Title: PowerPoint Presentation Challenges For Hospitals Serving Rural Communities
1Rural Health Advocacy 24 hours a day 7 days a
week
Tim Size, Executive Director Rural Wisconsin
Health Cooperative Sauk City, Wisconsin
2Outline of Presentation
- Myths About Rural Are Alive Well
- Almost Worst Rural Health Policy Awards for
2005 - Cross Section Public-Private Rural Health Issues
- Medicare Advantage
- Physician Supply
- Healthcare Costs
- Population Health
- Becoming More Effective Active Advocates
3MYTHS ABOUT RURAL
4Myths that Mislead Public Private Policy
- Rural is west ( TX, NC, PA, OH, MI, NY top rural
pop ) - Rural Americans are naturally more healthy
- Rural economy is mostly about agriculture
- Rural health care costs less than urban care
- Rural health care is inordinately expensive
- Rural health care is lower quality urban is
better - Rural hospitals are just band-aide stations
- Rural hospitals clinics are poorly
managed/governed - Rural residents dont want to get care locally
U.S. 2000 Census, Non-Metro Population By State
52005 Almost Worst Rural Health Policy Awards
- ? First Draft of June MedPAC Report
- ? 1st Launch of Hospital Compare Web Site
- ? Proposed CMS Rural Hospital Building Ban
- ? Federal Appropriations Bill for FFY 2006
6Medicare Payment Advisory Commission
- CAH payment designation ended two decades of
failed attempts to retro-fit to rural the PPS
Medicare payment methodology designed for large
urban hospitals - MedPAC is an advisory commission to Congress
- The initial draft of the June MedPAC report was
seen as inaccurate, hostile review of the CAH
program - Draft framed CAH designation as Federal charity
with recipients having to prove they were
deserving poor - The pushback from Commissioners, with technical
help from the field, was substantial and effective
7Hospital Compare Labled CAH as 2nd Class
8NRHA Responded with Reporting Guidelines
- Need to actively prepare for future when payers
and consumers pay attention to public reporting - Rural hospitals should fully engage in the
quality improvement and public reporting movement
- CAHs and PPS are both acute care hospitals
- CAH or PPS difference not relevant to quality
report - Compare service outcomes, not institution size
- Consumers should be able, at a minimum, to
readily compare all hospitals in their hospital
referral region
NRHA Policy Brief Approved 5/20/06
9Proposed Building Ban
10Appropriations Fight in 2005 for 2006
- President proposed to eliminate 8 programs worth
232 million and dramatically cut 3 others. - House of Representatives followed many of those
recommendations the Senate did not. - The first Conference Report eliminated 6 programs
worth 134 million and dramatically cut several
others. But it was defeated 209 to 224 in the
House! - The final bill restored funding for research and
policy and AHECS, and added money for outreach
and community health centers. Some programs
still cut.
Jennifer Friedman, VP Government Affairs and
Policy National Rural Health Association
11Presidents Again Slashes Rural Health
Does not include 29 million cut from eliminating
AHECs total cuts are over 160 million.
Jennifer Friedman, VP Government Affairs and
Policy National Rural Health Association
12Cross Section Rural Health Issues
13Challenges of a Privatized Medicare
14Strong Access Standards Are Key
- Beneficiary rights to local access, even if out
of network, is key for beneficiaries and for
local providers to have any clout in plan
negotiations - Plans must ensure that services are
geographically accessible and consistent with
local community patterns of care. - Need to open up current black-box which limits
beneficiary awareness and evaluation of CMS
enforcement of consistency of access standards
across plans, markets and time
CMS Medicare Managed Care Manual, Chpt. 4, page
57
15Protecting CAH/RHC Reimbursement
- HR 880 (Ron Kind) pay for CAH RHC at a rate
that is gt 101 percent traditional Medicare - SB 2819 (Coleman/Durbin) is comparable to HR 880
adds option of 103 percent of the applicable
interim payment rate - Right to local access still key payment rates
are meaningless if patients can be steered
elsewhere - AHA NRHA Supporting
16Other Needed Medicare Advantage Improvements
- Major increase beneficiary decision-making
assistance - Immediate on-line verification beneficiary
coverage - Restore States Rights to question plan behavior
- Regional CMS Office role as source of definitive
info - Regional CMS Office handle provider complaints
- Plan applications on-line within 30 days of
approval - Full/timely transparency re enrollment and
quality data - Encourage collaboration amongst rural providers
to level playing field re contract
development/review
DHHS National Advisory Committee on Rural Health
Human Services, Medicare Advantage
Sub-Committee, 6/13/06
17PHYSICIAN SUPPLY
18Wisconsin Academy of Rural Medicine
- Builds on pioneering work of Howard Rabinowitz at
Jefferson Medical College in Philadelphia. - Result of 25 years asking land grant UW be true
to roots - Goal rural focused medical school within the
Madison based University of Wisconsin medical
school - Recruit students with rural background and career
goals - Locate education and training programs in rural
areas of WI during 3rd and 4th years of Med
School - Use rural appropriate curriculum
19HEALTHCARE COSTS
20Health Care Costs - Review of Reality
- In 2005, employer-based health insurance premiums
rose by 9, the fifth consecutive year over 9 - HMOS, PPOs and POS plans all showed this increase
- Annual premium charges an employer for a health
plan covering a family of four averaged 10,800
in 2005 - Gross earnings, full-time, minimum-wage 10,712
- Since 2000, premiums have increased 73, vs 14
cumulative inflation 15 cumulative wage
increase - The average employee contribution has increased
more than 143 since 2000
National Coalition on Health Care
http//www.nchc.org/
21What To Do About Unsustainable Cost Trends?
- Most agree that health care costs must be
controlled but disagree on the best ways to
address rapidly escalating health spending and
health insurance premiums - Price controls and imposing strict budgets on
health care spending? - Free market competition solves the problem?
- With healthier lifestyles, less medical care
required? - Cost of inaction will severely affect employer's
bottom lines, business location and consumer's
pocketbooks - How do different approaches effect rural health
care?
National Coalition on Health Care
http//www.nchc.org/
22POPULATION HEALTH
23Health Outcomes Driven By Multiple Determinants
- Access to Health Care (est 10)
- Health Behaviors (est 40) e.g. smoking, physical
inactivity, overweight, sexually transmitted
disease, motor vehicle crashes - Socioeconomic factors (est 40) e.g. education,
poverty, divorce rates - Physical environment (est 10)
2005 Wisconsin County Health Rankings, University
of Wisconsin Population Health Institute
24Critical Link Population Economic Health
- Businesses will move to where healthcare
coverage is less expensive, or they will cut back
and even terminate coverage for their employees.
Either way, it's the residents of your towns and
cities that lose out, Thomas Donohue?President
CEO, U.S. Chamber of Commerce - If we can change lifestyles, it will have more
impact on cutting costs than anything else we can
do, Larry Rambo, chief executive officer of
Humanas Wisconsin and Michigan health insurance
markets.
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26Initial Local Hospital Community Steps
- Devote a periodic Board meeting to review
available population health indicators - Add Board members with specific interest in
population health measurement and improvement - Create a population health subcommittee of the
hospital board to explore opportunities for
hospital partnerships with other community
organizations - With local employers, develop interventions to
improve employee health expand experience to the
larger community
Population Health Improvement Rural Hospital
Balanced Scorecards by Size T, Kindig D,
MacKinney C., Journal of Rural Health 3/06
27Strong Rural Communities Initiative
- Sponsored by states Rural Health Development
Council embedded in Wisconsin Department of
Commerce - Acquired 700K from 3 sources with 4th looking
good - The goal improve health of rural communities and
reduce healthcare cost inflation by accelerating
use of collaboration among medical, public health
and business organizations that enhance
preventive health services - Six local community projects chosen from 22
proposals - Variety approaches to modifying poor fitness,
nutrition habits through wellness programs at
work/community
RWHC Eye On Health Newsletter, 7/06
28ADVOCACY SKILLS
29Besides Funding, What Drives Advocacy?
- Need to Correct Bias - MedPAC Report
- Opportunity to Reframe - Hospital Compare
- Short-term Fix Needed/Possible - Building Ban
- Broad Coalition Possible - R.H. Appropriations
- Address Core Need - Physician Supply
- Anticipate Problems - Medicare Advantage
- Cant Be Avoided - Healthcare Costs
- Long-term Significance - Population Health
30Your Advocacy Behaviors Matter
- Be Brief
- Be Accurate - NEVER false or misleading info
- Personalize Your Message - cite examples
- Be Prepared - know your issue
- Be Aware Every Issue Has Two Sides - there are
voters on other side - Be Courteous/Dont Threaten
- Be Patient - long process be in for long haul
Wisconsin Hospital Associations Grass Roots
Handbook
31NRHAs Three Prong Advocacy Strategy
- Make your best case Develop concise, credible,
persuasive, fiscally responsible, but emotive
arguments. - Make friends and form alliances Find
Congressional champions, develop agency contacts,
form alliances with a diverse set of groups. - Make it happen Use some or all of your advocacy
tools government relations, grassroots and
media advocacy based on your level of
engagement.
Jennifer Friedman, VP Government Affairs and
Policy National Rural Health Association
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33Rural Health Needs Your Advocacy 24/7
- Rural advocates have an ongoing challenge, an
attitude in parts of Washington, and around the
country (including CMS) that is frequently ill
informed, about rural health and the reality of
improving rural health and health care - Rural advocates must not become complacent, all
of us must become more skilled and more active.
34- Questions/Discussion?
- For a free electronic subscription of the
- RWHC Eye On Health monthly newsletter,
- send an email to office_at_rwhc.com with
- subscribe on the subject line.