Frontier Partners’ Meeting: Alaska FCHIP - PowerPoint PPT Presentation

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Frontier Partners’ Meeting: Alaska FCHIP

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  1. Frontier Partners’ Meeting:Alaska FCHIP Pat Carr Alaska State Office of Rural Health April 16, 2013

  2. Alaska’s Setting • Complex demographics, geography and history • Complex health care system. • Tribal beneficiaries comprise 20% of the population • Military/Veterans comprise another 14%. • Additional federal employees • Approximately 75% of Alaskan communities are inaccessible by road • Five of the seven CAHs eligible for this FCHIP Demo inaccessible by road

  3. How Alaskans Receive Health Care • Private sector, providing a broad range of services. • Public system, funding some hospitals, public health nursing and behavioral health. • Tribal system, which includes 20% of the population, far higher than the U.S. average of 2%. • Military and Veterans’ Administration; military accounts for 14% of the AK population

  4. AK Facilities Meeting Criteria for Demo Cordova Community Medical Center Norton Sound Regional Hospital Petersburg Medical Center Providence Seward Medical and Care Center Providence Valdez Medical Center Sitka Community Hospital Wrangell Medical Center

  5. Challenges to Facilities • Geographic isolation • Low population density, resulting in weak reimbursement base • Recruitment and retention of providers • Limited home health, hospice, and rehab services – not financially viable • Challenges in providing telehealth, low payment from originating site • No rural health clinics

  6. Service Concerns • Nursing home beds • Emergency Department services • Behavioral Health Services • Telehealth

  7. Medicare Charges for Inpatient Services – Frontier CAHs Source: Xerox State Health Care, LLC. From CMS Hospital Service Area File C 2010

  8. Desired Outcomes • Increase local capacity • Encourage integration • Decrease volume of patients requiring inpatient stays • Reduce volume of medical evacuations • Increase savings

  9. Recommendations for Payment Modifications in the Proposed FCHIP Demonstration • Creation of a grant or other mechanism for upfront support of Electronic Health Records capital expenditures • Creation of a grant or other mechanism for upfront support of Care Coordinators at the nursing or social work level • Home health, specialty clinics and physician home visits to be included on the cost report as allowable expenses

  10. Providence Valdez Medical Center

  11. Recommendations cont. 4. Waiver of telehealth restrictions contained in Section 1834(m), including: • Allow telehealth service delivery and reimbursement in the home • Allow Medicare reimbursement of diabetes education • Increase the telehealth “originating site” facility fee • Allow more flexibility in frontier telehealth privileging and credentialing • Alaska specific recommendation: Grant or other mechanism for upfront support for a Telehealth Coordinator role