Thank Senators Bennet and Udall for Their Efforts to Ensure Rural Healthcare Providers' Need are Addressed by the Senate

As part of the ongoing budget discussions, Colorado Senators Michael Bennet and Mark Udall, and New Mexico Senator Martin Heinrich, have put forward Amendment 612 to the proposed Senate budget to ensure that rural healthcare providers' needs are addressed by the Senate. The amendment, which can be viewed by clicking here, makes sure that the budget passed by the Senate has needed flexibility to extend rural health programs and create others. Voting on this and all other amendments to the proposed budget, is ongoing.  The Colorado Rural Health Center and the National Rural Health Association encourage you to thank Senators Bennet and Udall for their support of rural providers (click on the links to email your support).

Clarification Regarding the Colorado Health Insurance Cooperative

In a blog post dated March 15th, I erroneously reported that Colorado received a loan to create a CO-OP, and I would like to correct that information.  The Colorado Health Insurance Cooperative (CO-OP) was established in 2012 through a $69 million loan awarded by the Department of Health and Human Services (DHHS) under the Affordable Care Act (ACA).  The CO-OP is sponsored by the Rocky Mountain Farmers Union Educational and Charitable Foundation, and is a consumer governed and operated, nonprofit insurance company that aims to offer affordable, high quality health coverage to individuals and small businesses.  The CO-OP will primarily be made available through the Colorado Health Benefit Exchange and independent insurance brokers in 2013.

Study Says Medicaid Expansion for All States Would Pay Hospitals More By 2022

According to a study by the Urban Institute funded by the Robert Wood Johnson Foundation, states that expand Medicaid could see $2.59 gained in Medicaid revenue for every private insurance dollar lost. Under the Affordable Care Act (ACA), states have the option to raise the income eligibility mark for Medicaid to 133% of the federal poverty line starting in 2014 in exchange for full federal funding for the expansion for three years and not less than 90% of the added cost after that. Read about the study here, which examined current low-income patients who have private insurance but would be newly eligible for Medicaid coverage if the state expanded the program. In Colorado, Senate Bill 13-200 is making its way through the legislative process. If passed, Colorado will expand Medicaid eligibility to 133% beginning in 2014.

Improving Quality and Patient Safety for Vulnerable Populations

Dr. Bruce Siegel is the President and CEO of the National Association of Public Hospitals and Health Systems (NAPH), and is a contributor to the Learning Health System Commentary Series of the Institute of Medicine (IOM) Roundtable on Value & Science- Driven Health Care.  Authored commentaries in the IOM Series draw on the experience and expertise of field leaders to highlight health and healthcare innovations they feel have the potential, if engaged at scale, to foster transformative progress toward the continuously improving and learning health system envisioned by the IOM.  Statements are personal, and are not those of the IOM or the National Academies.

In this commentary, Dr. Siegel describes NAPH’s current efforts to improve the disproportionate burden of hospitalization and poor health outcomes for the nation’s safety-net patients. Read his discussion on several concepts central to continuously improving care, including the importance of integrated, coordinated patient care across various care delivery settings here.

Opinion Piece: The ACA is Pushing Physicians to Become Hospital Employees

It is estimated that by next year, about 50% of U.S. doctors will be working for a hospital or hospital-owned health system. A recent survey by the Medical Group Management Association, shows a nearly 75% increase in the number of active doctors employed by hospitals or hospital systems since 2000, reflecting a trend that accelerated around the time that the Affordable Care Act (ACA) was enacted.  Read Scott Gottlieb's recent opinion piece in the Wall Street Journal about hospital-acquired medical practices.

Will Medicare Cost Slow Down Close the US Budget Gap?

New evidence that the slowdown in healthcare costs over the past five years is happening not only because of a weak economy comes from the Economic Report of the President report, recently released by the President’s Council of Economic Advisers.  The report found that if the slowdown were to continue in the future, Medicare spending would basically remain flat as a share of the economy. Read more here about the Economic Report of the President as it examines changes in healthcare spending and unemployment rates across states.

Application for Benefits Daunting

According to an article in BenefitsPro, applying for benefits under President Barack Obama's healthcare overhaul could be as daunting as doing your taxes.  The draft of the application was released, and it runs 15 pages for a family of three.  Families USA Executive Director, Ron Pollack, expressed concern for the uninsured; he said they may be overwhelmed with the process and simply give up.  The Department of Health and Human Services (HHS) estimates it will receive more than 4.3 million applications for financial assistance in 2014, with online applications accounting for about 80 percent of them.  Because families can apply together, the government estimates 16 million people will be served.

Read the full article here, which includes a list of pros and cons for how the reform is shaping up.

Osteopathic Doctors May Help Ease Provider Shortage in Rural Areas

Osteopathic physicians have been around for more than 100 years.  But the recent growth in the field of osteopathy, both training facilities and number of graduates, may help reverse a looming shortage of primary-care providers that will hit rural communities especially hard.  Osteopathy programs historically have attracted more older applicants and career changers than MD programs, and recruit applicants in rural locations.  Read more about osteopathic physicians and the role they play in the healthcare workforce. LINK

CO-OP Opportunity for Insurance Coverage

When policy-makers decided not to include a public health insurance option in the Affordable Care Act, they compromised by adding the Consumer Operated and Oriented Plan (CO-OP) program to the law. Sponsored by consumer groups and other nonprofits, CO-OPs aim to offer consumers more options in states where few health insurers cater to individuals and small businesses. Colorado received a loan to create a CO-OP. 

A new policy brief from Health Affairs and RWJF reviews the challenges facing CO-OPs as they prepare for open enrollment in October. Read the brief.

HCPF Hosting Stakeholder Meeting to Discuss Churn

Earlier this year, Governor Hickenlooper announced that Colorado will expand Medicaid for adults up to 133% of the federal poverty level as part of the Affordable Care Act. Colorado will also be running its own state health insurance exchange, where eligible individuals and families will be able to shop for subsidized health insurance coverage. In preparation for this expansion, the Department of Health Care Policy and Financing (HCPF) has been working with stakeholders, the Center for Health Care Strategies, SHADAC, and other states to understand the needs and characteristics of this newly eligible population. 

HCPF would like to invite you to join the conversation on Monday, March 18 from 11:00 am to 1:00 pm for a stakeholder meeting to discuss “churn” – the movement of individuals between Medicaid and the exchange. 

Stakeholders may join via webinar and phone. To register for the webinar, click this link. If you’ve never attended a GoToMeeting webinar before, you will need to click “run” when the program prompts you. The webinar will allow you to see the slides during the meeting, but to hear the facilitator, you will need to call into the conference line and enter the participant code below.  

Call-in: 877-820-7831
Participant code: 946029#

Nurse Practitioners Say How They're Paid Affects Care They Can Provide

According to a study from Kaiser Health News published last week by the National Institute for Health Care Reform, researchers found that while scope of practice laws did not appear to restrict the primary care services nurse practitioners can provide to patients, they do affect how the advanced nurses are paid. Read more here.

Sequester Digest

News outlets around the country are covering the sequester and its impacts.  A collection of news articles relative to sequestration can be found below.  

The Washington Post: Republican Goal To Balance Budget Could Mean Deep Cuts To Health Programs
Anxiety is rising among House Republicans about a strategy of appeasement toward fiscal hard-liners that could require them to embrace not only the sequester but also sharp new cuts to federal health and retirement programs. Letting the sequester hit was just the first step in a pact forged in January between conservative leaders and Speaker John A. Boehner (R-Ohio) to keep the government open and the nation out of default. Now comes step 2: adopting a budget plan that would wipe out deficits entirely by 2023 (Montgomery, 3/4).

Politico: Paul Ryan Floats Change To Medicare Plan
Paul Ryan's budget will show how Republicans can balance a budget that's trillions of dollars out of whack. But the most significant unresolved issue comes down to a minuscule number: one year. Ryan — the House Budget Committee chairman — has privately been floating the idea of allowing his changes to Medicare to kick in for Americans younger than 56. In previous budgets, those 55 and older were exempted from his plan to turn Medicare into a premium-support — or voucher — program (Sherman and Allen, 3/4).

The Hill: GOP Centrists Balk At Ryan Medicare Shift
House Republican centrists are furious that GOP leaders are considering abandoning their pledge not to change Medicare retirement benefits for people 55 years and older. According to several sources, a handful of centrist GOP lawmakers attending a recent Tuesday Group luncheon erupted when Budget Committee Chairman Paul Ryan (R-Wis.) and House Majority Whip Kevin McCarthy (R-Calif.) broke the news (Hooper, 3/5).

The Medicare NewsGroup: Distrust Of Government Is A Hard Hurdle To Jump In Medicare Reform
One reason that changes to the Medicare program will be hard to make is because people distrust the federal government yet cherish what it offers them. This is a hard conundrum to overcome. The latest polling makes this point with great vigor. And the discussions among experts within different parts of the political spectrum illustrate why President Obama and Congress have scant prospect of success in producing any alterations to Medicare. … Skepticism about government is the deepest since the Pew Foundation began polling in 1958, when it found that 73 percent of Americans trusted the government in Washington, D.C., "all the time or most of the time." Today, the level of trust has shrunk to a meager 26 percent, according to the latest polling, conducted last month (Rosenblatt, 3/4).

Impact of Medicare Cuts on Colorado Rural Hospitals

As federal employees are contemplating smaller paychecks this week, administrators at rural hospitals are struggling just to keep their balance sheets in the black, thanks to the sequester.

In 2011, Medicare payments to Colorado hospitals were $253 million less than in 2009, according to the Colorado Hospital Association.  Now those same institutions are facing another 2 percent decrease in reimbursement for Medicare services.  That one-two punch could knock some hospitals out of the ring, according to Russ Johnson, CEO of San Luis Valley Regional Medical Center in Alamosa, Colorado.  Read the full article from ABC news here.  

Commission on Doc Pay Urges End to FFS, SGR

The National Commission on Physician Payment Reform released a dozen recommendations to ultimately change how physicians are paid by public and private payers, starting with the premise that physician salary and expenses account for 20% of healthcare spending, but the decisions doctors make influence another 60% of that spending.

The Society of General Internal Medicine convened the commission a year ago to suggest new ways to pay the nation's physicians that could improve patient outcomes and lower healthcare costs.  In the report released Monday, the commission concluded that the problems of physician payment are based on systemic issues, such as the traditional fee-for-service payment model, and problems pertaining specifically to Medicare, including the sustainable growth-rate formula to pay physicians and the operation of the Relative Value Scale Update Committee (RUC), which makes recommendations to the CMS. Read more here (may need free subscription).

New Analysis of Colorado Children and Health Insurance

The Colorado Health Institute recently released its annual analysis of the number of eligible children in the state who are not enrolled in the Medicaid or Child Health Plan Plus (CHP+) public insurance programs.

According to the analysis, about 125,000 Colorado children, or 9.7 percent of all children, did not have health insurance in 2011. This was a decrease from the 132,000 uninsured children in 2010.

View the 2011 estimates from the Colorado Health Institute here in three new publications:

• A fact sheet that summarizes the high-level findings and maps county-level estimates. 
• A data supplement that includes detailed tables of county-level data. 
• A methodology document that outlines the assumptions and processes used to create the estimates.

Docs Brace for $11 Billion Hit from Sequester

Friday's Cliff: Nondefense Programs to be Slashed by Roughly 8% 

WASHINGTON -- Medicare providers stand to absorb $11 billion of the $85 billion in federal spending cuts that start Friday and last for the rest of the fiscal year unless Congress takes 11th-hour action.

Under the impending sequester, Medicare payments to providers will be cut by 2%, and most nondefense programs will be slashed by roughly 8% starting Friday.

The across-the-board method to limit federal spending has been criticized and deemed harmful by both political parties and nearly all interest groups.  But with little agreement on what to replace the spending cuts with, it's growing more likely they will actually take effect. Read More

Ways & Means Chairman Hopes To Move Medicare ‘Doc Fix’ Plan

If done smartly, this issue could reshape our 

entire health economy for the better

The chairman of the House Ways and Means Committee made clear Tuesday that finding a solution to the vexing issue of setting Medicare physician payment rates is on his to-do list this year, and he got some tepid support from a key Democrat.

Rep. Dave Camp, R-Mich., said that the effort could be helped by a recent reassessment of how much it would cost.  Earlier this month, the Congressional Budget Office lowered its cost estimate for fixing Medicare’s physician payment formula over the next decade to $138 billion due to lower Medicare spending on physician services during the past three years.  In January 2012, the CBO estimated the cost of the fix at $316 billion, which it reduced to $245 billion last August. Read More

States Can Cut Back on Medicaid Payments, Administration Says

The federal government is bending over backward 

to show flexibility 

WASHINGTON — The Obama administration said Monday that states could cut Medicaid payments to many doctors and other health care providers to hold down costs in the program, which insures 60 million low-income people and will soon cover many more under the new health care law.

The administration’s position, set forth in a federal appeals court in California, has broad national implications as it comes as the White House is trying to persuade states to expand Medicaid as part of the new law.

The statement of federal policy infuriated health care providers and advocates for low-income people. But it may encourage wavering Republican governors to go along with the expansion because it gives them a tool to help control costs. Read More