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.