the health of rural people and to establish goals for reducing these threats. The survey should take 5-10 minutes to complete and does not require a professional background in health issues.

Rural Healthy People 2020 is an important companion document and resource to Healthy People 2020, a national framework for health and prevention. You can find a good article on the 2020 initiative written by Kim Krisberg in the American Public Health Association's The Nation's Health.

Federal Health Reform Accounts for Less than 5% of Rate Increases in Colorado

In response to speculation about the effects of federal healthcare reform on health insurance premiums in Colorado, the Division of Insurance, lead by Insurance Commissioner Marcy Morrison, conducted an analysis of recent rates and found that “while federal changes have minimally affected premium costs, numerous other factors are more significant across the board”. Read the news release from the Division of Insurance and learn more about factors which are driving healthcare insurance rate increases.

Looking ahead...but not too far

By now most of us have probably learned about the outcomes of yesterday’s election. In Washington, the House of Representatives will be Republican-controlled beginning January 2011 and Democrats will have a narrower margin in the U.S. Senate. Colorado voters will send Michael Bennett (D) back to the Senate for another term. Re-elected Representatives Mike Coffman (R), Diana DeGette (D), Doug Lamborn (R), Ed Perlmutter (D), and Jared Polis (D) will be joined in January by the newly elected Cory Gardner (R) and Scott Tipton (R).

But there’s work left to be done this year in Washington. Lawmakers will return to D.C. later this month for a post-election “lame duck” session and they will have a lot on their plates. On the agenda are spending bills for most government programs (including important rural and workforce provisions) and addressing a 23.6% Medicare payment cut for physicians that is scheduled to begin on December 1. National organizations are already mobilizing and we will keep you informed of opportunities to contact your member of Congress about these important healthcare issues.  

Back here in Colorado, voters rejected several tax cutting initiatives including Amendment 60, 61, and Proposition 101 as well as Amendment 63. Republicans appear to have taken a majority in the State House, the Democrats have maintained their majority in the State Senate, and John Hickenlooper (D) is the Governor-elect. With our state facing significant revenue shortfalls, FY 2011-12 budget briefings and hearings are scheduled to begin later this month.

Read a complete list of Colorado’s election results. And thanks for voting!

Governor Ritter’s FY2011-12 proposed budget released

In the midst of election activities (more to come on that later), Governor Ritter released his proposed budget plan for fiscal year 2011-2012.  Addressing a shortfall of over $714 million, the proposal includes targeted reductions in Medicaid and Children’s Basic Health Plan (CHP+), payment delays for Medicaid providers, and also a reduction in scheduled provider fee payments to hospitals. No direct cuts to Medicaid provider rates were proposed, however the payment delays and other proposed reductions will negatively impact Medicaid providers. This proposal is not yet final, as the Legislature and Governor-elect John Hickenlooper can make changes to the budget. CRHC will continue to monitor the budget process for opportunities to advocate on behalf of rural healthcare and share updates as they unfold. I welcome your feedback on budget issues—send me an email at ss@coruralhealth.org.