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

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

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

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

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

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

Read the article in USA Today.

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

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

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

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

Read the article in the Lane Report.

Grace Period Option Can Be Burden on Small Practices

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

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

Commissioner Salazar Convenes Health Care Cost Study Group

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

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

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

SGR "Pay-fors" Still Up in the Air

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

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

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

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

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

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

 

Rural Providers Come Together to Test Out ACO

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

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

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

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

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

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

New ACA Communications Webinar Online Now

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

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

Study Shows One in Four Families Struggle to Pay Medical Bills

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

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

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

Connect for Health Colorado and Colorado Medicaid Update

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

For immediate release:

January 17, 2014

CONNECT FOR HEALTH COLORADO AND COLORADO MEDICAID UPDATE

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

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

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

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

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

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

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

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

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

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

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

###

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

Copyright © 2014 OnSight Public Affairs, All rights reserved.

Office of Rural Health Policy Webinar on the ACA Today

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

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

$45 Million Set Aside to Strengthen Nursing

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

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

Medicare Expands Definition of Rural for Telehealth

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

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

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

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

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

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

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

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

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

Read the full report here.

Interest in Accelerated Medical School Programs Growing

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

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

Financial Challenges Top Concern for Community Hospital Leaders

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

The Challenges of Adopting Health IT for Rural Hospitals

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

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

Opening Day Speeches and State of the State

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

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

NOSORH Webinar: Preparing to Engage with Legislators and Policymakers

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

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