AHA Rural Chair Says Reimbursement Top Challenge

Alvin Hoover, CEO of King's Daughters Medical Center in Brookhaven, MS, chairs the American Hospital Association's Section for Small or Rural Hospitals. Read his interview in "Health Leaders" about the reimbursement challenges facing rural hospitals in the reform landscape. Hoover says the overarching challenge is going to be to helping the legislators understand that massive cuts to reimbursement to try to lower the deficit can't all be on the backs of hospitals.  Read the interview here. 

Congress Looks at SGR Repeal

Repealing the sustainable growth rate (SGR) formula for physician reimbursement under Medicare is a high priority for the new leader of the House Ways and Means Subcommittee. Rep. Kevin Brady (R-Texas), says he wants to work with the House Energy and Commerce Committee to craft legislation to permanently repeal the SGR and replace it with, "a reliable physician reimbursement formula that rewards quality." Read more about the idea of a SGR repeal here.

Anthem's Telemedicine Program Connects Members with Needed Services

Anthem Blue Cross’ telehealth network recently marked an important milestone. By providing over 50,000 specialty consults, they connected members in some of the state’s most rural underserved areas to needed healthcare services. Read about how they built their model from its original purpose as a vehicle to serve the growing Medi-Cal population, and how the program has grown over time to serve other Anthem members and even other health plans without a network of their own.

 

Medicaid Officials Release Rule Affecting Cost-Sharing and Coordination

The Centers for Medicaid and Medicare Services (CMS) released their 474-page proposed rule affecting cost-sharing and coordination with Exchanges earlier this month.  The proposed rule states officials would be able to charge Medicaid patients higher cost-sharing for some services than current regulations allow.

The proposed rule also affects a wide range of other Medicaid provisions, including appeals of eligibility determinations; coordination between Medicaid and the new healthcare law's insurance exchanges; the role of counselors to assist people with their coverage applications; procedures to verify employer-sponsored coverage; and the use of updated Medicaid eligibility categories.  You can read more in the Commonwealth Fund's blog. 

NE Study Shows Residents in Rural Counties are Less Likely to Have Health Insurance

A new health study says more uninsured people live in rural Nebraska, and experts say the implications for the future affect all of us. This is true for Colorado, as well as across the country. The rural economy is based on small business and self -employment. Small business owners face inherent challenges in providing coverage for themselves and their employees. Lower purchasing power, increased risk of adverse selection and higher marketing and administrative costs all contribute to insurers charging higher premium costs to smaller employers, a common practice in rural parts of the state. Read the article here, or read more about health disparities facing rural Coloradans in the Colorado Coalition for the Medically Underserved's most recent issue in their infographic series about access.

HHS Releases Long-awaited Privacy Rule

The US Department of Health and Human Services (HHS) released its highly anticipated and long-awaited privacy rule yesterday.  The rule expanded liability of business associates of hospitals, physicians and other Health Insurance Portability and Accountability Act (HIPAA) covered entities if they release data in ways that violate patient privacy.  Called the “omnibus” privacy and security rule because of its broad reach, it updates earlier HIPAA rules with more stringent privacy and security measures passed under the American Recovery and Reinvestment Act of 2009.

Read Secretary Kathleen Sebelius's news release here, or link to the 563 page rule in the Federal Register. 

Many of these changes will affect your current privacy and security policies and procedures. CRHC's Senior Advisor, David Ginsberg, will be reviewing the changes and providing summaries. Stay posted for further updates and resources.

Questions? Contact: David Ginsberg, Senior Advisor, Colorado Rural Health Center

Infographic on Healthcare Access in Rural Colorado Released

Joe Sammen, Community Partnership Coordinator for the Colorado Coalition for the Medically Underserved (CCMU), blogged this week about policy options to improve access for rural Coloradans. His opinion piece accompanied CCMU's lastest brief in their infographic series, a series that explores health from the perspectives of different populations. Developed using health survey data, the series demonstrates Coloradans’ varying experiences of health and healthcare. Read Joe's opinion piece here on rural healthcare reform and opportunities for coverage, and view CCMU's rural health infographic with data on access and coverage for rural Coloradans here.

Roughly 12,000 Jobs to be Added Statewide with Expansion of Medicaid

A proposal to expand Medicaid to cover 160,000 more Coloradans will add roughly 12,000 jobs statewide, according to a rough estimate by economic development leader Tom Clark.  Legislators will be debating whether to accept the federal offer this session, which as part of the Affordable Care Act, offers states the option to expand Medicaid to persons living below 133% of the federal poverty level. Gov. Hickenlooper recently gave the expansion his support and estimated it would bring $12.28 billion in federal funds back to Colorado taxpayers over 10 years. Read more here.

NBC Political Director Says Rural/Urban Divide “Stark”

NBC political director and chief White House correspondent, Chuck Todd, declared the “Rural-Urban political divide is as stark as it has ever been.” Speaking to a Washington, D.C. news radio station Monday, Todd said today’s divided nation is no longer “red state verses blue state, it’s rural verses urban.” He added that many of the politically divisive issues such as gun control and abortion stem from rural and urban differences that are “cultural.” Chuck Todd has been invited to speak during the National Rural Health Association's 24th annual Rural Health Policy Institute next month. Join other Coloradans in DC to continue the discussions about rural health and meet with Colorado's elected officials. Click here for more details on the Policy Institute. You can listen to Chuck Todd’s full interview here.

MedPAC Recommends 1% Pay Increase for Hospitals

Congress' primary Medicare advisory body recommended last week that HHS Secretary Kathleen Sebelius should limit hospital cuts she was required to make under a year-end fiscal cliff law to leave those facilities with a 1% payment increase next fiscal year.

The Medicare Payment Advisory Commission (MedPAC) unanimously recommended that Congress direct Sebelius to increase inpatient and outpatient prospective payments by the 1%, which is technically a reduction from the pre-existing legislative formula that said hospitals should receive a 1.8% increase starting next October.

Under the year-end American Taxpayer Relief Act of 2012, Sebelius was required to find $11 billion in savings from hospitals within four years through rate reductions. If the cut was evenly spread out over the four years—as the Congressional Budget Office assumed it would be—then it would reduce the fiscal 2013 update to a 0.6% cut.

However, if the MedPAC recommendation is followed, Medicare hospital spending would increase in the next fiscal year by up to $2 billion, according to the advisory body. Link to the full article here.

Health Cost Growth Slow But Showing Signs of Acceleration

A report recently released by the U.S. Centers for Medicare and Medicaid Services and published in Health Affairs, says U.S. healthcare spending rose at a historically low rate of 3.9 percent for the third consecutive year in 2011. But despite relatively low growth over the last few years, the figures showed signs of acceleration as the economy recovered from recession. Read the full article here.

Gov. Hickenlooper Announces Plans for Expansion of Medicaid in Colorado

Governor Hickenlooper announced this week his administration’s plans to expand Medicaid as part of federal healthcare reform.  This is a big win for rural Coloradans who typically earn lower wages than their urban counterparts and disproportionately experience unemployment. CRHC’s most recent policy survey shows members overwhelmingly support the expansion as a means to increase access to care for rural Coloradans, so this is exciting news for CRHC members and partners. 

The new eligibility standards will enable the state to cover an additional 160,000 adults. The federal government will cover 100% of the costs for the newly-eligible Medicaid population through 2016. After that, the federal match begins to taper down, and Colorado will be responsible for 10% beginning in 2020 (unless the law is changed).

The Governor’s press release can be found here.  Gov. Hickenlooper released a fact sheet and an FAQ with his announcement.  Click on the embedded links to read those documents. 

Rural Fiscal Cliff Averted

The rural fiscal cliff was averted this week when Congress came to an agreement at the 11th hour. David Lee of the National Rural Health Association released the following comments in regards to the legislation.

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Hundreds of millions of dollars in rural health cuts were prevented by Congress as part of the last-minute “fiscal cliff” legislation passed late in the night on New Year’s Day. While many were watching an underwhelming Orange Bowl, the President signed-into law legislation that reinstates critical Medicare reimbursement payments to over 850 rural hospitals, as well as prevented cuts to rural primary care physicians and rural ambulance providers.

The fiscal cliff bill, which included large tax provisions and an extension of unemployment compensation, also reinstated the Medicare Dependent Hospital program and the Low-Volume Hospital adjustment, which both expired October 1. Had Congress not restored these payments, many rural fiscally fragile facilities likely would be forced to close their doors.

This is a big win for rural providers and NRHA wishes to thank all of grassroots advocates who made their plea to Congress to prevent these harsh cuts. Stay tuned, we aren’t completely out of the woods. The 2% across-the-board sequestration cuts were delayed for two months, but the battle will begin again soon. Additionally, all rural payments were extended for only a one-year period and additional calls for cuts are surely just around the corner. This means, this year’s Policy Institute, where rural advocates appeal to their Members of Congress, significant than ever.

Below is a list of the rural Medicare provisions included in the fiscal cliff legislation:

Medicare Physician Payment Update. This provision guarantees seniors have continued access to their doctors by fixing the Sustainable Growth Rate (SGR) through the end of 2013. Medicare physician payment rates are scheduled to be reduced by 26.5 percent on December 31, 2012. This provision would avoid that reduction and extend current Medicare payment rates through December 31, 2013. 

Work Geographic Adjustment. Under current law, the Medicare fee schedule is adjusted geographically for three factors to reflect differences in the cost of resources needed to produce physician services: physician work, practice expense, and medical malpractice insurance. This provision extends the existing 1.0 floor on the “physician work” index through December 31, 2013. 

Payment for Outpatient Therapy Services. Current law places annual per beneficiary payment limits of $1,880 for all outpatient therapy services provided by non-hospital providers, but includes an exceptions process for cases in which the provision of additional therapy services is determined to be medically necessary. This provision extends the exception process through December 31, 2013. The provision also extends the cap to services received in hospital outpatient departments only through December 31, 2013. 

Ambulance Add-On Payments. Under current law, ground ambulance transports receive add-on to their base rate payments of 2% for urban providers, 3% for rural providers, and 22.6% for super-rural providers. The air ambulance temporary payment policy maintains rural designation for application of rural air ambulance add-on for areas reclassified as urban by OMB in 2006. This provision extends the add-on payment for ground including in super rural areas, through December 31, 2013, and the air ambulance add-on until June 30, 2013.

Extension of Medicare inpatient hospital payment adjustment for low-volume hospitals. Qualifying low-volume hospitals receive add-on payments based on the number of Medicare discharges. To qualify, the hospital must have less than 1,600 Medicare discharges and be 15 miles or greater from the nearest like hospital. This provision extends the payment adjustment until December 31, 2013.

Extension of the Medicare-Dependent hospital (MDH) program. The Medicare Dependent Hospital (MDH) program provides enhanced reimbursement to support rural health infrastructure and to support small rural hospitals for which Medicare patients make up a significant percentage of inpatient days or discharges. This greater dependence on Medicare may make these hospitals more financially vulnerable to prospective payment, and the MDH designation is designed to reduce this risk. This provision extends the MDH program until October 1, 2013.

For a full copy of the legislation, click here.

Rural Hospitals Get Relief In Fiscal Cliff Deal

The New Year’s Day “fiscal cliff” deal means at least an extra $450,000 this year to tiny Jones Memorial Hospital in rural upstate New York. Click here to read the full article from Kaiser Health News.

AAFP Responds to New York Times Editorial, “When the Doctor is Not Needed.”

The American Academy of Family Physicians responded to a recent editorial posted in the New York Times (see blog post on December 17th).  The LTE can be found below. 

Letters to the Editor

The New York Times

Dear Editor,

In discussing the primary care shortage, let’s not lose sight of what is actually needed versus what is proposed in various solutions. The solutions in “When the Doctor is Not Needed” (NYT Editorial Dec. 15) are short-term answers to a long-term, systemic problem. We must differentiate between providing a service and utilizing expertise.

If we are to improve patients’ health and help restrain costs, we need to ensure patients get the right care from the right professional at the right time. Sometimes that means the expertise of the nurse practitioner is the best. Other times, a pharmacists’ patient education expertise is most appropriate. At all times, the expertise and deep clinical training of a primary care physician is the foundation.

Nurse practitioners, physician assistants, even patients themselves can implement health services —checking pulse and blood pressure, monitoring blood sugar levels, giving insulin injections, and managing chronic conditions. But they don’t necessarily have the expertise to know why the service is needed or how to respond to complications or lack of response. Limiting patients’ access to services provided only by a retail clinic, a nurse practitioner, pharmacist or other health professional restricts the patient’s access to the full panoply of available knowledge. Such solutions don’t ensure that the patient receives the most appropriate care, nor do they prevent unnecessary repetition of tests and procedures.

That’s why the American Academy of Family Physicians has called for patient-centered medical homes with team-based care from all health care professionals: physicians, nurse practitioners, pharmacists, or any necessary subspecialty physicians. Each professional has a crucial role to play, but they are not interchangeable. Only with such a team will patients have access to care that is comprehensive, accessible, preventive, efficient and, most importantly, effective.

 

Reid Blackwelder, MD
President-Elect
American Academy of Family Physicians