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

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!

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. 

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).  

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.​

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.

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.

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.

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.

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.

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.

AHA Rural Chair Says Reimbursement Top Challenge

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

Medicaid Officials Release Rule Affecting Cost-Sharing and Coordination

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

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

Infographic on Healthcare Access in Rural Colorado Released

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

NBC Political Director Says Rural/Urban Divide “Stark”

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

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

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

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

CIVHC Answers Frequently Asked Questions About the APCD

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

NRHA's Rural Health Policy Institute

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

6 Questions About How the Fiscal Cliff Affects Healthcare

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

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

Provider Groups Lobby Against Fiscal Cliff

As lawmakers and President Barack Obama discuss possible changes to federal entitlement programs as part of a larger deal to avoid the fiscal cliff, provider groups are making their case loud and clear - cuts are not welcome. The fiscal cliff is the mix of expiring tax breaks and automatic spending reductions set to begin in January.

In a document provided to lawmakers, the American Hospital Association said, "providers already face billions of dollars in Medicare and Medicaid payment cuts, and additional reductions could jeopardize beneficiaries’ access to care. True entitlement reform and approaches to change the health care delivery system are needed – not provider cuts.” Read the full article here.