HEALTH REFORM MEETING THE NEEDS OF RURAL COMMUNITIES

1. HEALTH REFORMMEETING THE NEEDS OF RURAL COMMUNITIES • Brief History • • Great Plains Health Alliance • • Hill Burton Program • • Government Financed Health Care • • Evolution of the Rural Hospital • o Meeting Community Needs •  Community Expectations •  Development of Hospital Based Long Term Care •  Swing Bed Programs •  Critical Access Hospitals •  Rural Health Clinics • • Hospital Employed Medical Staff • • Provision of Emergency Medical Services • • Home Health • • Wellness Centers

2. Impact of Health Care Services in Rural Communities • Access to Health Care in a Rural Environment o Demographics o Transportation o Aging Population o Out Migration o Volunteer Based Emergency Medical Services • Quality Of Life • Return on Investment o Return of Insurance Dollars to the Community o Choosing Services that will Provide the Best Return of Dollars Back to the Community o Contribution to the Community’s Economic Engine o Financial Penalties from Medicare when Critical Access Hospitals Provide Services Beyond Traditional Hospital Services HEALTH REFORMMEETING THE NEEDS OF RURAL COMMUNITIES

3. Challenges • • Financing • o Local Tax Support • o Government Payment Models •  Critical Access Hospital Payment Methodology • • Strengths and Weaknesses • • Regulations (Congress and CMS) • o Lack of Understanding of Rural Environments and • Their Impact on the Total Medicare Expenditures • o Development of Regulation that Exceed Congressional Intent • o Unintended Consequences • o Transition to the New Medicare Administrative Contractors • o Recovery Audit Contractors •  Retroactive Enforcement •  Focus on Short Stays •  Evaluate Appeals Process HEALTH REFORMMEETING THE NEEDS OF RURAL COMMUNITIES

4. Challenges – Cont’d • • Manpower • o Physicians (Especially Primary Care Physicians) • o Allied Health •  PA/ARNP ‘s  Nurses •  Physical Therapists •  Lab/X-rays • • Aging Facilities • • Technology • o Diagnostic • o Electronic Medical Records • o Electronic Information Exchange • o Telemedicine HEALTH REFORMMEETING THE NEEDS OF RURAL COMMUNITIES

5. Policy Issues • • Dysfunctional Federal Government • • Technology • o Medicare Advantage Programs • o Specialty Hospitals • o Self Referrals • • Stabilize Physician Payment Methodology • o Incentivize Primary Care • o Impact of Rural Hospitals when Physician Payments • are Uncertain or Reduced • • Improve Impact Analysis Prior to Implementation of Regulations HEALTH REFORMMEETING THE NEEDS OF RURAL COMMUNITIES