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Carrie Cochran Deputy Associate Administrator for Rural ...

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Carrie Cochran Deputy Associate Administrator for Rural ...

  1. 1. The Federal Rural Health Landscape South Carolina’s 13 th Annual Rural Health Conference April 29-30, 2009 Carrie Cochran Deputy Associate Administrator for Rural Health Policy Health Resources and Services Administration U.S. Department of Health and Human Services
  2. 2. Today’s Presentation <ul><li>Washington Update </li></ul><ul><li>Health Care Reform </li></ul><ul><li>The Stimulus Bill </li></ul><ul><li>Emerging Challenges </li></ul><ul><li>Opportunities and Resources </li></ul>
  3. 3. About Office of Rural Health Policy <ul><li>Role of the Office of Rural Health Policy </li></ul><ul><li>Voice for Rural within HHS </li></ul><ul><li>Administers Rural Health </li></ul><ul><li>Grant Programs </li></ul><ul><li>Makes Policy Recommendations </li></ul><ul><li>Facilitates Rural Health Research </li></ul>
  4. 4. <ul><li>Tough Times: Thin Margins get Thinner </li></ul><ul><li>Local job losses </li></ul><ul><li>State cuts </li></ul><ul><li>Increase in the uninsured </li></ul>
  5. 5. Current Health Care Challenges <ul><li>Increases in the Uninsured, Underinsured </li></ul><ul><li>Decreased Revenues </li></ul><ul><li>Workforce Recruitment and Retention </li></ul><ul><li>Increased Focus on Quality and Reporting </li></ul><ul><li>Resources/Infrastructure </li></ul>
  6. 6. Health Care Reform <ul><li>Health Care Reform Front & Center </li></ul><ul><li>President’s Vision Key Principles </li></ul><ul><ul><li>Protect families’ financial health </li></ul></ul><ul><ul><li>Assure affordable, quality coverage </li></ul></ul><ul><ul><li>Provide portability of coverage </li></ul></ul><ul><ul><li>Guarantee choice of providers </li></ul></ul><ul><ul><li>Invest in prevention and wellness </li></ul></ul><ul><ul><li>Improve patient safety and quality </li></ul></ul><ul><ul><li>End barriers for pre-existing conditions </li></ul></ul><ul><ul><li>Reduce long-term growth of health care costs </li></ul></ul>
  7. 7. <ul><li>White House Forum a starting point </li></ul><ul><li>Opportunities for rural? </li></ul><ul><li>More information available: </li></ul><ul><ul><li>http://www.healthreform.gov/ </li></ul></ul>Health Care Reform
  8. 8. <ul><li>Some Common Themes </li></ul><ul><li>Rising Costs </li></ul><ul><li>Reductions in Access </li></ul><ul><li>A Need to Improve Quality </li></ul><ul><li>Linking Workforce </li></ul><ul><li>Current Proposals </li></ul><ul><li>Improving Access </li></ul><ul><li>Re-Emphasizing Primary Care </li></ul><ul><li>Improving Outcomes </li></ul><ul><li>Strengthening Medicare, Medicaid and SCHIP </li></ul>Health Care Reform
  9. 9. <ul><li>What Does This Means for Rural? </li></ul><ul><li>Long-Standing Access Problems </li></ul><ul><ul><li>Uninsured; Insurance Market Challenges </li></ul></ul><ul><li>Heavier Chronic Disease Burden </li></ul><ul><ul><li>Opportunity to Improve Outcomes and Value </li></ul></ul><ul><li>Workforce </li></ul><ul><ul><li>Already Focused on Primary Care but in dire need of more providers </li></ul></ul>Health Care Reform
  10. 10. <ul><li>Viewing Health Care Reform as part of the Recovery … </li></ul><ul><ul><li>New Report from the White House Office of Health Reform </li></ul></ul><ul><ul><li>More information expected </li></ul></ul>http://www.healthreform.gov/reports/inaction/inactionreportprintmarch2009.pdf Health Care Reform
  11. 11. The American Reinvestment and Recovery Act (ARRA) <ul><li>$787 billion stimulus package for: </li></ul><ul><li>Health Information Technology (HIT) </li></ul><ul><li>Community Health Centers </li></ul><ul><li>Prevention and Wellness </li></ul><ul><li>Health Workforce </li></ul><ul><ul><li>www.recovery.gov </li></ul></ul>
  12. 12. ARRA: HIT <ul><li>Medicare HIT Payments </li></ul><ul><li>Based on “Meaningful” HIT adoption through 2014 </li></ul><ul><li>PPS Facilities: Adjustment to Base Payment relative to Medicare share </li></ul><ul><li>CAHs: Payment based on Medicare Share + 20% of depreciation amount </li></ul><ul><ul><li>Paid via interim payments (not cost-settlement) </li></ul></ul>
  13. 13. <ul><li>Medicaid HIT Payments </li></ul><ul><li>Based on “Meaningful” HIT </li></ul><ul><li>adoption through 2014 </li></ul><ul><li>Eligible Professionals, including RHCs and FQHCs, get up to 85% of HIT-related costs </li></ul><ul><ul><li>Tied to meeting a 30% combined Medicaid, SCHIP, </li></ul></ul><ul><ul><li>uncompensated care patient population threshold </li></ul></ul><ul><li>Eligible Hospitals, including PPS and CAH, with at least 10% Medicaid patient volume </li></ul>ARRA: HIT
  14. 14. <ul><li>Other HIT Resources </li></ul><ul><li>Construction, renovation and </li></ul><ul><li>equipment, and acquisition of HIT </li></ul><ul><li>HIT workforce training </li></ul><ul><li>Regional health information exchange </li></ul><ul><li>HIT Extension Program- Regional Technical Assistance Centers </li></ul>ARRA: HIT
  15. 15. <ul><li>$7.2 billion in funds to extend broadband service nationally through USDA </li></ul><ul><ul><li>$4.7b for Broadband Technology Opportunities Program (BTOP) </li></ul></ul><ul><ul><li>$2.5 b for Rural Utilities Service (RUS) for grants/loans for deployment & construction of broadband systems </li></ul></ul>ARRA: Rural Broadband
  16. 16. ARRA: Workforce <ul><li>$500 million to strengthen the health care workforce </li></ul><ul><ul><li>$300m to National Health </li></ul></ul><ul><ul><li>Service Corps </li></ul></ul><ul><ul><li>$200m Title VII- Primary Care, Dentistry, AHECs </li></ul></ul><ul><li>Additional Labor Department Provisions </li></ul>
  17. 17. ARRA: Community Health Centers <ul><li>$2 billion to support CHC services, repairs and renovations, and investments in HIT </li></ul><ul><li>$155m New Access Points- awarded to 126 CHC for FY09 and FY10 </li></ul><ul><li>$337m Increased Demand for Services (IDS)- awarded to 1,128 CHC for FY09 and FY10 </li></ul><ul><li>http://bphc.hrsa.gov/recovery </li></ul>
  18. 18. <ul><li>$1 billion to support HHS initiatives and programs in Public Health Service Act </li></ul><ul><ul><li>$650m Evidence-based Prevention & Wellness </li></ul></ul><ul><ul><li>$350m Secretarial Initiatives </li></ul></ul><ul><ul><li>Evaluation of quality & effectiveness of program spending </li></ul></ul>ARRA: Prevention & Wellness
  19. 19. <ul><li>$130 million for rural community facility development through the USDA Capital Facilities Loan Program </li></ul><ul><ul><li>$67 million in loans </li></ul></ul><ul><ul><li>$63 million in grants </li></ul></ul><ul><ul><li>Translates to well over </li></ul></ul><ul><ul><li>$1 billion in guaranteed loans </li></ul></ul><ul><ul><li>for rural facilities </li></ul></ul>ARRA: Capital
  20. 20. <ul><li>Rural Business Programs </li></ul><ul><li>Rural Water and Waste Disposal Programs </li></ul><ul><li>Rural Community Facilities </li></ul><ul><li>Law Enforcement- Rural Drug Enforcement Assistance Program </li></ul><ul><li>Rural Housing Programs </li></ul><ul><li>Loans for Beginning Farmers </li></ul>ARRA: Other Rural Resources
  21. 21. Children’s Health Insurance Program Reauthorization (CHIPRA) <ul><li>CHIPRA extends, improves, and expands CHIP through 2013 </li></ul><ul><li>Rural Provisions: </li></ul><ul><ul><li>Focus on outreach and enrollment for un-enrolled rural children </li></ul></ul><ul><ul><li>Improve quality of care for pediatric services </li></ul></ul><ul><ul><li>New PPS reimbursements for RHC & FQHC </li></ul></ul>
  22. 22. Emerging Trends: Rural Hospitals <ul><li>Federal Quality Initiatives: </li></ul><ul><ul><li>Value-based Purchasing, Hospital Re-admission Payments, Bundled Episodes of Care, Care Coordination, Implementation of the Medical Home Model, QIO 9th Scope of Work </li></ul></ul><ul><li>Medicare Recovery Audit Contractors </li></ul><ul><li>Changes to the Medicare Advantage Program </li></ul><ul><li>Monitoring Medicare & Medicaid Payments </li></ul>
  23. 23. Emerging Trends: Workforce <ul><li>Continued Workforce Shortages- Physicians, Nurses, other Allied Health </li></ul><ul><li>National Attention to Workforce Issues Growing </li></ul><ul><ul><li>Stimulus Package has a significant investment in both NHSC and Title VII and VIII </li></ul></ul><ul><ul><li>Labor’s Workforce Investment Act Programs got a big boost </li></ul></ul>
  24. 24. ORHP Structure <ul><li>Community-Based Division </li></ul><ul><ul><li>9 grant programs </li></ul></ul><ul><li>Hospital- State Division </li></ul><ul><ul><li>4 grant programs </li></ul></ul><ul><li>Border Health Division </li></ul><ul><li>Policy-Research Team </li></ul><ul><ul><li>3 grant programs </li></ul></ul>
  25. 25. Community-Based Division <ul><li>Rural Health Services Outreach </li></ul><ul><li>Rural Health Network Development </li></ul><ul><li>Rural Network Development Planning </li></ul><ul><li>Delta States Development Network (Delta) </li></ul><ul><li>Small Rural Provider Quality Improvement </li></ul><ul><li>Radiation, Exposure, Screening and Education Program Black Lung Clinic Program (BLCP) </li></ul><ul><li>Delta Health Initiative (DHI) </li></ul><ul><li>Rural AED (RAED) </li></ul><ul><li>Frontier Extended Stay Clinic (FESC) </li></ul>
  26. 26. <ul><li>State Offices of Rural Health (SORH) </li></ul><ul><li>Rural Hospital Flexibility Grant (Flex) </li></ul><ul><li>Small Rural Hospital Improvement Program (SHIP) </li></ul><ul><li>Critical Access Hospital HIT Network Grants (CAH-HIT Network) </li></ul>Hospital-State Division
  27. 27. <ul><li>Rural Recruitment and Retention Network </li></ul><ul><li>National Rural and Urban Underserved </li></ul><ul><li>Workforce Summit </li></ul><ul><ul><li>Focus on Primary Care Providers </li></ul></ul><ul><ul><li>August 2009, Washington DC </li></ul></ul><ul><li>HRSA BHPR Programs </li></ul><ul><ul><li>NHSC </li></ul></ul><ul><ul><li>Nursing Scholarships and Loans </li></ul></ul><ul><ul><li>Medicare GME </li></ul></ul><ul><ul><li>http://bhpr.hrsa.gov/ </li></ul></ul>ORHP Resources: Workforce
  28. 28. <ul><li>Health Workforce Information Center </li></ul><ul><li>Web site - Easy access to key </li></ul><ul><li>information on over 50 workforce </li></ul><ul><li>topics and 80 professions, including: </li></ul><ul><ul><li>Events & training, Organizations, </li></ul></ul><ul><ul><li>Funding, News and Updates, Resources </li></ul></ul><ul><li>HWIC Call Center </li></ul><ul><ul><li>1-888-332-4942 </li></ul></ul><ul><ul><li>info@healthworkforceinfo.org </li></ul></ul>healthworkforceinfo.org ORHP Resources: Workforce
  29. 29. <ul><li>Patient Safety Pharmacy Collaborative </li></ul><ul><li>Started in 2008 </li></ul><ul><li>Team-based training </li></ul><ul><ul><li>Institute for Healthcare Improvement “Model for Improvement” </li></ul></ul><ul><ul><li>Open to HRSA Grantees as well as CAHs, RHCs </li></ul></ul><ul><li>New Class to Start in 2009 </li></ul>Pharmacist in Jordan, MT ORHP Resources: Quality
  30. 30. <ul><li>Resources for CAHs Capital Planning </li></ul><ul><ul><li>Protype Design </li></ul></ul><ul><ul><li>Capital Planning Manual In Development </li></ul></ul>http://portal.hud.gov/portal/page?_pageid=73,1827038&_dad=portal&_schema=PORTAL (Click on CAH Planning, Design and Construction Guide) ORHP Resources: Capital
  31. 31. ORHP Resources: RHC TA Series <ul><li>Help for Rural Health Clinics through free quarterly technical assistance conference calls </li></ul><ul><li>Past topics include billing, pandemic flu, HIT, etc. </li></ul>A Rural Health Clinic in Michigan <ul><ul><li>http://www.narhc.org/members/orhp_series.php </li></ul></ul>
  32. 32. ORHP Resources: Research <ul><li>New Manuals </li></ul><ul><ul><li>Mental Health Best Practices </li></ul></ul><ul><ul><li>FQHC-CAH Collaboration </li></ul></ul><ul><ul><li>Rural HIV Best Practices </li></ul></ul><ul><ul><li>CAH Capital Planning </li></ul></ul><ul><li>Rural Health Research Gateway </li></ul><ul><ul><li>Learn more about past and ongoing studies and policy briefs http://www.ruralhealthresearch.org/ </li></ul></ul>
  33. 33. <ul><li>2009 Report to the Secretary- The National Advisory Committee on Rural Health and Human Services </li></ul><ul><li>Rural Implications of the Medical Home Model </li></ul><ul><li>Serving At-Risk Children in Rural Areas </li></ul><ul><li>Workforce and Rural Economic Development </li></ul>ORHP Resources
  34. 34. Rural Assistance Center <ul><li>One-Stop Shopping </li></ul><ul><ul><li>- Funding Info </li></ul></ul><ul><ul><li>- Resource Guides </li></ul></ul><ul><ul><li>- Best Practices </li></ul></ul><ul><li>Web-Based Services & </li></ul><ul><li>Electronic Updates </li></ul><ul><li>Subscribe on the website </li></ul><ul><li>Customized Assistance </li></ul>http://raconline.org Phone: 1.800.270.1898 E-mail: [email_address] Hours – Monday – Friday 8 AM – 5 PM CT
  35. 35. Contact Information Carrie Cochran Deputy Associate Administrator for Rural Health 301-443-4701 [email_address] http://ruralhealth.hrsa.gov/

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