1. KHA Overview  Began in 1929  Member-driven organization  All 126 hospitals are members  Provide proactive leadership to create an environment in which Kentucky hospitals are successful in serving their communities  Our mission is to improve the health status of the citizens of Kentucky

2. Vision and Objectives Vision Represent hospitals dedicated to sustaining and improving the health status of Kentuckians Objective Implement health policies that enhance the ability of hospitals to deliver health care services to their communities in a cost effective manner

3. KHA Activities I. Advocacy II. Patient Safety III. Reimbursement IV. Rural Assistance V. Workforce Initiatives VI. Preparedness VII. Resources

4. Input and Guidance  Certificate of Need  Strategic Planning  Legislative  Statewide Data  E-Health Staff Advisory  Effective Communications in Hospitals  Medicaid Technical Advisory Committee  Emergency Preparedness  Wage Index  Small Rural and Critical Access Hospital Forum  Psychiatric/Chemical Dependency Hospital Forum  Rehabilitation Hospital Forum  Long-term Acute Care Hospital Forum Committees Forums

5. Rural Healthcare Activities  KY is the 6 th most rural state in the country  Only 35 of the 120 counties are classified as urban (US Dept of Agriculture)  75 of KY’s hospitals are classified as Rural/Non MSA  These include the 29 CAHs located in rural counties  Despite this, 29 Counties are considered Medically Underserved  63 counties are designated a Health Professional Shortage Area for primary medical care

6. Rural Healthcare Activities  KHA partners with the State Office of Rural Health on Grants  Small Hospital Improvement Program granted $323K to 38 eligible hospitals  FLEX grant funded $191K to support CAHs and other small, rural hospitals

7. Key Issues Facing Rural Hospitals  Healthcare Reform Keeping rural hospitals whole in the health reform process Improving reimbursement for “Tweener” hospitals Inclusion of rural programs: Flex and SHIP grants, 340B drug discount program and others Minimizing harm from cost-containment measures like Readmission policies and reduction of DSH payments.  Data Reporting Demands  Increasing rural providers  Maximizing health professional shortage area and medically underserved area designations.

8.  Includes 20 members from many disciplines  Hospital  CHC/FQHC/RHC  AHEC  Universities  Students  Committee meets 3 rd Tuesday each month from 3-4 p.m. (ET) via Conference Call KHRA Legislative Committee Activities

9.  Support measures that promote the equitable distribution of future health care professionals and the maintenance and support of existing providers, which include the following – loan repayment or tax incentive programs, health professional shortage area (HPSA) and medically underserved area (MUA) designation reform and the development of a Governor’s Certified Shortage Area designation.  Support the development of community-oriented primary care – including oral and mental health services – in rural areas with unmet need, particularly for the uninsured and underinsured. KHRA Legislative and Policy Agenda

10.  Support measures related to health care reform activities that ensure that rural Kentuckians have increased access to primary care services including mental health and dental.  Support reform of malpractice insurance coverage for medical practitioners to include a state-level review panel of experts to determine the merits of a case before plaintiffs can go to trial. KHRA Legislative and Policy Agenda

11.  Support a Legislative Research Committee study regarding the implementation of rural-track postgraduate medical training programs. The study should include the following residency programs family medicine, internal medicine, obstetrics/gynecology, emergency medicine, general surgery, hospitalist, and/or other specialty areas of need identified. Such a study would include representatives of the three medical education programs within the Commonwealth of Kentucky, as well as Kentucky Rural Health Association, Kentucky Primary Care Association, Kentucky Hospital Association, The Kentucky Institute of Medicine, and representatives of the existing residency programs in the state. KHRA Legislative and Policy Agenda

12.  Support measures to require that funds collected within the Kentucky Provider Tax stay within the health care delivery system.  Support updates and improvement of the process and methodology for designating health professional shortage areas to ensure adequate depiction of need.  Support the continued modernization of Medicaid. KHRA Legislative and Policy Agenda

13.  Support measures designed to improve rural residents’ overall health, specifically – expansion of smoking and tobacco-usage prevention and cessation programs; efforts to decrease drug and alcohol abuse through prevention and treatment programs; and efforts to address the health problems associated with obesity.  Support measures to fund development of a statewide trauma system.  Support development of e-health standards on a statewide basis to assure that the health care needs of rural residents and the technology issues facing rural practitioners are met. KHRA Legislative and Policy Agenda

14. AGENDA  Hear from State Health Care Leaders  Advocacy 101  Educate your legislators on rural health care issues KHRA Day In Frankfort Save the Date – February 2, 9-12 a.m.

15. Elizabeth Cobb Kentucky Hospital Association ecobb@kyha.com 502-426-6220