Presentation on theme: "Brock Slabach, MPH, FACHE Senior Vice President for Member Services National Rural Health Association."— Presentation transcript:
Brock Slabach, MPH, FACHE Senior Vice President for Member Services National Rural Health Association
Improving the health of the 62 million who call rural America home. NRHA is non-profit and non-partisan.
National Rural Health Association Membership 2013
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62 million rural Americans rely on rural health providers. 20 percent of the population lives in rural America, yet they are scattered over 90% of the landmass. Extreme distances, challenging geography and weather complicate health care delivery. “Rural Americans are older, poorer and sicker than their urban counterparts… Rural areas have higher rates of poverty, chronic disease, and uninsured and underinsured, and millions of rural Americans have limited access to a primary care provider.” (HHS, 2011) Disparities are compounded if you are a senior or minority in rural America. Status of Rural
Rural disparities/challenges Rural Health Clinics – Social Security Act Community Health Centers, created in the War on Poverty. Rural disparities still grave. Serve more challenging populations: language, cultural issues. Delayed care - - sicker populations.
Nearly a half century later, extreme problems persist… Owsley County is a county located in the Eastern Coalfield region of Kentucky. As of 2010, the population was 4,755. According to the 2010 Census reports, Owsley County is the "poorest county in the United States.” Robert F. Kennedy famed poverty tour highlighted the malnutrition of eastern Kentucky (field hearings on hunger). His tour was not unique: his brother John had planned to come in December of 1963, Johnson came in 1964 and, in later years, Nixon, Ted Kennedy, Bill Clinton, Paul Wellstone, and John Edwards all conducted "poverty tours" that included eastern Kentucky.
Death by Zip Code University of Washington Study, July 2013 Largest report on status of America’s health in 15 yrs. Health equates to wealth The study found that people who live in wealthy areas like San Francisco, Colorado, or the suburbs of Washington, D.C. are likely to be as healthy as their counterparts in Switzerland or Japan, but those who live in Appalachia or the rural South are likely to be as unhealthy as people in Algeria or Bangladesh. For example, women in Marin County, California, where the median household income is $89,605, have the highest life expectancy -- 85 years -- while women in Perry County, Kentucky, with median income $32,538, have the lowest life expectancy – just under 73 years. Men living in wealthy Fairfax County, Virginia, median income $108,439, have a life expectancy of almost 82 years, while men in nearby McDowell County, West Virginia, where the median household income is $39,550, had the lowest life expectancy in the country – 63.9 years.
Why is there an assault on rural health care? Loss of champions; New members who don’t know why certain rural payments exist; Strong fiscal conservative movement; CMS negative attitude toward CAHs; Confusing rural payment system - - many see payments as “bonuses”
Rural champions exit Congress Many other rural champions are also leaving or have left – Sen. Harkin (D-IA), Sen. Rockefeller (D-WV), Sen. Inouye (D- HI), Sen. Conrad (D-ND), Sen. Bingaman (D-NM), Sen. Lugar (R-IN), Sen. Snowe (R-ME). Senator Max Baucus (D-MT) – Staunch rural health advocate, will not seek re-election in 2014 CAH program Rural primary care programs Rural demonstration projects NOTE: Sen. Ron Wyden (D-OR) next in line for Finance Chair.
Why did Congress create varying Medicare payments to rural providers? RHCs: 1977 – “…to address an inadequate supply of physicians serving Medicare beneficiaries in rural areas.”
SEQUESTRATION - 2% CUT TO ALL RURAL HOSPITALS MDH EXPIRATION - 12% INPATIENT CUT to 200 RURAL HOSPITALS LVH EXPIRATION - 13% INPATIENT CUT TO 650 RURAL HOSPITALS 25% CUT in DSH PAYMENTS TO RURAL HOSPITALS (Non-CAH) CODING AND DOCUMENTATION CUTS HOLD HARMLESS - 4% CUT IN OUTPATIENT PAYMENTS 5% CUT UNCOMPENSATED CARE TO RURAL HOSPTIALS (Non-CAH) And wave after wave of cuts for rural PPS hospitals…
Critical Access Hospitals are not immune… SEQUESTRATION - 2% CUT TO ALL RURAL HOSPITALS CAH REIMBURSEMENT CUTS – (President’s budget) ELIMINATION OF CAH STATUS FOR NEARLY 50 HOSPITALS (President’s budget) PROPOSAL TO ELIMINATE ALL CAHs (CBO budget proposal) PROPOSED CUTS IN FLEX AND OUTREACH GRANTS PROVIDER TAX CUTS 35% CUT UNCOMPENSATED CARE 41% of CAHs operate at a financial loss. Medicare cuts will mean reductions in services, job loss, or worse, hospital closures - - jeopardizing rural seniors’ access to care.
HHS Office of Inspector General Report threat to majority of Critical Access Hospitals in the country. –Unlike previous proposals that called for the elimination of CAH status of a small fraction of CAHs, this proposal would decimate rural health. –Unprecedented slashing of the rural health delivery system. –Greatest attack to date. Why Report Can be so Damaging in this Congress. –Unlike previous attacks which provided general reductions of many programs, this is laser targeted specifically on CAHs –Could not hit Congress at a worse time. OIG Report/Attack on Critical Access Hospitals
Headway made with Press and Congress “NRHA, AHA Slam OIG Report Urging Cuts To Critical Access Hospitals” Inside Health Policy “Deep cuts to Medicare funding ‘would effectively kill rural healthcare’.” Modern Healthcare
Rural Medicare Extenders Expire March 31, 2014 In the Senate Finance Permanent repeal of SGR (expires Mar 31) MDH and LVH permanent (expires Mar 31) General supervision for outpatient Work floor for GPSI Telehealth 96 hour rule offered, retracted
Important Backdrop Omnibus spending bills (appropriations) passed for discretionary spending accounts last week; rural health language inserted. Expiration of nation’s borrowing authority (debt ceiling) occurs on or around Feb. 7, 2014. Keep rural health programs from becoming funding sources for other priorities.
Slowdown In Health Cost Growth HospitalsNational Health Expenditures Source: CMS OACT National Health Statistics Group; Historical Tables. 3.9% 4.3% Annual Change in Spending Growth
Source: Centers for Medicare and Medicaid Services, Offices of Enterprise Management
MEDICAID Disproportionately important to rural America (rural patients and rural economies). 17.4 % of a state’s budget. One-half of all newly insured under ACA will be covered by expanded Medicaid. (Estimated 5 million in rural would be covered.) Supreme Court decision: Allowed states to “opt-out” or seeking waivers Many rural states are opting out – possibly leaving rural uninsured
Mental Health Essential Health Benefits Requirements Within the new health care law, mental health services are now considered “essential health benefits” for the purposes of plans being included within the newly created state exchanges. Furthermore, if an insurance plan is allowed to be a part of the new state exchanges, then the health plan must include mental health parity as applied in the Public Health Service Act. Additionally, Medicaid must also include mental health parity as well as include payments for mental health services. This means that mental health services must be included in the benefits offered within plans that are part of the state exchanges and also Medicaid and that mental health services must have the same cap on pay-outs as medical and surgical benefits (mental health parity).
Rural Hospital Access ActS. 842 and H.R. 1787 Senate Resolution on importance of rural health providers S.R. 26 Strengthening Rural Access to Emergency Services Act S. 328 Extension of FESC DemonstrationS. 239 Healthy Vets Act of 2013H.R. 635 Rural Hospitals are Essential ActH.R. 356 The DSH Reduction Relief ActS. 1555 and H.R. 1920
Legislation to Support The Medicare Audit Improvement ActS. 1012 and H.R. 1250 The Two-Midnight Rule Delay ActH.R. 6398 Protecting Access to Rural Therapy Services Act S. 1143 and H.R. 2801