Barnhart_New Model of Rural Health
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Transcript of Barnhart_New Model of Rural Health
Memorial Health System Anthony Medical Center Ashland Health Center Atchison Hospital Rawlins County Health Center
Republic County Hospital Mitchell County Hospital Health Systems Sumner County District #1 Hospital Neosho Memorial Regional Medical Center
Clay County Medical Center Citizens Medical Center Comanche County Hospital Mercy Hospital Columbus Cloud County Health Center
Morris County Hospital Lane County Hospital Ellinwood District Hospital Ellsworth County Medical Center Newman Regional Health
Greenwood County Hospital Fredonia Regional Hospital Anderson County Hospital Girard Medical Center Goodland Regional Medical Center
Kiowa County Memorial Hospital Hanover Hospital Harper Hospital District #5 Herington Municipal Hospital Hiawatha Community Hospital
Graham County Hospital Hillsboro Community Hospital Clara Barton Hospital Holton Community Hospital Horton Community Hospital
Sheridan County Health Complex Stevens County Hospital Allen County Regional Hospital Hodgeman County Health Center
Stanton County Hospital Kingman Community Hospital Edwards Co. Hosp. and Healthcare Ctr. Kiowa District Healthcare
Rush County Memorial Hospital Kearny County Hospital Pawnee Valley Community Hospital Wichita County Health Center Lincoln County Hospital
Lindsborg Community Hospital Hospital District #1 of Rice County Jewell County Hospital St. Luke Hospital and Living Center
Community Memorial Healthcare, Inc. Meade District Hospital/Artesian Valley Health System Medicine Lodge Memorial Hospital
Ottawa County Health Center Minneola District Hospital Wilson Medical Center Ness County Hospital District #2 Norton County Hospital
Logan County Hospital Decatur Health Systems, Inc. Community HealthCare System, Inc. Osborne County Memorial Hospital
Oswego Community Hospital Phillips County Health Systems Rooks County Health Center Gove County Medical Center
Grisell Memorial Hospital District #1 Russell Regional Hospital Sabetha Community Hospital Cheyenne County Hospital
Satanta District Hospital, Clinics & LTCU Scott County Hospital Sedan City Hospital Nemaha Valley Community Hospital
Smith County Memorial Hospital Stafford County Hospital Hamilton County Hospital
Greeley County Health Services Trego County-Lemke Memorial Hospital Wamego Health Center Washington County Hospital
F.W. Huston Medical Center William Newton Hospital
New Rural Health Model
Change is Scary
Change is Inevitable
Phone: 913.449.1354 Roger Barnhart E-Mail: [email protected]
Comparing approximately 70 metrics from previously closed rural hospitals:
• Market Position
• Balance Sheet
• Costs
• Charges
• Outcomes
673 rural hospitals (1 out of 3) are under financial duress
210 are at high risk of closing
Source: iVantage Analytics
Change Must Happen
• Rural hospitals make a substantial imprint on local economies
• Often the largest employers and economic drivers
• The American hospital institution is in the midst of massive and disruptive change
• America must bring down its crippling health care costs
Source: American Hospital Association
Change is Happening
• Creation of Quality Reporting Requirements
• Creation of the Payroll Based Journal Staffing Reporting System
• Creation of Alternate Payment Models
• Value Based Purchasing (VBP)
• Accountable Care Organization
Source: Kansas Foundation for Medical Care
Affordable Care Act
Protecting Access to Medicare Act of 2014
• Mandated that the 30 day all cause readmission quality measure begins Oct. 1, 2015 (FY ‘16)
• Mandated that Post Acute Care (PAC) Assessment alignment between all post-acute providers
• Foundation for Value Based Purchasing and Quality Reporting requirements
• 42 CFR 483; CMS-1622-F -Enacts the 30 All-Cause Readmission Quality Measure
• First time Critical Access Hospitals (CAHs) are included in readmission reporting
• Aligns the SNF VBP Program with the National Quality Strategy
• Data will be collected from Inpatient PPS claims from the hospital and claims submissions
Source: Kansas Foundation for Medical Care
CMS Requirements for Rural Health
• Quality Reporting requirements begin in Oct. 1, 2016 (FY 2017)
• The first year of reporting will be voluntary
• If data isn't reported up to a 2% reimbursement penalty
• Imposed in FY 2018 (Oct. 1, 2017)
• Current measures used include the 30 Day All Cause Readmission rate for each nursing home
• Very conservative/economic driven model
• Pays high performers, average stays the same, poor performers could receive reduced payments
Source: Kansas Foundation for Medical Care
CMS Requirements for Rural Health
Source: 2010 U.S. Census BureauProjected Percentages of 65+ Population 2015 Source: : 2010 U.S. Census Bureau
Source: 2010 U.S. Census BureauProjected Percentages of 65+ Population 2025 Source: : 2010 U.S. Census Bureau
• Collaboration among two or more rural providers
• Including all continuum providers – public health, home health, LTC, EMS,
assisted/independent living, etc
• Also to include other community resources – schools, government, faith based
organizations and other mental and social services
• Project activities and goals based on locally identified needs, interests and priorities through
discussion with members of the community
• Projects with the purpose of improvement of the health of the service area, by moving the
healthcare system toward care that is safe, effective, efficient, patient/community- centered,
timely and equitable for the entire service area as well as individual patients
Source: National Rural Health Association
Rethinking Rural Health
Patient__
Family
Urban
Hospital Rural
Community Hospital
Post-Discharge Clinic
Mental Health
Transportation
Pharmacy
Senior Services
Area Agency on AgingRehab
Assisted
Independent Living
Durable Medical
Equipment
Physician
Long Term Care
Skilled Nursing
Family Care Provider
Home Health/Hospice
Phone: 913.449.1354 Roger Barnhart E-Mail: [email protected]
• Properly utilized, the patient would follow a well-coordinated path of increasing and/or decreasing
levels of service(s) throughout the continuum until reaching a level of self-sufficiency
• Expanded healthcare services
• Enabling rural communities expanded services otherwise unavailable
• Improves care coordination
• Quality of care improves
• Cost of care declines – efficiencies of services
• Less outmigration for healthcare services
Continuum of Care Collaboration
Derived from one of three fundamental payment approaches:
• Service-based payment/fee-for-service mechanism
• Bundled-based payment, which aggregates different services and providers
• Ex: hospitals, physicians and post-acute providers bundling cost for hip replacements
• Population-based payment
• Seeking to aggregate total care and costs across the continuum
• An ACO for a defined population
Risk adjustments and incentives that drive care quality and efficiency include:
• Patient safety and experience
• Socioeconomic adjustment of the population served
Transforming to Value Based Care
Source: 2015 AHA Committee on Research