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4. Economic factors hit health care sector particularly hard
Job losses; increases in the uninsured; folks putting off elective procedures and end up with higher acuity; tougher cases
Support services being cut at the state level (home care aids, transportation, etc.)
Always difficult to recruit providers in rural areas; even tougher now
And while most agree that the increased focus on quality is a good thing, the rapid ramp up of reporting requirements both at the Federal and State level is a challenge
And, doing all this at a time when facilities are aging, capital can be hard to get and there is a need to invest in HIT
Typical reaction in tough economic times is to retrench; that’s easy to do in some industries but not always possible in HC; folks still get sick; still need services; and you can’t turn them away
MEDICARE PART A TRUST FUND PROJECTED TO BE INSOLVENT IN 2019
PART B COST/PREMIUMS CONSUMING AN INCREASING PORTION OF SOCIAL SECURITY PAYMENTS
HEALTH OUTCOMES VARY WIDELY FROM PLACE TO PLACE AND ARE INFERIOR TO MANY OTHER DEVEOPED COUNTRIES
Economic factors hit health care sector particularly hard
Job losses; increases in the uninsured; folks putting off elective procedures and end up with higher acuity; tougher cases
Support services being cut at the state level (home care aids, transportation, etc.)
Always difficult to recruit providers in rural areas; even tougher now
And while most agree that the increased focus on quality is a good thing, the rapid ramp up of reporting requirements both at the Federal and State level is a challenge
And, doing all this at a time when facilities are aging, capital can be hard to get and there is a need to invest in HIT
Typical reaction in tough economic times is to retrench; that’s easy to do in some industries but not always possible in HC; folks still get sick; still need services; and you can’t turn them away
MEDICARE PART A TRUST FUND PROJECTED TO BE INSOLVENT IN 2019
PART B COST/PREMIUMS CONSUMING AN INCREASING PORTION OF SOCIAL SECURITY PAYMENTS
HEALTH OUTCOMES VARY WIDELY FROM PLACE TO PLACE AND ARE INFERIOR TO MANY OTHER DEVEOPED COUNTRIES
5. Hear consistently that CAHs are facing workforce shortages
- docs, nurses, allied health etc.
HRSA has a number of programs that are important to rural, including the NHSC, the HHS J1 and Conrad 30 programs as well as nursing scholarships and loans. AHECs also play a key role.
Problem is demand greatly outstrips supply of funding
For example, under the Nursing Scholarship Program we awarded 172
scholarships out of 4,894 applications (only about 3.5
percent of the total applications) during 2007.
Similar numbers in the nursling loan repayment
and far more applicants for NHSC loan repayment than we could fund
Also the challenge with Medicare GME and the whole underlying training and acredidation system is that it favors urban-based training
Some legitimate reasons for this (some training has to take place in an AHC
But may be other places where we could do more ambulatory and community training
How to strike a balance; MedPAC discussing this, others
Hear consistently that CAHs are facing workforce shortages
- docs, nurses, allied health etc.
HRSA has a number of programs that are important to rural, including the NHSC, the HHS J1 and Conrad 30 programs as well as nursing scholarships and loans. AHECs also play a key role.
Problem is demand greatly outstrips supply of funding
For example, under the Nursing Scholarship Program we awarded 172
scholarships out of 4,894 applications (only about 3.5
percent of the total applications) during 2007.
Similar numbers in the nursling loan repayment
and far more applicants for NHSC loan repayment than we could fund
Also the challenge with Medicare GME and the whole underlying training and acredidation system is that it favors urban-based training
Some legitimate reasons for this (some training has to take place in an AHC
But may be other places where we could do more ambulatory and community training
How to strike a balance; MedPAC discussing this, others
6. All know about the long decline in family medicine match rate
Numbers in the pipeline for other PC disciplines such as internal medicine also not high enough to fill this expected gap
AAMC calling for an increase in med school enrollment
Clearly needed but … which disciplines???
Also important to note that WF issues and in particular physician training is shared responsibility ..
Feds have a role
States also have a role; WWAMI good example of where it works well; other States across country not so wellAll know about the long decline in family medicine match rate
Numbers in the pipeline for other PC disciplines such as internal medicine also not high enough to fill this expected gap
AAMC calling for an increase in med school enrollment
Clearly needed but … which disciplines???
Also important to note that WF issues and in particular physician training is shared responsibility ..
Feds have a role
States also have a role; WWAMI good example of where it works well; other States across country not so well
7. There is $5 billion for health professions training, including $65 million for the NHSC
Dept of Labor gets $3.95 billion, including $500 M States for WIA projects and $750 m for competitive grants for worker training in high growth and emerging industries and HC is definitely that if you look at Labor’s own WF projections for the next 10 years
And, as a way to bring more attention to these important issues, HRSA will hold a National R and U US WF Summit in August in WDC focusing on primary care …
… Joint effort of ORHP, BPHC, BHPr, NHSC
There is $5 billion for health professions training, including $65 million for the NHSC
Dept of Labor gets $3.95 billion, including $500 M States for WIA projects and $750 m for competitive grants for worker training in high growth and emerging industries and HC is definitely that if you look at Labor’s own WF projections for the next 10 years
And, as a way to bring more attention to these important issues, HRSA will hold a National R and U US WF Summit in August in WDC focusing on primary care …
… Joint effort of ORHP, BPHC, BHPr, NHSC
8. For the last few years, there have been significant changes in the Medicare program.
It has begun making the transition from a passive payer of health services to a more active purchaser of these services.
Most folks would agree this is the right way to go …
And it has led to the beginning steps toward pay for performance and is laying the groundwork for value-based purchasing.
It’s hard to argue with the notion that Medicare payments should be tied to making sure high quality of care is given
The challenge, however, comes in the details.
And as with most major public policy changes like this the big question is are we designing a system that will work as well for rural as it will for urban and that question is vitally important for CAHs
The jury is still out on that.
For the last few years, there have been significant changes in the Medicare program.
It has begun making the transition from a passive payer of health services to a more active purchaser of these services.
Most folks would agree this is the right way to go …
And it has led to the beginning steps toward pay for performance and is laying the groundwork for value-based purchasing.
It’s hard to argue with the notion that Medicare payments should be tied to making sure high quality of care is given
The challenge, however, comes in the details.
And as with most major public policy changes like this the big question is are we designing a system that will work as well for rural as it will for urban and that question is vitally important for CAHs
The jury is still out on that.
9. Diagnosis related group
Right now, hospitals get a full payment update if they report on a limited but growing set of quality measures
pneumonia, congestive heart failure and AMI, patient satisfaction
The complaints you hear are that while these measures are broadly relevant for hospitals as a whole, they are only partially relevant for rural hospitals
As this chart shows, the kinds of things we’re measuring are a small part of what small rural hospitals do
And when you have small numbers, measuring quality can be tricky and no one has come up with an answer for that yet … Diagnosis related group
Right now, hospitals get a full payment update if they report on a limited but growing set of quality measures
pneumonia, congestive heart failure and AMI, patient satisfaction
The complaints you hear are that while these measures are broadly relevant for hospitals as a whole, they are only partially relevant for rural hospitals
As this chart shows, the kinds of things we’re measuring are a small part of what small rural hospitals do
And when you have small numbers, measuring quality can be tricky and no one has come up with an answer for that yet …
10. About 18 months ago, CMS produced a report to Congress on how it might create a value-based purchasing program, meaning how they might create a system for adjusting payments to hospitals based on how they score on a range of quality measures.
It was a thoughtful report and was based on feedback they got from two large public meetings.
It pointed out the challenges making this move might pose for small rural hospitals
It included a good discussion of the challenge of small numbers
But, it also didn’t offer any solutions to those problems.
But this is an issue that is here to stay. Congress has begun offering bills to move Medicare in this direction.
And philosophically, it makes sense. We ought to be able to find a way to reward good high quality hospital services.
About 18 months ago, CMS produced a report to Congress on how it might create a value-based purchasing program, meaning how they might create a system for adjusting payments to hospitals based on how they score on a range of quality measures.
It was a thoughtful report and was based on feedback they got from two large public meetings.
It pointed out the challenges making this move might pose for small rural hospitals
It included a good discussion of the challenge of small numbers
But, it also didn’t offer any solutions to those problems.
But this is an issue that is here to stay. Congress has begun offering bills to move Medicare in this direction.
And philosophically, it makes sense. We ought to be able to find a way to reward good high quality hospital services.
11. But, the challenge is how to get there in a way that works for all hospitals, whether you are a 600-bed teaching hospital or a 10-bed CAH.
I’m not sure how to get there but there are folks who are putting some thought to this.
The Rural Policy Research Institute has produced a response to CMS’ VBP Report to Congress and it’s a good, thoughtful examination of the issues.
It notes that we have to get to a place with more relevant measures for rural hospitals
And it discusses the low numbers issues. But, the challenge is how to get there in a way that works for all hospitals, whether you are a 600-bed teaching hospital or a 10-bed CAH.
I’m not sure how to get there but there are folks who are putting some thought to this.
The Rural Policy Research Institute has produced a response to CMS’ VBP Report to Congress and it’s a good, thoughtful examination of the issues.
It notes that we have to get to a place with more relevant measures for rural hospitals
And it discusses the low numbers issues.
12. The Rural Policy Research Institute folks have also produced a report looking at the specific issues related to CAHs.
The CMS Report on VBP is silent on CAHs. It focuses only on PPS hospitals.
But, it seems inconceivable that we would leave 1,300 CAHs out of a system that the rest of Medicare will eventually be in but …
At same time, this points out that we do need to be careful about how CAHs are pulled in.
A bill from Sens. Grassley and Baucus would create a demonstration VBP program for CAHs while requiring it for all PPS facilities.
That approach might make sense; provide some time to do it right. The Rural Policy Research Institute folks have also produced a report looking at the specific issues related to CAHs.
The CMS Report on VBP is silent on CAHs. It focuses only on PPS hospitals.
But, it seems inconceivable that we would leave 1,300 CAHs out of a system that the rest of Medicare will eventually be in but …
At same time, this points out that we do need to be careful about how CAHs are pulled in.
A bill from Sens. Grassley and Baucus would create a demonstration VBP program for CAHs while requiring it for all PPS facilities.
That approach might make sense; provide some time to do it right.
13. The VBP is just one of a number of quality issues facing CAHs.
CMS has dramatically changed the roles of the QIOs for the current scope of work.
Under the previous scope, there was a requirement to work with CAHs and we saw a lot of benefit to that.
We’ll have to wait and see what the impact of the change is.
On a more positive note, we’re seeing introduction of a broader set of measures including a transfer measure and other OP measures, which are more relevant to rural.
We’re also hearing that some RH and CAHs are getting a bit overwhelmed by the public and private reporting requirements. The VBP is just one of a number of quality issues facing CAHs.
CMS has dramatically changed the roles of the QIOs for the current scope of work.
Under the previous scope, there was a requirement to work with CAHs and we saw a lot of benefit to that.
We’ll have to wait and see what the impact of the change is.
On a more positive note, we’re seeing introduction of a broader set of measures including a transfer measure and other OP measures, which are more relevant to rural.
We’re also hearing that some RH and CAHs are getting a bit overwhelmed by the public and private reporting requirements.
14. Our hope is that the Flex program can be a help in a range of quality and performance improvement activities for CAHs.
Got re-authorized in 2008 .. New charge: QI PI and Benchmarking
Completes a shift away from conversion
SHIP: Also a resource; technically $8k per
seeing some States be creative with funds
Buying software for all hospitals to ease with the Hospital Compare reporting;
Others doing joint training
Like to see more of that …
Problem for 2009: Authorization Our hope is that the Flex program can be a help in a range of quality and performance improvement activities for CAHs.
Got re-authorized in 2008 .. New charge: QI PI and Benchmarking
Completes a shift away from conversion
SHIP: Also a resource; technically $8k per
seeing some States be creative with funds
Buying software for all hospitals to ease with the Hospital Compare reporting;
Others doing joint training
Like to see more of that …
Problem for 2009: Authorization
15. CAH designation is no longer “the new thing”
Program is well established; been around for more than 10 years
View CAH and Flex as “public policy success”
stabilized RHs; improved access
W/ success come challenges
W/ close to 1,300 CAHs, a major part of the Medicare program
As such, invites scutiny and attention; just like any other large part of the Medicare program
New studies; finding some good things; also some concerns;
CAH designation is no longer “the new thing”
Program is well established; been around for more than 10 years
View CAH and Flex as “public policy success”
stabilized RHs; improved access
W/ success come challenges
W/ close to 1,300 CAHs, a major part of the Medicare program
As such, invites scutiny and attention; just like any other large part of the Medicare program
New studies; finding some good things; also some concerns;
16. Creates an interesting new era for CAHs
Take a look at this study on Hospital remoteness and 30-day risk standardized mortality rates
The upshot is that they thought they’d find differences as they moved out to small rural hospitals
But, they didn’t.
Small rural hospitals, including CAHs, did just fine.
It included transfers in which patient went upstream and counted that outcome and attributed back to RH
Important caveat; some might say misleading
Others might say shows good continuity of care
Know Hosp Compare would not count those;
so #s might be different w/ standard
Point is; lots of ways to look at this; context key Creates an interesting new era for CAHs
Take a look at this study on Hospital remoteness and 30-day risk standardized mortality rates
The upshot is that they thought they’d find differences as they moved out to small rural hospitals
But, they didn’t.
Small rural hospitals, including CAHs, did just fine.
It included transfers in which patient went upstream and counted that outcome and attributed back to RH
Important caveat; some might say misleading
Others might say shows good continuity of care
Know Hosp Compare would not count those;
so #s might be different w/ standard
Point is; lots of ways to look at this; context key
17. Got other studies now out; two sponsored by the Agency for Health Research and Quality
An Iowa study showed that quality improved after conversion to CAH … good news; and not surprising
Another study looked at a standard measure of efficiency … found that PPS more “efficient” …
Defining “efficiency” challenging
Have Flex monotoring team studies that show on HC measures, CAHs do as well or better on Pneumonia; not as well on AMI or CHF (again, not surprising)
Got other studies now out; two sponsored by the Agency for Health Research and Quality
An Iowa study showed that quality improved after conversion to CAH … good news; and not surprising
Another study looked at a standard measure of efficiency … found that PPS more “efficient” …
Defining “efficiency” challenging
Have Flex monotoring team studies that show on HC measures, CAHs do as well or better on Pneumonia; not as well on AMI or CHF (again, not surprising)
18. Also know that the HHS Office of the Inspector General has been looking at and will continue to look at CAH costs
We’re working with them; offered to help; and we’re interested in their findings;
Some health economists have a long-standing concern that efforts to control costs less under C-B reimbursement than under a PPS
Others dispute; say always pressure to control costs for your other payers and to keep costs and charges in line with competitors Also know that the HHS Office of the Inspector General has been looking at and will continue to look at CAH costs
We’re working with them; offered to help; and we’re interested in their findings;
Some health economists have a long-standing concern that efforts to control costs less under C-B reimbursement than under a PPS
Others dispute; say always pressure to control costs for your other payers and to keep costs and charges in line with competitors
19. Mention all of this … to try to provide some context
These kinds of questions & studies part of life in an established p-gram;
Important to know what’s going on
Overall believe we have a good story to tell
CAH status has been a lifeline;
At same time; important to identify problems and be proactive in addressing any concerns;
Better to do that than have a “solution” hoisted upon you Mention all of this … to try to provide some context
These kinds of questions & studies part of life in an established p-gram;
Important to know what’s going on
Overall believe we have a good story to tell
CAH status has been a lifeline;
At same time; important to identify problems and be proactive in addressing any concerns;
Better to do that than have a “solution” hoisted upon you
20. Important to stay in touch with key issues in larger hospital environment;
MedPAC, others looking at things like re-admissions and how to avoid; bundled payments to promote better continuity of care
Those likely to happen in PPS;
What might it mean for CAH, how would you do it? Better to be thinking now
Similarly; lots of discussion on medical home; some see it as a way to improve quality; others to control costs; some see it as both
What might that mean in a CAH context? Important to stay in touch with key issues in larger hospital environment;
MedPAC, others looking at things like re-admissions and how to avoid; bundled payments to promote better continuity of care
Those likely to happen in PPS;
What might it mean for CAH, how would you do it? Better to be thinking now
Similarly; lots of discussion on medical home; some see it as a way to improve quality; others to control costs; some see it as both
What might that mean in a CAH context?
22. CMS will be making $35 billion in Health Information Technology incentive payments between 2011 – 2015
And, after 2015, Medicare will begin reducing payments for providers that do not use HIT/HER
Still sorting through this language to better understand how it will actually work
Defining what “meaningful” HITadoption is also going to be a key issue
Meaningful Use comments due by June 26. CMS will be making $35 billion in Health Information Technology incentive payments between 2011 – 2015
And, after 2015, Medicare will begin reducing payments for providers that do not use HIT/HER
Still sorting through this language to better understand how it will actually work
Defining what “meaningful” HITadoption is also going to be a key issue
Meaningful Use comments due by June 26.
23. Also payments for RHCs and FQHCs … through Medicaid
They’ll get payments if they meet a threshold of Medicaid, SCHIP and uncompensated care that exceeds 30 percent of their visits
There are other HIT funds in ARRA
Want to set up HIT Regional Extension Ctrs to provide TA and education
Specifically mentions CAHs and reaching out to rural and individual or small group practices Also payments for RHCs and FQHCs … through Medicaid
They’ll get payments if they meet a threshold of Medicaid, SCHIP and uncompensated care that exceeds 30 percent of their visits
There are other HIT funds in ARRA
Want to set up HIT Regional Extension Ctrs to provide TA and education
Specifically mentions CAHs and reaching out to rural and individual or small group practices
24. Other Resources
HIT Extension Program- Regional Technical Assistance Centers
HIT workforce training
Regional health information exchange
Construction, renovation and equipment, and acquisition of HIT Medicare Incentives for PPS Hospitals
$2M Base +Discharge Payment x Medicare Share
No penalty until 2014
Incentives discontinue after 2015
Medicare Incentives for CAHs
Eligible for 4 years of enhanced Medicare Payment with immediate full depreciation of certified EHR Costs
Total EHR Costs x (Medicare Share + 20%)
Only eligible through 2014, if adoption occurs after 2014 no additional incentives occur
Maximum Eligible Professionals are eligible for either Medicare or Medicaid Incentives – NOT BOTH
Acute Care Hospitals, including CAHs are eligible for both
Eligible Professional cannot be Hospital based and must have a patient load of 30% Medicaid
Payments cover up to 85% of net allowable costs to adopt and operate EHR Technology
Allowable costs for the first year are to be the average costs expended for the implementation or upgrade of an EHR system to not exceed $25 K and cannot occur after 2016
Subsequent years are to be calculated at 85% 0f 10K to not exceed 2016
If provider is ped, then patient volume must be 20% Medicaid and the incentives will be taken at 2/3 the rate
If eligible provider practices at a FQHC or RHC then patient volume must be 30% “needy” Individuals
Medicaid, sliding fee, uncompensated care, or receiving assistance under Title XXI
Eligible Hospitals
All Children’s Hospitals, Acute Care Hospitals (including CAHs) with at least 10% Medicaid Patient Volume
(EHR Cost + Medicaid Share) x 50% for one year period
or
(EHR Cost + Medicaid Share) x 90% for 2 year period
4 year transition schedule to be utilized to attain Aggregated Payment
Medicare Incentives for PPS Hospitals
$2M Base +Discharge Payment x Medicare Share
No penalty until 2014
Incentives discontinue after 2015
Medicare Incentives for CAHs
Eligible for 4 years of enhanced Medicare Payment with immediate full depreciation of certified EHR Costs
Total EHR Costs x (Medicare Share + 20%)
Only eligible through 2014, if adoption occurs after 2014 no additional incentives occur
Maximum Eligible Professionals are eligible for either Medicare or Medicaid Incentives – NOT BOTH
Acute Care Hospitals, including CAHs are eligible for both
Eligible Professional cannot be Hospital based and must have a patient load of 30% Medicaid
Payments cover up to 85% of net allowable costs to adopt and operate EHR Technology
Allowable costs for the first year are to be the average costs expended for the implementation or upgrade of an EHR system to not exceed $25 K and cannot occur after 2016
Subsequent years are to be calculated at 85% 0f 10K to not exceed 2016
If provider is ped, then patient volume must be 20% Medicaid and the incentives will be taken at 2/3 the rate
If eligible provider practices at a FQHC or RHC then patient volume must be 30% “needy” Individuals
Medicaid, sliding fee, uncompensated care, or receiving assistance under Title XXI
Eligible Hospitals
All Children’s Hospitals, Acute Care Hospitals (including CAHs) with at least 10% Medicaid Patient Volume
(EHR Cost + Medicaid Share) x 50% for one year period
or
(EHR Cost + Medicaid Share) x 90% for 2 year period
4 year transition schedule to be utilized to attain Aggregated Payment
25. $500 million to strengthen the health care workforce
$300m to National Health Service Corps
$200m Title VII- Primary Care, Dentistry, AHECs
Topic: Strengthening the Health Workforce
Program Purpose:
Support programs such as the National Health Services Corps which place providers in underserved communities. Further, it will fund existing workforce programs (Title VII and VIII) which are critical for the education and training of the next generation of doctors, nurses and other providers.
Amount of AARA Funding:
The act provides $500 million to support these programs
$300 million goes towards the National Health Services Corps to assist communities in health professional shortage areas (HPSAs) in the recruitment and retention of clinicians through scholarships and loan repayment contract in return for primary health care services (mental, medical, dental etc) in underserved communities of greatest need. May include both national and state loan repayment programs, SEARCH, etc.
The NHSC scholarship application opened early March
The NHSC loan repayment program opened in March and is to be open for 18 months. There will be 3-month application cycles over the AARA funding.
$200 million for all the disciplines trained through the primary care medicine and dentistry program, public health prevention program, scholarship and loan repayment programs (Nurse training)
RPF opened March 19th
Submission Date: April 17th
Funding Obligation: June 1st, 2009
Impact on Grantees:
Inform grantees when funding opportunities are available since there are more available funds
Listen to the workforce issues grantees mention (non-compete apps) because there will be more placements available
Topic: Strengthening the Health Workforce
Program Purpose:
Support programs such as the National Health Services Corps which place providers in underserved communities. Further, it will fund existing workforce programs (Title VII and VIII) which are critical for the education and training of the next generation of doctors, nurses and other providers.
Amount of AARA Funding:
The act provides $500 million to support these programs
$300 million goes towards the National Health Services Corps to assist communities in health professional shortage areas (HPSAs) in the recruitment and retention of clinicians through scholarships and loan repayment contract in return for primary health care services (mental, medical, dental etc) in underserved communities of greatest need. May include both national and state loan repayment programs, SEARCH, etc.
The NHSC scholarship application opened early March
The NHSC loan repayment program opened in March and is to be open for 18 months. There will be 3-month application cycles over the AARA funding.
$200 million for all the disciplines trained through the primary care medicine and dentistry program, public health prevention program, scholarship and loan repayment programs (Nurse training)
RPF opened March 19th
Submission Date: April 17th
Funding Obligation: June 1st, 2009
Impact on Grantees:
Inform grantees when funding opportunities are available since there are more available funds
Listen to the workforce issues grantees mention (non-compete apps) because there will be more placements available
26. ARRA: Community Health Centers $2 billion to support CHC services, repairs and renovations, and investments in HIT
$155m New Access Points- awarded to 126 CHC for FY09 and FY10
$337m Increased Demand for Services (IDS)- awarded to 1,128 CHC for FY09 and FY10
http://bphc.hrsa.gov/recovery Topic: Health Center Program (Federal Qualified Health Centers)
Program Purpose:
Health centers provide comprehensive culturally competent, primary health care services to over 16 million medically underserved and uninsured patients. Health centers are community-based and patient-directed organizations that improve the health of their patients and communities by addressing financial, geographic, cultural, linguistic and other barriers to care.
Amount of AARA Funding:
The act provides $2 billion to support services, investments in HIT, and renovations and repairs.
New Access Point grants were awarded to a total of 126 community-based organizations that submitted highly-rated but unfunded applications to become New Access Points in FY 2008. The new health centers will receive $155 million in FY 2009 and 2010. (April 1, 2009) Those grants mean another 750,000 people in 39 states and two territories will have access to quality health care.
Increased Demand for Services (IDS) grants were awarded to 1,128 health center grantees that applied to receive a share a of $337 million, awarded by formula in 2009 and 2010, to help health centers care for an additional 2 million people hit hard by the economic downturn. Half of the new health center patients, it is expected, will have no health insurance. (June 1, 2009)
Health Center Modernization, Renovation and Repair grants will provide assistance for construction, renovation and equipment and for HIT. There will be grants for minor capital, major capital and to support HIT systems and networks. The scheduled award date is July 1, but there have not been any RFPs for these opportunities.
"We have acted quickly to put Recovery Act dollars to good use in communities across America," said President Obama. "The construction and expansion of health centers will create thousands of new jobs, help provide health care to an estimated 750,000 Americans across the country who wouldn’t have access to care without these centers, and take another step toward an affordable, accessible health care system."
Impact on Grantees:
FQHCs are partners in the community (many are part of the consortiums for rural health Outreach and Network grants).
With the additional funds, CHCs will be able to support the increased demand for health services by uninsured patients.
More information: http://bphc.hrsa.gov/recovery/ (includes the organizations funded through the New Access Points and IDS grants)
Topic: Health Center Program (Federal Qualified Health Centers)
Program Purpose:
Health centers provide comprehensive culturally competent, primary health care services to over 16 million medically underserved and uninsured patients. Health centers are community-based and patient-directed organizations that improve the health of their patients and communities by addressing financial, geographic, cultural, linguistic and other barriers to care.
Amount of AARA Funding:
The act provides $2 billion to support services, investments in HIT, and renovations and repairs.
New Access Point grants were awarded to a total of 126 community-based organizations that submitted highly-rated but unfunded applications to become New Access Points in FY 2008. The new health centers will receive $155 million in FY 2009 and 2010. (April 1, 2009) Those grants mean another 750,000 people in 39 states and two territories will have access to quality health care.
Increased Demand for Services (IDS) grants were awarded to 1,128 health center grantees that applied to receive a share a of $337 million, awarded by formula in 2009 and 2010, to help health centers care for an additional 2 million people hit hard by the economic downturn. Half of the new health center patients, it is expected, will have no health insurance. (June 1, 2009)
Health Center Modernization, Renovation and Repair grants will provide assistance for construction, renovation and equipment and for HIT. There will be grants for minor capital, major capital and to support HIT systems and networks. The scheduled award date is July 1, but there have not been any RFPs for these opportunities.
"We have acted quickly to put Recovery Act dollars to good use in communities across America," said President Obama. "The construction and expansion of health centers will create thousands of new jobs, help provide health care to an estimated 750,000 Americans across the country who wouldn’t have access to care without these centers, and take another step toward an affordable, accessible health care system."
Impact on Grantees:
FQHCs are partners in the community (many are part of the consortiums for rural health Outreach and Network grants).
With the additional funds, CHCs will be able to support the increased demand for health services by uninsured patients.
More information: http://bphc.hrsa.gov/recovery/ (includes the organizations funded through the New Access Points and IDS grants)
27. USDA also got extra funding, beyond their normal appropriation, to fund capital projects
They’ll have $67 million in loans and $63 million in grants
Know that USDA has made a concerted effort over the past few years to reach out to CAHs
Prime opportunity to do more …
Reach out to them via the State USDA offices USDA also got extra funding, beyond their normal appropriation, to fund capital projects
They’ll have $67 million in loans and $63 million in grants
Know that USDA has made a concerted effort over the past few years to reach out to CAHs
Prime opportunity to do more …
Reach out to them via the State USDA offices
28. There is billions in funding to expand broadband deployment with an emphasis on rural communities.
USDA offers grants and loans for broadband. Commerce is also offering grants.
This is, obviously, important to rural health as it is directly tied to the ability to take advantage of health information technology.
New research from USDA shows that while broadband is broadly available in many rural areas, there are significant cost issues.
So, this deployment could help make it universally available and also hopefully lower the costs … There is billions in funding to expand broadband deployment with an emphasis on rural communities.
USDA offers grants and loans for broadband. Commerce is also offering grants.
This is, obviously, important to rural health as it is directly tied to the ability to take advantage of health information technology.
New research from USDA shows that while broadband is broadly available in many rural areas, there are significant cost issues.
So, this deployment could help make it universally available and also hopefully lower the costs …
29. What Does This Means for Rural?
Long-Standing Access Problems
Uninsured; Insurance Market Challenges
Heavier Chronic Disease Burden
Opportunity to Improve Outcomes and Value
Workforce
Already Focused on Primary Care but in dire need of more providers
What Does This Means for Rural?
Long-Standing Access Problems
Uninsured; Insurance Market Challenges
Heavier Chronic Disease Burden
Opportunity to Improve Outcomes and Value
Workforce
Already Focused on Primary Care but in dire need of more providers
30. Rural as a Leading Edge of Health Care Reform
New Report from the White House Office of Health Reform
Rural Listening Session at White House May 4, 2009
A lot of discussion about health care reform
Administration has made the argument that even in the worsening economy you can’t afford not to address this issue, that it affects so many parts of the economy from business competitiveness to personal finance, etc.
And the Key Committees on the Hill have been discussing it, Sen. Baucus has released a blueprint for reform.
The White House recently held a forum on health care
There seems to be wide agreement that something needs to be done, but then again that is the easy part. The challenge is in the details and there are widely differing approaches from the left and the right.
But, there are some key themes that are emerging.
Access: uninsured, under insured, problems in the individual and group marketplace … hits rural as heavily dependent on the individual market and public programs
Re-Emphasizing Primary Care: We’ve known this in rural for years; studies show regular access to PC improves outcomes but we don’t have enough out there.
Improving Outcomes: Spend a lot and still get poor outcomes;
Strengthening Medicare and Medicaid: Important to ruralA lot of discussion about health care reform
Administration has made the argument that even in the worsening economy you can’t afford not to address this issue, that it affects so many parts of the economy from business competitiveness to personal finance, etc.
And the Key Committees on the Hill have been discussing it, Sen. Baucus has released a blueprint for reform.
The White House recently held a forum on health care
There seems to be wide agreement that something needs to be done, but then again that is the easy part. The challenge is in the details and there are widely differing approaches from the left and the right.
But, there are some key themes that are emerging.
Access: uninsured, under insured, problems in the individual and group marketplace … hits rural as heavily dependent on the individual market and public programs
Re-Emphasizing Primary Care: We’ve known this in rural for years; studies show regular access to PC improves outcomes but we don’t have enough out there.
Improving Outcomes: Spend a lot and still get poor outcomes;
Strengthening Medicare and Medicaid: Important to rural
31. Health Care Reform: Senate Finance Committee Transforming the Health Care Delivery System: Proposals to Improve Patient Care and Reduce Health Care Costs
Expanding Health Care Coverage: Proposals to Provide Affordable Cover to All Americans
Financing Comprehensive Health Care Reform: Proposed Health Systems Savings and Revenue Options Timeline Timeline
32. Health Care Reform: Senate Finance Committee
Themes for transforming Health Care Delivery
Value-based purchasing for hospitals & CAHs
Transitional care payments
CMS Chronic Care Management Innovation
Bundling of Payments & Readmissions
GME Primary Care Redistribution
33. Health Care Reform Resources RUPRI Health Panel- Rural Perspectives & Commentary
http://www.rupri.org/panelandnetworkviewer.php?id=9
Department of Health and Human Services http://www.healthreform.gov
Senate Finance Committee
http://finance.senate.gov/healthreform2009/home.html
36. We are awarding more than 100 outreach grants this spring
We’ll have a competition this summer for our QI program focusing on chronic disease and using a patient registry with specific chronic disease management training … guidance out in June and applications due in October … expect to make 75-90 awards …
Also have the NW planning grants … community planning funding …
Recovery Act also has $650 million in funding for prevention and wellness, focusing on chronic diseases … not yet clear how that money will go out but we will know soon.
Tremendous opportunity for rural given high rates of chronic diseaseWe are awarding more than 100 outreach grants this spring
We’ll have a competition this summer for our QI program focusing on chronic disease and using a patient registry with specific chronic disease management training … guidance out in June and applications due in October … expect to make 75-90 awards …
Also have the NW planning grants … community planning funding …
Recovery Act also has $650 million in funding for prevention and wellness, focusing on chronic diseases … not yet clear how that money will go out but we will know soon.
Tremendous opportunity for rural given high rates of chronic disease
37. Last year, our agency began a new initiative focused on providing training to health care teams on Rx and patient safety.
All of us put funds into it and we got a fairly good response as a number of the teams are rural folks, but mostly FQHCs but also a few CAHs.
The training relies on the IHI “Model for Improvement”
The deal is the training is free but you need to put up the funds to get to the training. If you tried to pay for this training on your own, it would cost in the six figures.
Many of the folks are HRSA grantees but we have made a deal that allows CAHs and RHCs to apply for the program even if they are not HRSA grantees.
We’d like to see a bigger representation of of CAH and RHC folks this year
Last year, our agency began a new initiative focused on providing training to health care teams on Rx and patient safety.
All of us put funds into it and we got a fairly good response as a number of the teams are rural folks, but mostly FQHCs but also a few CAHs.
The training relies on the IHI “Model for Improvement”
The deal is the training is free but you need to put up the funds to get to the training. If you tried to pay for this training on your own, it would cost in the six figures.
Many of the folks are HRSA grantees but we have made a deal that allows CAHs and RHCs to apply for the program even if they are not HRSA grantees.
We’d like to see a bigger representation of of CAH and RHC folks this year
