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Critical Access Hospital Advisory Council. Cari Fouts, Program Director Jen Dunn, CAH Program Coordinator. Welcome!. Introductions What’s in your binder? Housekeeping. CAH Advisory Council Agenda. Overview of current CO CAH program Update on current, new and developing CAH programs

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Critical Access Hospital Advisory Council

Cari Fouts, Program Director

Jen Dunn, CAH Program Coordinator


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Introductions

What’s in your binder?

Housekeeping


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Overview of current CO CAH program

Update on current, new and developingCAH programs

Explore HIT/ARRA requirements and opportunities

Strategic planning for future programs and project development

Learn about the QHi Benchmarking Tool



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Balanced Budget Act 1997

Rural area, or special provision

25 acute care beds, additional 10 distinct part rehab or psychiatric allowable

Average length of stay, 96 hours or less

35 miles from nearest hospital or CAH, or more than 15 miles of mountainous terrain, OR necessary provider before 12/05


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Enhanced Payment through Medicare

Most inpatient/outpatient services 101% of reasonable and allowable costs

Ambulance services owned/operated receive 101%

Provider-Based rural health clinics receive cost based reimbursement








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Medicare Rural Hospital Flexibility Program (Flex), created in 1997

Funding to support conversion and infrastructure to strengthen rural health care

  • Performance Improvement/Quality Improvement

  • Supporting Hospitals

  • Evaluation

  • Integration of EMS services

  • Networking (optional)

  • Conversion to CAH status (optional)


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Quality Improvement (Hospital Compare?)

Financial and Operational Performance Improvement

Community Engagement and Impact (regional and local collaborations)

Health Information Technology


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Colorado Department of Public Health and Environment

Colorado Foundation for Medical Care

Colorado Hospital Association

Centers for Medicare & Medicaid


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Board Webinar series

Member only Website access (tools and resources)

RAC resources –

  • CAH self audit tool

  • Group Discounted rates for Milliman or Interqual and EHR Physician Advisor services

    QHi Benchmarking Resource

    Nurse Leadership Training

    Capital Equipment Purchases - RACE Program

    Grant Writing Program – GROW

    RHC Technical Assistance Services


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Colorado Credentialing Network

Revenue Cycle Management Services

Peer Review Network Expansion

Swing Bed Online Training

Observation and UM Manual/Training

Community Paramedic Program


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Health Reform

Senate proposal has combined the Finance Committee and the HELP (Health, Education, Labor, and Pension) Committee.

Proposal being analyzed by the Congressional Budget Office (CBO) to determine costs.

Senate bill content unclear - not publicly released.

Rural amendments that NRHA is working to get included, once a bill is brought to the floor:

  • Allow flexibility in CAH bed count,

  • Raise the RHC cap to $92,

  • Waive the 35-mile rule for CAH designation, and

  • Rural Training Track funding for medical schools.

    Still many unknowns and uncertainty if there are enough votes to avoid a filibuster.

    Timeframe was set for this week or next, but there is talk that things could get pushed out until 2010.


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Health Reform

Combined three bills (current bill almost 2,000 pages) and received an approximate $1 trillion price tag from the CBO.

Hoped to have a floor vote this week; not likely to happen.

There are not enough votes to pass the current bill (need 218).

Points of contention: public plan option, cost, immigration, etc.

Note: House introduced a bill (H.R. 3961) that addresses the Sustainable Growth Rate (SGR) that would fix the current mandated cuts that must be addressed each year concerning Medicare rates to physicians. The Senate voted down a similar bill in October.

SGR not being addressed in any of the health reform proposals due to the price tag ($245 billion over 10 years)


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Legislative Updates

FY09-10: ~ $1.4 billion General Fund shortfall addressed during 2009 legislative session

Since then, an additional $589 million shortfall has been addressed

1.5% Medicaid Provider cuts effective September 1st; an additional 1% Medicaid Provider cuts effective December 1st

Delayed Medicaid payments – final two weeks of payment for FY09-10 will be shifted into FY10-11

Cuts and delayed payments will not apply to RHCs


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Legislative Updates

H1N1 Waiver available if bed capacity is reached:

http://www.cms.hhs.gov/H1N1/Downloads/RequestingAWaiver101.pdf

Final CMS OPPS Rule – outpatient therapeutic services supervision

  • Non-physician supervision as long as service is within scope

  • Must be “immediately” available to assist

  • Auditors not allowed to cite hospitals from 2000-2008


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Capacity building Grant

Capacity Building Grant to spread funding opportunity across all CAHs.

28 CAHs awarded funding


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Capacity Building Grant

Quality Improvement

HIT and Regulatory Compliance

Outmigration Studies

EMS Budget Tool Training

Education

  • Trauma Designation Consultation

  • Billing and Coding

  • Swing Bed Training

  • Board Training

  • Simulation Training

  • Leadership and Management


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Capacity Building Grant

Quality Improvement - 6 CAHs for Total of $20,691

HIT - 4 CAHs for Total of $28,825

Regulatory Compliance - 4 CAHs for Total of $19,000

Education/Capacity Building - 14 CAHs for Total of $83,425

  • Billing and Coding - 7 CAHs for Total of $39,400

  • Board Training - 4 CAHs for Total of $19,700

  • Swing Bed Training – 2 CAHs for Total of $3,400

  • Leadership Training – 4 CAHs for Total of $15,768

    Additional Funding Options (Outmigration Studies)

  • 3 CAHs for Total of $22,500


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    Capacity Building Grant

    Innovative Programs/Projects

    • 10 CAHs selected for Total CBG of $50,400

    • Examples

      • Health Fair

      • Prenatal Education

      • Customer Service Training Program

      • Cost Reporting

      • CAH Recertification

      • Montrose – feasibility study to build new CAH


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    Capacity Building Grant

    Grant guidance NOW AVAILABLE!

    Each hospital eligible for $8000 for 09/10

    Applications due back December 4, 2009

    New opportunities:

    • Business Development

    • Employee Satisfaction Survey

    • HIT Consortium

    • Credentialing Network and Services

    • Expanded Outmigration Options

    • EHR Physician Advisor, Milliman/InterQual


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    SHIP Grant

    Approximately $9000 available

    HIT Consortium Opportunity

    16 Hospitals Participating in Consortium

    Keefe

    Delta


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    Statewide Initiatives

    Center for Improving Value in Health Care (CIVHC)

    HIT Regional Extension Center

    RHC HIT Solutions

    Association of Rural Health Clinics of Colorado (ARHCC)

    Hospital Quality Incentive Payment



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    What do you find most beneficial about the Flex grant?

    How can we improve what we are currently doing?

    In a perfect world ($ no object!), what would the Flex grant provide?


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    CHA Rural Hospital Conference/CAH Workshop Merging in 2010

    • Topics?

      Quality Improvement Workshops in conjunction with Annual Conference


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    Frequency (Monthly, Bimonthly, Quarterly, TBD)

    Potential Topics

    • Board Governance

    • RAC/MIC/MAC, vegetable soup

    • Regulatory Changes

    • Observation Status

    • Others?


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    HIT Consortium Advisory Committee

    Peer Review Network Expansion Pilot


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