ISSUES IN RURAL HEALTH PLANNING WEBINAR 2 THURSDAY, JULY 21, :00 – 2:00 PM UNDERSTAND THE PROS AND CONS OF RURAL HEALTH CLINICS

Learning Objectives  Understand the role and function of a Rural Health Clinic  Identify the primary benefits of opening a Rural Health Clinic  Learn the process of being certified as a Rural Health Clinic  Explore the downside of opening a Rural Health Clinic 2

Definition of a RHC  Established through Public Law , the Rural Health Clinic Services Act, 1977, to increase the provision of primary care services for Medicare and Medicaid patients residing in rural communities.  RHC can be provider-based or independent (freestanding).  Provider-Based: integral part of a hospital, nursing home, home health agency  Independent: stand alone clinics  Status can be public, private, or not-for-profit 3

Requirements for a RHC  Staffed with a mid-level practitioner practicing at least 50% of the time  Provide basic laboratory services  Develop written clinical protocols and operational policies and procedures  Conduct an annual evaluation  Gain certification by Medicare 4

RHC Location Requirements  Must be in a Health Professional Shortage Area (HPSA) or Geographic Primary Care or  Must be in a Medically Underserved Area/Population (MUA/P)  Designation must be less than 3 years old 5

Benefits of Opening a Rural Health Clinic  Potential of significant higher reimbursement (looking at all payors in the aggregate)  Increased coordination between hospital and physicians  Increased clinical integration with hospital  Greater flexibility in financing and efficiencies with administration and shared staff 6

Potential Downsides of Operating a RHC  Increased costs related to hospital wage and benefits  More facility costs  Less effective cost management  Decreased physician control of practice staff  Less control of financial accountability and productivity

Steps Necessary for RHC Certification  Confirm site eligibility  Evaluate financial feasibility  Assess cost of hiring needed staff  Complete a RHC application and a CMS provider enrollment form  Receive RHC certification inspection by ADHS  File a CMS cost report to have the Medicare rate determined

Current RHC Reimbursement Rate ??  Current RHC maximum encounter rate - $78.07

Important Resources  Center for Medicare and Medicaid  Web Site:  National Association of Rural Health Clinics  Web Site:  Listserve:  Rural Assistance Center  Web Site:  Toll Free #:  Revised Arizona Rural Health Clinic Manual, 2011 (available soon)

Questions + Contacts  Connie Belden, Team Leader, ADHS Licensing   Joyce Hospodar, Rural Health Office   Ron Smith, CFO, Wickenburg Community Hospital 