Author Suggests Solution to Doctor Shortage - A Solution Long Employed in Rural Healthcare

An editorial published in The New York Times on December 16th says the expansion of healthcare coverage to millions of uninsured Americans under the Affordable Care Act will make the doctor shortage even worse. The author suggests the sensible solution to this crisis — particularly to address the short supply of primary care doctors — is to rely much more on nurse practitioners, physician assistants, pharmacists, community members and even the patients themselves to do many of the routine tasks traditionally reserved for doctors. What the author may not know is that this solution has long been employed in the world of rural health. Read the full opinion here. 

    

Don’t Miss This Important Meeting Hosted by HCPF to Discuss Distribution of Savings to RHCs, FQHCs, BHOs and RCCOs

The Department of Health Care Policy and Financing is beginning a series of ongoing discussions bringing together the Regional Care Collaborative Organizations (RCCOs), the Primary Care Medical Providers (including FQHCs and RHCs), and the Behavioral Health Organizations (BHOs), with HCPF acting as a mediator, to discuss an equitable distribution of savings for these parties. The first of these discussions will be held at the next Accountable Care Collaborative (ACC) Payment Reform Subcommittee meeting tomorrow, December 14th from 2:30 PM to 4:30 PM in the 1st floor conference room at 225 E. 16th Avenue. The agenda can be found here, and the call in information can be found below.

Call-in information:
Toll: 1-720-279-0026
Toll free: 1-877-820-7831
Passcode: 610450#
Mute/unmute: *6

HHS Says No Enhanced Match for Partial Medicaid Expansion

The Obama administration filled in a key detail of what states must do to receive full federal funding for an expansion of Medicaid under the 2010 health law. Health and Human Services Secretary Kathleen Sebelius said in a letter sent Monday to governors that states cannot partially expand their Medicaid programs and get full federal funding. In a blog post, Sebelius also outlined other points of the guidance being provided to states, and gave a conditional nod to exchange plans submitted by Colorado, Connecticut, Massachusetts, Maryland, Oregon and Washington. Click on the embedded links to read more.

New Issue Brief Says Coloradans Facing More Barriers to Accessing Oral Healthcare

According to a new Colorado Health Access Survey (CHAS) report, the number of Coloradans without dental insurance grew to 2.1 million in 2011 from 1.8 million in 2009 – a 17 percent increase from the 2008-2009 baseline survey. Over 2.5 times as many Coloradans were without dental insurance than were without health insurance in 2011 (829,000 uninsured Coloradans). The problem is even more pronounced among Hispanic Coloradans, the majority of whom (52.8%) reported that they lack dental insurance, an increase from 47.6% in 2008-2009.

The brief, A Growing Problem: Oral Health Coverage, Access and Usage in Colorado, is based on CHAS data from the 2011 CHAS. It shows that all Coloradans are facing more barriers to accessing oral health care, compared to 2008-2009 when the survey was last done. The brief also shows:

• Having dental insurance makes a significant difference in whether Coloradans seek dental care. Of Coloradans who had dental insurance, 76.9% visited a dental professional. Of those with no dental insurance, 44.5% visited a dental professional. 
• Hispanic Coloradans lack dental insurance at a higher rate (52.8%) than white (39.1%) and black (29.9%) Coloradans.
• Lower-income Coloradans lack dental insurance at a higher rate than those with higher incomes. In addition, uninsured Coloradans with low incomes did not seek dental care as often as uninsured Coloradans with higher incomes.
• Cost is the reason nearly one in four Coloradans (22.9%) did not get the dental care they needed, according to the 2011 CHAS. Even those with dental insurance do not always seek care because of cost. More than a third (36.6%) of Coloradans who did not get needed dental due to cost had dental insurance.

 

Raising the Medicare Age Could Leave Thousands Uninsured

It's predicted that lawmakers will reach a fiscal cliff deal that includes a hike in the Medicare eligibility age — a concession to those on the right who seem determined to see very deep entitlement cuts, even if they take benefits away from vulnerable seniors. One argument for raising the eligibility age is that seniors who lose benefits can get insurance through Medicaid or the Obamacare exchanges.
But a new report to be released this week undercuts that argument — and finds that up to half a million seniors could lose insurance if the eligibility age is raised. Read the article here.

CIVHC Answers Frequently Asked Questions About the APCD

Colorado’s All Payer Claims Database (APCD) went live on November 1st at www.cohealthdata.org. The APCD is a secure database that includes claims data from commercial health plans, Medicare and Medicaid. The APCD was created by legislation in 2010 and administered by the Center for Improving Value in Health Care (CIVHC). Since the launch, CIVHC received some common questions which they've answered below. For the complete list of APCD Frequently Asked Questions, click here.

Question: When will it be possible to see more detailed data and reports like cost and quality reporting at the medical group, clinic or physician level?

Answer: We expect to begin reporting comparative cost and utilization information at the level of named facilities, payers and provider groups beginning in late 2013. We are currently developing processes and procedures to share and vet information with affected groups.

Question: Will data or reports eventually be available for individual diagnoses?
Answer: We expect to begin reporting on the incidence/prevalence and costs to treat common chronic diseases beginning in mid-2013. Entities with an interest in a specific diagnosis or set of diagnoses can request a specialized report through the Data Release Process.
Question: Will you eventually capture and report on quality metrics?

Answer: Yes, we are currently working with stakeholder groups both locally and nationally as well as APCDs in other states to identify appropriate and meaningful quality metrics to include in APCD cost and utilization reporting. We anticipate adding quality metrics by the end of 2013.

Question: Will www.cohealthdata.org eventually provide information that allows consumers to make more informed choices regarding their health care?

Answer: Yes, by the end of 2013 we anticipate releasing a consumer focused section www.cohealthdata.org that will provide comparative cost, quality and value information. One of APCD’s core goals is to provide information that allows consumers to better manage resources and make value based decisions regarding their health care. Information based on the APCD will allow consumers, for the first time, to meaningfully shop for health services and better manage their own care.

Question: Are there plans to link the Colorado APCD to other data such as clinical information maintained by the Colorado Regional Health Information Organization (CORHIO) or Quality Health Network (QHN)?

Answer: Finding ways to link together cost and utilization information from the APCD with clinical information systems will eventually provide for a fuller picture of cost, quality and value. However, combining data sources from Health Information Exchanges and the APCD present numerous technical, privacy and resource challenges. No timetable has been established for this work.

Question: Will the Colorado APCD provide data and reports by payer type?

Answer: Yes, once data from additional payers is added, users will be able to view data and reports by payer type, e.g., Medicare, Medicaid, commercial plans, etc. Click here for payers currently included in the APCD and the timeline for adding additional payers.
Question: Will risk adjustment be based on the same methodology used by Medicare?

Answer: The Colorado APCD will begin generating reports based on risk-adjusted data mid-2013. Initially, risk adjustment of Colorado APCD data will be performed using tools developed by 3M. The Colorado APCD has the ability to use other tools for risk adjustment as well, including the Hierarchical Condition Categories (HCCs) currently used by the Centers for Medicare & Medicaid Services (CMS).

Question: Currently, I cannot see who the providers, facilities or counties are in the snapshot reports on imaging services, routine deliveries or knee arthroscopy. Will I be able to see data on a named facility or provider basis in future releases?

Answer: Yes. As we add additional payers and the APCD becomes more representative of Colorado’s insured population, we plan to provide results at finer levels of detail. We anticipate providing cost and utilization data at the level of named facilities, payers and provider groups beginning in late 2013.

Question: I can’t see the interactive maps on my iPad or iPhone, will this be possible in future releases?                

Answer: We hope to address this issue in future releases but in the meantime, those without Flash capability can access the underlying data in the maps by clicking on the Data Sheet within the Maps Tab, or on the Reports Tab

NRHA's Rural Health Policy Institute

With health reform, the fiscal cliff and a new Congress set to decide the future of healthcare, change is coming to rural America. NRHA's Rural Health Policy Institute is a great opportunity for you to educate your elected officials, advocate for your facilities and continue the fight to protect rural healthcare. The Colorado Rural Health Center is the state contact for NRHA's 24th Rural Health Policy Institute, so come with CRHC staff as we learn more about rural health policy and visit our elected officials on the hill!

6 Questions About How the Fiscal Cliff Affects Healthcare

The impending "fiscal cliff" is a package of automatic spending cuts and tax hikes set to kick in next month unless President Barack Obama and Capitol Hill agree on a way to stop them.

Kaiser Health News poses a few questions and answers about what could happen in the weeks before the end-of-year deadline. Read the article here. 

Policy Update from NOSORH

"Fasten your seatbelts, it's going to be a bumpy year!" Bill Finerfrock said during his "Exploring Rural Health Policy Issues" webinar on Nov. 13th. The NOSORH-sponsored webinar was one of the daily webinars offered during the week-long celebration of National Rural Health Day 2012.

At the center of the presentation was a "Washington Update," where Finerfrock gave a run-down on coming changes in House Committee memberships including Ways and Means, and Appropriations, and possible changes in Cabinet-level posts including Defense, State, Justice and Treasury. Finerfrock said that issues that were left unresolved prior to Congressional Adjournment include Bush Tax Cuts, Payroll Tax Cuts, the SGR "fix" (sustainable growth rate fix for Medicare), and Sequestration, which, combined, form what the press is calling the "fiscal cliff." Finerfrock said he thinks Congress will do something to avoid the fiscal cliff. However, if they don’t, the consequences would include a 26.5 percent cut in physician fee schedules, which would have an adverse effect on rural health clinics. Sequestration would also cause a 7- 8 percent annual cut in affected non-defense programs. At this point, he said, there is nothing to do but wait and see. The NOSORH-sponsored webinar was one of the daily webinars offered during the week-long celebration of National Rural Health Day 2012.

For a viewable recording of Finerfrock’s full webinar, click here; for a copy of Finerfrock’s presentation during the webinar, click here.

Source: The Branch: An Update for State Offices of Rural Health and our Partners. December 2012. NOSORH.