Update from the CEO: Veteran's healthcare in Colorado

On May 27th, our country celebrated the 145th Memorial Day and last week I had the opportunity to visit Pearl Harbor and the Arizona Memorial. As I paid my respects to the brave American’s that serve our county I felt compelled to dedicate this month’s article to veteran’s healthcare in our state. Colorado’s veterans make up 10.7 percent of the state’s population, totaling 405,244 people. Many of our rural communities, however, have significantly higher densities of veterans. For example, 20 percent of Custer County residents are veterans.

Recently, healthcare for veterans has been in the media frequently and rightfully so. The Department of Veteran Affairs released a study concluding that 22 veterans across the country commit suicide daily. That’s more than combat deaths and child gun deaths combined (Huffington Post, 2013). Nationwide, 11-20 percent of Iraqi veterans suffer from Post-Traumatic Stress Disorder (PTSD). In Colorado, there are 48,607 Iraq and Afghanistan veterans and 30 percent of those individuals have been diagnosed with a mental health disorder (National Council on Behavioral Health, 2012). That number does not, however, indicate the number who received treatment for their diagnoses. Veterans are given few options when it comes to getting sustainable help.

According to the Veterans Administration’s website, veterans can receive community based treatment at seven rural facilities or through two telehealth facilities, although mental health is not always a covered service at every location. So what is being done about this?

In 2012, the Executive Order entitled Improve Access to Mental Health Services for Veterans was released from the White House. One of the goals was to hire 1,600 mental health providers, and to date, 1,058 have been employed (Huffington Post, 2013). That’s a start, but what is specifically being done in Colorado? As Senator Michael Bennet pointed out in a letter to the Veterans Affair’s secretary in April 2013, “Veterans living throughout rural Colorado have contacted my office with concerns about the distance they must travel to receive medical and mental health care from VA facilities. In some cases, veterans have to travel hours for relatively common procedures. As you may expect, even some shorter drives over mountain passes in Colorado can be treacherous during winter months, which is especially cumbersome when veterans need to make frequent visits to health care providers for ongoing medical or mental health issues.”

Awareness of the issue has been publicized, but it’s time to take action on efforts that will benefit our rural veterans throughout Colorado. There are multiple initiatives underway, and the Colorado Rural Health Center will be engaging their partners to help implement solutions. Health Care Policy and Finance (HCPF) has launched the State Innovation Model project with funds from CMS. The purpose will be to integrate behavioral health and primary care. At the kick-off meeting on May 29th, Sue Birch, Executive Director of HCPF, stated that solutions to this problem must be “thoughtful and intentional when addressing the urban, rural, frontier plague.”

Solutions to veteran’s mental health are projected to save money over the long-term. The National Council on Behavioral Health estimates that for every dollar initially invested in providers of veterans care, our healthcare system will save $2.50 over two years. Additionally, if the country’s 210,000 veterans suffering from PTSD and major depression received evidence-based treatment, the cost would be $481 million. The subsequent savings from avoidable psychiatric crises and associated costs would be $1.2 billion.

As innovation for the treatment of behavioral health disorders for veterans emerges and receives funding, the Colorado Rural Health Center will be advocating that options are distributed throughout rural and frontier areas of the state.

CRHC welcomes new member Gunnison Valley Family Physicians

Last month Gunnison Valley Family Physicians (GVFP) joined CRHC's Membership. GVFP is an independent rural clinic providing quality primary family healthcare to the Gunnison Valley since 1941.  Check out the GVFP staff and doctors or their new Healthy Living Program

GVFP Fun Fact: Did you know that GVFP includes a healthy recipe in their monthly newsletter?  Check out this month's issue or click here for a full list of recipes.  Definetely suggest this month's BBQ Chicken Sliders!

The staff at CRHC welcome Gunnison Valley Family Physicians!

A Word from Our Classic Sponsor: Unique Solutions Associates Inc.

Unique Solutions Associates Inc. (USA), a preferred provider with CRHC, is a creative platform that enables key decision makers in healthcare to reduce cost and improve productivity by connecting with USA’s panel of SolutionsProviders™. These SolutionsProviders™ offer unique products and services that produce exceptional, cost-reducing results.


Ed Cody, CEO of USA, was formerly a partner in a top 20 CPA and consulting firm. He led their healthcare consulting practice to become one of the largest 15 practices in the country. Ed created the USA platform to enable decision makers to quickly and confidently enter into relationships with pre-qualified, entrepreneurial companies known as USA SolutionsProviders™. Ed and the Associates of USA use their many years of industry experience and knowledge to create win-win relationships that continue for years.

Featured below are some of the many USA SolutionsProviders™ that can benefit your facility:

Capital Building Retirement Program - Exceptional retirement benefits for key employees. This Solution is structured to simultaneously “grow capital” and to “recruit and retain talent.”

Hospital Resource Optimization – Contractually guarantees all client hospitals new savings and net revenues in excess of a 7 to 1 ROI basis.

Investment Strategy and Advisory Services – Uses relationships that typically serve the largest and most successful foundations in the world to help your facility.

LED Lighting – LED lighting solutions that result in significant electric cost reduction and positive cash flow from the start.

Waste Utility and Cost Reduction – Specializes in substantially reducing waste disposal and recycling costs, as well as auditing utility bills for overcharges and errors. These audits are done on a risk-free and results-oriented basis.

Medical Supply Expense Reduction – This Provider has a 100% success rate in reducing healthcare providers’ medical supply costs. They work entirely on a success basis and only get paid when actual savings are received.

Web-based Nurse Scheduling – Addresses the needs of scheduling difficulties at medical institutions. Healthcare providers are able to closely monitor a multitude of factors that help improve efficiency and productivity while controlling costs, including staff scheduling, real-time productivity, incident command, census-based staffing, employee rewards and acuity-based staffing.

USA also has significant preferred partner relationships with other state and regional health networks. In these and other relationships, USA and its Unique SolutionsProviders™ have helped hundreds of hospitals and other healthcare providers. These solutions have resulted in several million dollars of savings and additional revenues.

USA is looking forward to bringing these unique solutions to the members of CRHC. To learn more, visit visit www.uniqsa.com or email Ed Cody at ecody@uniqsa.com.

Member of the Month: Custer County Clinic

The Custer County Clinic was born from a vision to establish a medical clinic for the region’s mountainous communities and seeks to provide responsive top quality medical care for all patients in a friendly and professional manner. A two-room ranger station and garage were acquired in 1970. With updates and expansion, Custer County Clinic now operates an 11,000 square foot outpatient clinic in Westcliffe, Colorado. The clinic is certified by the Centers for Medicare and Medicaid Services as a Rural Health Clinic and is the only provider of preventive and primary care services in Custer County and southern Freemont County. Custer County Clinic's service area is home to 8,170 residents. Approximately 41% of the service area residents have income below 200% of the federal poverty level. Twenty-four percent of Custer County residents are age 65 or older, more than twice the statewide average of 11%.

The clinic faced financial and operational difficulty in early 2012 and by June the clinic was on the verge of closing. Immediate actions allowed the clinic to reduce the net projected loss for fiscal year 2012 by more than half. The restructuring of the financial processes has allowed the clinic to maintain its role in the community and has set it to be on track to end fiscal year 2013 in a cash positive state. In fact, Custer County Clinic saw 733 patients in the month of May; an 83 percent increase from exactly one year ago.

It is now the focus of the Custer County Clinic to be a leader in rural health care. A new culture has emerged within the clinic and the community to serve as a model for rural healthcare. Clinic staff are engaged and motivated in providing high quality care. The governing board and clinic leadership is focused upon not only providing quality health care but in endowing a sustainable business model thus insuring the clinics ability to provide primary health needs to Custer County.

A number of outstanding needs have been identified to achieve the goals established for the clinic. There has been no investment in the clinics physical plant, infrastructure, or equipment over the past 4-8 years. With these needs in mind, the clinic has installed an IstyMeds dispensary. The new formulary was delivered on May 16th and will have about 90 drugs available to the providers to prescribe onsite. Additionally, patients will be able to have their insurance companies pay for the medications at the time of transaction. This will be faster, more reliable and provide a greater service to the patients visiting the clinic.

Custer County Clinic has been a member of Colorado Rural Health Center (CRHC) for nearly a decade. As CRHC continues to support Custer County Clinic, we congratulate them for their many recent accomplishments. A staff member working closely with the clinic stated, “After every phone call with David Noble, [Custer County Clinic's Executive Director] I am continually impressed. Each month there is a new success driving the clinic forward.” For this reason, CRHC is proud to announce Custer County Clinic as this month’s Member of the Month! To learn more about the clinic, visit their website.

Interested in supporting Custer County Clinic? Consider attending the High Mountain Hay Fever Bluegrass Festival. Proceeds from this event support the clinic, with $45,000 raised in 2012. The festival will be held July 11-14th at the west end of Main Street in Westcliffe, on a bluff directly overlooking the spectacular Wet Mountain Valley and the Sangre de Cristo Mountains. This year’s performers include, Old Time Kozmic Trio, Foghorn String Band, Red Molly, Kathy Kallick Band, Blue Canyon Boys and Steel Pennies, to name just a few. This promises to be a great event! Click here for more information.

Colorado Offers Exchange ‘Assister’ Money To Many Groups

Kaiser Health News
June 11, 2013

Obamacare in Colorado is getting down to the details, in dollars and cents.

One of the 16 states that is setting up its own online insurance marketplace, Colorado on Monday named 58 organizations it’s selected to form its “assistance network” to help residents sign up for health coverage on the exchange. But no organization is getting all the money it applied for, and it’s unclear how many will accept the grants they’ve been offered. That may mean gaps in reaching all corners of the state, or specifically targeted populations, such as refugees, rural Latinos, or the disabled.

A total of 74 groups applied in April for assistance network grants to do the work, they ranged from hospitals andcounty public health agencies to ethnic associations and the Colorado Motor Carriers Association, “the voice of trucking in Colorado.”

Their collective ask? More than $57 million. Money available? Seventeen million, mostly from expected but yet-to-be-awarded federal and local health foundation grants.

“That’s meant some very difficult decisions needed to be made getting us into our budget range,” said Assistance Network Manager Adela Flores-Brennan.

“Some may say, ‘We can’t do this,’” said exchange CEO Patty Fontneau. “Realize we had to cut 70 percent of the requests, when you look at the amount of money that was requested.” Read more here.

Walgreens to pay $80M to settle prescription-drug violations in Colorado, elsewhere

Denver Business Journal
June 12, 2013

Walgreen Co. will pay $80 million to settle federal civil charges that its pharmacies in Colorado and other states repeatedly violated the federal Controlled Substances Act in tracking and dispensing powerful pain pills.

Authorities said the civil settlement with the nation's biggest pharmacy chain was the largest in the history of federal enforcement of the drug law to crack down on prescription-drug violations. Other major pharmacy companies and drug wholesalers have been targeted previously.

The allegations by the U.S. Drug Enforcement Administration focused on a large Walgreens distribution center in Jupiter, Fla., but also included retail pharmacies in Cañon City and Pueblo as well as others in Michigan and New York.

The settlement resolves an investigation by the office of U.S. Attorney for ColoradoJohn Walsh, among others.

"Stores that sell controlled substances must keep careful track of their inventory," Walsh said. "Those that don't, like Walgreens in this case, face severe penalties, like the record $80 million penalty announced today." Read more here.

NRHA: Rural America’s Oral Health Care Needs

National Rural Health Association

In June 2012, Vermont Senator Bernie Sanders introduced “The Comprehensive Dental Reform Act” seeking to address five main components to end the US oral health crisis. These components included: expanding coverage; creating new oral health access points; enhancing the workforce; improving education; and funding new oral health research.1 Senator Sanders’ bill has garnered support across the health care spectrum as the realistic dangers of dental disease, as well as the detrimental effects it has on both individuals personally as well as the health care system in general, continue to grow in concern for health care professionals, policymakers and citizens alike. To read the full policy brief click here

Health Care Innovation Awards

Rural Assistance Center
Letter of Intent (Required): Jun 28, 2013
Application: Aug 15, 2013

The Health Care Innovation Awards will provide funding to test new payment and service delivery models that will deliver better care and lower costs for Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) enrollees.

Funding will be awarded for organizations to test and evaluate new payment and service delivery models that have a high likelihood of driving health care system transformation and delivering better outcomes. Specifically, in this second round, CMS is seeking proposals in the following categories:
  • Models that are designed to rapidly reduce Medicare, Medicaid, and/or CHIP costs in outpatient and/or post-acute settings
  • Models that improve care for populations with specialized needs
  • Models that test approaches for specific types of providers to transform their financial and clinical models
  • Models that improve the health of populations – defined geographically (health of a community); clinically (health of those with specific diseases); or by socioeconomic class – through activities focused on engaging beneficiaries, prevention (for example, a diabetes prevention program or a hypertension prevention program), wellness, and comprehensive care that extend beyond the clinical service delivery setting
Click here for more information.

Community Access to Child Health (CATCH) Implementation Funds Program

Rural Assistance Center
Deadline: July 31, 2013

The American Academy of Pediatrics' Community Access to Child Health Implementation Funds program supports pediatricians in the initial and/or pilot stage of implementing a community-based child health initiative. The program is designed to help increase children’s access to a medical home or specific health services not otherwise available.

Priority will be given to projects serving communities with the greatest demonstrated health care access needs and health disparities. Strong collaborative community partnerships and future sustainability of the project are encouraged.
  • Grants are available for programs that offer:
  • Community-based initiatives that increase children's access to medical homes or health services not otherwise available and connecting uninsured/underinsured populations with available programs
  • Connecting uninsured/underinsured populations with available programs
  • Secondhand smoke exposure reduction
  • Initiatives to address community barriers to immunizations
  • Native American child health
Click here for more information.

In-Hospital Mortality No Different at Critical Access Hospitals

HealthDay News
May 3, 2013

For eight inpatient surgical procedures, mortality is similar at critical access hospitals (CAHs) and non-CAHs, but costs are higher at CAHs

Adam J. Gadzinski, M.D., from the University of Michigan Health System in Ann Arbor, and colleagues used data from the Nationwide Inpatient Sample and American Hospital Association to assess the utilization, outcomes, and costs of inpatient surgery performed at CAHs. At least one year of data were available in the Nationwide Inpatient Sample for 34.8 percent of the 1,283 CAHs and for 36.4 percent of the 3,612 non-CAHs reporting to the American Hospital Association.

The researchers found that mortality was equivalent at CAHs and non-CAHs for eight common procedures examined (appendectomy, cholecystectomy, colorectal cancer resection, cesarean delivery, hysterectomy, knee replacement, hip replacement, and hip fracture repair). The only exception was an increased risk of in-hospital death for Medicare beneficiaries undergoing hip fracture repair in CAHs (adjusted odds ratio, 1.37). Costs at CAHs were 9.9 to 30.1 percent higher (P < 0.001 for all eight procedures), despite shorter hospital stays (P ≤ 0.001 for four procedures). Learn more by reading the full article here.

NACHC Statement on Release of Fiscal Year 2013 Spending Plan for Health Centers

National Association of Community Health Centers
May 9, 2013

Today, the Administration announced their plans for implementing the final FY2013 appropriation for the Health Centers program.

NACHC is grateful to the Administration and Congress that all available funding for the Health Centers program will be utilized in the current fiscal year. As a result, Community Health Centers will not experience reductions to their current operations. Additionally, we are pleased that existing health centers will receive an update to their base grants to assist in keeping up with growing patient populations and the rising costs of care.

The plans also call for funding an estimated 25 new health centers from the total of over 400 applications recently submitted. That will be good news to those communities, and we look forward to continuing our work with both Congress and the Administration to ensure access for all communities in need. Read more here.

Recruitment and Training of Racial/Ethnic Health Professionals in Rural America

National Rural Health Association
February 2013

Rural populations experience significant healthcare disparities compared to urban counterparts. This is particularly true of the increasing minority populations in rural areas. Common sense suggests that clinicians who understand the language and tradition of their patients and the communities in which they live may offer more complete and culturally effective health care. Additionally, clinicians of minority and multicultural background contribute more effective care to patients in rural and remote areas. There is evidence that a Black or Hispanic patient is more likely to seek care from a clinician of their own race because of personal preference or language, and not only because of geographic proximity. Yet, minorities are seriously under-represented in health professions, and the situation is not improving. Learn more by reading the full report,

New Hospital Pricing Data: What it Says, What it Means

The webinar, "New Hospital Pricing Data: What it Says, What it Means" was facilitated by Academy Health on behalf of the Robert Wood Johnson Foundation's Changes in Health Care Financing and Organization (HCFO) program and the Centers for Medicare and Medicaid Services. The following is a link to the  archived recording of the presentation available on the AcademyHealth website. Please note that we are unable to circulate the presentation slides. 

We hope that you will find the seminar useful in your work. If you have any questions, please email hcfo@academyhealth.org

69% of Employers Plan to Offer Healthcare Coverage After 2014

HealthLeaders Media
May 20, 2013

The Patient Protection and Affordable Care Act is having little effect on workforce strategies, employer survey data shows. More than two-thirds of employers say they will continue to provide healthcare coverage when health insurance exchanges begin operation in 2014.

Despite ominous predictions that employers would drop healthcare coverage en masse in response to the strictures of the healthcare reform law that has not come to pass.

Instead, employers are largely are planning to keep offering health plans to their workers and the Patient Protection and Affordable Care Act is having little effect on workforce strategies, employer survey data shows.

Still, look for employees to continue to pay a larger portion of their healthcare premiums as well as the medical care they receive. Read the full article here.

E.R.’s Account for Half of Hospital Admissions

The New York Times
May 20, 2013

Emergency rooms account for about half of the nation’s hospital admissions and accounted for virtually all of the rise in admissions between 2003 and 2009, according to a study released on Monday.

Although emergency rooms are widely considered expensive places for diagnostic care, physicians are increasingly relying on them to determine whether a patient needs to be hospitalized.

The study’s findings raise important questions about how emergency rooms contribute to high health care costs in the United States and what their role will be in the future as the nation undergoes fundamental changes in health care delivery. One goal of the Obama administration’s health care law was to reduce reliance on costly emergency room care. Read the full article here.

Role of Health-Law 'Navigators' Under Fire

The Wall Street Journal
May 20, 2013

Lawmakers across the country are tussling over the Obama administration's plans to create a small army of assistants to guide millions of Americans as they sign up for new health-insurance options available this fall.

Backers of the health-care overhaul face an uphill battle to spread the word about the law, in the face of consumer research that suggests most uninsured people know little about it and are skeptical about the value of health insurance generally. Some Democrats have openly worried that the administration is doing too little to make sure the enrollment process goes smoothly.

That is where the "patient navigators" are supposed to come in. But their role has come under question from Republicans who have criticized the administration's plans to educate people on the new legislation. Health and Human Services Secretary Kathleen Sebelius has already drawn fire for conversations with health-industry executives in which she encouraged them to help the nonprofit organization leading the campaign to publicize the law's benefits. Critics said that it was inappropriate for the government to turn to outside groups. Click here to read the full article. 

Primary care physicians generate more revenue for hospitals than specialists

Medical Economics 
May 8, 2013

A new survey that shows a "seismic shift" in medicine provides primary care physicians (PCPs) with a strong argument that they should be compensated more generously by hospitals. 

PCPs generate more annual revenue for hospitals than specialists do, according to staffing firm Merritt Hawkins. 

PCPs (defined in the survey as family physicians, general internists, and pediatricians) generated a combined average of $1.57 million for their affiliated hospitals last year, compared with a combined $1.43 million across 15 specialties, according to the survey.

Those numbers represent a big change from 2002, when Merritt Hawkins first conducted the survey. At that time, PCPs generated $1.27 million annually for affiliated hospitals, whereas specialists generated $1.59 million. So over the past decade, primary care's generated revenues have jumped 23%, whereas specialists' have declined 10%.

“A seismic shift is taking place in medicine, away from specialists and toward primary care physicians” Mark Smith, president of Merritt Hawkins, said in a statement.

Read the full article here to find out what the company attributed the revenue shift to.

Doctors Transform How They Practice Medicine

Kaiser Health News
May 15, 2013

Dr. Thomas Bellavia transformed his traditional medical practice in Hasbrouck Heights, N.J., into a so-called medical home where patients are seen by teams of doctors and nurses. He says it has paid off in better, more coordinated care for his patients and healthier income for the nurse practitioners and physicians in his group.

Dr. Mark Holthouse took a different tack -- limiting his El Dorado, Calif., clinic to 400 patients a year, and adding services such as acupuncture and fitness coaching. He said he and his team now spend more time with patients, who pay a monthly fee of $220 for a package of basic services, on top of what their insurance plans reimburse the practice.

Like Bellavia and Holthouse, many doctors are changing how they work in response to turmoil in the health care system. Both newly minted and veteran physicians face economic uncertainty amid sharpening demands from the government and insurers to improve quality while curbing costs – trends that accelerated under the 2010 health care overhaul. Read more here.

HHS Report Shows Strong Growth in Use of Electronic Health Records

The Commonwealth Fund
May 28, 2013

More than half of all doctors now get Medicare or Medicaid incentive payments for using electronic health records, according to a report federal officials released last week. But Republicans say medical professionals should not just use the records in their own offices but also should exchange them with other providers.

Republican lawmakers, backed by a business and insurance company alliance known as the Health IT Now Coalition, have been pushing the Department of Health and Human Services (HHS) in recent months to end Medicare and Medicaid IT bonus payments for providers who do not share electronic medical data with other providers.

The response from HHS officials has been to point to the progress that has been made since the Medicare and Medicaid incentive payments for providers that adopt electronic records was included in the 2009 stimulus law (PL 111-5).

Find out how the HHS exceeded its goal by reading the full article here. 

One-stop shop for care

ModernHealthcare.com
May 25, 2013

When Dr. Rich Zane arrived last year at the University of Colorado Hospital to become chair of its newly formed emergency medicine department, he found an emergency room built to handle 25,000 patients a year but was seeing 60,000.

Patients faced long wait times, satisfaction plummeted and many simply left without treatment. The ER was constantly on diversion. Like most hospitals, Zane said, it was operating under “a process that's predicated on 1960s medicine and we're practicing it in 2013.

”He set out to transform ER operations. Last month, the 467-bed hospital unveiled a re-envisioned emergency department. It has no wait. There's no such thing as triage, and patients see a doctor as one of their first points of contact.

The Aurora-based hospital is the latest example of medical centers confronting the central paradox of today's emergency-room care: more and more patients—and their primary-care doctors—are taking advantage of the emergency department's ability to offer a 24/7, one-stop shop for all their ailments. And as they do, hospitals are seeing new opportunities to tap into that demand. Read the full article here.

'It is getting a lot harder to do this': Doctor shortage strains practices

NBC News
May 25, 2013

Tucked among the cornfields, windmills and water towers of Littlefield, in west Texas, Dr. Isabel Molina treats one patient after the next at Lamb Healthcare Center.

Littlefield is a small, dusty town of about 6,500 people, but Molina's two-doctor practice draws from a much larger area. She and her partner serve a total population of about 15,000, she estimates. To keep up with her patient load, Molina regularly works 13-hour days without stopping to eat.

"I usually eat breakfast over charts. I usually eat lunch over charts while I call patients back and take care of my dictations," says Molina, 38. "I do love what I do, but it is getting a lot harder to do this."

Molina is just one of thousands of primary care doctors nationwide working in an area designated as having too few health professions to meet the needs of the population.

The Association of American Medical Colleges (AAMC) estimates that there is a shortage of up to 20,000 physicians and that the deficit will grow to 100,000 physicians in the next decade...read more here.

In Case Of Tornado, EHRs Can Be Just The Prescription

Kaiser Health News
May 24, 2013

Everyone expects a hospital to be ready to jump into action when disaster strikes. But what about when the disaster devastates the hospital itself?

Turns out, it helps a lot to have an electronic medical record system in place.

At least that was the case at Moore Medical Center in Oklahoma, a small hospital right in thepath of the tornado that ripped through the suburbs of Oklahoma City on Monday. Three-hundred people — staff, patients and community members — hunkered down in the cafeteria, stairwells and chapel as 200-miles-per-hour winds demolished the building around them.

One patient in labor stayed on the second floor with two nurses, where they could continue to monitor the fetal heartbeat.

Amazingly, everyone survived. Within an hour, 30 patients had been transferred to the two other hospitals that are part of the Norman Regional Health System. And every one of them arrived with their medical histories fully intact. The woman in labor even delivered a healthy baby later that evening.

“The transfer was totally seamless,” says John Meharg, director of health information technology at Norman, which has had an electronic health record system for the past five years. “We’re very fortunate that we’re a little ahead of the game,” he said.

If the hospital system had still been using paper, Norman explains, “the first thing we would have had to do was find their records. And with all of the hustle and bustle of a disaster, they can easily get lost.” As for any records left behind in files, he continues, “if the tornado doesn’t get them, the subsequent rain would ruin them. The roof’s gone, the walls are gone, and the windows are gone.”

Instead, physicians at the two transfer hospitals were able to pick up care for the Moore patients where their home physicians left off. Even if the patients had been taken to hospitals outside of the Norman system, their records would still have gone along with them. That’s because Oklahoma City has a regional health information exchange that allows the various hospital systems in the area to access all patient records, says Meharg.

“I’m very happy,” he adds, breathing a sigh of relief. “The systems never missed a beat. It would really have been a mess if we weren’t electronic.”

June is National Men's Health Month!

The purpose of Men’s Health Month is to heighten the awareness of preventable health problems and encourage early detection and treatment of disease among men and boys. This month gives health care providers, public policy makers, the media, and individuals an opportunity to encourage men and boys to seek regular medical advice and early treatment for disease and injury.


The staff at CRHC wore blue on Thursday, June 13th to support and promote Men's Health Week.  Wear BLUE was created by Men’s Health Network to raise awareness about men’s health issues. There is an ongoing, increasing and predominantly silent crisis in the health and well-being of men. Due to a lack of awareness, poor health education, and culturally induced behavior patterns in their work and personal lives, men’s health and well-being are deteriorating steadily. A Wear BLUE event can educate men, women, and their families of the need to raise awareness of this silent crisis in men’s health. Check out this the Wear Blue Website for information, tools, and resources to help you plan an impactful Wear BLUE event in your workplace, religious, or community group. Wear BLUE provides a unique platform for awareness and education efforts as well as visual support.

Other ways to join the cause...
  • Post an article or Men's Health Logo on your social media sites
  • Print and distribute Men's Health Flyers (Spanish versions available) 
  • Ask a local nurse, doctor, or health educator to give a lecture on men’s health at your workplace, church, community group, senior center, health department, etc.
  • Take your dad/brother/uncle/grandfather/significant other to the doctor
  • Click here for other great ideas...

Great resources and fact sheets

HCPF May At a Glance

Click here to read the full At a Glace report by the Department of Health Care Policy and Financing.

Caring for the community

ModernHealthcare.com
May 25, 2013

Regional programs taking concept of ACOs to a much broader level.

About four years ago, Nick Macchione, who oversees San Diego County's public health system, had an idea to expand the accountable care organization concept in a way that would involve a much broader range of stakeholders working together to improve the health of an entire region.

During a meeting that focused largely on the role of healthcare providers in reducing hospital admissions, Macchione says he remembers thinking that the ACO approach alone will do little to fix fragmented healthcare. “I said we can do better than ACOs,” Macchione recalls. “We've got to do an accountable care community.”

Read more about the county's Live Well philosophy by reading the full article here. 

Moab Regional Hospital board hires new CEO

The Times-Independent
May 31, 2013

The board of directors of Moab Regional Hospital has announced the hiring of a new chief executive officer for the hospital. Robert (Robb) Austin has taken over the duties as Moab Regional CEO, according to a news release from the hospital.

Board members said Austin has “a proven track record in hospital operations and development and has dedicated his entire professional career to working and serving rural communities.”

“Moab Regional Hospital has made a great deal of progress financially over the last year and now has a solid foundation and bright future. The board and hiring committee are confident that Robb Austin’s experience and visionary leadership in rural healthcare will allow the hospital to overcome challenges and leverage opportunities as we navigate healthcare reform,” said Mike Bynum, MRH board chairman. “Our physician partners and staff members interviewed Robb personally, which was much appreciated and certainly contributed to his eagerness to become a part of our team.” Click here to read the full article.

Evidence for Medical Homes Still Evolving

Medpage Today
May 30, 2013

Joseph Ashwal, MD, knew a good deal when he saw one.

The family physician wanted to take the lead on starting a patient-centered medical home (PCMH) model for his 25-physician practice in Frederick, Md., after reading a nearly 100-page treatise from the area's largest private payer.

The program from CareFirst BlueCross BlueShield -- like so many others -- would pay a bonus for spending extra time with their sicker patients. The money would cover a care coordinator nurse to help oversee these patients' care.

That nurse would help identify the practice's most needy patients, help develop a care plan with their physician, and ensure that the patient saw it through.

"That nurse does a lot of work so the physicians don't have to do it," Ashwal told MedPage Today.

The program -- the Total Care and Cost Improvement Program -- has been a game-changer for Ashwal and his practice, Frederick Primary Care Associates, yielding more than a 20% increase in payments from CareFirst last summer for the group's success during 2011 in lowering spending by keeping patients out of the hospital and emergency departments. Read the full article here.

Colorado hospital profits soar despite health turbulence

The Denver Post
May 30, 2013

Colorado hospital profits are soaring despite overall turbulence and uncertainty in the health care marketplace, according to a new analysis of competition in the state.

Colorado's HMOs also had strong profits and added tens of thousands of new members as they enjoyed growth in managing Medicare patients, said the report by Allan Baumgarten, a national health finance analyst.

Denver-area hospitals have seen profits grow for the past 10 years and reached $774.6 million in net income as a group in 2011, the last year of full figures, said Baumgarten's Colorado Health Market Review. That income was a margin of 12.3 percent of net patient revenues of $6.3 billion for the Denver metro hospitals, the report said.

Find out what health care economists say many hospitals have benefited from by reading the full article here.

ACA still missing key regulatory details

ModernHeathcare.com
May 30, 2013

Some key regulatory details remain unanswered in the final months before the Patient Protection and Affordable Care Act's major provisions launch.

Obama administration officials have insisted that they have issued all of the major regulations for the 2010 healthcare overhaul and are now focused on implementing the law's central pillars—state health insurance exchanges and expanded Medicaid coverage—later this year. But health policy experts said they still expect important regulations implementing provisions of the law, plus a large amount of so-called subregulatory guidance.

Sam Batkins, director of regulatory policy at the conservative American Action Forum, counts 32 proposed rules that remain to be finalized, including final IRS rules on Medicare taxes and rules requiring providers to report and return Medicare overpayments within 60 days.

Other highly anticipated regulations still to come this year deal with various components of the health insurance marketplaces, experts say. Those new exchanges are expected to begin enrolling millions of private insurance subscribers in each state Oct. 1 and start providing coverage in January.

To find out what the four rules addressing various aspects of exchanges will be, read the full article here.

The Affordable Care Act: Improving Incentives for Entrepreneurship and Self-Employment

Robert Wood Johnson Foundation
May 31, 2013

Traditionally, individuals considering leaving their job to strike out on their own have worried that they may be denied health insurance coverage because they have preexisting conditions, fear losing access to a trusted physician, or are unable to afford the premiums without an employer sharing the costs. The result is that some U.S. workers feel “job lock,” being tethered to their jobs and unable to leave, even if their skills and talents no longer match their position.

New research estimates that the number of self-employed Americans will be 1.5 million higher in 2014 because of the Affordable Care Act (ACA). Beginning next year, access to high-quality, subsidized health insurance coverage will no longer be exclusively tied to employment, which could lead people to pursue their own businesses as self-employed entrepreneurs.

To find out what the ACA provisions that may encourage more people to start their own business include read the full article here.

Opinion: Spend Money on Universal Care Not Costly Exchange

Solutions
May 29, 2013

Coloradans need health care. It’s a basic human right. Yet as we get more information about Colorado’s new health insurance exchange, it seems less certain that people will get the health care they need.

The exchange, also called a marketplace, seems more complex every day. I wonder if Coloradans who need the help most will even be able to understand this new system, much less figure out how to get care.

There is a simple solution. We need universal health care, specifically a public single-payer health system that would assure all of us who need care can access it.

The complexity of implementing and understanding the reforms required under the federal Affordable Care Act (ACA) also known as Obamacare, has become more apparent in recent days. Health Care for All Colorado, the state’s leading advocacy group for a universal public single-payer system, contends that this complexity will lead not only to unnecessary confusion for patients and caregivers but also to increased costs for premiums and other administrative costs that will continue to drive the cost of health care ever higher.

Obamacare regulates health insurance companies. Find out what its major values include by reading the full article here.

Language bank provides live telephonic interpretation for practitioner, patient

Herald Mail
May 30, 2013

An elderly woman heads into the emergency room with severe stomach pain. She hardly understand what’s happening, let alone how the doctors will fix it. All she knows is that it hurts, she’s alone and she doesn't speak English. As medical personnel come and go from the curtained examination area, she glances from one person to another, hoping to pick up a familiar phrase. 

But the woman has little more than a dozen words in her English vocabulary. And her husband, who is in the waiting room — the only family she has — is equally linguistically confused. Medical jargon often is difficult to understand. So imagine going to a doctor who doesn't speak your language.You’re sick and feeling vulnerable. You want your health problem to be remedied.But it becomes a game of charades, with gesturing and pointing. And the patient’s diagnosis becomes lost in translation.

For people who speak limited English, going to a medical facility can be so intimidating that many put off visits, often until they’re in critical condition. It’s the type of problem that Meritus Medical Center faces almost every day.

As a result, it has implemented a service to meet the needs of an increasingly diverse patient population. Find out how this language interpretation program is going to enhance patient care by clicking here.

Medicare Spending Variations Mostly Due To Health Differences

Kaiser Health News
May 28, 2013

The idea that uneven Medicare health care spending around the country is due to wasteful practices and overtreatment—a concept that influenced the federal health law -- takes another hit in a study published Tuesday. The paper concludes that health differences around the country explain between 75 percent and 85 percent of the cost variations. 

“People really are sicker in some parts of the country,” said Dr. Patrick Romano, one of the authors.

That’s a sour assessment for those hoping to wring large savings out of the health care system by making it more efficient. Some, such as President Barack Obama’s former budget director, Peter Orszag, assert that geographic variations in spending could mean that nearly a third of Medicare spending may be unnecessary.

Their conclusions are based on the wide differences in spending, which in 2011 rangedfrom an average of $14,085 per Medicare beneficiary in Miami, to $5,563 per beneficiary in Honolulu, even after Medicare’s cost of living and other regional adjustments — but not health status — were taken into account.

The new study comes as advisors to the government consider whether regional differences are a useful tool to reduce health spending. An Institute of Medicine panel is preparing a report on whether Congress should pay less to hospitals and doctors in areas where there is heavy use of medical services, and more in regions where spending is lower. That report is due out this summer, but an interim version indicated that the panel was opposed to the idea. Read more here

National Council Name Chage

National Council for Behavioral Health
June 6, 2013

Kittens have notoriously short attention spans. They chase the most exciting thing around. To entice them, you must get right to the point. So, what was the National Council for Community Behavioral Healthcare to do?
Shorten our name, of course. Click here to view the video.

AHA Defends Hospital Consolidations

HealthLeaders Media
June 12, 2013

The volume of mergers and acquisitions in healthcare is "consistent with efforts to try to achieve economies of scale… and changes in demand and particularly to realign and enhance services," says a report from the American Hospital Association.

The American Hospital Association contends that "the overwhelming majority" of hospital consolidations are "pro-competitive," improve quality and access to healthcare at a lower cost for the communities they serve. 

And despite the seemingly daily accounts of mergers and acquisitions in the hospital sector, an AHA-commissioned report from FTI Consulting found that only 551 community hospitals—about 10% of all community hospitals—were involved in consolidations from 2007-2012 with an average of one or two hospitals acquired in most transactions. The report (PDF) was published Monday.

"It's a very dynamic industry with a large range of pressures in efforts to really realign care in the best site, with the best quality and most efficient cost of care delivery," Meg Guerin-Calvert, senior managing director at FTI, told reporters at a press conference Monday. Read the full article here.

Colonoscopies Explain Why U.S. Leads the World in Health Expenditures

The New York Times
June 1, 2013

Deirdre Yapalater’s recent colonoscopy at a surgical center near her home here on Long Island went smoothly: she was whisked from pre-op to an operating room where a gastroenterologist, assisted by an anesthesiologist and a nurse, performed the routine cancer screening procedure in less than an hour. The test, which found nothing worrisome, racked up what is likely her most expensive medical bill of the year: $6,385.

That is fairly typical: in Keene, N.H., Matt Meyer’s colonoscopy was billed at $7,563.56. Maggie Christ of Chappaqua, N.Y., received $9,142.84 in bills for the procedure. In Durham, N.C., the charges for Curtiss Devereux came to $19,438, which included a polyp removal. While their insurers negotiated down the price, the final tab for each test was more than $3,500.

“Could that be right?” said Ms. Yapalater, stunned by charges on the statement on her dining room table. Although her insurer covered the procedure and she paid nothing, her health care costs still bite: Her premium payments jumped 10 percent last year, and rising co-payments and deductibles are straining the finances of her middle-class family, with its mission-style house in the suburbs and two S.U.V.’s parked outside. “You keep thinking it’s free,” she said. “We call it free, but of course it’s not.”

Find out what a basic colonoscopy costs in other developed countries by reading the full article here

Most Doctors Don’t Meet U.S. Push for Electronic Records

Bloomberg
June 3, 2013

Fewer than 1 in 10 doctors used electronic records last year to U.S. standards, according to a survey that shows the challenge facing a multibillion-dollar effort to digitize the health system for improved patient care.

Only 9.8 percent of 1,820 primary-care and specialty doctors said they had electronic systems that met U.S. rules for “meaningful use,” a list of tasks such as tracking referrals or filling prescriptions online. Less than half all those surveyed, or 44 percent, had any system in place, according to the report published by the journal Annals of Internal Medicine.

The Obama administration has spent about $15 billion since 2009 to help doctors and hospitals adopt electronic health records, fueling growth for vendors such as McKesson Corp. (MCK) andCerner Corp. (CERN) In March, the administration said it was considering new regulations, amid complaints that the systems are hard to use and don’t share information easily.

Find out what the he survey “ should be of concern to policy makers,” found by clicking here.

Study highlights cost benefit of expanding Medicaid

ModernHealthcare.org
June 3, 2013

An independent study released today in the journal Health Affairs on the economic impact of Medicaid expansion under healthcare reform found that states' share of the cost of expanding Medicaid under reform would be lower than the cost of providing uncompensated care to their uninsured residents.

The RAND Corp. looked at the 14 states considered least likely to support or allow for the expansion of Medicaid under the Patient Protection and Affordable Care Act—Alabama, Georgia, Idaho, Iowa, Louisiana, Maine, Mississippi, North Carolina, Oklahoma, Pennsylvania, South Carolina, South Dakota, Texas and Wisconsin. These states were among the first whose governors said they would not support the expansion. According to RAND's analysis, if those 14 states do not expand Medicaid, 3.6 million more people will go uninsured, the state governments will spend an additional $1 billion on uncompensated care in 2016, and they will forfeit $8.4 billion annually in federal payments.

“States that do not expand Medicaid will not receive the full benefit of the savings that will result from providing less uncompensated care,” Carter Price, the study's lead author and a mathematician at RAND, said in a news release. “Furthermore, these states will still be subject to the taxes, fees and other revenue provisions of the Affordable Care Act, without reaping the benefit of the additional federal spending, which will cost those states economically.” Read the full article here.

CMS unveils charges for outpatient hospital procedures

ModernHealthcare.com
June 5, 2013

Less than a month after the CMS released data on what hospitals charge for inpatient procedures, the agency has released similar information about the prices hospitals submit and are paid on the outpatient side.

The greater transparency comes as hospitals have pushed back against the initiative, arguing that the data isn't meaningful to consumers because of the gulf between what hospitals charge and the bottom line for patients.

HHS Secretary Kathleen Sebelius unveiled the calendar year 2011 data on Monday as part of Health Datapalooza IV, an annual conference on data transparency. In addition to the pricing information for 30 hospital outpatient procedures, the CMS released county-level data on Medicare expenditures and the different brands of electronic health records being adopted.

As with inpatient services, hospital charges ran the gamut. For instance, Fort Walton Medical Center, Pensacola, Fla., charged $32,105.64 in 2011 for a level IV upper airway endoscopy. The 257-bed hospital, part of publicly traded HCA, was reimbursed an average of $1,396.45.

Yet for the same procedure, 98-bed Park Ridge Health, Hendersonville, N.C., part of Adventist Health System, charged $1,527.95, find out how much they were reimbursed by clicking here.

Commercial insurers less likely to offer ACOs 'upside-only' shared-savings arrangements

ModernHealthcare.com
June 5, 2013

Commercial insurers participating in accountable care arrangements are less likely than Medicare to use payment models featuring the “upside-only” shared savings preferred by providers, according to an analysis released Wednesday by the Premier healthcare alliance.

Premier's study of 85 ACO payer arrangements showed that more than one-third of these are for upside-only shared savings—where savings are split evenly between insurers and providers and there are no penalties imposed for failing to meet goals. But of these upside models, only 21% are offered by commercial payers; more than half are through the Medicare Shared Savings Program or Medicare Advantage.

A Premier official criticized commercial insurers for not doing more upside-only payment arrangements. Upside-only options are more attractive to providers, particularly in the early years of an ACO, because they allow providers to test care delivery models without the fear of financial losses while also offering the opportunity to earn enough in shared savings to offset ACO development costs. Click here to read the full article.

Employment is Forecasted to Soar for the NP and PA Workforce

National Rural Health Resource Center
June 3, 2013

Minnesota is suffering from a primary health care workforce shortage and the road to improved population health begins with increased access to care. A large portion of the primary care workforce is nearing retirement while fewer medical students are choosing primary care as their specialty. These shortages are particularly significant in the rural parts of Minnesota. Clearly there are benefits of Nurse Practitioners (NPs) and Physician Assistants (PAs) to health care organizations, and the Obama administration has championed NPs and PAs as an important part of the answer to our nations' health care problems.

Growth in the number of PAs has grown substantially in the past several years. In March 2012, Minnesota had over 1,700 licensed PAs, over three times the number from 10 years ago. According to Health Guide USA, PA opportunities are expected to increase 30% from 2010-2020 due to increased need. This should be particularly true for PAs working in rural and medically underserved areas, as well as those working in primary care. With more physicians entering non-primary care areas of medicine, there will be a growing need for primary health care providers, including PAs. Additionally, general population growth and an increase in the number of insured citizens, due to health care reform, will further spur opportunities for PAs as more people seek health care. Read the full article here.

America's Health Rankings 2013 Senior Report

United health Foundation
2013

America's Health Rankings Senior Report compares the health of all 50 states to each other using 34 different measures of health ranging from smoking and obesity to ICU usage.

In the next 15 years, America’s senior population will grow by 53 percent. People are living longer lives than ever before. Unfortunately, while we are living longer lives, we are seeing poorer health among people aging into their senior years. By looking holistically at key measures related to seniors’ lifestyles, social supports, environment, clinical care and health care outcomes, we get a comprehensive picture of senior health that reflects the unique challenges of each state. Based on a rigorous review of 34 measures, the 2013 America’s Health Rankings Senior Report finds Minnesota is the leading state for senior health and Mississippi ranks last for senior health.

Learn more about senior health in your state today by following this link.

Five Steps for Community Hospitals to Become Great

Becker's Hospital Review
May 29, 2013

When it comes to the hospital sector, large tertiary facilities and academic medical centers like Massachusetts General Hospital in Boston and Northwestern Memorial Hospital in Chicago garner a lot of the attention. In some regards, it makes sense. These institutions treat some of the sickest patients in the country, are hubs for groundbreaking research and have resources that few other healthcare organizations can match.

However, for most Americans, the community hospital is the prototypical image of a hospital. Babies being born, broken arms being mended, illnesses being treated — all of this occurs within a building that in many ways is the nucleus of each particular community.

Community hospitals may not be destination medical centers to treat the global masses, but they can still be "great" facilities. Here, three community hospital CEOs explain what these types of organizations must do to take the extra step from merely "average" or "good" to become "great." 

1. Create a sense of trust and stability. When Tim Browne was appointed CEO of Carolina Pines Regional Medical Center, a 116-bed hospital in Hartsville, S.C., in 2011, he became the hospital's seventh CEO in a matter of less than a decade. Hospital employees, physicians and the general public were desperate for consistency within the hospital's leadership, and Mr. Browne — who actually was born and raised in Hartsville — said he made it his top goal to make the hospital a bastion of stability for his community and gain trust back.

"I spent a lot of time outside the walls of the hospital, in addition to inside, just listening and being involved in local events and basically reconnecting with local business and industry," Mr. Browne says. "I had been told the hospital had been absent [within the community], and we made a true grassroots effort to get back and reconnected."

To read the other four steps of becoming a great community hospital click here.

A Contrarian’s View on Private Exchanges

The Commonwealth Fun
June 6, 2013

An enormous amount of ink and energy have been devoted to private health exchanges, leading some to believe they will become the next big thing in health care as large employers flock to them in droves. Champions of private exchange aren’t hard to find—at least two large employers have already dumped their traditional plans and pushed employees into private exchanges. But will anyone else follow suit?

Robert Galvin, M.D., who led GE’s global health benefits office for 15 years and now helps dozens of companies manage their health care benefits as the CEO of Equity Healthcare, says: not right away.

Will Other Employers Follow Darden Restaurants and Sears into Private Exchanges?
Speculation about the market potential of private exchanges moved into high gear in late 2012, when Darden Restaurants and Sears both said that they would drop coverage as soon as they reasonably could and direct employees to shop for coverage through their own private health exchanges. Both firms have since moved forward with those pledges. At first glance, the benefits of a private exchange for providing employee coverage seem compelling—expanded choices for employees, a minimum of administrative hassle, and dramatically simplified budgeting, at least in the short term.

Nevertheless, Galvin doesn’t see Sears and Darden as early movers in a more general shift. “They’re both low-wage employers with lots of part-time employees and fairly high turnover,” he said. “They’re essentially large versions of the small employers that exchanges were designed for, so it’s not that surprising that they’re interested. They’re not good bellwethers for the rest of the market.”

Are Private Exchanges the New 401k? Find out by reading the full article here.

Electronic Health Records: Are We There Yet? What’s Taking So Long?

Robert Wood Johnson Foundation
June 6, 2013 

am a family physician, but one who doesn’t currently practice and importantly, one who isn’t slogging day after day through health care transformation. I do not want to be presumptuous here because the doctors and other health professionals who are doing this hard work are the heroes. They are caring for patients while at the same time facing tremendous pressure to transform their life’s work. That includes overwhelming pressure to adopt and use new information technology.

This level of change is hard, difficult and confusing—with both forward progress and slips backward. Nevertheless, doctors, take heart, because you are making progress. It may be slow at times, but it’s substantial—and it’s impressive. Thank you.

The Annals of Internal Medicine today published a study (I was one of the authors) finding that more than 40 percent of U.S. physicians have adopted at least a basic electronic health record (EHR), highlighting continued progress in the rate of national physician adoption of EHRs. The study, also found that a much smaller number, about 9.8 percent of physicians, are ready for meaningful use of this new technology.

Some might say, “Wake up, folks!” Look at those small meaningful use numbers. Change course, now. After all of this time and tax-payer expense, less than 10 percent of doctors are actually ready to use these important tools meaningfully. What’s up with that? 

To me, though, this study is good news. All who care about health care transformation should be heartened by the progress—but also impressed by the enormous challenge that our health professionals have undertaken. To read the full article click here.

Comparing Rural and Urban Medicare Part D Enrollment Patterns

University of Minnesota, Rural Health Research Center
May 2013

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 facilitated prescription drug coverage for Medicare beneficiaries through the Part D program. Beginning in January 2006, Medicare beneficiaries enrolled in traditional fee-for-service Medicare could select drug coverage through a stand-alone prescription drug plan while beneficiaries in Medicare Advantage (MA) plans could select an integrated option (MA-PD).

Prior to 2006, approximately 59% of rural beneficiaries and 75% of urban beneficiaries had some type of drug coverage. Rural beneficiaries were more likely to have self-purchased Medigap drug coverage while urban beneficiaries were more likely to have obtained drug coverage through their employers. With the implementation of the Part D program, Medigap prescription drug policies are being phased out and employers are receiving subsidies encouraging them to retain employee drug coverage through the Retiree Drug Subsidy program. The potential benefits of Part D enrollment include improved access to drugs, reduced out-of-pocket drug expenditures, and better health outcomes. The degree to which rural beneficiaries benefit depends on a number of factors, including their health needs, their medication needs, and what type of drug coverage they had prior to Part D enrollment, if any...

Key Findings:
- Overall Medicare Part D enrollment rates increased from 55.5% in 2006, the first year of the program, to 61.4% in 2009. Annual increases were between 1 and 5 percentage points.
- Rural Part D enrollment rates consistently lagged behind urban rates by 2 to 4 percentage points, increasing  from 53.7% in 2006 to 58.6% in 2009, compared to urban rates increasing from 56.0% to 62.3%, respectively. To read more the study's key findings click here.

Premium Assistance in Medicaid

Robert Wood Johnson Foundation
June 6, 2013

States have proposed using expansion funds to buy private coverage for Medicaid beneficiaries through the new health insurance exchanges.

Nearly a year after the Supreme Court’s June 2012 decision declaring the Affordable Care Act’s (ACA) Medicaid expansion optional, states continue to grapple with whether or not to pursue the option for newly eligible populations. Although the Medicaid expansion accounted for about half the total number of people projected to gain coverage under the ACA, many states, to date, have declined to expand Medicaid or are learning toward rejecting the option because of cost and political concerns. But the long-term consequences of denying the Medicaid expansion, especially large coverage gaps for millions of low-income people, are also prompting some states to consider novel alternatives for extending Medicaid under the ACA.

One approach that has piqued states’ interest is using the additional federal funds as “premium assistance” for eligible Medicaid beneficiaries to purchase private coverage through the law’s new health insurance exchanges.

It remains to be seen how many states will pursue the premium assistance approach in order to move their Medicaid rolls to the private exchanges. While the option appeals greatly to conservative leaders looking to reduce the role of government in healthcare, many details must still be negotiated. Advocates speculate that exchanges may offer more efficient cost sharing, greater competition, reduced fraud, less churning, higher reimbursement rates and better provider networks. However, not all of the states choosing premium assistance will see all of these benefits. Alternatively, the cost to an individual state may be higher than traditional Medicaid.

This policy brief examines a range of policy issues surrounding premium assistance using Medicaid expansion funds, and next steps for states.

Access to EHR Notes Lauded by Patients, Providers

HealthLeaders Media
May 14, 2013

In a pilot, a system which permits patients to view all the notes in their electronic health records was such a hit with hospital patients and physicians that Beth Israel Deaconess Medical Center and Geisinger Health System are dramatically expanding their OpenNotes programs.

Possibly the most famous consumer of electronic health records is Dave deBronkart, better known as e-Patient Dave.

Several years ago, deBronkart participated in a trial of a new program that permitted patients to view all the notes in their EHR.

"I experienced a direct benefit," deBronkart recalls. "Weeks after a visit, I thought, 'Wasn't I supposed to have something followed up?' Heaven knows where my printed visit notes were … it was late in the evening, so ordinarily I'd have waited till morning and maybe remembered to call in and have someone look it up—very inefficient and vulnerable to 'I forgot.'

"Instead, I went online right then and there, just as you might with anything else, from airline reservations to credit card info. There it was: actinic keratosis—a precancerous lesion. I had it removed, quickly, easily, inexpensively." deBronkart says the diagnosis was "not academic" for him. "Thirty years earlier I had a skin cancer removed from my nose. And about a year later I was found to have a new one on my jaw.

"As a guy who worked in technology all his life," deBronkart says, "it's clear to me that what's happening here is that value in healthcare depends on information plus awareness. In that moment I was aware of the information, which enabled action." To read more about the benefits of EHR click here.

CRHC's CAH Financial Workgroup Webinar

All Colorado CAHs are invited to join the quarterly webinars of the CAH Financial Workgroup. The next webinar will be held on June 19. For more information, contact Caleb Siem cs@coruralhealth.org.

Rate of patients going from ED to ICU rises

Nurse.com News
May 15, 2013

ICU admissions from the ED increased by almost 50% between 2002 and 2009, according to a study.

"The increase might be the result of an older, sicker population that needs more care," Peter Mullins, MA, the study’s lead author and a researcher with the George Washington University School of Public Health and Health Services, said in a news release.

Mullins and his colleagues conducted the study by using data from the National Hospital Ambulatory Care Survey, a sample of hospital-based EDs in the United States during a seven-year period. They found that ICU admissions jumped from 2.79 million in 2002-03 to 4.14 million in 2008-09. During the same time frame, overall ED admissions grew by only 5.8%. To read about the study's key findings click here.

Hospitals Thinking Beyond 30-Day Readmissions

HealthLeaders Media
May 29, 2013

Operating under the assumption that the government is moving toward enacting reimbursement penalties for all-cause readmissions, some hospitals and readmission prevention experts are already developing corresponding strategies.

When asked why their efforts to prevent 30-day readmissions focus only on patients with heart failure, pneumonia, or heart attack, many hospital leaders shrug: because those readmissions are the only ones for which hospitals suffer a stiff reimbursement penalty.

While many hospitals intend to target all-cause readmissions eventually, for now, it represents a steep front-end expense their budgets are not yet ready to absorb in a fee-for-service world, especially for readmissions that are not yet at risk for penalties.

Amy Boutwell, MD, MPP, is a readmission prevention expert and practicing physician at Newton-Wellesley Hospital in Newton, Mass. She recalls a seminar she held in December for representatives of 62 New Jersey hospitals.

"I asked everyone in the group, 'Is anyone taking this all-cause approach?' And none of them were," she says. "They just don't have it on their radar. Their 'first phase' of efforts is still very much focused just on one disease. Their challenge in 2013 is to move from one disease-focused pilot to a broad portfolio of efforts." Click here to read the full article.

The Health Care Law - Health Insurance Marketplace 101

A presentation on the main provisions in the health care law (the Affordable Care Act) and how to access care in your community. Topics include the Health Insurance Marketplace, how to enroll in health insurance and how to receive updates on implementation of the law. A brief question and answer session will provide answers to commonly asked questions.

Thursday, July 11, 2013
12:00 PM - 1:00 PM MDT
Presented by U.S. Department of Health & Human Services


Webinar: Best Practices, Resources, and Strategies for Employment for Service Members, Veterans, and their Families



This webinar will focus on the current state of veterans’ employment, as well as best practices in employment strategies for SMVF. The presenters will provide information on promising practices from states that are partnering with business and industry, and outline strategies that employers and SMVF can use to bridge gaps in employment. The webinar will also include an overview of the U.S. Department of Veterans Affairs (VA) Veterans Employment Toolkit. A question and answer session will follow the presentations.
Tuesday, June 25, 2013
2:00–3:30 p.m. (EDT)
Objectives:
• Identify SMVF employment best practices, including training on military culture and transferable skills
• Discuss opportunities for business and community partnerships to increase SMVF employment
• Recognize common obstacles to hiring from both the job-seeker and employer perspectives
• Identify information and resources for employers hiring veterans
• Identify resources for service members and veterans entering the civilian labor force
• Discuss strategies to support veterans in the workplace to retain and advance in their jobs
Target Audience:
Representatives from state, territory, and tribal behavioral health systems serving SMVF, employers, representatives from military family coalitions, and SMVF advocates
If you have any questions about your registration, please contact Michelle Cleary, Project Associate, at 518-439-7415 ext. 5259 or by email at mcleary@prainc.com.

State Strategies to Measure Care Coordination

Care coordination is a focal point of health care delivery reform initiatives across the country, yet there has been limited progress in measuring it, particularly for children and between primary medical care and community service providers. How can states and providers begin to measure this crucial element of care? Join speakers from CMS, NASHP, and two states (Oklahoma and Minnesota) that participated in the Assuring Better Child Health and Development (ABCD) III Initiative for a national webcast to address this question. Speakers will set the national context for pediatric care coordination measurement, highlighting relevant CMS activity, and share care coordination measurement strategies, results, and lessons learned from ABCD III. Although ABCD III focused on improving care coordination for children ages birth to three, the information shared will be relevant for measuring care coordination among other populations.

Monday, June 24, 2013
3:30 pm - 5:00 pm EDT
Sponsored by National Academy for State Health Policy



For New Doctors, 8 Minutes Per Patient

The New York Times
May 30, 2013

At a social gathering not long ago, a colleague and I exchanged stories about residency training, fondly remembering the patients who had helped us grow both as doctors and as people.

A doctor-in-training we both knew listened intently to our conversation, but when we asked him about his experiences with patients, he looked lost and struggled for a response.

“My generation is different from yours,” he finally said, and then told us about getting “caught” sneaking back to the hospital earlier that year to talk with a couple of patients. He had already officially signed out for the night, but even going back just to say hello would count toward and push him over his 80-hour weekly work limit. Such a violation could cause his residency program to lose its accreditation.

“My generation is different because we can’t have the same relationships with patients as you did,” the young man said. “We just don’t have the time.”

His comment unnerved me then and for a long time afterward. I knew he was being honest about his own experiences, but I couldn’t believe that the same held true for all doctors-in-training. After all, most people I knew became doctors because they wanted to interact with patients.

Now a new study confirms what the young doctor told us: doctors-in-training are spending less time with patients than ever before.To read more about the study's finding click here.