Rural Providers on Edge as Sequestration Deadline Gets Closer

Sequestration, the automatic and across-the-board federal spending cuts that were specifically designed to be so painful that they never would occur, are likely to take effect on March 1st. This is different than what we were hearing just a few weeks ago. The 2% mandated cuts to Medicare totaling more than $2.9 billion in 2013 will disproportionately ill-effect the small rural providers that rely on federal government funding to keep their doors open.

According to Maggie Elehwany, the National Rural Health Association's vice president of government affairs and policy, says all signs are pointing towards sequestration going into effect putting rural providers on edge. Read the article in HealthLeaders Media here.

Colorado to Receive $2 Million to Continue Work on a Comprehensive State Health Care Innovation Plan

The Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced Thursday the first recipients of the State Innovation Models initiative awards.  Twenty-five states received nearly $300 million in awards will support the development of models of care that will transform healthcare delivery throughout the states. 

Over $250 million in Model Testing awards will fund 6 states – Arkansas, Maine, Massachusetts, Minnesota, Oregon, and Vermont – in implementing their plans for healthcare delivery transformation.  These states will use these funds to test multi-payer payment and service delivery models on a broader scale within their state.  An additional 19 states will receive nearly $35 million to develop their State Health Care Innovation Plans that will guide for comprehensive health care transformation.

Colorado is one of three states that will receive pre-testing assistance to continue to work on a comprehensive State Health Care Innovation Plan.  States receiving pre-testing awards will have six months to submit their State Health Care Innovation Plans to CMS.

Learn more about the State Innovation Models initiative and view the 25 awardees here.

Final Rule on Essential Health Benefits Released

The Obama administration released the final rule on essential health benefits this week, which sets the parameters for the types of benefits that must be offered by insurers starting in 2014. Kaiser Health News is tracking the news coverage; read capsules from Politico and The Hill, as well as link to the proposed rule here.  A bill will be introduced in the Colorado legislature this session which will allow the Division of Insurance to promulgate rules around essential health benefits, as well as align state law with federal statutes for implementation of healthcare reform.

Report Says Medicaid Expansion Will Boost Colorado's Economy

A new study of Medicaid expansion commissioned by the Colorado Health Foundation, and conducted by legislative budget analyst Charlie Brown and a team of economists, says expanding Medicaid to an estimated 275,000 additional people will cost Colorado less than the price of not adding them.  Brown and his team found that expanding Medicaid would be similar to a stimulus program for Colorado because millions of federal dollars will flow into the state to pay for the new patients’ care (federal taxes will pay 100 percent of the costs of Medicaid expansion from 2014 to 2016, then taper to 90 percent by 2020).

Key findings from the report include:

• In FY 2025-26, the last year of the study period, a comparison of the "no expansion" and "full expansion" options shows that the following economic impacts will occur as a result of the decision to fully expand Medicaid:
• The economy, as measured by state gross domestic product (GDP), will be 0.74 percent larger than if Colorado does not expand its Medicaid program. Expansion will result in just less than $4.4 billion in additional state economic activity in 2025.
• Average annual household earnings will be $608 more with full Medicaid expansion compared to no expansion.
• Colorado will have 22,388 more jobs in 2025 if the state fully expands Medicaid.
• While Medicaid expansion is not free, the combination of federal support for expansion populations and state savings in programs makes full expansion less costly to the General Fund than no expansion until FY 2020-21.
• By FY 2025-2026, state General Fund appropriations would be a cumulative $133.8 million less for full Medicaid expansion than if the state chose not to expand.
• The larger economy that would result from Medicaid expansion will generate more state tax revenue without an increase in tax rates. In FY 2025-26, tax revenue is projected to be $128 million higher due to a decision to expand Medicaid. In each year, the combination of the additional revenue generated from the larger economy and savings in other General Fund programs is sufficient to fund the state's share of the cost of Medicaid expansion.
• Compared to no expansion, Medicaid expansion will add an additional 275,000 Coloradans to Medicaid enrollment by FY 2025-26. Those added to Medicaid insurance include 209,000 newly eligible adults without dependent children, 44,000 newly eligible parents and an additional 22,000 currently eligible but not enrolled children and parents.
• Medicaid expansion will reduce the number of uninsured non-elderly Coloradans by 189,000 by FY 2025-26 and reduce the percentage of uninsured in the non-elderly population from 11.1 percent to 7.7 percent compared with non-expansion.

Read the press release from the Colorado Health Foundation and link to the full report here.

Healthcare as an Economic Stabilizer

Princeton economics professor Uwe Reinhardt provided his perspective this week on the impact of healthcare on the economy.  Reinhardt says the healthcare sector has functioned for some time as the main economic locomotive pulling the economy along, and in the last two decades, it has created more jobs on a net basis than any other sector.  Read more of his perspectives and enjoy an economics lesson here.

Nurse Practitioners Push To Help Care For Health Law's Newly Insured

More than 27 million Americans will soon gain health coverage under the health law. But who will treat them all?

"With such a large coverage expansion, and with an anticipated shortage of primary care physicians available to serve them, some states have or are considering allowing so-called advanced practice nurses -- those with advanced degrees -- to treat more patients. David Hebert is at the issue’s center. Hebert, a veteran health care lobbyist and former CEO of the American College of Nurse Practitioners, is the first CEO of the American Association of Nurse Practitioners (AANP) -- a new group with 42,000 members recently formed from the merger of the American College of Nurse Practitioners and the American Academy of Nurse Practitioners."

KHN's Alvin Tran sat down recently with Hebert to discuss the changing role nurse practitioners may soon have, as well as some physicians' efforts to stop them.

Click here to read edited excerpts of that discussion:

New Medicaid Estimates

According to a new cost-benefit analysis from the Colorado Health Institute, expanding Medicaid would cost Colorado about $1 billion over 10 years and add an estimated 240,000 to the state’s Medicaid rolls, including as many as 73,000 people who could switch from private to public health insurance. 

Colorado lawmakers expect to introduce a bill in the coming weeks that will outline the state's plans for Medicaid expansion.  Read the informative blog post from Health Policy Solutions here.

Dueling Legislative Approaches to Fixing the Doc Pay Emerge

Dueling legislative approaches to overhaul the Medicare physician payment formula emerged this week. The new movement on the stubborn problem comes as the Congressional Budget Office revised the 10-year cost of fixing it down by more than 40%, to $138 billion from $245 billion, based on lower spending on physician services in recent years. 

There are some general similarities in the proposals, but there are also critical differences between an approach contained in bipartisan legislation introduced Wednesday by Rep. Allyson Schwartz (D-Pa.) and a Republican bill expected from Ways and Means Health subcommittee Chairman Kevin Brady (R-Texas) in the coming months.

Both the bills would replace the sustainable growth-rate formula with temporary increases while replacement methodologies were devised, but the bills differ on important points, including whether federal officials or physician groups would take the lead in developing new payment systems and the degree to which fee-for-service payments would be eliminated.

Read the article in Modern Affairs here (account may be needed), or link to the proposals from Rep. Schwartz or Rep. Brady.

Notice for Employers Re. Exchanges Requirement Delayed

The Department of Labor announced last week that the requirement that employers provide notice to their employees of the existence of Exchanges will not take effect on March 1st.  It is expected that the timing for distribution will be late summer or early fall of 2013. 

The Colorado Health Benefit Exchange (COHBE) is a public entity governed by a Board of Directors. The Exchange, scheduled to open for business in October of this year, will be a new marketplace where  individuals and small businesses in Colorado can shop for and buy health insurance based on quality and price.  

Read more about the Exchange here, or learn more by visiting the Frequently Asked Questions from the Department of Labor regarding the requirements for notice to employees. 

Lessons Learned from Early Adopters of Remote Patient Monitoring Technologies

Remote patient monitoring such as home teleheath and telemonitoring can help improve coordination, improve patients’ experience of care, and reduce hospital admissions and costs. These technologies remotely collect, track, and transmit health data from a patient’s home to a healthcare provider and can facilitate communication and help engage patients in the management of their own care. A new brief from The Commonwealth Fund offers findings from case studies of three early remote patient monitoring adopters: the Veterans Health Administration, Partners HealthCare, and Centura Health at Home. Read the case studies and lessons from early adopters here.