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Published byTrevor Rafe Blair Modified over 9 years ago
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National Rural Health Association November 2015
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Rural programs fighting for survival, today, originated from historic challenges ◦ Critical Access Hospital program ◦ Federally Qualified Health Centers ◦ Rural Health Clinics ◦ Swing Bed program Medicare and Medicaid, originally projected by some to fail within first two years
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Rural hospital closures stemming from: ◦ Significant changes in reimbursement ◦ Expanded regulatory burden ◦ Low volume realities under value based purchasing Provider shortages stemming from: ◦ Medical education limits ◦ Recruitment and retention limitations ◦ Distance to specialty/subspecialty support ◦ Growing breakdown in rural EMS system
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Gap widening between urban and rural beneficiaries ◦ Lack of Medicaid expansion is most highly rural states ◦ Reduced adoption of ACO’s and other value-based payment vehicles ◦ Proliferation of narrow networks ◦ Reduced level of employer-based insurance ◦ Increase in cost of private insurance premiums
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Rural providers historically hampered by law of small numbers in a world driven by volumes ◦ CAH program born of DRG implementation and subsequent impact ◦ Older and poorer communities translate to less desirable payer mix than urban counterparts ◦ Cost per patient driven by higher fixed costs spread across lower volumes
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Rural Providers are better positioned to thrive in new models of care than urban counterparts ◦ Primary care vs. specialty focus ◦ Telemedicine and community-based care experience ◦ Continuum of care often connected ‘under one roof’ ◦ Social determinants of health better understood ◦ Care coordination based upon personal connection with patient panel
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Trickle down strategy not bringing significant rural providers into Alternative Payment Models Initial risk-bearing models required an aggregation of patients across communities Growing understanding of the need to address underlying realities of cost-based reimbursement ◦ Calculating savings against a constant baseline ◦ Law of diminishing returns
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Medicare Shared Savings Program successes Disease Specific Shared Savings models Episodic Bundled Payment structures Intensive Care Coordination options ‘stolen’ from oncology model Financial lessons from FESC and other rural demonstration projects Care coordination, home monitoring and other research-based tools
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State-based initiatives to define new option for struggling CAH’s NRHA Future of Rural Health Task Force AHA Urban/Rural Task Force Save Rural Hospitals legislation includes ‘glidepath’ demonstration option Building upon the success of historic demonstration projects ◦ Montana ◦ EACH/RPCH
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Power of NRHA Policy Congress white papers Task Force recommendations and new model development Partnership with other associations Conference peer-to-peer learning Journal evidence-based practices Targeted education on key issues i.e. HIT and Population Health GRASSROOTS ADVOCACY!
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Office of Rural Health Policy continues to strengthen and expand HRSA participation in issues ranging from Health Professional Shortage Area designation to Office of National Coordinator interest in expanding rural tele-health White House Council seat at the table on rural issues Centers for Medicare & Medicaid Innovation Senate/House caucus & committee testimony
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Peer support and encouragement to reduce burn-out, turnover Avoiding ‘avoidance’ Identifying delivery system gaps and new models to address them Embracing ambiguity as a license to test better options Remember rural health challenges existed more than 50 years ago and we found many opportunities for success – we will again
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