1. Brock Slabach, MPH, FACHE Senior Vice President for Member Services National Rural Health Association Sounds of Rural Tennessee RHA of Tennessee

2. HAPPY NATIONAL RURAL HEALTH DAY November 15, 2012

3. Improving the health of the 62 million who call rural America home. NRHA is non-profit and non-partisan.

4. National Rural Health Association Membership 2012

5. Membership and Foundation www.ruralhealthweb.org Join NRHA Today! Give to our newly formed Foundation

6. 2012-13 Meetings  M&M Conference Asheville, NC, December 5-7, 2012  Rural Health Policy Institute Washington, DC, February 3-5, 2013  Annual Conference Louisville, KY, May 7-10, 2013  Quality/Clinical Conference Chicago, IL, July 16-17, 2013  RHC/CAH Conference Austin, TX, Oct. 1-4, 2013

7. 2012 Top 20 Critical Access Hospitals Three Categories: Quality, Finance and Patient Experience of Care

8. National Top 20 CAH in Quality Wellmont Hancock County Hospital, Sneedville, Tenn

9. The Sounds of Rural Health Care:

12. 12 states have nearly half or more of the Medicare population living in rural counties —with Vermont (73 percent), Wyoming (69 percent), and Montana (67 percent) having the largest share.

13. Sounds of 2012 Election The more things change, the more they stay the same Voters retained status quo Same President Same Congress –D Senate Control –R House Control

14. Congress Senate –52 Democrats –46 Republicans –2 Independents (both will caucus with D’s) Net gain of 2 D’s in Senate House –237 Republicans –198 Democrats Pickup of 8 D’s so far in House

15. President Electoral Vote Count –Obama332 –Romney206 Popular Vote Count –Obama60.7 M50.8% –Romney57.8 M48.3%

16. Initial Observations ACA will remain in tact ACA battle will move to States ACA regulation dump release soon ACA mandate ballot measure –FL rejected anti-mandate measure –AL, WY and MO approved anti-mandate law

17. Alas, same problems… The “Fiscal Cliff:” Bush era tax cuts end Dec. 31 Payroll tax cuts end Dec. 31 SGR Fix Required, 30% cut to physician fee schedule Sequester scheduled for January 1, 2% reduction

18. Devastating Impact of Sequestration Rural Health Care Safety Net is fragile 2% across the board cuts are disproportionately harmful to rural. Rural hospitals and clinics operate at a narrow financial margin - - in fact 41% of CAH’s are operating in the red

20. NRHA and Health Reform For reform to be effective in rural America, the access to care crisis in rural America must be eliminated. To resolve the access crisis, reform must eliminate: –The workforce shortage crisis –Long-standing payment inequities –Aging Rural Infrastructure –Health Disparities

21. A Little History CBO Options for Deficit Reduction Republican Proposal for rural, $14B cut House Ways & Means Dems: CBO option President’s Budget MedPAC Pay Fors on Budget Deal Feb. 2012 –Medicare bad debt

22. MDH—Expired Sept. 30 Medicare Dependent Hospitals Fact SheetFact Sheet - find out why MDHs are important to your community and rural America Letter to Editor Letter to Editor - send a letter to your local newspaper Letter to Members of Congress Letter to Members of Congress - send a letter to your members of Congress Letter to HHS Secretary Kathleen Sebelius from NRHA StudyStudy by North Carolina Rural Health Research and Policy Analysis Center on the economic benefits of rural MDH facilities. ListList of All Medicare Dependent Hospitals in the United States. MapMap of all Medicare Dependent Hospitals State by State.

23. States with Most MDH Facilities Tennessee: 24 Texas: 19 Illinois: 13 Mississippi: 13 Pennsylvania: 13 Kentucky: 11 New York: 11 North Carolina: 11 Louisiana: 10 Alabama: 8 Missouri: 8 Virginia: 8 Oklahoma: 8

24. Low-Volume Adjustment- Expired Sept. 30 Fact Sheet - find out why Low-Volume hospitals are important Fact Sheet Letter to Editor - send a letter to your local newspaperLetter to Editor Letter to Members of Congress - send a letter to your members of Congress about your Low-Volume Hospital.Letter to Members of Congress

25. The demographics… “For 50 million Americans living in rural areas across the country, accessing quality health care is not only challenging but costly. Rural areas have higher rates of poverty, chronic disease, and uninsurance, and millions of rural Americans have limited access to a primary health care provider.” HHS, 2011

26. Our Advocacy Message Quality Emergency Department Cost VALUE

27. How do we fight… Investing in rural health care is needed for both the – rural patient (and maintaining access to care); and – rural community Demonstrate cost-effectiveness of providing care in rural America.

28. The Rural Hospital Access Act of 2012 S. 2620, Sen. Charles Schumer, NY, Author No Tennessee Co-sponsors HR 5943, Rep. Tom Reed, 32 cosponsors

29. Other Issues Physician Supervision ICD10 Conversion Delay, Oct. 1, 2014 OIG Investigation of CAH’s Meaningful Use of EHR’s

30. Brock Slabach, MPH, FACHE Senior Vice President for Member Services National Rural Health Association bslabach@nrharural.org THANK YOU