Getting to 2015: Critical Issues Facing CAHs Pre-Conference Session 12 th Annual Small and Rural Hospital Meeting Nov th, 2012 Charlotte, NC

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1 Getting to 2015: Critical Issues Facing CAHs Pre-Conference Session 12 th Annual Small and Rural Hospital Meeting Nov th, 2012 Charlotte, NC Tom Morris Associate Administrator Department of Health and Human Services Health Resources and Services Administration Office of Rural Health Policy

2 Today s Topics Current Environment for CAHs How to Respond Resources for CAHs

3 CAH Scrutiny: Fair Play or Cheap Shots?

4 AHRQ Study on CAH Inefficiency in the Journal Of Health Policy, Politics and Law, 2010

5 JAMA Article, 2011 CAHs have Lower Quality Higher Mortality Fewer Resources

6 MedPAC Report 2012 CAHs benefit not targeted; Results in extra costs to Medicare Rural Access = Urban Access

7 The Rural Health Fix Timeline 2010 ACA Passage 1983 Introduction of PPS Rural Hospital Closures and Initial Adjustments Base Payment Demos Swing Beds SCHs Rural Hospital Fixes CAH Method II Extension of MDH DSH Expansion OPPS Hold Harmless Lab Billing 340B Coverage Expansion Frontier Adjustment MDH Extension 340B expansion System Redesign? Volume to Value? MDHs

8 An Alternative View CAH and Flex A Public Policy Success Story The Changing Health Care Environment and CAHs Leveraging the Tools At Hand Flex Funding Flex Monitoring Team and TASC

9 Flex Program Need Outcomes Assessment Measures Activities

10 Flex Big Picture Improve on Hospital Outcomes Collect Uniform Outcomes Across the Flex Program Demonstrate Program Impact

11 Medicare Beneficiary Quality Improvement Project (MBQIP) Phase 1 Measures (Begin September 2011) Pneumonia: Hospital Compare CMS Core Measure (participate in all sub-measures); AND Congestive Heart Failure: Hospital Compare CMS Core Measure (participate in all sub-measures) Phase 2 Measures (Begin September 2012) Outpatient 1-7: Hospital Compare CMS Measure (all submeasures that apply); AND Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Phase 3 Measures* (Begin September 2013) Pharmacist CPOE/Verification of Medication Orders Within 24 Hours; AND Outpatient Emergency Department Transfer Communication *Reporting tool for Phase 3 Measures is yet to be determined

12 MBQIP Participation by ORHP Region 100% 90% MBQIP Participation 80% 70% 82% 85% 76% 77% 60% 50% 40% 30% 20% 66% 63% Region A: 54 of 66 CAHs (82%) Region B: 156 of 236 CAHs (66%) Region C: 477 of 559 CAHs (85%) Region D: 118 of 187 CAHs (63%) Region E: 214 of 281 CAHs (76%) US Total: 1019 of 1329 CAHs (77%) 10% 0% Region A Region B Region C Region D Region E U.S. Total (Northeast) (Southeast) (Midwest) (Southwest) (Northwest)

13 Next Up An MBQIP for the Financial Side of CAHs

14 Resources

15 Tools and Resources for CAHs

16 Nursing Scholarship Program Nursing Education Loan Repayment Program Native Hawaiian Health Scholarship Program NSP NELRP Faculty Loan Repayment Program FLRP NHHSP BCRS NHSC SLRP NHSC SP NHSC LRP National Health Service Corps SCHOLARSHIP PROGRAM NHSC S2S LRP National Health Service Corps STATE LOAN REPAYMENT PROGRAM National Health Service Corps STUDENTS TO SERVICE LOAN REPAYMENT PROGRAM National Health Service Corps LOAN REPAYMENT PROGRAM

17 CAH site policy under 3-year Pilot NHSC will approve entire CAH as a service site. Including the ER, swing bed unit, skilled nursing facility (SNF) Clinicians time in the inpatient setting will now count towards service obligation. In general, up to 24 hours of the minimum 40 hours of fulltime practice; 12 hours in the case of half-time practice Disciplines include: Physicians, Physician Assistants, Nurse Practitioners, and Certified Nurse Midwives Must Be in a Health Professional Shortage Area (and score matters)

18 NHSC site Eligibility See all patients, regardless of ability to pay. Accept Medicare, Medicaid & Children s Health Insurance Program beneficiaries. Utilize a sliding fee scale or a charity care policy for low-income patients. Must have a financial assistance plan in place for those below 200% of poverty (without regard for assets) Services at no charge, or a nominal charge, for those below 100% of poverty Schedule of discounts for those between 100% and 200% of poverty The NHSC can provide you with examples

19 NHSC site application process Applicant submits a site application online. Visit and review the Service Site Guide Determine if you are in a HPSA Go to the Apply tab on the web site to begin the online application Primary Care Offices (PCOs) review applications and make a recommendation. BCRS Regional Offices review & make final determination. Utilize DRO staff to answer any specific questions you have on the application process and required documentation

20 CAH Site Application Tip List NHSC counts hours on a weekly basis. Clinicians that spend a week on, a week off of inpatient coverage would not be eligible For scholar placement, both the CAH and the affiliated outpatient site must be in a HPSA of 16 or higher (for FY 2013 cycle). Read the NHSC Site Guide & the Loan Repayment Guidance. Become familiar with program requirements, especially related to practice location and hourly requirements

21 The 340b Program Opportunity for CAHs Lower Drug Costs Focus on Safety Net Providers Key Elements The Prime Vendor The Contract Pharmacy Option

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23 Contact Information Tom Morris Associate Administrator Rural Health Policy Health Resources & Services Administration U.S. Department of Health & Human Services