Critical Access Hospital Advisory Council

1. Critical Access Hospital Advisory Council Cari Fouts, Program Director Jen Dunn, CAH Program Coordinator

2. Welcome! Introductions What’s in your binder? Housekeeping

3. CAH Advisory Council Agenda Overview of current CO CAH program Update on current, new and developingCAH programs Explore HIT/ARRA requirements and opportunities Strategic planning for future programs and project development Learn about the QHi Benchmarking Tool

4. A TRUE Rural Hospital…

5. What is a CAH? Balanced Budget Act 1997 Rural area, or special provision 25 acute care beds, additional 10 distinct part rehab or psychiatric allowable Average length of stay, 96 hours or less 35 miles from nearest hospital or CAH, or more than 15 miles of mountainous terrain, OR necessary provider before 12/05

6. Why become a CAH? Enhanced Payment through Medicare Most inpatient/outpatient services 101% of reasonable and allowable costs Ambulance services owned/operated receive 101% Provider-Based rural health clinics receive cost based reimbursement

7. CO Critical Access Hospitals

9. Family Health West

10. The Memorial Hospital

11. Colorado’s Rural Health Clinics

12. Grand River Hospital and Medical Center

13. Estes Park Medical Center ED

14. CAH/Flex Review Medicare Rural Hospital Flexibility Program (Flex), created in 1997 Funding to support conversion and infrastructure to strengthen rural health care • Performance Improvement/Quality Improvement • Supporting Hospitals • Evaluation • Integration of EMS services • Networking (optional) • Conversion to CAH status (optional)

15. Proposed New Flex Focus Areas Quality Improvement (Hospital Compare?) Financial and Operational Performance Improvement Community Engagement and Impact (regional and local collaborations) Health Information Technology

16. Colorado CAH Partners Colorado Department of Public Health and Environment Colorado Foundation for Medical Care Colorado Hospital Association Centers for Medicare & Medicaid

17. New Programs/Resources in 08/09 Board Webinar series Member only Website access (tools and resources) RAC resources – • CAH self audit tool • Group Discounted rates for Milliman or Interqual and EHR Physician Advisor services QHi Benchmarking Resource Nurse Leadership Training Capital Equipment Purchases - RACE Program Grant Writing Program – GROW RHC Technical Assistance Services

18. Programs in Progress Colorado Credentialing Network Revenue Cycle Management Services Peer Review Network Expansion Swing Bed Online Training Observation and UM Manual/Training Community Paramedic Program

19. Health Reform - Senate Health Reform Senate proposal has combined the Finance Committee and the HELP (Health, Education, Labor, and Pension) Committee. Proposal being analyzed by the Congressional Budget Office (CBO) to determine costs. Senate bill content unclear - not publicly released. Rural amendments that NRHA is working to get included, once a bill is brought to the floor: • Allow flexibility in CAH bed count, • Raise the RHC cap to $92, • Waive the 35-mile rule for CAH designation, and • Rural Training Track funding for medical schools. Still many unknowns and uncertainty if there are enough votes to avoid a filibuster. Timeframe was set for this week or next, but there is talk that things could get pushed out until 2010.

20. Health Reform - House Health Reform Combined three bills (current bill almost 2,000 pages) and received an approximate $1 trillion price tag from the CBO. Hoped to have a floor vote this week; not likely to happen. There are not enough votes to pass the current bill (need 218). Points of contention: public plan option, cost, immigration, etc. Note: House introduced a bill (H.R. 3961) that addresses the Sustainable Growth Rate (SGR) that would fix the current mandated cuts that must be addressed each year concerning Medicare rates to physicians. The Senate voted down a similar bill in October. SGR not being addressed in any of the health reform proposals due to the price tag ($245 billion over 10 years)

21. Colorado State Budget Legislative Updates FY09-10: ~ $1.4 billion General Fund shortfall addressed during 2009 legislative session Since then, an additional $589 million shortfall has been addressed 1.5% Medicaid Provider cuts effective September 1st; an additional 1% Medicaid Provider cuts effective December 1st Delayed Medicaid payments – final two weeks of payment for FY09-10 will be shifted into FY10-11 Cuts and delayed payments will not apply to RHCs

22. CAH Noteworthy Legislative Updates Legislative Updates H1N1 Waiver available if bed capacity is reached: http://www.cms.hhs.gov/H1N1/Downloads/RequestingAWaiver101.pdf Final CMS OPPS Rule – outpatient therapeutic services supervision • Non-physician supervision as long as service is within scope • Must be “immediately” available to assist • Auditors not allowed to cite hospitals from 2000-2008

23. Grant Programs Capacity building Grant Capacity Building Grant to spread funding opportunity across all CAHs. 28 CAHs awarded funding

24. Capacity Building Grant Categories Capacity Building Grant Quality Improvement HIT and Regulatory Compliance Outmigration Studies EMS Budget Tool Training Education • Trauma Designation Consultation • Billing and Coding • Swing Bed Training • Board Training • Simulation Training • Leadership and Management

25. Funding Breakdown Capacity Building Grant Quality Improvement - 6 CAHs for Total of $20,691 HIT - 4 CAHs for Total of $28,825 Regulatory Compliance - 4 CAHs for Total of $19,000 Education/Capacity Building - 14 CAHs for Total of $83,425 • Billing and Coding - 7 CAHs for Total of $39,400 • Board Training - 4 CAHs for Total of $19,700 • Swing Bed Training – 2 CAHs for Total of $3,400 • Leadership Training – 4 CAHs for Total of $15,768 Additional Funding Options (Outmigration Studies) • 3 CAHs for Total of $22,500

26. Individual Projects Capacity Building Grant Innovative Programs/Projects • 10 CAHs selected for Total CBG of $50,400 • Examples • Health Fair • Prenatal Education • Customer Service Training Program • Cost Reporting • CAH Recertification • Montrose – feasibility study to build new CAH

27. CBG Cycle 09/10 Capacity Building Grant Grant guidance NOW AVAILABLE! Each hospital eligible for $8000 for 09/10 Applications due back December 4, 2009 New opportunities: • Business Development • Employee Satisfaction Survey • HIT Consortium • Credentialing Network and Services • Expanded Outmigration Options • EHR Physician Advisor, Milliman/InterQual

28. Small Hospital Improvement Program (SHIP) SHIP Grant Approximately $9000 available HIT Consortium Opportunity 16 Hospitals Participating in Consortium Keefe Delta

29. Statewide Initiatives Statewide Initiatives Center for Improving Value in Health Care (CIVHC) HIT Regional Extension Center RHC HIT Solutions Association of Rural Health Clinics of Colorado (ARHCC) Hospital Quality Incentive Payment

30. 2010 Strategic Planning

31. Strategic Planning – Flex 2010 What do you find most beneficial about the Flex grant? How can we improve what we are currently doing? In a perfect world ($ no object!), what would the Flex grant provide?

32. Workshop/Educational Event Structure CHA Rural Hospital Conference/CAH Workshop Merging in 2010 • Topics? Quality Improvement Workshops in conjunction with Annual Conference

33. Webinar Educational Series Frequency (Monthly, Bimonthly, Quarterly, TBD) Potential Topics • Board Governance • RAC/MIC/MAC, vegetable soup • Regulatory Changes • Observation Status • Others?

34. Volunteers needed! HIT Consortium Advisory Committee Peer Review Network Expansion Pilot