Health Reform: A Rural Policy Prospective


Published on

Information on how the national health reform movement will impact rural America.

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide
  • Here is where notes go… Testing whether this prints.
  • Health Reform: A Rural Policy Prospective

    1. 1. A Rural Policy Prospective<br />November 16, 2009<br />Alan Morgan<br />Chief Executive OfficerNational Rural Health Association<br />
    2. 2. NRHA Mission<br /> The National Rural Health Association is a national membership organization with more than 20,000 members whose mission is to provide leadership on rural issues through advocacy, communications, education and research.<br />
    3. 3.
    4. 4.
    6. 6.
    7. 7. Medicare’s cost-based payments to CAHs were roughly $6 billion in 2006, representing 4 percent of all Medicare inpatient and outpatient payments to hospitals.”<br />
    8. 8. Healthcare Critical to Rural Economy<br />Healthcare is the fastest growing segment of rural economy.<br />Each rural physician generates 23 jobs in the local rural economy <br />In most rural communities hospitals are the largest or second largest employer<br />Health care often represent up to 20 percent of a rural community&apos;s employment and income. <br />
    9. 9. Appropriations and the Budget<br />Looking great for 2010!<br />
    10. 10. Rural Health Safety Net Programs<br />Rural Outreach and Network Grants<br />Rural Health Research<br />State Offices of Rural Health<br />Rural Hospital Flexibility Grants<br />Rural and Community Access to Emergency Devices<br />Rural EMS<br />Community Health Centers<br />National Health Service Corps<br />Title VII and Title VIII<br />Areas Health Education Centers<br />Geriatric Programs<br />Denali Commission<br />Delta Health Initiative<br />
    11. 11. House Acts<br />House passes health reform.<br />NRHA did not support House bill.<br />Positive steps but falls <br /> short of significantly <br /> improving access crisis<br /> in rural America.<br />
    12. 12. The Obama Team<br />Gov. Kathleen Sibelius, HHS Sec. Designate<br />Nancy-Ann DeParle, Health Reform Czar<br />Mary Wakefield, HRSA Administrator<br />Rep. Rahm Emanuel, WH Chief of Staff<br />
    13. 13. Health Information Technology<br />$2b for grants and office of HIT coord.<br />Incentive payments for meaningful adoption:<br />RHC/FQHC<br />30% needy patients<br />Medicaid cover no more than 85% of IT costs<br />Eligible providers<br />Medicare up to 41k<br />Medicaid, if 30% Medicaid – 85% of IT costs<br /><ul><li>CAHs
    14. 14. Depreciation value of Medicare IP % plus 20%
    15. 15. Paid same yr. as becoming meaningful
    16. 16. PPS Hospitals
    17. 17. Base of 2m plus amount per discharge up to 23k
    18. 18. Paid over four year period</li></li></ul><li>The Solution:<br />To resolve the health care crisis in rural America, the rural health care safety net must be prevented from crumbling. Four reforms are crucial:<br />The workforce shortage crisis must be abated;<br />Equity in reimbursement must occur;<br />Decaying rural health care infrastructure must be repaired and non-existent infrastructure must be created; and<br />Health disparities among vulnerable populations must be corrected. <br />
    19. 19. So Many Moving Parts…<br />Senate HELP Committee - - insurance, workforce, non-Medicare<br />Senate Finance Committee - - Medicare, Medicaid, Social Security, Graduate Medical Education<br />House Ways and Means – Medicare, Graduate Medical Education <br />Energy and Commerce - - Medicaid, Insurance, workforce<br />Education and Labor - - Education loans<br />
    20. 20. The President’s 8 Principles<br />Reduce health care costs <br />Protect families from bankruptcy and debt of medical costs<br />Guarantee choice of doctors and health plans<br />Invest in prevention and wellness<br />Improve patient safety and quality of care<br />Ensure affordable coverage for everyone<br />Maintain coverage when you lose job<br />End barriers to coverage for pre-existing conditions.<br />
    21. 21. CAHs: What NRHA is fighting for…<br /><ul><li>Reinstatement of “Necessary Provider” for CAHs;
    22. 22. Extension of the Flex grant program;
    23. 23. Expansion of the 340B drug program to CAHs;
    24. 24. Equity for CAHs in Medicare stimulus dollars for health information technology;
    25. 25. Flexibility in stringent bed count requirements for CAHs;
    26. 26. Improving a CAH’s access to capital;
    27. 27. Elimination of CAH “Isolation Test” for ambulance reimbursement;
    28. 28. Ability for a CAH to negotiate reimbursement rates of a “public plan” health care option;
    29. 29. Greater ability for a CAH to recruit and retain physician residents and physicians; and
    30. 30. Ensuring equitable reimbursement for CAHs for anesthesia services.</li></li></ul><li>Finance Rural Positives<br /><ul><li>Workforce Provisions
    31. 31. Expands Rural Residency Programs
    32. 32. Encouragement of Rural Training Track Programs
    33. 33. Bonus payments for primary care and general surgery
    34. 34. Workforce Shortage Advisory Committee</li></ul> <br /><ul><li>Medicare Provisions
    35. 35. Extension of Floor on Medicare Work Geographic Adjustment
    36. 36. Two-year extensions of important Medicare provisions for Rural Providers
    37. 37. Rural Hospital Flex Program
    38. 38. Therapy Cap Services
    39. 39. Physician Pathology Services
    40. 40. Ground Ambulance Services
    41. 41. Medicare Mental Health Services
    42. 42. Rural Hospital Flexibility Program
    43. 43. Lab Services
    44. 44. Medicare Dependent Hospital Program
    45. 45. Temporary Relief to Low-Volume Hospitals
    46. 46. Home health add-on for home health in rural areas.</li></li></ul><li>Rural amendments passed<br /> <br /><ul><li>Bingaman – Ensuring GME redistribution is available to rural and other underserved states – 50% of redistributed slots to rural
    47. 47. Bingaman – Establishing “Teaching Health Centers” to increase number of primary care physicians – Grants to develop residency programs at ambulatory care centers (RHCs, FQHCs, etc)
    48. 48. Bingaman – Ensures Appropriate Consultation with Mental Health and Substance Abuse Experts
    49. 49. Conrad – Two-year extension of “super rural” bonus payment for ambulance services
    50. 50. Lincoln – To restore the ratios used in determining geographic hospital wage index reclassification to the pre-October 1, 2008 levels until the first fiscal year after the secretary makes a proposal(s) that considers the nine points specified in the Tax Relief and Health Care Act of 2006
    51. 51. Carper – Provides workplace wellness tax credits
    52. 52. Stabenow – To provide training for advance practice nurses
    53. 53. Stabenow – To establish a National Center on Hospital Quality
    54. 54. Rockefeller – Would add free clinics to list of provider eligible for Medicare and Medicaid incentives under the American Recover and Reinvestment Act of 2009
    55. 55. Technical Correction on page 121 of Mark – Clarifies that CAHs are eligible to receive 101% of reasonable cost for providing outpatient services regardless of billing method and for providing ambulance services.
    56. 56. Grassley - - GPCI
    57. 57. Rockefeller - - Medicare Commission</li></ul> <br />
    58. 58. H.R. 3200/Rural Positives<br /><ul><li>340B Drug Expansion – CAHs, MDH, SCH, RRC, expand to inpatient drugs.
    59. 59. Primary Care Investment
    60. 60. NHSC
    61. 61. GME grants for expanding residency programs to RHCs and FQHCs
    62. 62. Primary care payment increases – extra 10% bonus for primary care in HPSA.
    63. 63. IOM Study on Geographic Adjustment Factors
    64. 64. Medicare “Extenders” plus:
    65. 65. marriage and family therapists; and
    66. 66. Mental health counselors</li></li></ul><li>Important Rural Amendments<br />Bennet (D-CO) <br />CAH HIT<br />RHC 340B<br />State Offices<br />Pryor (D-AR) <br />CAH 35-mile waiver<br />Wyden (D-OR)<br />CAH bed flex<br />Wyden (D-OR)<br />RHC cap<br />Murkowski (R-AK) <br />Frontier clinic grant program<br />Udall (D-CO)<br />Workforce/pipeline<br />Harkin (D-IA)<br />Agriculture Safety Program<br />Durbin (D-IL)<br />CRNA <br />Johanns (R-NE)<br />MedPAC and Medicare Commission rural rep<br />Nelson (D-NE) <br />Rebasing for small hospital demo program currently in effect.<br />
    67. 67. The Time Table<br />Urgency to get bill done this year.<br />So many delays. Goal was to finish committee work in June and have Floor debate in July.<br />
    68. 68. We Need You!<br />You are your own best voice<br />Your member of Congress listens when you speak<br />You will have more success than I<br />
    69. 69. Join NRHA Today!<br /><br />Click button: Become a Member<br />Access to Social Networking: NRHA Connect<br />Regulatory and Legislative Guides<br />E-news and Rural Roads<br />Much, Much More<br />