Safety Net Clinic Week Is Almost Here!

Don't forget to celebrate Safety Net Clinic Week! Safety Net Clinic Week, August 18th - 22nd, is a week dedicated to celebrating Rural Health Clinics and Community Safety Net Clinics. In its fifth year, this week provides the opportunity to express our appreciation and gratitude to all the clinics who dedicate their time, energy and resources to serving their communities. Despite limited human and technical resources, these clinics are creating innovative solutions to delivering patient-centered, high quality care to patients in your community!  

IOM Report Questions Physician Shortage

An Institute of Medicine panel's vision for overhauling Medicare-funded medical training questions two beliefs that are widely held in healthcare: that a severe physician shortage is imminent and the only way to avoid it is an infusion of federal money for more residency positions. The report (found here), written by a 21-member committee co-chaired by former CMS administrators Dr. Donald Berwick and Gail Wilensky, says shortages are created by poor geographic distribution of physicians and lopsided ratios of primary care and specialty physicians and that recent research suggests the answers lie in new technology and innovations in healthcare delivery.

Read more about the report and reaction from physician groups in or Modern Healthcare.

Mounting Challenges Put Nonprofit Hospitals At Tipping Point

According to a report released Wednesday from Standard & Poor's Rating Services, small and stand-alone nonprofit hospitals are facing mounting pressure from weak operating margins and lower patient volumes, with more signals of stress on the way.

The rating agency warned the healthcare sector was at, "a tipping point where negative forces have started to outweigh many providers' ability to implement sufficient countermeasures." Beginning in 2013 and continuing into this year, credit downgrades outpaced upgrades at an accelerating rate.

Stand-alone providers are under greater pressure from physician departures, rising bad debt and higher employee benefit costs. To shoulder the challenges, smaller providers have increasingly sought out mergers with larger health systems in order to seek scale and offset increasing operating pressures. Larger healthcare organizations can better leverage their scale with vendors and insurers, eliminate duplicate services, absorb major IT project costs, as well as attract top management and physicians. Read the article in Reuters here.

How Will You Celebrate Safety Net Clinic Week?

The fifth annual Safety Net Clinic Week is quickly approaching! Safety Net Clinic Week (SNCW), co-sponosored by CRHC and ClinicNET, will be held August 18th through the 22nd. It is dedicated to celebrating Rural Health Clinics (RHCs) and Community Safety Net Clinics (CSNCs). In an effort to celebrate, support and raise awareness for Colorado's healthcare safety net, we encourage your clinic to participate in this important week devoted to educating the public, policymakers and other community leaders about Colorado's RHCs and CSNCs. 

We have created a toolkit to help clinics participate in SNCW 2014. We encourage you to use the resources below to have the most successful advocacy week as possible. In addition, a webinar is available to CRHC members on August 6th at 12:00 PM to provide more information on SNCW and the resources available to clinics to celebrate. 

The toolkit links can be found below, and click here to register for the webinar.  

Short Overview of SNCW
SNCW 2014 Logo
Governmental Proclamation or Resolution
SNCW Invitation Template
SNCW Fact Sheet
SNCW Press Release
List of All RHCs and CSNCs

Critical Times for Small and Rural Hospitals

Although Critical Access Hospitals (CAHs) are protected from many of the disruptions of the Patient Protection and Affordable Care Act, their fates will differ greatly depending on their individual circumstances. Geography, the right mix of services, affiliation with larger partners, and, most critically, cuts of preferential reimbursements that CAHs currently receive but that are far from guaranteed in the future—all of these play a role.

Thanks to the decision of many states not to expand Medicaid, whether a small rural hospital or critical access hospital survives may depend on a host of variables over which leaders have little or no control. For instance, many organizations stand to benefit as more of the previously uninsured acquire health insurance, unless, of course, your state decided to not expand Medicaid. 

Read the article in HealthLeaders Media here.

CMS Wants to Know - Can Medicaid Beneficiaries Find a Doctor?

The Centers for Medicare and Medicaid Services (CMS) is planning to conduct its first nationwide research effort to answer the question of whether adult Medicaid beneficiaries can find providers, and if factors such as being in managed Medicaid versus a fee-for-service offering aid or hurt the search. 

What it's likely to find, according to interviews conducted with state Medicaid officials and medical society officials in 20 states, is a mixed picture overshadowed by general concerns that reimbursement rates remain too low to entice many doctors to accept new Medicaid patients. Read the article in Modern Healthcare here.

CMS Proposes Rule to Expand Telehealth Payments

Wellness and behavioral health visits are among a few telehealth coverage expansions the Centers for Medicare & Medicaid Services (CMS) wants to add to the list of Medicare reimbursable telehealth activities under a proposal released Thursday last week. Providers also would be paid for telehealth services in rural areas nearer big cities under a geographical expansion in the proposed rule.

The 609-page proposed rule principally deals with annual changes to polices under the Medicare Physician Fee Schedule, including eliminating the exclusion for continuing medication education (CME) under the Sunshine Act that requires drug companies and medical device makers to disclose payments to physicians.
Added to the list of covered telehealth services by the proposal are annual wellness visits, both for an initial visit, and for subsequent visits, if they include a personalized prevention plan of service. 

Read the article in Modern Healthcare here (requires a free subscription).

A June 27th article in Insurancenewsnet.com discusses four major barriers to telehealth adoption. Read the article here, which includes an interview with Ed Bostick, Executive Director of the Colorado Telehealth Network.

Medical Boards Draft Model Law Designed to Make It Easier to Treat Patients Out-of-State and Online

Officials representing state medical boards across the country have drafted a model law that would make it much easier for doctors licensed in one state to treat patients in other states, whether in person, by video-conference or online.

The plan, representing the biggest change in medical licensing in decades, opens the door to greater use of telemedicine and could alleviate the doctor shortage, a growing problem as millions of people gain insurance coverage under the Affordable Care Act.

The draft legislation, in the form of an interstate compact (a legally binding agreement among states), was developed by the Federation of State Medical Boards, composed of the agencies that license and discipline doctors. “The proposed compact would create a new pathway to speed the licensing of doctors seeking to practice medicine in multiple states,” said Dr. Humayun J. Chaudhry, the president of the Federation. “It would allow doctors to see more patients than ever before, if they want to.”

Read the article in the New York Times here.

Provider Shortage Worsening, Demand Growing

Health and Human Services spokeswoman Erin Shields Britt says continuing to build the primary care workforce will take time, but she notes President Obama's budget working its way through Congress has several new ways to expand the primary care workforce, which includes nurse practitioners and pediatricians. The Affordable Care Act (ACA), she says, significantly increases the number of primary care providers in rural and underserved areas and increases Medicare and Medicaid payment for services delivered by primary care practitioners.

An article in USA Today this week outlines some of the challenges that continue to get in the way of training and placing providers. The challenges include the rising cost of medical school, more lucrative specialty care and scope of practice laws. Read the article here.

Medicaid Dental Benefits Extended Further Beginning July 1

Beginning July 1st, Medicaid beneficiaries have access to more dental services under a benefit that became available April 1st.

The new benefit provides Medicaid adults age 21 and older with access to up to $1,000 in dental services per state fiscal year, according to a release from the Colorado Department of Health Care Policy and Financing (HCPF). "A healthy mouth and health body go hand-in-hand," said Susan Birch, Executive Director of HCPF in a statement. "We have already heard from many of our clients how grateful they are since the initial benefit began in April. Having this enhanced benefit in place will help our clients maintain good oral health and improve their overall health and quality of life."

The extended benefit covers basic preventive dental exams, diagnostic and restorative dental services including extractions, root canals, crowns, partial dentures, complete dentures, periodontal scaling, root planning and other procedures requiring prior authorization.

The expansion is funded through the federal and state government. Colorado's share of the funding comes from a state fund that formerly funded Cover Colorado.

Read the July 1 press release from HCPF here.    

Celebrate the 5th Annual Safety Net Clinic Week August 18th - 22nd!

The Colorado Rural Health Center and ClinicNET are celebrating the 5th annual Safety Net Clinic Week (SNCW) August 18th through the 22nd! In an effort to raise awareness about the diversity and impact of Colorado's healthcare safety net, this week is devoted to educating public officials and the community about these vitally important healthcare clinics - federally certified Rural Health Clinics (RHCs) and Community Safety Net Clinics (CSNCs).

RHCs and CSNCs provide access to primary care serves for individuals and families that are low-income, underinsured and uninsured and to those residing in rural and frontier communities. Patients who are uninsured and do not qualify for public insurance are often asked to pay for services as a flat fee or on a sliding fee scale based on their income level, and some clinics are free.

More information about SNCW 2014 will be coming soon. Think about hosting an open house or offering tours to your elected officials. It’s a great opportunity to showcase what you do to provide access to health in your community!

340B Drug Discount Program Under Scrutiny

The 340B drug pricing program lets thousands of hospitals, community health centers and family planning clinics buy outpatient prescription medications from manufacturers at an estimated 25 to 50 percent discount. Participants can then charge higher rates to insured patients and keep the additional revenue.

To qualify for the program, hospitals and clinics must meet federal requirements, such as non-profit status, serving a certain percentage of low-income or uninsured patients or receiving federal grants. The Affordable Care Act broadened the type of facilities that can qualify for the 20-plus year program, including Critical Access Hospitals, the smallest rural hospital.

Growth in the program is raising alarms among drug makers and some members of Congress who say that some facilities should not be eligible and that the money they receive from the discounts is not always being plowed back into patient care. The Health Resources and Services Administration (HRSA) runs they program, and Administration officials have promised to propose clearer rules for the program. Proposed regulations had been expected as early as this month, but a recent federal district court ruling has put into question whether HRSA has that authority.

Despite the ruling, HRSA says they plan to move forward with the proposed regulation, and it has been expected to touch on several areas, including eligibility and contracting. 

• Eligible patients: Patients who have a “relationship” with a 340B hospital or clinic are eligible to receive the discounted 340b drugs. But exactly what constitutes such a relationship isn’t clearly defined. “There’s always been a discussion about who truly is a patient of a covered entity and who truly can receive a 340B drug,” said David Ivill, a 340B expert with the law firm McDermott Will & Emery.
• Eligible facilities: Currently if a clinic is included in an eligible hospital’s Medicare cost report it can qualify for 340B drug pricing. Analysts expect a new regulation would provide more clarity on which facilities qualify and which ones don’t. While one part of a qualifying 340B hospital might serve large number of poorer patients, an affiliated clinic could see mostly insured patients. Under current rules both qualify to receive the discounted drugs.
• Contract pharmacies: Some providers in the 340B program can contract with outside pharmacies, like Walgreens, to give patients the flexibility of filling their prescriptions at locations that may be more convenient than a hospital pharmacy. A report released in February by the HHS Inspector General found inconsistencies in how some contract pharmacies determine who is eligible for the discounts and in how they conduct the oversight activities that HRSA recommends. In a statement, a HRSA spokesman said the agency has followed up individually with pharmacies identified in the report “to determine necessary next steps.”

Read the full article in Kaiser Health News here.

Missouri Bill Aims to Reduce Workforce Shortage by Allowing New Route to Become “Assistant Physicians”

Missouri may soon allow licensed medical school graduates to practice medicine and prescribe drugs without having completed a residency.

The proposal (Senate Bill 716), which has passed the state legislature and awaits the governor's signature, aims to address the issue of providing adequate healthcare in rural and other underserved areas of the state.

Under the bill, graduates of accredited medical schools could become “assistant physicians” and provide primary care services in rural or medically underserved areas if they haven't completed residency training. However, they must have completed the first two steps of their medical licensing exam. A collaborating physician would be responsible for all services rendered by the assistant physician.

Under rules from the Centers for Medicare and Medicaid Services, an assistant physician would also be considered a physician assistant. Read the article in Modern Healthcare here (requires a free subscription).  

Colorado Division of Insurance Releases First Look at Health Plans for 2015

The Colorado Division of Insurance released preliminary information this week from plans submitted by health insurers for Affordable Care Act (ACA) coverage in 2015. Rate and benefit information for the 2015 plan year was submitted to the Division of Insurance (DOI) on June 6th. Since that time, DOI staff has been conducting initial reviews to check the filings for completeness.

According to the preliminary study of rate filings provided by the DOI, Colorado residents and small businesses could face anywhere from a 10 percent increase in their health insurance premiums next year to a 10 percent drop in prices.

Commissioner of Insurance Marguerite Salazar commented, “We are pleased to see such a high number of carriers and plans. Rates seem to be holding relatively steady, which means we will continue to see a strong market in 2015 that will provide Colorado consumers with many options for health insurance.”

Over the summer, the Division of Insurance staff will examine each plan to make sure it is in compliance with the requirements of the Affordable Care Act and state and federal laws. The DOI will review the rates to ensure they are not excessive or inadequate. In addition, the DOI will also verify whether the plans meet the federally defined metal tier coverage levels: bronze (60% of medical expenses paid by the plan), silver (70%), gold (80%) and platinum (90%). These percentages are referred to as “actuarial value.” 

During the review period, Colorado consumers can submit public comments on the filings, which will be reviewed and considered by the Division of Insurance. The DOI will complete its review in September, then notify carriers and Connect for Health Colorado of the approved plans for 2015. Once approved, final plans will be posted on the DOI’s website. DOI will also provide summary information and charts detailing the number of approved carriers and plans for 2015, both on and off Connect for Health Colorado. Read the press release from the DOI here.  

AMA Calls to Give Veterans Access to Private Sector Health Providers

According to the American Medical Association (AMA), veterans facing long wait times for healthcare at government hospitals should have access to private doctors.

The AMA, the largest doctor’s group in the U.S., voted at its annual meeting yesterday to ask President Obama to give veterans access to private-sector health providers until a backlog at the Veterans Administration is reduced. More than 57,000 veterans waited longer than 90 days for an initial appointment at VA medical centers, according to an audit released yesterday. Read the article in in Bloomberg News here.

New Report About Narrow Networks Released by McKinsey Center

Roughly half of the products sold on exchanges in 2014 were narrow-network plans, according to a study by the McKinsey Center for US Health System Reform (read the study here). In the largest city in each state, that figure jumped to 60 percent.

The vast majority of exchange customers had a choice between broad- or narrow-network plans, the McKinsey study found. Broad network plans were available to 90 percent of potential customers, while narrow-network plans were an option for 92 percent of that population. Read the rest of the article in Modern Healthcare here (requires a free subscription). 

Creating rules around network adequacy are difficult for rural areas as a balance must be struck to create standards strong enough for meaningful access protections, but flexible enough to be achievable for the Qualified Health Plans. This discussion won't be over any time soon.

New Study From CHA Shows Impact of Medicaid Expansion on Hospital Volumes

A new study from the Colorado Hospital Association (CHA) shows the impact of Medicaid expansion on hospital volumes in the 26 states that chose to expand Medicaid eligibility under an option offered through the Affordable Care Act. The study shows that the Medicaid proportion of patient volume at hospitals in states that expanded Medicaid increased substantially in the first quarter of 2014. At the same time, the proportion of self-pay and overall charity care declined in expansion-state hospitals. You can listen to the article on Colorado Public Radio here, and read the study from CHA here.

Save the Date for Safety Net Clinic Week 2014!

Save the date for Safety Net Clinic Week 2014! SNCW 2014 will be celebrated August 18th through the 22nd. It is a week dedicated to raising awareness of all the various types of clinics with a commitment to serving patients who might otherwise have difficulty getting medical care.

Why is it important to celebrate Safety Net Clinic Week? Because while safety net clinics have some similarities, they also look very different from one another, and it is important to know where, why and how healthcare is currently being delivered. When it comes time for the federal, state, or even local government to make decisions regarding provider reimbursements, tobacco tax funds, Medicare or Medicaid payments, public coverage program eligibility, electronic health records (EHR) incentives, or other important policy choices, the people making those decisions need to understand how they affect safety net clinics like yours.

Therefore, the Colorado Rural Health Center and ClinicNET encourage you to celebrate Safety Net Clinic Week August 18th through the 22nd. Look for more information from CRHC and ClinicNET soon!

What Will Happen As Networks Continue to Narrow?

In the midst of all the turmoil in healthcare these days, one thing is becoming clear: No matter what kind of health plan consumers choose, they will find fewer doctors and hospitals in their network — or pay much more for the privilege of going to any provider they want.

These so-called narrow networks, featuring limited groups of providers, have made a big entrance on the newly created state insurance exchanges, where they are a common feature in many of the plans. While the sizes of the networks vary considerably, many plans now exclude at least some large hospitals or doctors’ groups. Smaller networks are also becoming more common in healthcare coverage offered by employers and in private Medicare Advantage plans.

Insurers, ranging from national behemoths like WellPoint, UnitedHealth and Aetna to much smaller local carriers, are fully embracing the idea, saying narrower networks are essential to controlling costs and managing care. Major players contend they can avoid the uproar that crippled a similar push in the 1990s. Read the article in the New York Times here.

Division of Insurance to Seek Shift on Geographic Rating Areas for 2015

Press Release from Colorado Division of Insurance (May 9, 2014)

The Colorado Division of Insurance (DOI) today announced it will ask the federal government for approval to change Colorado’s geographic rating areas for health insurance for 2015.

Geographic rating areas are geographical units made up of metropolitan statistical areas (MSAs), counties or three-digit zip codes, which are used by insurance carriers to price premiums.

The DOI seeks to reduce the number of rating areas from 11 to nine, combining four rural areas into two larger rating areas, while retaining the seven urban (or metropolitan statistical areas, or MSAs). Such a change will require approval from the U.S. Department of Health and Human Services.

“Consolidating the higher health cost regions into larger rating areas will spread the risks and the costs of providing health care more equitably over a larger population,” said Marguerite Salazar, Commissioner of Insurance. “We understand that people across the state are concerned about high health care costs and the impact on health insurance premiums. This is the fairest way of addressing the issue and working toward stable premiums in all regions of the state.”

The announcement comes after a meeting last week of the Health Care Cost Study Group. At that meeting, the DOI put forth three options for rating areas following presentation of an actuarial analysis commissioned by the DOI for the study group. The DOI invited comments through Wednesday, May 7.

The DOI received 306 comments of which 138 addressed the rating area options. Of those, 117 were supportive of the nine rating areas structure.

As part of this change, on Friday, May 9, DOI will formally request approval from the Department of Health and Human Services to change Colorado’s rating area structure. Due to this change, the DOI also will extend its deadline for insurance carriers to provide plans and rates for 2015 from May 15 to June 6, providing time for insurance carriers to adjust to the new areas.

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The Colorado Division of Insurance regulates the insurance industry and assists consumers and other stakeholders with insurance issues. DORA is dedicated to preserving the integrity of the marketplace and is committed to promoting a fair and competitive business environment in Colorado.

Survey Says - Healthcare Executives Don't Trust Payers

A survey designed to measure the level of trust that hospital executives have in health insurance companies finds several factors that contribute to low scores, including the length of time it takes for claims to be paid, and the rates hospitals and physicians are paid.

Payers scored poorly on all three of the new trust questions in the annual National Payor Surveyconducted by ReviveHealth, a Nashville, TN based strategic communications firm and Catalyst Healthcare Research. The results from the final question, which asked providers whether a particular payer "balances its interests with ours and doesn't routinely take advantage of us," were particularly dire. Read the article in HealthLeaders Media here.

New Telemedicine Policy Draws Opposition

New guidelines issued by the Federation of State Medical Boards (FSMB) could have a chilling effect on the growth of telemedicine – especially in rural areas and among low-income patients, say some patient advocates, healthcare providers and healthcare companies. But the Federation says the updated guidance will safeguard patients’ privacy and ensure high-quality care in the current fast-changing healthcare delivery environment.

As part of a wide-reaching April 26 policy statement, FSMB changed the definition of telemedicine to care that “typically involves the application of secure videoconferencing… to provide or support healthcare delivery by replicating the interaction of a traditional encounter in person between provider and a patient.” It is not, according to the Federation, “an audio-only, telephone conversation, e-mail/instant messaging conversation or fax.”

The statement, which is not a legal document but is intended to help state medical boards’ develop professional policies and standards for their members, triggered a backlash from some stakeholders. Read the rest of the article in Kaiser Health News here. 

Telemedicine Still Facing Barriers In Most States

With more than 7 million people signing up for coverage under federal healthcare reform and millions more gaining coverage under Medicaid Expansion, providers now need to reach more rural patients than ever before. But providers and payers in many states are still struggling with outdated laws and other obstacles in their effort to reach patients in remote areas.

But experts say those barriers to care are slowly disappearing as more states pass laws to allow Medicaid to reimburse providers. That effort is also being helped by pilot programs launched by providers and insurers in an effort to improve care and generate savings by allowing rural residents to address health problems before they get worse. Read the article in Health Leaders Media.

Insurance Extension Decision Could Impact Many Coloradans

Insurance Commissioner Marguerite Salazar announced Friday that state residents who extended plans that do not meet minimum benefits required under federal healthcare reform before the end of last year may extend them again through the end of 2015 if their insurers continue to sell the plans.

It is unknown how many of the roughly 100,000 people currently covered by such plans in Colorado will have the opportunity to re-up and will choose to do so. But the people in such plans are viewed by many health analysts to be healthier than those who recently have purchased insurance for the first time. And keeping them out of the larger risk pool could cause prices for insurance policies to rise across the board.

Read more about how the extension decision could impact Coloradans in the Denver Business Journal or read about a national study on the impact of the canceled plans in Politico.

Is Rate Relief Coming to Colorado's Ski Towns?

Last Friday, Colorado Insurance Commissioner Marguerite Salazar said she wants to redraw the geographic rating boundaries which previously lumped together Garfield, Pitkin, Eagle and Summit Counties and created the most expensive insurance market in the U.S. Commissioner Salazar announced that by redrawing the boundaries, those counties will now be part of a 22 county region. 

Read more about the change in boundaries in Kaiser Health News or in Health News Colorado.

Study Says When Hospitals Buy Physician Practices, Costs Go Up

A new study gives ammunition to what health economists and health insurers have argued for years: When hospitals buy physician practices, the result is usually higher hospital prices and increased spending by privately insured patients.

The study, published Monday in the journal Health Affairs, was based on an analysis of 2.1 million hospital claims from workers of self-insured employers between 2001 and 2007. The analysis by Stanford University researchers found prices were most likely to increase when hospitals bought physician practices, as opposed to hospitals forming looser contractual relationships with physicians.

Read the article in Kaiser Health News.

Tax Credit Extension Sought to Aid Rural Providers

Advocates are trying to persuade Congress to permanently extend a tax incentive program that helps small and rural healthcare providers obtain financing for building and expansion projects.

The New Markets Tax Credit Program was authorized in 2000 and last extended for two years on Jan. 1, 2013. The current push is to make the program permanent, which President Barack Obama supported in his fiscal 2015 budget proposal. In the House, Reps. Jim Gerlach (R-PA) and Richard Neal (D-MA) reintroduced legislation earlier this month that would make the program permanent rather than requiring reauthorization every two years. Similar bipartisan legislation was introduced in the Senate last summer.

Cuyuna Range Hospital District in Crosby, MN, is among the rural providers that have taken advantage of the program. The district, which operates 25-bed Cuyuna Regional Medical Center, wanted to finance a $15.7 million project last year to expand its operating rooms and surgical clinics. The program allowed Cuyuna to save 18 percent on its borrowing costs, or about $2.3 million. 

“It's a real opportunity for rural healthcare for expansion,” said John Solheim, Cuyuna Regional's CEO. “It helps you create equity and economic development.”

For healthcare providers, the program allows them to reap savings through a lower interest rate from lenders and makes them more attractive borrowers at a time when many rural hospitals are struggling to obtain financing.  

Read the full article in Modern Healthcare (requires a free subscription).  

AHA Files Suit Against HHS Over "Two-Midnight" Rule

The American Hospital Association filed two lawsuits Monday against the two-midnight rule and was joined in its suit by several state hospital associations and individual hospitals.

“The two-midnight rule undermines medical judgment and disregards the level of care needed to safely treat patients,” said Richard Umbdenstock, president and CEO of the AHA, in a release announcing the lawsuits. “Hospitals stand by a physician's decision on what care is appropriate for each patient. The two-midnight rule is misguided and we feel confident the court will agree.”

“The hospitals take issue with the wholly arbitrary requirement that a physician must certify at the time of admission that a Medicare patient is expected to need care in the hospital for a period spanning two midnights to be considered an inpatient,” the release also said.

The doc-fix bill recently approved by Congress included a six-month extension before compliance would be enforced for the two-midnight rule. AHA apparently plans to use that time contesting it in court.

The existing two-midnight rule says admitting physicians must have good reason to believe that a patient will need two nights in the hospital before Medicare will pay full inpatient rates under Part A for the stay. Lacking such documentation, Medicare auditors will generally classify the stay as outpatient observation, which pays hospitals much less under Part B and sticks the patient with a 20% co-payment. That rule went into effect Oct. 1. But it was modified so that Medicare's aggressive recovery audit contractors could not overturn claims under the new policy until Sept. 30, 2014.

The enacted legislation requires Medicare to extend that recovery-auditing moratorium until March 31, 2015. It also gives Medicare officials the discretion to extend what's known as the “probe and educate” process until the same date next year. Under that process, a different set of companies, known as Medicare administrative contractors, can audit a small number of short-stay inpatient claims and train hospitals on how to submit more accurate bills. 

Read the article in Modern Healthcare (requires a free subscription).  

HHS Secretary Kathleen Sebelius Resigns, OMB Director Sylvia Mathews Burwell to Step In

Health and Human Services Secretary Kathleen Sebelius announced her resignation Friday, ending a tumultuous tenure as the public face of the Affordable Care Act. In a Rose Garden ceremony, President Obama nominated his budget director as her successor.

According to federal health officials, Sebelius approached Obama in early March and told him that, with the insurance enrollment period ending that month, the time had come for new leadership at HHS. A White House official, who spoke on the condition of anonymity to discuss internal deliberations, said Sebelius told the president that “she felt confident in the trajectory for enrollment and implementation of the Affordable Care Act.”

Obama on Friday nominated Office of Management and Budget Director Sylvia Mathews Burwell to take Sebelius’s place. Although Burwell does not have an extensive background in healthcare policy, she is known for her strong management skills and has experience in issues of poverty and global health issues from her time at the Bill and Melinda Gates Foundation. Moreover, she is popular on Capitol Hill. The Senate confirmed her as OMB director 96 to 0 almost exactly a year ago. Her nomination to lead HHS will require Senate confirmation as well. Read the full article in The Washington Post.

When A Rural Hospital Closes, The Town Struggles To Survive

The story of Hancock Memorial Hospital in the tiny town of Sparta, Georgia is not unique. Hancock Memorial Hospital was among the first of nine rural hospitals that have closed across Georgia since 2000. Today, it’s overgrown with weeds and vines, while the roof caves on the gurneys and computers still inside. When County Commissioner Sistie Hudson tries to recruit a new industrial employer, one of the first things they ask is: “Do you have a hospital?” That's a non-starter for most businesses. 

University of North Carolina professor Mark Holmes studied the economic impact of 140 rural hospital closures nationwide. He found that three years out, losing a hospital costs a community, on average, “about 1.6 percentage points in unemployment, about $700 in per capita income, and that was in [year] 2000 dollars so that’d be probably about $1,000 currently." 

Read, or listen, to the story on American Public Media, Marketplace.

Obama Signs Doc-Fix Bill

A 64-35 Senate vote Monday cleared the measure through Congress. The law also delays nationwide implementation of the ICD-10 diagnostic codes until 2015.

The $21 billion bill would stave off a 24% cut in Medicare reimbursements to doctors for a year and extend dozens of other expiring healthcare provisions, such as higher payment rates for rural hospitals. The legislation is paid for by cuts to healthcare providers, but fully half of the cuts won't kick in for 10 years.

This patch comes after lawmakers failed to reach a deal on financing a permanent fix. Read the article in Modern Healthcare here.

Final Surge Pushes ACA Enrollment in Colorado

Enrollment for private health insurance coverage for this year ended Monday with a surge that led to 118,628 Coloradans signing up on the state exchange (Connect for Health Colorado). Some 12,000 people signed up during the last week of open enrollment.

Enrollments under the Affordable Care Act are expected to continue to climb over the next few weeks in Colorado. Those who started their applications prior to the deadline, but were unable to complete them, will be given more time.

Connect for Health Colorado reported yesterday (Tuesday) that between Oct. 1st and March 31st, more than 277,000 Coloradans obtained either commercial or public health insurance under the Affordable Care Act. Medicaid gained 158,521 enrollees. The federal program expanded under the law in Colorado to cover lower-income single adults as well as disabled people, mothers, pregnant women and children.

Read the article in the Denver Post here.

With ICD-10 Delayed, Answers Needed from CMS

As part of the House's Protecting Access to Medicare Act of 2014, which delays cuts in physician's Medicare rates (SGR) by another year, the national implementation of the next-generation medical coding system known as ICD-10 has also been pushed out. This delay has focused intense attention on the Centers for Medicare and Medicaid Services (CMS) to provide clarity for how hospitals, doctors, insurance companies should move forward.

The bill signed by President Obama on Tuesday prohibits CMS from enforcing any mandate to switch to the newer system until at least Oct. 1, 2015, but the act leaves CMS with many questions to answer. Among them:

• Will Oct. 1, 2015, become the new deadline?
• Will the agency allow organizations that are ready to implement ICD-10 to do so voluntarily?
• Would the agency scrap ICD-10 altogether and instead wait for ICD-11, which is due to be released in 2017?

Read the article in Modern Healthcare here.

Update from the National Rural Health Association on HR 3402

On Monday the Senate passed a 12-month delay of cuts scheduled to take affect under the Medicare Sustainable Growth Rate (SGR). In addition to the delay of these cuts, the bill (H.R. 3402) would extend the Medicare Dependent Hospital Program, Low-Volume Hospital adjustment, current rural and “super-rural” ambulance payment rates, and the rural “work floor” in the geographic practice cost index. The National Rural Health Association (NRHA) is appreciative of efforts made to extend these programs permanently in the Senate as well as the one year extension of the programs.

NRHA also sought to include regulatory relief as part of this bill, including addressing issues with the 96-hour condition of payment rule currently experienced by Critical Access Hospitals as well as mandating that supervision levels for outpatient therapy services be reverted to a level of “general.” While these issues were not included in the package passed Monday, NRHA will continue to advance these efforts through NRHA-supported legislation that has already been introduced in both the House and Senate.​

Will New Rules to Prevent Narrowing of Networks Drive Away Payers?

Healthcare providers have raised alarms over narrow provider networks in the public health insurance exchanges, but Moody's Investors Service says proposed rules to open up the networks could drive health plans to drop out of the new market.

Proposed federal rules that would limit the ability of health plans to craft narrow provider networks for the Affordable Care Act exchanges would benefit some hospitals, but tighter regulation could create an unbearable level of risk for insurers, market analysts say. In a healthcare "sector comment" released recently, Moody's Investors Service predicts that plans to limit narrow networks in 2015 would benefit rural hospitals and safety net hospitals because those facilities are the most likely to be left out of a narrow network.

"If [hospitals] are considered essential, that would protect them from being excluded from a narrow network," Moody's Senior Vice President Lisa Martin said Monday of the new rules under consideration at the federal Centers for Medicare & Medicaid Services. "[They provide] protection in terms of market share."  Read the article in Health Leaders Media here. 

New Revenue Projections Released in Advance of Budget Bill

Economists delivered new projections to the legislature's budget committee last week in advance of the introduction of the budget bill for fiscal year 2014-15. 

Revenues have rebounded solidly since the Great Recession, and the state expects a surplus of $257 million this fiscal year, and more than double that next year. Democratic Senator Pat Steadman of Denver says much of that money is already slated to be spent on education or other programs, or will go to trying to restore past budget cuts. “The legislature this year has a very ambitious number of proposals introduced for tax credits and new spending, not all of which I think can be funded under today’s revenue estimate," Steadman says. Read the rest of the article about the revenue forecast at Colorado Public Radio here.

On March 20, 2014 the Joint Budget Committee approved a state budget to be introduced in the House and Senate. The budget shows a total increase of 17.9% and a General Fund increase of 8.7% compared to fiscal year 2013-2014. Provider reimbursements will be expanded by 2% for children's hospitals, after care hours, surgery centers, and many other areas to improve health care costs for all. The State Legislature has also approved funding to the Department of Human Services for increased coverage, awareness, and help for those affected my mental illness. In addition to healthcare, the budget also allocates additional funding to higher education, K-12 education, flood and wildlife recovery.

Update on the Doc Fix

From the National Rural Health Association (NRHA): Early this morning the House Rules Committee posted a bill that would delay all scheduled cuts under the Sustainable Growth Rate (SGR) for 12 months. In addition to the delay in SGR cuts, the bill includes a number of rural Medicare extenders that NRHA has been advocating for. Specifically, the current ambulance payment rates for rural and super-rural trips, the "work floor" in the geographic practice cost index, the Medicare Dependent Hospital program, and the Low-Volume Hospital adjustment were included in the package. The therapy cap exception process is also included in this bill. 

While NRHA had hoped that a permanent fix for the SGR and permanent extension of the rural Medicare programs could be accomplished, we are pleased that the House has decided to include these critical programs in another patch. The inclusion of these programs will stave off draconian Medicare cuts for rural providers throughout the nation. It is important to note, however, that some of the offsets or "pay-fors" proposed in this bill would harm rural providers. Extension of the Medicare sequester and modification of Medicaid DSH payments will harm many providers.

Read what Modern Healthcare had to say about the doc fix in this article posted yesterday.

Colorado Legislature Readies to Tackle Telecom, Rural Broadband Reform - Again

Colorado House Democratic leaders say they plan to reintroduce telecommunications law reforms as early as next week, believing they have tweaked the legislation enough to get it over the hurdles that killed similar bills the past four years.

Rep. Angela Williams, the Denver Democrat who will sponsor the package, said that one of the keys to this year’s effort will be breaking the changes into three bills rather than one large proposal that united opponents to various facets of it in the past.

“We’ve been working since November with over 50 individuals, coalition partners and eight sponsors to develop what I call legislation that will change the landscape in Colorado,” Williams said. “What we’ve tried to do is find a good balance ... Everybody has had an opportunity and has had to give and take.” Read the article in the Denver Business Journal here.

With Less Than Two Weeks To Go, More Than 100K Coloradans Have Signed Up For Private Insurance

There's less than two weeks remaining for people who don't have health coverage to get it. Plans won't be available on demand after that until next fall. So far, more than 100,000 Coloradans have now signed up for new, private health insurance plans through the state's online shopping portal. That number is less than initial goals anticipated, but still good compared with other states in general. About 15,000 Coloradans bought health plans through Connect for Health Colorado in the past two weeks. That's the fastest pace since mid-December, when there was a surge of customers getting coverage that would start Jan. 1, 2014. Read the story in CPR news here.

Connect for Heath Colorado and Colorado Medicaid have released their most recent enrollment metrics as of March 17, 2014. Since October 1, 2013, Medicaid has enrolled 151,050 individuals under the Medicaid expansion and Connect for Health Colorado has enrolled 100,112 Coloradans in private health insurance coverage.

For more Medicaid enrollment metrics, including by gender, age and county of residence click here. Additional enrollment metrics from Connect for Health Colorado can be found here.

House Passes SGR Bill Without Rural Extenders, Senate Bill To Come to Floor Next Week

A once-bipartisan proposal to finally reform the deeply flawed way that Medicare pays doctors succumbed Friday to the partisan politics of Obamacare, particularly the unpopular individual mandate. The House voted 238-181 to replace the payment formula -- the complicated equation that for more than a decade has required annual "doc fixes" -- and to pay for it by delaying Obamacare's individual mandate for five years. Read the full article in Politico here.

An article posted Friday in Modern Healthcare said the legislation to pay for a permanent repeal of Medicare's physician-payment formula by delaying financial penalties for those without health insurance coverage by five years would increase the number of Americans without health insurance by about 13 million in 2018, the nonpartisan Congressional Budget Office reports. Read the article here.

S. 2110, the Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 will likely come to the Senate Floor next week. This bill, introduced by Senate Finance chairman Ron Wyden late last week, is modified from previous Senate legislation but is similar to a strong rural bill that was reported out of the Senate Finance committee last December. S. 2110 contains a permanent fix to the SGR and includes all rural Medicare extenders (the Work geographic adjustment, Medicare payment for therapy services, Medicare ambulance services, the Medicare Dependent Hospital program and the Low Volume Hospital adjustment) and make all but the ambulance provisions permanent.

The bill’s passage is in doubt and strong grassroots support is needed. A likely partisan fight will occur over how to pay-for the bill. (Democrats support using savings from the scaling down of overseas conflicts and Republicans support eliminating the health insurance mandate in the ACA). Ranking Finance member, Orrin Hatch introduced a Republican bill (S.2122) which also contains the rural Medicare extenders but utilizes the ACA cuts as a pay-for.

Sweeping New Health Plan Rules Proposed

The Obama administration issued sweeping new proposed rules (PDF) late Friday affecting provider networks in insurance exchange plans, consumer access to quality information about plans, selection of plans in the small business exchanges, state rules on enrollment navigators, and reinsurance and medical loss ratios for insurers.

The Centers for Medicare and Medicaid Services (CMS) and (US Department of Health and Human Services) HHS said the proposed rules and draft standardized notices that issuers would be required to use when renewing or discontinuing plans will help to ensure consumers understand the changes and choices in the individual and group market.

“We are concerned that some enrollees, particularly those with certain complex medical conditions, are having trouble accessing in a timely fashion clinically appropriate prescription drugs,” read a preamble to the proposed rules.

Healthcare providers and consumer advocacy groups have complained about exchange health plans narrowing their networks to exclude a significant number of hospitals,physicians, clinics, and other providers. Plans say narrowing their networks is necessary to keep premiums affordable. The insurance industry and business groups are likely to view the new proposed rules with concern. Read the rest of the article in Modern Healthcare here.

House Passage of H.R. 4015, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014

The following note regarding the passage of HR 4015 was released today, March 14th, by the National Organization of State Offices of Rural Health (NOSORH).  It provides some helpful insight into the next steps and political viability of the bill.    

Today, in a largely partisan vote, the House of Representatives passed a bill permanently repealing the Medicare Sustainable Growth Rate (SGR). H.R. 4015, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014, is the previously agreed upon bipartisan/bicameral framework put forth by the three Congressional Committees with jurisdiction over the SGR.

In addition to formally repealing the SGR, the bill:

• Authorizes annual automatic 0.5% payment update for five years (2014 – 2018).
• Consolidates the three existing Medicare quality programs into a single value-based incentive program.
• Provides incentives for providers to switch to alternative payment models (APMs) such as a 5% bonus to providers who receive a significant portion of their revenue from an APM.

Although the framework for the permanent fix has broad support, finding $138B over ten years to pay for the permanent fix has been a serious obstacle that has become increasingly partisan as today’s vote approached.

The bill passed today by the House, pays for the permanent fix with a Republican supported measure delaying the Affordable Care Act’s individual mandate for five years (starting next year). In addition to covering the cost of a permanent fix, the Congressional Budget Office has estimated that this “pay for” will save an additional $30B but will also result in 13 million more people being uninsured and an average increase of health insurance premiums between 10 and 20 percent. Democrats have attempted to use unspent war funds as the offset; however Republicans are adamantly against such a measure.

The bill still must pass through the Democrat-controlled Senate and be signed by the President in order to become law. The prospect of this bill, with a five year delay of the individual mandate as the offset, becoming law is extremely unlikely. The Democrats in the Senate are publicly opposed to this offset and the President has already stated he will veto the bill if it comes to his desk in this form.

Congress has until March 31st, when the current patch expires, to prevent automatic 24% cuts in Medicare payments to physicians under the SGR. Congress could still come together to figure out agreeable offsets for a permanent fix or they could pass another short-term patch to give them more time to come to an agreement on offsets. A nine-month patch to prevent the 24% cuts through the end of the year has been discussed.

With Deadline For Open Enrollment Looming, Nearly 4.2 Million Have Enrolled in Private Health Plans Sold Through Exchanges

More than 4.2 million people have enrolled in private health plans sold through the Affordable Care Act's insurance exchanges as of March 1, the Obama administration reported Tuesday.

However, the administration didn't say how many of those people have paid their first month's premiums or how many were previously uninsured.

The 4.2 million mark is well below the goal of 5.6 million that federal health officials had when open enrollment started last October. Open enrollment ends March 31 and the White House had hoped to enroll 7 million by that time. Read the rest of the article in Medpage Today here.

Are Rural Interests Being Met By the Colorado Legislature This Year?

As the legislature reaches mid-session, lawmakers are receiving an “incomplete” grade for addressing rural Colorado; being told by rural interests that they still have much more work to do.

Even though both sides of the aisle included rural Colorado in their talking points at the beginning of the session, provincial interests have watched as proposals they supported this year were killed. And they have not seen other bills move to address several important issues to them, including lowering healthcare premiums and addressing transportation needs. Read the full article in the Colorado Statesman here.

It's Looking Likely That We'll See Yet Another SGR Patch (That Makes 18!)

Lawmakers can't agree on a way to plug the $122 billion hole in the budget that would be created by the elimination of the reimbursement cuts and "chances are not great" for a permanent fix by the March 31 deadline, says the co-chair of the GOP Doctors' Caucus.

Congress likely will not find a permanent solution for the Sustainable Growth Rate (SGR) funding formula before the deadline expires at the end of March, and will impose yet another temporary fix and re-address the issue later this year, a leading House Republican says. Read the rest of the article in Health Leaders Media here.

For more information, check out last week's article by Emily Ethridge of CQ Roll Call, or read the article by Kristin Paulson, CIVHC's Senior Manager of Policy and Initiatives, on how the Doc Fix has the potential to improve readmissions here.

Bill Aims to Encourage Doctors to Try Rural Colorado

A bill making its way through the legislature this year aims to encourage doctors to give rural Colorado a try. Senator Aguilar's bill, Senate Bill 14-144, would require the state to study how rural residency programs aid rural communities in recruiting and retaining doctors, what effect massive medical school loans have on physician retention, and investigate possible future funding options from federal, state or private sources. Read the full bill here, and check out the rest of the article here at Colorado Public Radio.

President Obama's Budget Includes Largest Increase of National Health Service Corps Ever

President Obama will propose boosting the National Health Services Corps (NHSC) from 8,900 a year to 15,000 a year over the next five years, as well as spending $5.23 billion to train 13,000 primary care residents over the next 10 years, in his budget next week, administration officials told USA TODAY. The budget, which Obama will reveal Tuesday, marks the first time Medicare funds will be used to increase the number of medical residents, and it's the largest-ever proposed increase of the corps, officials said.

The administration hopes to boost both team-based care, as well as send residents out to rural areas and areas with lower access to care, officials said. The president's budget proposal:

• Adds $5.23 billion over 10 years to train 13,000 primary care residents in high-need communities, and in team-based care, such as an accountable care organization.
• Extends higher payments to Medicaid providers, including physician assistants and nurse practitioners, by one year at a cost of about $5.44 billion.
• Adds $3.95 billion over the next six years in the National Health Services Corps to support growing the program from 8,900 primary care providers in 2013 to at least 15,000 annually starting in the 2015 fiscal year.

"This is a booster shot unlike any other before now," said Mary Wakefield, administrator of the Health Resources and Services Administration.

The proposal also addresses a shortage of mental health providers by offering residencies for psychiatrists, psychiatric nurse practitioners and other mental health providers as part of the team-based approach.

Read the article in USA Today.

Community Tools Are Available to Combat the Higher Rates of Childhood Obesity In Rural Areas

The Altarum Institute, a nonprofit health-systems research and consulting organization, reported today that children living in rural areas are about 25 percent more likely to be overweight or obese than children in urban areas. Rural communities have come up with several strategies to battle childhood obesity. 

According to Sarah Lifsey and Karah Mantinan of the Altarum Institute, studies have found that there is little open public space in rural areas, often because of a lack of a strong government to provide and maintain such public spaces. They also cite research showing that rural children are also at increased risk of poverty compared to children in cities or suburbs, and face lower access to healthcare, lower levels of physical activity and lower-quality food.  Many rural families who lack access to fresh and healthy foods live in “food deserts,” Studies have found poverty and childhood obesity are more likely in rural food deserts.

Tools are available to help with this planning such as the Rural Active Living Assessment Tools, developed by the Robert Wood Johnson Foundation. Other resources include the Rural Assistance Center, funded by the U.S. Department of Health and Human Services Rural Initiative, which features a Rural Obesity Prevention Toolkit developed by the Nutrition Obesity Research Center’s Walsh Center for Rural Analysis, as well as a resource guide for rural areas developed by the University of North Carolina’s Active Living by Design.

Read the article in the Lane Report.

Grace Period Option Can Be Burden on Small Practices

A provision in the Affordable Care Act offers patients who qualify for an advanced tax subsidy when purchasing a product through the exchange a grace period in which they may neglect to pay their premiums for up to 90 days. During the first 30 days of the grace period, insurers have to pay any claims incurred by the patient. But for the next 60 days, nothing is guaranteed. If the patient visits the doctor, the insurer can “pend” the claim – wait to pay the provider until the patient pays his premium. At the end of the 90-day grace period, if the patient has not paid the premium, the insurer can cancel the coverage and refuse to pay the pended claims, or recoup the payments it’s already made. That puts the provider's office at risk.

Practices are encourages to check first with the insurer to make sure everything is in order before proceeding with the visit. If the premium has not been paid, the provider can give the patient the option of rescheduling the appointment or paying in cash and then applying to his insurer for the payment. But this extra step for verification takes time. Insurance companies are scrambling to staff up in order to answer phone calls, as well as offer portals to verify eligibility for these patients. Read more here.   

Commissioner Salazar Convenes Health Care Cost Study Group

According to an analysis from the Kaiser Family Foundation, the Colorado resort region that includes Aspen, Vail and Garfield and Summit counties has the highest health insurance premiums in the nation (click here to read the report about the rates in new geographically delineated health insurance markets). Earlier this year, Colorado Insurance Commissioner Salazar decided not to change Colorado's geographic rating system for either this year or next. Now Garfield County is threatening to sue the Commissioner for approving the rates for 2015 (read the article here).

Commissioner Salazar has convened a group to study the issue and to produce proposals for reducing health costs and premiums by May. The Health Care Cost Study Group, which which began meeting last week, includes industry representatives, health policy cost experts and consumers.

“It will be a challenge to dig into the costs of healthcare and the factors behind those costs, but this group is up to the challenge,” Salazar said in a written statement. “This is the first step in a journey to a better understanding.” Read more about the first meeting and the representatives of the study group here.

SGR "Pay-fors" Still Up in the Air

If Congress doesn't take action, the current SGR patch is set to expire at the end of March enacting a 24% pay cut.  While ideas for "pay-fors" for the repeal seem to be scarce, provider groups agree on one thing - the time to repeal the SGR is now.  Discussion of a nine month delay until after the elections surfaced, but Congressional leaders and provider groups rejected that proposal.  The delay would have been the 17th temporary legislative patch delaying the cuts.  Read more in Modern Healthcare. 

As part of a discussion draft of pay-fors, the Senate Finance Committee looked at Critical Access Hospital (CAH) mileage and reimbursement.  While these are ideas and not endorsed options, CAHs are vulnerable.  It's important to continue to advocate.  Engage your mayor, Chamber of Commerce, and county commissioners - make your letters to your electeds patient-focused.  Critical Access Hospitals protect patient access, protect the rural economy and save taxpayer dollars.

Rural Physicians More Likely to Participate in QI Efforts and Discuss Cost of Care with Patients

A new study in the National Rural Health Association’s Journal of Rural Health finds rural primary care physicians are more likely to participate in quality improvement activities than their urban counterparts. According to Alan Morgan, CEO of the National Rural Health Association, “Quality healthcare can be found in rural towns all across America. Rural primary care often faces significant challenges with equal or better patient outcomes. It’s time to start looking at what’s done right in rural.” 

A survey of 2,000 rural and urban family practitioners indicated that while rural communities may have fewer training options, rural primary care physicians are significantly more likely to participate in quality improvement activities. The study also found that rural physicians were more likely to agree that physicians should discuss the costs of care with their patients and to report having added Medicaid or uninsured patients during the preceding year.

The peer-reviewed article on the study can be found here (a subscription may be required).

 

Rural Providers Come Together to Test Out ACO

Nine rural communities have joined forces to qualify the National Rural ACO (NRACO) for the Medicare Shared Savings Program. The NRACO includes a diverse cross-section of healthcare providers across the country, including Rural and Critical Access Hospitals, Rural Health Clinics, Federally Qualified Health Centers, and independent physician practices.

Accountable Care Organizations (ACOs) are required to have at least 5,000 Medicare beneficiaries and meet rigorous program requirements. This patient base can make it extremely difficult for rural areas to form ACOs. The number of beneficiaries attributed to each NRACO member community ranged from 252 to 3,507, well shy of the 5,000 beneficiaries required to participate. CMS estimates an average start-up cost and first-year operating expense of $1.7 million for an ACO, which is unaffordable for small rural community health systems. By themselves, none of the NRACO's member communities could have qualified or afforded to become Accountable Care Organizations.

According to the NRACO's founder, Lynn Barr, the organization was formed to overcome these barriers and make the program accessible to small community health systems: "Rural communities can join the NRACO at a fraction of the cost of setting up their own program, and reap the benefits for their communities and patients."

"Rural health systems provide about 70% of all care to their community. This program will help them coordinate the care provided outside their community and act as advocates for their patients," according to NRACO Board Chair, Timothy Putnam, CEO of Margaret Mary Community Hospital. "Forming the NRACO allowed us to do what is right for our patients and fulfill the mission of serving the health needs of our community, while at the same time blazing a trail for other rural communities to follow."

The vision of the NRACO is to be the national leader of the transformation of rural healthcare systems from fee-based to value-based care by creating an affordable, replicable framework that results in the best possible health for rural communities, at the lowest possible cost, and strengthens and preserves the rural health safety net.

You can read more about NRACO here or by signing up for a free subscription to Modern Healthcare here.

New ACA Communications Webinar Online Now

The Department of Health Care Policy and Financing, Division of Insurance and Connect for Health Colorado have released a new joint communications webinar. The webinar discusses how community partners can assist in reaching the uninsured and begin to educate consumers on how to use their coverage. The webinar also provides an overview of the resources available for consumers, partners and providers about the Affordable Care Act, Medicaid expansion, Connect for Health Colorado and the changes to private health insurance.

The webinar can be found on Colorado.gov/HCPF/ACAResources or by clicking here. Following the webinar, if you have questions you may submit them to ACAImplementation@hcpf.state.co.us.

Study Shows One in Four Families Struggle to Pay Medical Bills

According to a government survey published in the Bloomberg Personal Finance this week, one in four US families struggled to pay medical bills in 2012, and one in 10 said they had costs they couldn't pay at all.

The survey, released from the National Center for Health Statistics at the US Centers for Disease Control and Prevention, also found the lack of health insurance increased the burden of medical debt.

Major provisions of the Affordable Care Act take effect this year as the Obama administration seeks to extend healthcare coverage to most of the nation’s 48 million uninsured. The law may help lessen some of the financial burdens of medical care, said Karen Pollitz, a fellow at the Kaiser Family Foundation. "Unpaid medical bills is the number one reason why families declare personal bankruptcy,” Pollitz said in a telephone interview. “It causes people to lose equity in their homes, to endanger their retirement and their kid’s college education. It will destroy a family financially.” Read the rest of the article here.

Connect for Health Colorado and Colorado Medicaid Update

Read the latest enrollment number from Colorado Medicaid and Connect for Health Colorado below. You can read the press release in your browser by clicking here.

For immediate release:

January 17, 2014

CONNECT FOR HEALTH COLORADO AND COLORADO MEDICAID UPDATE

DENVER, CO – Between October 1, 2013, and January 15, 2014, more than 165,000 Coloradans have signed up or been approved for 2014 health coverage, according to data released today from Connect for Health Colorado and the Colorado Department of Health Care Policy and Financing.

After an extremely busy December, the first two weeks of January continues to see steady interest from Colorado shoppers and enrollment activity. January 15 was the deadline for Coloradans to sign up for private health insurance that takes effect February 1. The next deadline is February 15 to have private health insurance start on March 1. Open enrollment continues until March 31. Enrollment for Medicaid is year-round.

“We are encouraged to see steady interest from Coloradans during the second half of our open enrollment period and we are focused on reaching as many Coloradans as possible to help them shop for health insurance and apply for new tax credits to reduce costs,” said Patty Fontneau, CEO of Connect for Health Colorado.

“Together with our partners at Connect for Health Colorado, we are reaching and enrolling the uninsured,” said Susan Birch, Executive Director of the Colorado Department of Health Care Policy and Financing. “The numbers released today further demonstrate Colorado as a leader in the nation. We are among a handful of States with technology in place to allow for real time eligibility determinations for Medicaid. The technology, along with our strong network of county and community partners, has allowed us to enroll individuals into new coverage faster than many other states many of which have much larger populations to reach.”

Coloradans signed up for health insurance:
165,137 (Total) 101,730 (Medicaid) 63,407 (private health insurance)

Individual and family customer accounts:
86,235 (from PEAK) 155,854 (private health insurance)

Daily website visitors (average daily from January 1st - 15th):
4,546 (Medicaid) 7,982 (private health insurance)

** More metrics information about Medicaid is available here and more metrics information about Connect for Health Colorado is available here.

Through state laws, Connect for Health Colorado was established as a non-profit entity with a Colorado mission. In addition, Colorado is expanding eligibility for Medicaid. Private health insurance purchased through Connect for Health Colorado’s competitive marketplace and the expanded eligibility for Medicaid both take effect in 2014. Enhanced federal funding that is available starting January 1, 2014 will support the Medicaid expansion.

Connect for Health Colorado has been open since October 1, 2013 and operates with separate technology and customer service operations from the federal marketplace, healthcare.gov. Connect for Health Colorado is open to individuals, families and small businesses. Individuals and families can choose from up to 150 private health insurance plans from ten carriers and small employers can create small group plans from up to 92 health insurance plans provided by six carriers. The Customer Service Center is open from 7 am to 8 pm Mondays through Saturdays at 1-855-PLANS-4-YOU (855-752-6749). More information is available at www.ConnectforHealthCO.com.

Colorado Medicaid and the Child Health Plan Plus (CHP+) are public insurance programs for low income Coloradans. The Department of Health Care Policy and Financing administers these programs. Coloradans have multiple ways to apply for coverage, Colorado.gov/PEAK is the online application for public assistance programs including medical assistance. For more information visit Colorado.gov/hcpf or visitColorado.gov/health. The Medicaid Call Center (800-221-3943 for general questions and 800-359-1991 to check application status) are available 8 a.m. to 6 p.m. Monday through Friday. The call center is closed on state holidays.

###

Contact information:
Ben Davis, ben@onsightpa.com, 303-552-6790 (Connect for Health Colorado)
Rachel Reiter, Rachel.Reiter@state.co.us, 303-866-3921 (Colorado Medicaid)

Copyright © 2014 OnSight Public Affairs, All rights reserved.

Office of Rural Health Policy Webinar on the ACA Today

Join the Office of Rural Health Policy's call today on the Affordable Care from 1:00 - 2:00 pm. You can also find a list of previous and upcoming calls on the ORHP website. As always, you can share your experiences or questions at ORHP-ACAQuestions@hrsa.gov. The call information can be found below.

Wednesday, January 29, 2014
1 - 2 pm MST
Call-in Number: (800) 857-3749
Passcode: ORHPACA

$45 Million Set Aside to Strengthen Nursing

The federal government announced late last year it would deliver $55.5 million in fiscal 2013 to programs designed to strengthen, diversify, and grow the healthcare workforce.

The bulk of the funds, 82 percent ($45.4 million), are targeted at the largest segment of the healthcare workforce - nurses. Many of the grants support the Future of Nursing: Campaign for Action’s call for a more highly educated and more diverse nursing workforce and for more interprofessional collaboration among nurses and other healthcare professionals, according to Winifred Quinn, PhD, co-director of the Center to Champion Nursing in America, an initiative of AARP, the AARP Foundation, and the Robert Wood Johnson Foundation. Read the full article here.

Medicare Expands Definition of Rural for Telehealth

Effective January 1st, the Centers for Medicare and Medicaid Services (CMS) expanded the definition of “originating sites” to include Health Professional Shortage Areas (HPSAs) that are located in rural census tracts of Metropolitan Statistical Areas. Also, as part of the update to the Physician Fee Schedule for 2014, Medicare added “Transitional Care Management Services” to the list of codes eligible for payment when provided via telehealth.

Medicare defines “originating site” as the location of an eligible Medicare beneficiary at the time the service is provided via telemedicine. To find out if an authorized originating site is eligible for Medicare telehealth payment, check out the new payment eligibility analyzer from the Health Resources and Services Administration. Check out the tool here.

Will the "Doc Fix" Really Happen? The SGR Explained

After years of legislative wrangling and last-minute patches, expectations are high among physician groups, lawmakers and Medicare beneficiaries that Congress could act by March 31st of this year to permanently replace the current Medicare physician payment formula. While committees in both chambers have approved their own "doc fix" proposals, the approaches have yet to be reconciled, and none have identified how they would pay for a repeal.

Kaiser Health News printed these frequently asked questions and answers about the Sustainable Growth Rate (SGR) formula and how Congress may change it. It's one of the best explanations on the SGR I've read. If you have questions, I encourage you to check it out!

Colorado Network of Health Alliances, A Statewide Learning Network Convened by CCMU

In dozens of communities across Colorado, formal health alliances are using collective impact approaches to tackle the major social issues of healthcare. Some of the alliances have been around for decades and others are just now exploring formalization, but all of them are working on a common agenda, using collaborative leadership strategies, to improve the local healthcare system and ensure access to care for all community members.

Since 2012, the Colorado Coalition for the Medically Underserved (CCMU) has convened these alliances in a statewide learning network called the Colorado Network of Health Alliances. Last week, CCMU published a year-in-review document, Progress & Possibilities, detailing the first year of the network, including current membership (21 alliances) and highlights of the work being done by these groups. They also identified three strategies for local healthcare change that are common across the members of the Colorado Network of Health Alliances:

1. Developing Healthcare Leadership for Change – Health alliances are on the front lines of identifying and developing champions for healthcare change in communities across Colorado. These organizations have the unique ability to bring diverse and high-powered leaders and stakeholders together to work toward common goals.
2. Increasing Access to the Healthcare System – Health alliances are working hard to catalyze new healthcare access points, to maximize enrollment in new health insurance coverage options, and planning to care for the needs of Coloradans who will remain uninsured after the Affordable Care Act is implemented.
3. Improving and Strengthening the Healthcare System – Through formal alliances, health and community leaders across the state are constantly searching for ways to coordinate services, limit duplication, and pool resources.

Read the full report here.

Interest in Accelerated Medical School Programs Growing

In an article published in the Journal of the American Medical Association in 2012, University of Pennsylvania Vice Provost Ezekiel Emanuel and Stanford economist Victor Fuchs proposed that a year of medical school could be eliminated "without adversely affecting academic performance." The overall time it takes to train physicians, they wrote, is an example of waste in medical education and could be shortened without affecting patient care or eroding clinical skills; students could be assessed on "core competencies rather than on time served." 

Some experts are raising questions about the length of medical school in part because much of the fourth year is devoted to electives and applying for a residency. If the fourth year were to be eliminated, it could cut the amount of student loan debt for students and get them into the workforce faster. Read the rest of the article here.

Financial Challenges Top Concern for Community Hospital Leaders

For the tenth straight year, "financial challenges" have been listed as the number one concern of healthcare executives, according to an annual survey from the American College of Healthcare Executives. The second concern was healthcare reform implementation, followed by government mandates and patient safety and quality (both which ranked third). Read the article in HealthLeaders Media.

The Challenges of Adopting Health IT for Rural Hospitals

Michael Archlueta, Director of IT for Mt. San Rafael Hospital in Trinidad was recently quoted in Becker's Hospital Review. When discussing the challenges of rural health IT adoption, Mr. Archlueta said, "At times, I've faced difficulty in regards to having limited resources made available to me. "The challenge has been the tremendous work-load that I’m juggling and expectations that I’m continuously striving but successfully overcoming all obstacles." 

Mt. San Rafael Hospital is not alone. Across the country, other small rural hospitals face hurdles when it comes to funding, personnel and other resources needed to implement EHRs and other forms of health IT. Read the article here.

Opening Day Speeches and State of the State

On the first day of the session, Senate President Morgan Carroll and Senate Minority Leader Bill Cadman gave speeches marking opening day, as did Speaker of the House Mark Ferrandino and House Minority Leader Brian DelGrosso. Partisanship, economic development, particularly in rural areas, and unemployment were common topics. 

On Thursday Governor Hickenlooper delivered his State of the State. The Governor stated his number one priority is to focus on job growth in the state. He too emphasized the need for job creation in rural parts of the state. The links to all the speeches are embedded above.

NOSORH Webinar: Preparing to Engage with Legislators and Policymakers

The National Organization of State Offices of Rural Health (NOSORH) invites you to participate in a webinar: Preparing to Engage with Legislators & Policymakers. The webinar takes places on Wednesday, January 22, 2014 at 12:00 p.m. MST. 

As the budget discussion in Washington continues and the Colorado legislative session is underway, it's a good time to connect with your legislators on the issues that matter to you. This webinar provides an opportunity to learn how to educate elected officials and how to tell your story with talking points and messages for legislators. Register for the webinar here.

The 2014 Colorado Legislative Session Begins Today!

The 69th session of Colorado General Assembly begins today! We’re predicting this may not be a healthcare-heavy session. Implementation is in full swing, so this year we’ll see some clean up bills along with some other small changes. However, given the changes in the composition of the Senate due to the recalls (the Senate is now split 18-17 Democrats, a change from 20-15 Democrats last year), and the fact that this is an election year, there may be some surprises yet. Stay tuned for updates on the budget and other bills impacting rural Colorado from CRHC! Use this link throughout the session to see which bills have an official CRHC position.

Obamacare May Cut Bad Debt Says Southwest Memorial Hospital

As more people in Montezuma County sign up for insurance under the federal healthcare law, Southwest Memorial Hospital in Cortez may take on far less bad debt. Southwest Health System said patients were unable to pay about $4.6 million in medical bills during the 12 months leading up to October 2012.

In preparation for Obamacare, the hospital became certified in the fall to sign people up for Medicaid and other forms of insurance. According to Kent Helwig, CEO of Southwest Memorial Hospital, the hope is that people will seek out preventive care and make fewer trips to the emergency room when they have insurance. Read the rest of the article in the Cortez Journal here.