September Revenue Forecast

Colorado’s economic growth has slowed over the summer, according to today’s revenue forecasts released by the Office of State Planning and Budgeting and the Colorado Legislative Council. The state economy faces many national and global threats; however, agriculture and oil prices are strong. The state’s current FY 11-12 budget is in balance, with a $64 million projected surplus. For FY 12-13, forecasters projected a surplus of approximately $370 million, assuming that the current year’s surplus is rolled over and the economic outlook remains steady. Given this minimal projection for the next year and annual increases in demand for services including Medicaid, spending reductions are expected for the coming year. Read more. 

White House Releases Deficit Reduction Proposal Calling for Medicare, Medicaid Changes

The White House proposal that was released today calls for reducing the nation’s debt by $3 trillion over the next ten years. The deficit reduction plan puts forth significant reductions in Medicare and Medicaid spending that will drastically impact rural healthcare providers and communities, including lowering Critical Access Hospital (CAH) reimbursement, eliminating CAH designation for any facility within 10 miles of another hospital, lowering the federal matching rate for Medicaid to the states, and reducing the Medicaid Hospital Provider Fee. As Congress moves forward with deficit reduction activities in the coming weeks, this proposal will be under consideration. Members of Congress need to hear from their constituents about the impact these cuts will have on rural providers and access to care in rural communities. CRHC will be providing additional information, resources, and opportunities to communicate with your elected officials in the coming days. Read NRHA's response to the White House proposal. 

Latest Estimates of Colorado’s Uninsured

Earlier this month, the U.S. Census Bureau released information on Americans’ income, poverty, and health insurance coverage for 2010. Nationally, median household income declined and the poverty rate increased. While the number of Americans without health insurance increased, the overall percentage was not statistically different from the previous year. The Colorado Health Institute (CHI) released a report on state-level findings, noting that Colorado was the only state that recorded a statistically significant decline in the number of uninsured individuals between 2007-08 and 2009-10. Read CHI’s report. 

Community Paramedics Responding to Community Needs

Today’s New York Times features an article on community paramedics, highlighting Eagle County’s program. Read more. 

Deadlines Extended for Medicare Bundled Payment Initiative

The CMS Innovation Center has extended the deadlines for letters of intent and applications for its Bundled Payments for Care Improvement initiative (BPCI) released on August 23rd. Letters of intent for BPCI Model 1 are now due on October 6th, 2011. Applications for BPCI Model 1 are now due on November 18th, 2011. Read more. 

Loan Repayment Application Cycle Opening

Do you have a healthcare provider at your rural facility who is interested in loan repayment? Let them know that the Colorado Rural Outreach Program Loan Repayment Program application cycle is opening in October. Read more.

Nearly Half of Office Based Physicians Working With NPs and PAs

The Centers for Disease Control and Prevention's National Center for Health Statistics reported in an Aug. 17 data brief that 49% of physicians working in office settings work with nurse practitioners, physician assistants, and certified nurse midwives. Primary care practices were the most likely specialty to work with these practitioners. Read more. 

Complete CRHC's Policy and Advocacy Survey Today

Please inform the Colorado Rural Health Center’s (CRHC) policy & advocacy efforts for 2012 by completing our annual survey. Your feedback is invaluable and will help guide our work. The survey should take approximately 5 minutes to complete and can be accessed by clicking here. The survey will be open until Friday September 30, 2011. Please complete the survey only once. Your responses are greatly appreciated!

New Health Information Technology Website Available

The Office of the National Coordinator for Health Information Technology has launched a new website www.HealthIT.gov. The website has information and resources for both healthcare consumers as well as providers. The site also addresses privacy questions regarding electronic health records. 

Nonfinancial Barriers and Access to Healthcare

A recent study found that more U.S. adults postpone or go without medical care for nonfinancial reasons than for financial ones. Although affordability issues did limit access to care, nonfinancial barriers including availability and accessibility of care often overlapped with financial barriers. Read more.

Community Paramedics Meeting Healthcare Needs in Eagle County

Read more about The Community Paramedic Program, a pilot project through the Western Eagle County Ambulance District, that partners paramedics with physicians to provide in-home health monitoring and check-ups. The program is an innovative solution to some of the challenges of providing healthcare in rural communities.

The Budget Control Act of 2011: Implications for Medicare

A new brief by the Kaiser Family Foundation, The Budget Control Act of 2011: Implications for Medicare, provides an overview of the new law that came out of this summer’s negotiations on raising the debt ceiling and deficit reduction, including a timeline and process for raising the debt ceiling and lowering the federal deficit. The brief also describes the role of the new Joint Select Committee on Deficit Reduction, aka the “Super Committee”, examines how Medicare spending could be affected by changes proposed by the Committee, or if that process fails, by sequestration. Click here to read the brief. 

New Website Available to Answer Questions, Provide Information on Health Insurance

The Colorado Division of Insurance has created a new website for consumers and business owners to answer questions and provide information about health insurance, including what drives the cost of insurance premiums, how to select a plan, and how to get help when an insurance claim is denied. Click here to access the website or go to www.askdora.colorado.gov and click on the “Are You Prepared for Changes in Health Insurance?” button.

New Critical Access Hospital Data Initiative

Rural healthcare providers and advocates know that rural health is not ‘a smaller version’ of urban healthcare systems and that current national measurement and benchmarking systems may not accurately capture and reflect the quality work of rural health providers. The Medicare Beneficiary Quality Improvement Project (MBQIP) is a three-year, voluntary initiative for Critical Access Hospitals (CAH) intended to create a national database of rural appropriate and relevant quality data to demonstrate to policymakers the work CAHs are doing. CAHs that participate in MBQIP will be able to share best practices among one another and be benchmarked against other CAHs across the nation. As Medicare moves toward payment tied to quality and public reporting, MBQIP provides an opportunity for CAHs to prepare for future changes. 

MBQIP’s first of three phases begins in September 2011. To learn more, watch the short MBQIP video on YouTube and contact Jen Dunn or Michelle Mills for additional information.

Denver Post Coverage on Scaling Back Medicaid Expansion

Today's Denver Post covers the recent announcement by the Colorado Department of Health Care Policy and Financing that it will be limiting Medicaid coverage for adults without dependent children. Click here for the article.

Update on State Medicaid Expansion

The Colorado Department of Health Care Policy and Financing has made decisions regarding expanding Medicaid coverage to adults without dependent children, including when and how the expansion will begin and who will be eligible in the first phase. Please click here to read the update provided by The Colorado Coalition for the Medically Underserved's Connect Campaign. 

CMS Creates Medicare Bundled Payment Initiative for Interested Providers

The Centers for Medicare and Medicaid Services (CMS) has invited interested providers to “help test and develop” four different models of bundling payments. Under this initiative, CMS would link payments for multiple services patients receive during an episode of care. Three models involve a retrospective bundled payment arrangement and one model would pay providers prospectively. Nonbinding letters of intent must be submitted by Sept. 22 or Nov. 4, depending on the model that providers plan to pursue. Click here for detailed information on this initiative. 

Policy Brief: U.S. Rural Hospital Charges Due to Ambulatory Care Sensitive Conditions

A new policy brief by the RUPRI Rural Health Center for Policy Analysis examines the trends and regional variations of rural hospital charges due to ambulatory care sensitive conditions (ACSCs), by insurance type, from 2000 to 2004. While ACSC-related charges as a percentage of all charges in rural hospitals decreased by 4.5% during this time period, for uninsured and Medicaid patients the percentage of total ACSC-related charges increased from 12.5% to 15.0%. The authors suggest that investing targeted resources that support ambulatory primary care in rural communities could reduce hospitalizations and associated costs. Click to read the brief. 

The Geography of Need: Identifying Human Service Needs in Rural America

A recent study by the Rural Policy Research Institute, The Geography of Need: Identifying Human Service Needs in Rural America, proposes a new methodology for creating a human service profile based on characteristics of a population and also documents how human service needs differ significantly, in both the degree of need as well as the types of needs, in metropolitan and non-metropolitan counties. The study includes county-level maps that illustrate these characteristics and profiles. Click here to read the report. 

ClinicNET and CRHC Release Patient Centered Medical Home Landscape Brief

Quality care delivered in a Patient Centered Medical Home (PCMH) model involves many different tools, staff, and strategies, including health information technology, health information exchange, and patient registries, to deliver culturally and linguistically appropriate care to patients and their families when and where they need it. ClinicNET and CRHC support the PCMH model and provide services to assist clinics in pursuing PCMH certification or designation. To read the new PCMH brief and to learn more about efforts in Colorado, please click here.

Rural Council Report Focused on Economic Growth

The White House Rural Council released a new report entitled Jobs and Economic Security for Rural America. The report lays out the economic landscape facing rural America and highlights five key areas: creating jobs and promoting economic growth, improving access to quality healthcare and education, fostering innovation, expanding outdoor opportunities, and supporting veterans and military families. Click here to read more and download the report. 

Safety Net Clinic Week is Coming Soon—Are You Ready?

Safety Net Clinic Week is just around the corner, August 22-26. This week is a great opportunity to educate lawmakers and communities about the diversity of Colorado’s safety net. Many rural health clinics and community-funded safety net clinics will be participating by hosting state and federal elected officials to their clinics, holding community open houses, etc. Please click here to access a toolkit that will help clinics that would like to participate. Please contact Alicia or Sara to share what activities you are planning for the week or for assistance.  

Update from CHI on Rural APNs and PAs in Colorado

Colorado Health Institute’s Jackie Colby presented new findings about rural nurse practitioners (APN) and physician assistants (PA) practice patterns at CRHC’s annual conference on Thursday, August 11. The new analysis, based on respondents to CHI’s previous APN and PA surveys, found that about 11 percent of both PAs and APNs work in rural areas yet there are nearly twice as many APNs as PAs overall. Read more.

Dual-eligible Medicare/Medicaid Beneficiaries

Earlier this summer, Colorado received $1 million from the Centers for Medicare & Medicaid Services to plan an integrated model of care for individuals who are dually-eligible for Medicare and Medicaid. A new post from Health Reform GPS gives a detailed summary about some of the challenges in coordinating care for these individuals who are typically older and experiencing multiple chronic conditions as well as provisions in the Affordable Care Act that are intended to address these challenges. Read the post.  

Update on Congressional Deficit “Supercommittee”

The deal reached by Congress and the White House that raised the debt ceiling also called for the creation of a bipartisan Congressional “supercommittee” called the Joint Select Committee on Deficit Reduction. This committee is charged with finding at least $1.2 trillion in savings. These recommendations are due by Thanksgiving, with the entire Congress to vote on them by Christmas to avoid automatic cuts in military and healthcare programs, specifically payments to Medicare providers. Nearly all of the members of this committee have been named. Click here to read about this committee and its members to date.  

Colorado Health Benefit Exchange Board to Hold 3rd Meeting

The next meeting of the Colorado Health Benefits Exchange (COHBE) board will be held this Thursday, August 11th from 9:30 AM – 1:00 PM in the Legislative Services Building (200 E. 14th Ave., across the street from the State Capitol). It has not been determined if the meeting will be broadcast on the web. The by-laws committee of the Exchange Board had a conference call yesterday to discuss legal counsel and the process for developing the by-laws. Committee members Steve Erkenbrack, Ken Lund, and Richard Betts will make recommendations to the Board during its meeting Thursday. The Board is also expected to appoint a Chair. 

Peter Marcus of The Colorado Statesman, a weekly nonpartisan political paper, wrote a great article yesterday detailing the Board’s process so far and some of the controversy surrounding its appointments and funding. Click here to read the article.

For more information on the Colorado Health Benefit Exchange, contact Alicia. 

LGBT Health Survey Available Online

The One Colorado Education Fund has created an online survey to measure the healthcare needs and experiences of lesbian, gay, bisexual, and transgender (LGBT) Coloradans. The anonymous survey is available in both English and Spanish and will be open through August 26. The Survey is an opportunity for LGBT Coloradans, including those living in rural communities, to share their experiences and feedback. Click here to access to survey. Read more. 

Defining Rural: Issue for White House Rural Council?

U.S. Agriculture Secretary and Chair of the White House Rural Council Tom Vilsack said that he would ask the Council to consider streamlining the many existing definitions of “rural” in use among federal agencies. The federal government has 16 agencies with 88 programs that have varying and contradictory definitions of rural America for eligibility purposes. Read more. 

New Report on “Modernizing” Rural Healthcare

A recently released report by the UnitedHealth Center for Health & Reform Modernization examines the health needs of rural America and how well the healthcare system is able to respond. The paper looks at coverage, access, and quality in rural communities and also outlines recommendations for addressing issues including greater use of telemedicine, expanded roles for nurse practitioners and physician assistants, designing regulations to meet the needs of rural areas, and engaging more rural consumers in improving their health. Read more. 

Debt Ceiling Update

Congress and the White House reached a deal to raise the nation’s debt ceiling and avoid default. In addition to increasing the federal borrowing limit, the plan also included substantial deficit reduction measures. The agreement, which operates in two parts, would raise the debt ceiling by $900 billion immediately in August and September and require an equal $900 billion spending reduction.  Medicare and Medicaid would not be impacted by these initial cuts, despite earlier information that Medicare payments to rural hospitals could be reduced by roughly $14 billion and Medicaid matching rates would be lowered. Thank you to all who called or wrote their Members of Congress to express concern about these cuts.

The second component of the debt ceiling legislation creates a 12-member “super congress” made up of equal numbers of members of both parties and both bodies of Congress. This committee would be responsible for making recommendations for $1.2-1.5 trillion in additional savings by Nov. 23. The committee may target Medicare and Medicaid for reductions to achieve these savings. The committee’s recommendations would be subject to a simple up-or-down vote before Dec. 23 and could not be filibustered.  If the recommendations pass, the President could request an additional increase in the debt ceiling of $1.5 trillion. If Congress fails to either act on the committee’s proposal or send a balanced budget amendment to the states before the end of the year, then an automatic “trigger” of across-the-board spending cuts totaling $1.2 trillion would go into effect. The cuts would apply to both mandatory and discretionary spending programs beginning in 2013. Medicaid, Social Security, and veterans’ benefits would not be subject to the cuts, but Medicare provider payments would face a cut of up to 2 percent over nine years (2013-2021). The president would then be authorized to request an additional increase in the debt ceiling of $1.2 trillion.

The agreement passed both the House and Senate and the President is expected to sign it as soon as possible. Click here to read more about the agreement and its potential impact on health programs. 

Health Insurance Exchange Focus Groups

Health Insurance Exchanges are online marketplaces where consumers can shop and buy health insurance products in the independent and small business markets.  Given the high number of ranchers, farmers and small business owners in rural areas, it is crucial the experiences and ideas of rural Coloradans are heard in order to ensure the Exchange works for residents from all parts of the state.  The Colorado Center on Law and Policy is hosting focus groups around the state to better understand the consumer needs, opinions and perspectives of the Exchanges.  This is a great opportunity to provide the rural voice in the process.  A list of the meetings outside the Denver-metro area is below. More information can also be found at Colorado Insurance Exchange Focus Groups.

 

Grand Junction

Dates: August 1st and 2nd

Time: 6-8 pm

Place: Mesa County Workforce Center

Sterling

Date: August 8

Time: 6-8pm (room reserved 5.30 to 8.30)

Place: CSU Extension Room

Address: 508 S. 10th Avenue

Greeley

Date: August 1st

Time: 6-8pm (room reserved 5.30 to 8.30)

Place: Centennial Park Library

Address: 2227 23rd Avenue

Pueblo

Date: August 3rd

Time: 6-8pm (room reserved 5.30 to 8.30)

Place: Rawlings Library (Thurston Room)

Address: 100 E. Abriendo Ave

IOM Report on Improving Access to Oral Health Care

Underserved communities and populations, including rural areas, experience significant access barriers in obtaining oral health care. The Institutes of Medicine (IOM) recently released a report “Improving Access to Oral Health Care for Vulnerable and Underserved Populations” that assesses the current oral healthcare system and recommends strategies for improving access to oral health care. Read more. 

Colorado Health Benefit Exchange Board Holds Second Meeting

The Colorado Health Benefit Exchange (COHBE) Board held their second meeting on Monday, July 25th. Much of the discussion centered around the Board's operations. A summary of the key discussions is below:

Work Groups – The members of the board will participate in the workgroups which best fit their skill set and expertise.

Adoption of By-laws – A small group was formed to look into the by-laws and explore options for private council.  A working outline of the by-laws has been created; the small group will revise them, based upon recommendations from other board members, and bring them back to the full board for review.

Election of Chair and Vice-Chair – A relationship with legal council should be established before adopting the by-laws, which will include the charter for the Chair and Vice-Chair.  Upon adoption of the by-laws, the Board will appoint a Chair and Vice-Chair.  Three members have expressed interest in serving in those positions.

Interim Rules of Operation – The Board discussed the rules of operation to be used prior to the adoption of the by-laws.  Two suggestions were made as revisions to the current rules; the threshold for a board quorum will be increased to six (from three), and the search for the Executive Director will be included in the public meetings. 

Conflict of Interest – The Board discussed whether or not their position could prevent them from serving on other boards.  This will be addressed in the by-laws, but for now the Board agreed disclosure is critical.

Report from Data and Advisory Workgroup (DAWG) – DAWG is working with the Wakely Consulting Group to model the characteristics of the consumers purchasing in the Exchange, model their purchasing habits and estimate the cost of providing their coverage.

 

Meeting Logistics – The Board is looking for a permanent meeting location and standing meeting time.  Due to the travel distance for some members and the amount of work to do, the length of the meetings will be extended to four hours. 

The Colorado Health Institute is convening a variety of workgroups related to the Exchange.  For more information on the Data and Advisory Workgroup (DAWG), the Marketing, Enrollment and Outreach Workgroup (MEOW), the Eligibility, Verification and Enrollment (EVE), and the Small Employer Workgroup (SEWG), visit CHI’s website.  CRHC encourages rural residents to participate in these work groups in order to ensure the rural voice is heard as the Exchange is developed.  Please contact Alicia Haywood of CRHC if you have questions or would be interested in participating.

The next

The next meeting will be held August 11^th from 9:30 – 10:30 AM in the Legislative Services Building across from the Capitol.

CMS Hosting ACO Accelerated Development Learning Session, September 15-16 in San Francisco, CA

The Centers for Medicare & Medicaid Services (CMS) is offering free Accountable Care Organization (ACO) Accelerated Development Learning Sessions to provide executive leadership teams from existing or emerging ACO entities the opportunity to learn about essential ACO functions and ways to build capacities needed for ACOs. The second Accelerated Development Learning Session will be held in San Francisco, CA on September 15-16. Click here for more information and to register. 

Safety Net Clinic Week, August 22-26-Clinic Toolkit Now Available

The second annual Safety Net Clinic Week is August 22-26, 2011.The week will be devoted to educating the public and policy makers about often overlooked providers, Community Funded Safety Net Clinics (CSNCs) and federally certified Rural Health Clinics (RHCs), that care for uninsured and underinsured Coloradans. 

A toolkit of resources is now available for clinics that would like to participate in Safety Net Clinic Week activities. Click here for the toolkit. Please consider hosting an open house or legislative visit at your clinic during the week. Contact Alicia or Sara for more information on how you can get involved with Safety Net Clinic Week. 

Update on Federal Deficit Reduction Negotiations

The bipartisan “Gang of Six” in the U.S. Senate has put forward a plan for deficit reduction. Reports have stated that the deal, totaling $3.7 trillion over 10 years, would include 26 percent revenue increase and 74 percent spending cuts. Early information shows a possible $200 billion in cuts to health care. The released information, however, does not include the specifics of where these cuts would be made. Earlier proposals have included reducing or eliminating the Medicaid Hospital Provider Fee, $14 billion in Medicare cuts to rural providers, and reducing the federal matching rate for Medicaid to the states.

Because the details the health care cuts under consideration are still unknown, it is critical to continue communicating with our members of Congress, especially Senators Bennet and Udall. Please contact Senator Bennet, Senator Udall, and your Representative with this message: “Please protect Medicare and Medicaid as you consider changes and cuts in the federal budget. Rural communities rely on these programs and significant cuts will threaten access to care and economic growth in rural Colorado.” Feel free to personalize your message with how Medicare and Medicaid impact your community. Thanks to all who have already contacted your elected officials.

You can contact your legislators by phone and email: 

Senator Michael Bennet, 202.224.5852 

Senator Mark Udall, 877.768.3255 

Capitol Switchboard, 202.224.3121 (ask for your Representative's office and to speak with the staff who handles health issues)

Click here for a list of Colorado's members of Congress and email addresses for their healthcare staff. If you don't know who represents you in Congress, click here and enter your zip code.

CMS Releases Proposed Rules for Health Insurance CO-OPs

The Centers for Medicare & Medicare Services (CMS) proposed rules regarding the creation of Consumer Operated and Oriented Plans (CO-OPs), private non-profit, consumer-governed health insurance plans. These new plans could get seed money to increase competition under the new rules announced by the Department of Health and Human Services. Read more. 

Colorado HealthStory Holds Its First Community Forum

Last night, Colorado HealthStory, a project of the Colorado Rural Health Center, the Colorado Coalition for the Medically Underserved and ClinicNET, held its first community forum in Aurora.  After collecting stories in Aurora for two months, Colorado HealthStory staff convened community members for a local forum and listening session.  The forum was attended by storytellers, city officials, community activists and the media.  During the forum, attendees listened to some of the stories collected in Aurora, shared issues related to health and discussed key health data specific to Aurora, as well as identified local efforts to address these issues.  The next community forum will be held in Summit County, followed by Rocky Ford, both later in the summer.

In tandem with its first forum, the website for Colorado HealthStory was launched yesterday at www.coloradohealthstory.org.  There, visitors can find out more about the project, hear the stories and find out when HealthStory will be in their community.  As well as visiting the website, Colorado HealthStory can be found on Facebook and followed on Twitter, and videos can be viewed on Vimeo.  

The Colorado Health Benefits Exchange Board of Directors Appointed and Holds First Meeting

Governor Hickenlooper announced the appointments to the Colorado Health Benefits Exchange Board on June 29^th.  Click here to view the press release and Executive Order.  The first meeting of the Board of Directors was held Monday, July 11^th and was well attended by consumer advocates and business representatives.  The next meeting is scheduled for July 25^th.  CRHC is actively participating in the development of the Exchange by attending the board meetings, taking part in the workgroups and monitoring the Legislative Oversight Committee, as well as identifying opportunities to provide input and expertise on behalf of rural Coloradans.  For more information on the board meetings and workgroups, visit the Colorado Health Institute’s website.  For questions regarding the Exchange or activities related to its creation, contact Alicia Haywood. 

County Health Comparisons-Rural Losing Ground

A recent analysis of the County Health Rankings found that Americans residing in major cities live longer, healthier lives overall than rural Americans—a reversal from decades past. Rural residents face higher rates of health issues including diabetes, stroke, heart attack, and high blood pressure. Limited access to care is cited a factor contributing to these growing health disparities in rural areas. Read more.

Comments on USDA Rural Development Needed

The USDA Rural Development is accepting written comments from stakeholders about rural development priorities for President Obama’s 2013 budget and 2012 Farm Bill principles. USDA Rural Development funds programs that are critical to rural counties such as rural water/wastewater infrastructure, community facilities, hospitals and clinics, broadband expansion, housing, renewable energy and business development initiatives.  This is an important opportunity to share insights about how Rural Development can enhance its program administration and delivery to rural counties. The ‘bricks & mortar’ funding available through Rural Development plays a key role in supporting and expanding rural communities here in Colorado and across the nation.

Click here for more information and questions that USDA would like feedback on from the public. Although no firm deadline has been established, comments are preferred by the end of July and can be emailed directly to USDA. 

CO-OP Health Plans & Rural Health Insurance Markets

A recent report assesses the opportunities and challenges of using the Consumer Operated and Oriented Plan (CO-OP) program in federal health reform to address the limitations of the rural private health insurance market. Download the report. 

Flex Monitoring Team Responds to JAMA Article on Quality of Care at CAHs

The Flex Monitoring Team, the nation's leading experts on rural health care quality, has prepared a detailed analysis of last week's article in JAMA on quality of care at critical access hospitals (CAH). The JAMA article concluded that compared with non-Critical Access Hospitals (CAH), CAH’s had fewer clinical capabilities, worse measured processes of care, and higher mortality rates for patients with AMI, CHF or pneumonia. “The report is simply deficient when it comes to understanding the basic role of a Critical Access Hospital within a rural community,” said Alan Morgan, National Rural Health Association CEO.  “The current quality measurement systems available do not adequately reflect the core work of what rural hospitals do on a daily basis.”

Funded by HRSA, the Flex Team has provided detailed national and state reports on CAH quality for the past six years. Their numerous reports document the substantial progress in quality improvement that CAHs have made during that time frame, as well as areas in which there is still room for improvement. Click here to view the Flex Team's response to the JAMA report.

CRHC has been working with the 29 CAHs in Colorado for over 10 years on quality improvement activities including the Quality Network, 100,000 Lives Campaign, 5 Million Lives Campaign, Quality Health Indicators (QHi) Benchmarking, and iCARE (Improving Communication & Readmission). For more information on CRHC’s CAH quality improvement programs, contact Jen Dunn, CAH Program Manager.

Call to Action: Contact Your Member of Congress & U.S. Senators Today

As has been mentioned in previous posts, political leaders in Washington are discussing options for raising the nation’s debt ceiling limit by August 2^nd and cutting federal spending to address the deficit. Medicare and Medicaid are under consideration for substantial spending cuts, including reducing the federal Medicaid matching rate to the states, and limiting or eliminating the Medicaid hospital provider fee that supports expansion of coverage to the uninsured and the hospitals that care for the medically vulnerable.

As you know, Medicare and Medicaid are essential to rural healthcare providers and communities. The proposed cuts will severely compromise access to healthcare for rural residents and hamper local economies that depend on healthcare providers for jobs and economic development. Colorado’s Congressional delegation needs to hear from you about the importance of Medicare and Medicaid to rural Colorado. Please take five minutes today or no later than Wednesday July 13 to contact Senator Bennet, Senator Udall, and your Representative with this message: “Please protect Medicare and Medicaid as you consider changes and cuts in the federal budget. Rural communities rely on these programs and significant cuts will threaten access to care and economic growth in rural Colorado.” Feel free to personalize your message with how Medicare and Medicaid impact your community. 

You can contact your legislators by phone and email: 

Senator Michael Bennet, 202.224.5852

Senator Mark Udall, 877.768.3255

Capitol Switchboard, 202.224.3121 (ask for your Representative's office and to speak with the staff who handles health issues)

Click here for a list of Colorado's members of Congress and email addresses for their healthcare staff. If you don't know who represents you in Congress, click here and enter your zip code.

Thank you for your calls and emails. Please contact Sara if you have any questions and we will post updates on the budget negotiations as they are available.  

 

Emergency Department Visits in Rural and Non-Rural Communities

A new statistical brief by the Agency for Healthcare Research and Quality compares emergency department (ED) visits in rural and non-rural communities. Rural ED visits were more likely to be billed to Medicare, Medicaid, or no payer than in non-rural communities. Also, fewer ED visits in rural communities resulted in hospital admissions. Read the report for additional information.  

States Cutting Medicaid Rates, Healthcare Programs At Risk in Budget Negotiations

Several states, including Colorado, began their fiscal years on July 1 by reducing Medicaid payment rates to providers and hospitals. A Kaiser Health News report outlines various states’ changes in Medicaid, including payment and benefit reductions, that may further compromise access to care for Medicaid recipients.

In Washington, Medicaid and Medicare program cuts are under consideration as political leaders negotiate budget and debt issues. Negotiators are discussing serious reductions in Medicaid, including reducing the federal matching rate to the states and limiting or eliminating the Medicaid hospital provider fee that both supports Colorado’s coverage expansions to the uninsured and our hospitals that care for the un- and underinsured. Negotiations are expected to continue for the next several weeks as the national debt ceiling limit approaches on August 2^nd. Given the critical role that Medicare and Medicaid play in rural communities, CRHC has been communicating with Colorado's members of Congress about these issues and will be sharing opportunities for you to contact your member directly in the coming days. Please contact Sara if you have any questions.  

Life Expectancy Declines For Some of Colorado's Rural Communities

A new study by the University of Washington featured in the Denver Post found that from 1997-2007 life expectancy decreased for women in several rural counties on the Eastern Plains. Overall, life expectancy in many rural, non-mountain resort counties is relatively lower. Read more. 

Governor Hickenlooper Announces Appointments to the Colorado Health Benefits Exchange Board

Governor Hickenlooper announced the appointments to the first Colorado Health Benefits Exchange Board today.  “This will be a Colorado-based health exchange that is created by Coloradans, for Coloradans,” said Hickenlooper. “The Exchange represents a broad collaborative effort between businesses, consumers, providers, the insurer community and the state legislature.  We are excited to be a leader among states on this issue, and one of 10 states that passed legislation.”

The Exchange will be governed by nine voting board members and three ex-officio members.  The members appointed by the Governor, Senate and House Majority and Minority leadership are:

• Richard T. Betts of Telluride, with a term to expire 2013.  Betts is the owner, ASAP Accounting & Payroll, Inc.
• Eric Grossman of Englewood, with a term to expire 2013.  Grossman is a vice president of TriZetto.
• Robert S. Ruiz-Moss of Lone Tree, with a term to expire 2013.  Ruiz-Moss is the Chief Executive Officer of Anthem Blue Cross.
• Elizabeth Soberg of Centennial, with a term to expire 2013.  Soberg is the Chief Executive Officer of UnitedHealthcare of Colorado.
• Gretchen Hammer of Denver, with a term to expire 2015.  Hammer is the Executive Director for the Colorado Coalition for the Medically Underserved.
• Stephen ErkenBrack of Grand Junction, with a term to expire 2015.  ErkenBrack is the president of Rocky Mountain Health Plan.
• Arnold Salazar of Alamosa, with a term to expire 2015.  Salazar is the Executive Director of Colorado Health Partnerships, LLC.
• Nathan Wilkes of Arapahoe, with a term to expire 2015.  Wilkes is the founder and principal consultant, Headstorms, Inc.
• Dr. Michael Fallon of Denver, with a term to expire 2015.  Fallon is an emergency room physician

The Colorado Health Exchange was created by Senate Bill 11-200.  It will be an independent public entity not affiliated with an existing state agency or department and initially funded by gifts, grants and donations.  The first meeting of the Exchange Board will be held on Monday, July 11^th.  CRHC will be monitoring the activities of this board, particularly as it pertains to access and affordability for rural Coloradans. 

Recent Changes in Health Insurance Coverage in Rural and Urban Areas

A report by the Rural Health Research & Policy Analysis Center compares changes in health insurance coverage for non-elderly Americans in rural areas to changes in urban areas during the recent economic recession from 2007 through 2009. In general, rural and urban areas were equally affected by shifts away from private coverage and towards public coverage and uninsurance between 2007-2009; however, rural residents continued to be less likely to have private coverage and more likely to have public coverage than their urban counterparts. Read more. 

Addressing Colorado’s Primary Care Physician Shortages

An article in the Colorado Springs Gazette discusses the current shortage of primary care physicians in rural areas that is projected to worsen in the coming years. The article highlights the clinical team in Rocky Ford & Ordway, including a full time nurse practitioner and part time, traveling family physician, who are meeting the healthcare needs of their communities. Read more. 

CRHC Accepting Nominations for Rural Health Excellence Award

CRHC is now accepting nominations for the 2011 Rural Health Excellence Award. This prestigious award is given annually by Colorado Rural Health Center to honor those who have made a notable contribution to health, healthcare, or a healthcare delivery system in rural Colorado. For 2011, the award will be presented during the 20th Annual Colorado Rural Health Conference August 11-12th, at the Denver Tech Center Hyatt Regency.

To be eligible for the award, a candidate must have made a significant contribution to the health, healthcare, or a healthcare delivery system in a rural Colorado community, area, or region. Healthcare providers, board members, administrators, volunteers and others are eligible for nomination. Despite their enormous contributions, CRHC Board Members are not eligible for nomination while serving on the Board.


To nominate someone, complete the entry form. The deadline for nominations is July 15, 2011.Contact Nadine Gressett with questions. 

National Prevention Strategy Released

The nation’s first National Prevention and Health Promotion Strategy (National Prevention Strategy) was released last week by U.S. Surgeon General Regina Benjamin, MD. The Strategy’s goal is to increase the number of Americans who are healthy at every stage of life and provides strategic directions and priorities to address health disparities and create healthier workplaces, schools, and communities. Read more. 

June Revenue Forecast

The Governor's Office of State Planning and Budget released its June revenue forecast for General Fund revenue, estimating an increase in revenues by $78.1 million compared with the March 2011 forecast. Although citing some positive economic developments, the forecast projects flat revenues for FY 11-12 and estimates a shortfall of $22.4 million in the coming year to maintain a four percent reserve requirement. Modest economic growth is not expected until FY 2012-2013. Read more.

Safety Net Clinic Week is August 22-26, 2011

In efforts to raise awareness of Colorado's healthcare safety net providers and clinics, ClinicNET and the Colorado Rural Health Center are sponsoring the second annual Safety Net Clinic Week on August 22-26, 2011. The week will be devoted to educating the public and policy makers about often overlooked providers, Community Funded Safety Net Clinics (CSNCs) and federally certified Rural Health Clinics (RHCs), that care for uninsured and underinsured Coloradans. 

There are currently 33 identified CSNCs in Colorado. These clinics tend to be non-profit, rural & urban, and privately funded and they provide primary care services to uninsured and underinsured individuals. Colorado has 52 federally certified RHCs that provide primary care services in some of the most rural and remote areas of Colorado. 

We will be posting more information on Safety Net Clinic Week, including ideas and resources to assist clinics that would like to participate. If you work at a CSNC or RHC and are interested in hosting a site visit with policy makers, we are here to help and will have more information coming soon. 

New Medicare Advantage Policy Brief

Roughly one in four of the nation’s 47 million Medicare beneficiaries currently participate in Medicare Advantage. A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation explains how Medicare Advantage plans work, how they are different from traditional “fee-for-service” Medicare, ways in which the plans will change under provisions in the Affordable Care Act, and the debate over the possible effects on the plans. Click here to read the brief. 

ACA Provisions to Strengthen the Nursing Workforce

The Affordable Care Act (ACA) contains many provisions related to healthcare workforce issues, including strengthening primary care, national workforce policy development, increasing the supply of healthcare workers, education and training of the workforce, and other supports and improvements to the existing workforce. This Implementation Brief by HealthReformGPS focuses on those provisions of the ACA that specifically target the strengthening of the nursing workforce.

Senators Bennet and Udall Give Their Support For Rural Health Programs

Senators Michael Bennet and Mark Udall signed onto a letter to the leaders of the U.S. Senate Labor, Health and Human Services, and Education subcommittee to acknowledge current fiscal constraints and request continued support for critical rural healthcare programs in Fiscal Year 2012. The programs referenced in this letter, including the National Health Service Corps, Area Health Education Centers, Medicare Rural Hospital Flexibility Program, and the State Offices of Rural Health, play significant roles in promoting access to quality care for Colorado’s rural communities. CRHC thanks Senator Bennet and Senator Udall for their leadership and support for rural healthcare. 

Process for Legislators with Appointment Authority for the Colorado Health Benefit Exchange Board To Nominate Applicants

Applicants for a gubernatorial appointment to the Colorado Health Benefit Exchange Board (established by SB 200) were required to turn in their applications to the Office of Boards and Commissions by May 23^rd.  However, some of the legislators with appointment authority are asking for the applicants to apply to them directly. Click here for the application for appointment by Representative Sal Pace (House Minority Leader). Applications for appointment by Rep. Pace must be submitted by June 20^th, and he is only considering applicants who apply to him directly.  Senate President Shaffer prefers a separate cover letter and resume as well (though not an application). Senate Minority Leader Mike Kopp is only accepting applications (to include cover letter, resume, and references) from individuals who have not applied to Governor Hickenlooper. 

Applicants should be sure to outline which of the SB 200 qualifications they bring to the Board.  The legislators with appointment authority are below—the email addresses to submit applications are available by clicking on the links. 

Senate President Brandon Shaffer

Senate Minority Leader Mike Kopp

Speaker of the House Frank McNulty--send letter and resume to this email address.

House Minority Leader Sal Pace--send application to this email address.

Please contact Alicia Haywood if you have any questions. 

White House Creates Rural Council

President Obama signed an executive order creating the first White House Rural Council. On a media call this morning, Secretary of Agriculture Tom Vilsack called the Council an “unprecedented commitment to rural America”. The Council will coordinate programs across government to encourage public-private partnerships to promote further economic prosperity and quality of life in rural communities nationwide. Healthcare is identified as one of the key factors for promoting growth that the Council will be discussing. Read more. 

Webinar on American Community Survey

The Rural Assistance Center is sponsoring a webinar on Tuesday, June 21 at 1:00pm on the American Community Survey (ACS), a continuous collection survey that provides more frequent and up-to-date data for all communities. The webinar will discuss the ACS, considerations in using it, and how rural communities can use ACS data to drive policy development. Click here for more information and to register.

California’s Efforts to Advance Telehealth

A new article discusses California’s ongoing efforts to promote and expand access to primary and specialty care in its rural and underserved communities through telehealth. The article suggests that to reduce health disparities and further expand telehealth's reach will require overcoming several financial, policy, and technical hurdles, providing insights for other states including Colorado. Read more. 

Bighorn Leadership Program Seeking Applicants from Western Slope

Interested in directly impacting the health of communities on the Western Slope? Want to influence public policy? Looking to hone your civic leadership skills? Consider applying to the 2011 Bighorn Leadership Development Program. The Bighorn Leadership Program presented by Engaged Public and in collaboration with Colorado State University are seeking individuals to participate in The Bighorn Health Care Policy and Project Lab. The Lab will include public leadership curriculum with an additional component allowing participants the opportunity to focus on the actual implementation of a health related policy or project. Individuals who live on the Western Slope and who have a specific interest in developing their own public leadership skills, health care policy and healthy living in order to better serve their communities and constituencies are encouraged to apply. The application deadline is June 24. Download the application or call 303.282.9250 ext 6 or 303.416.1531.

CMS Hosting Call on The Pioneer ACO Model, June 7 10:00-11:30am MT

The Centers for Medicare & Medicaid Services (CMS) will host a Special Open Door Forum on the request for applications for the Pioneer Accountable Care Organization (ACO) Model released on May 17, 2011. The call is on Tuesday, June 7, 10:00-11:30am MT. Dial 1-866-501-5502 Conference ID  70961782. Click here to read a full call announcement and to access background materials on The Pioneer ACO Model. 

NHQR State Snapshot

State Snapshots of state-specific healthcare quality information are now available. The state-level information used to create the Snapshots is based on data collected for the National Healthcare Quality Report (NHQR). Colorado’s Snapshot as well as other resources regarding healthcare quality and disparities are available online. 

Colorado Receives “B” on Children’s Oral Health

A new report released today by the Pew Center on the States gives Colorado a “B” for the second year in a row on its efforts to provide basic oral healthcare for children. Colorado met 5 of the study’s 8 benchmarks aimed at addressing children’s oral health needs. Read the report and download Colorado’s fact sheet here. 

Providing HIV/AIDS Prevention and Treatment in Rural Colorado

According to CDC reports, while AIDS diagnoses have slowly decreased in metropolitan areas since 1985, moderate increases in nonmetropolitan areas are emerging, reflecting the spread of the epidemic from urban into smaller suburban and non-urban areas. An article in The Rural Monitor (published by the Rural Assistance Center) highlights the work of the Northern Colorado AIDS Project in providing HIV/AIDS prevention and treatment in rural areas and some of the challenges these communities face. Read the article. 

Upcoming Call for Community Transformation Grants

The Centers for Disease Control and Prevention (CDC) recently announced the availability of $100 million to support Community Transformation Grants. In addition to smoke-free living, active living and healthy eating, these new grants will focus on high-impact, quality clinical and other preventive services, social and emotional wellness, and healthy and safe physical environments. The funding is available to support evidence- and practice-based community and clinical prevention and wellness strategies that will lead to specific, measurable health outcomes to reduce chronic disease rates.

CDC will be holding a conference call prior to the deadline for submitting Letters of Intent to apply for funding. The call for the Mountain time zone is May 25, 2011 1:00 p.m. - 2:00 p.m. (EDT). This conference call can be accessed by calling 1-888-972-9343. The leader for this call is Lori Elmore and the passcode is 8899773. The Letters of Intent are due to CDC on Monday, June 6, 2011. Click here for more information.

New Study Looks at Model for Healthcare Education and Care Delivery for Chronic Disease in Rural Communities

A new study released by Health Affairs highlights Project ECHO, an unique partnership in New Mexico between an urban academic medical center and primary care providers in rural communities. According to the authors, Project ECHO “presents an atypical example of a health care innovation in which the rural sector leads the way” and “affords an alternative model for meeting the needs of rural patients with complex diseases.” Please note this article will be available online and free-of-charge for only two weeks beginning May 19 and will then require a subscription or payment to view. Click here to download the paper.

2011 Legislative Session Wrap-Up

We posted an overview of the 2011 legislative session, highlighting several rural health bills and the FY 11-12 budget. Also check out our final bill list.

CMS Announces New ACO Options and Initiatives

The Centers for Medicare & Medicaid Services (CMS) today announced new options and initiatives for providers interested in becoming Accountable Care Organizations (ACOs).  First, the Center for Medicare and Medicaid Innovation (Innovation Center) will support a new ACO model that will be available to providers this summer – the Pioneer ACO Model, which is designed for advanced organizations ready to participate in shared savings. Second, the Innovation Center is seeking comment on the idea of an Advance Payment ACO Model that would provide additional up-front funding to providers to support the formation of new ACOs.  And third, provider groups interested in learning more about how to coordinate patient care through ACOs can attend free new Accelerated Development Learning Sessions.  Read more. 

Technology Helping Rural Communities Address Healthcare Needs

Today’s Denver Post highlights technology being used in clinics and colleges in several rural communities throughout Colorado to connect with healthcare specialists and educators. Read the article. 

Final Bill Tracker Posted

CRHC’s bill tracker is updated through the final day of the legislative session (May 11). We will update and post a complete listing of all the bills that CRHC was tracking this session later in the week.  

Informing Rural Primary Care Workforce Policy: What Does the Evidence Tell Us?

A new report by the Rural Health Research Gateway reviews 51 publications constituting the body of evidence-based research produced by the federally-funded Rural Health Research Centers from 2000 to 2010 which are relevant to the rural primary care workforce. The report looks at research in the following categories: Supply & Demand; Recruitment & Retention; Training Pipeline & Education; Lifestyle & Compensation; Nurse Practitioners, Physician Assistants, & International Medical Graduates; and New Directions for Primary Care. Download the report.

Colorado Health Benefit Exchange Board Accepting Applications

Applications are now being accepted for appointments to the Colorado Health Benefit Exchange Board and are due May 23. With the passage of SB11-200, Colorado now begins work on establishing a health insurance exchange for individuals and small businesses. The Governor’s press release provides additional information about the expertise required to be an eligible applicant. If you are interested in serving on the Board, please contact Alicia Haywood or 720.248.2748.

Upcoming Health Policy Webinars

The Colorado Health Institute is holding a series of webinars that will begin on May 25 about important health policy issues including publicly funded insurance programs, the private health insurance market, community health profiles, and the state health insurance exchange. Click here to learn more and to register.

State Budget Update

Governor Hickenlooper signed the state budget Long Bill late last week however several budget balancing bills, including bills concerning healthcare services, still require action by the General Assembly. Read more on the state budget in today's Denver Post.

Profiles of Colorado APN & PA Workforce

The Colorado Health Institute has prepared and released profiles of Colorado's advanced practice nurses and physician assistants. Download the reports and learn more about these two professions that play vital roles in our state's rural healthcare workforce.

SB 200 Passes House

SB 200, Colorado Health Benefit Exchange, passed the Colorado House today on a 44-21 vote. Thank you to all who called their representatives. We will keep you updated as SB 200 moves through its final stages of reconciling amendments and going to Governor Hickenlooper for signature. 

CMS Conference Call on May 9 to Discuss ACOs

The Centers for Medicare & Medicaid Services (CMS) is hosting a conference call on May 9^th, 2011, from 1:00-2:00 pm MDT to discuss proposed new rules for Accountable Care Organizations (ACOs). This call is intended to help the public understand what CMS, the agency administering the ACO program through Medicare, is proposing to do and to ensure that the public understands how to participate in the formal comment process. The call number is 888-989-4351, conference ID 5320738. Click here for more information on ACOs. 

Call to Action: Contact your State Representative Today

This week, the Colorado House will vote on SB 11-200, a bipartisan bill to establish a Colorado Health Benefit Exchange. A health insurance exchange will help Coloradans across the state who are seeking individual or small group insurance coverage by providing information about health insurance options. SB 200 puts Colorado on a path to develop its own insurance marketplace that will meet the unique needs of all Coloradans.

CRHC supports SB 200 and encourages you to call or email your representative today and ask them to support SB 200. Click here for contact information on all Colorado’s General Assembly members. Click here to identify your elected officials. Thanks!  

Family Physicians Impact Readmission Rates

A new report published in American Family Physician compared the proportion of family physicians and readmission rates in counties across the country. The findings indicate that hospital readmissions and costs for pneumonia, heart attack, and heart failure decrease as the number of family physicians increases. Read more. 

New Study Explores Roles of Nurse Practitioners and Physician Assistants in Improving Access to Primary Care

A new report by the Kaiser Commission on Medicaid and the Uninsured looks at the potential of nurse practitioners and physician assistants to increase the supply of primary care, in areas experiencing physician shortages as well as system-wide, as Medicaid expands to cover more uninsured adults. Read the report. 

Updated Bill Tracker

CRHC's Bill Tracker is current through April 28.

State Budget Update

As reported earlier, the FY11-12 Long Bill and several related bills went to conference committee last week. During its negotiations, the committee increased funding for the Primary Care Fund (SB 219), including $1 million for the Health Care Services Fund clinics (eligible for a $1 million federal match) and $413,500 for the Special Distribution Fund clinics. These increases bring the total state funding for the Special Distribution Fund to $2,163,500 and the Health Care Services Fund to $11,750,000 (eligible for a $11.75M federal match). The conference committee report must still be approved by the House and Senate and signed by the Governor and we will keep you updated as the budget bills advance. Thanks to the many clinics and primary care advocates who contacted their state legislators about the importance of primary care funding. 

Friday, April 29 Named Colorado Rural Health Day

In an effort to acknowledge the vital services of rural healthcare practitioners across Colorado, State Representative Tom Massey (R-60) has introduced House Joint Resolution 11-1018 to recognize “Rural Health Day” as Friday, April 29^th, 2011. Senator Betty Boyd (D-21) is the Senate sponsor. CRHC worked closely with Rep. Massey and other state legislators who co-sponsored HJR 1018 to propose a resolution recognizing the hard work being done to provide healthcare to rural communities. Read the press release and contact Sara Schmitt for more information. 

Collaboration with FQHCs

The Affordable Care Act provides a requirement that Community Health Centers (FQHCs) demonstrate that they have made, and will continue to make, reasonable efforts to maintain collaborative relationships with other health care providers in their catchment areas. Specifically, the legislation lists Rural Health Clinics, low-volume hospitals, Critical Access Hospitals, Sole Community Hospitals, and Medicare Dependent Hospitals as the entities with which a Community Health Center should demonstrate a collaborative relationship.

New Access Point grant applications and Service Expansion grants for FQHCs will be judged and scored, in part, on the extent to which they demonstrate the collaboration and coordination of the delivery of healthcare services with other healthcare providers in their service area. A November 2010 Policy Assistance Letter from the Bureau of Primary Health Care provides additional information on this expectation.

This report from Stroudwater Associates is intended to provide non-FQHC healthcare providers with a better understanding of the circumstances regarding FQHC service expansions and it also describes the collaboration efforts encouraged by HRSA when considering expansion.

Comparison Of Medicaid Provisions In Deficit-Reduction Proposals

A new issue brief from the Kaiser Commission on Medicaid and the Uninsured compares several proposals, including ones by President Obama and the House Budget Committee Chairman Paul Ryan (R-Wis.), to address Medicaid spending as part of a broad-based debt- and deficit-reduction package. Click to read the brief. 

Health Care Workforce: Future Supply vs. Demand

A new issue brief from the Alliance for Health Reform assesses the healthcare workforce, which workers are most needed, and gives strategies on dealing with the problem of shortages. Click to read the brief.

New ACO Resources

Health Reform GPS, a joint project between Robert Wood Johnson Foundation and George Washington University, has posted an overview for the Medicare Shared Savings Program for Accountable Care Organizations (ACOs).

The Broadband Speed Divide

A new article on Daily Yonder looks at broadband Internet access between rural and urban areas based on data released this year by the National Telecommunications and Information Administration. The analysis found that nationally the gap in access to broadband Internet between rural and urban areas is narrowing, however significant differences remain in choice of provider and download speeds. These issues are significant for healthcare delivery in rural areas in providing telemedicine as well as health information technology.