Rural Spotlight

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Reform Options

PubHub has made the following reports available:

Health Affairs/RWJF Policy Brief: Paying Physicians for Medicare Services

Examines the pros and cons of multiple scenarios for cutting physician payments for Medicare, including allowing scheduled reductions to take effect, abandoning the sustainable growth rate system, long-term modifications, and other payment reform options. 

Use of Comparative Effectiveness Research in Drug Coverage and Pricing Decisions: A Six-Country Comparison

Examines the review processes of comparative effectiveness research in drug coverage and pricing in Denmark, the United Kingdom, France, Germany, the Netherlands, and Sweden. Considers policy implications for the United States, including limitations.

Will the Patient Protection and Affordable Care Act of 2010 Improve Health Outcomes for Individuals and Families?

Summarizes how healthcare reform provisions including coverage expansions, enhancements, and focus on prevention and safety, quality, and coordination of care will affect children and families. Considers supply limitations and implications for access.

The Challenging Role of Rural Physicians

The Evansville Courier and Press has released an article supporting the need for health reform in rural America. Some counties only have a couple doctors for all of the residents who live there. The article focuses on challenges faced by these small town doctors. Read the article here.

Office of Civil Rights (OCR) Issues New Rules for HIPAA Privacy and Security

The OCR proposed a new rule on July 8, which promises to strengthen and widen the enforcement of HIPAA. The modifications include:

1. Placing additional restrictions on disclosures of PHI with regards to marketing, fundraising, and health plans
2. Allowing patients greater access to their health information
3. Mandating that business associates of HIPAA-covered entities follow the same regulations as the covered entities themselves
4. Preventing the sale of PHI without prior authorization of the patient

HHS has also created a website, where the agency will provide current policies and future privacy initiatives.

View the privacy website here.

View the HHS Press Release here.

HHS Releases Final Rules for Meaningful Use and Electronic Health Records

On July 13th, two companion rules regarding meaningful use and standards and certification of EHRs were released.

There were several major changes in the CMS final rule on meaningful use. For one, eligible professionals and eligible hospitals will experience greater flexibility with regards to the required objectives for demonstrating meaningful use. The requirements have been divided into two groups: a "core" group of objectives which must all be met and a "menu" set of objectives that hospitals and providers can pick and choose five to demonstrate.

In addition, the list of objectives was expanded to include the provision of condition-specific patient education resources and the recording of advance directives for eligible hospitals. The definition of a hospital-based EP was clarified as an individual who performs almost all of their services in an inpatient hospital setting or emergency room only. Finally, the rule expands the definition of acute-care hospital to include designated Critical Access Hospitals for the Medicaid incentive program.

The Final Rule will be published in the Federal Register on July 28th. The Final Rule released by the ONC on standards and certification remained the same.

View the CMS MU Final Rule here.

View a comprehensive overview of the changes here.

View the ONC Final Rule on Standards, Implementation Specifications and Certification Criteria here.

View the HHS Press Release here.

EHR Final Rules Provide Blueprints to Better Healthcare

With the recent published rulings on EHR certifications and standards and meaningful use, Dr. David Blumenthal believes we have the foundation necessary to support the effort to improve healthcare across America. EHRs provide a wide array of benefits:

• Make medical histories readily available to physicians so they may make more knowledgeable clinical decisions
• Allow for easier tracking of results
• Provide warnings of serious health conditions and possible drug interactions through automatic alerts
• Enable e-Prescribing

While many have already begun their EHR implementation process, there are still many more who have yet to do so. The rulings that have been released will serve as a guide for those embarking upon their EHR journey.

Read Dr. Blumenthal's full blog post here.

Gain more up-to-date meaningful use information here.

Comparing Health Care in Modern Nations

PubHub has made the following report available:

Measuring the U.S. Health Care System: A Cross-National Comparison

Compares U.S. healthcare data including hospital beds and physicians, hospital and physician visits, healthcare spending, and high-tech procedures per capita, as well as life expectancy with those of twenty-nine other industrialized countries.

Electronic Health Record Incentive Program

On July 13, 2010, the Centers for Medicare & Medicaid Services (CMS) released a final rule outlining the Medicare and Medicaid incentive guidelines for Eligible Providers (EPs) and Eligible Hospitals (EH) for
Stage 1 of Meaningful Use (MU). The final rule defines the minimum requirements that providers must meet through their use of certified Electronic Health Record (EHR) technology in order to qualify for the
payments. The MU rule is to be used in tandem with rules that have been released by the Office of the National Coordinator that define Certified EHR Technology.

CMS has modified the eligibility requirments for Critical Access Hosptials (CAH) by expanding the definition of acute care hospitals to include the CMS Certification Number (CCN) of 1300-1399, which now enables CAHs to qualify for the Medicaid incentives under MU as long as 10% of their inpatient census constitutes Medicaid recipients. Also, CMS has incorporated a definition of a hospital-based EP as one who performs substantially all of his or her services in an inpatient hospital setting or emergency room only, which  conforms to the Continuing Extension Act of 2010.  Additionally, the final rule reduces the the number of quality measures for both EHs and EPs to those that are NQF-endorsed and electronically specified as of the publication of the final rule. Further, the rule establishes a core set of Objectives(15)
and Measures to be met by all EPs and EHs and a menu set of Objectives and Measures of which any five may be chosen.

Another rurally important note is that CMS has expanded the definition of Physician Assistant-led Rural Health Clinics: 1) When a PA is the primary provider in a clinic (for example, when there is a part-time
physician and full-time PA, CMS would consider the PA as the primary provider); 2) When a PA is a clinical or medical director at a clinical site of practice; or 3) When a PA is an owner of an RHC.

Requirements for meaningful use incentive payments will be implemented over a multi-year period, phasing in additional requirements that will raise the bar for performance on IT and quality objectives in later years.The rule also includes the formula for the calculation of the incentive payment amounts; a schedule for payment adjustments under Medicare for covered professional services and inpatient hospital services provided by EPs, eligible hospitals and CAHs that fail to demonstrate meaningful use of certified EHR technology by 2015; and other program participation requirements. Learn more here.

Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology

On July 13, 2010, the Office of the National Coordinator for Health Information Technology (ONC) released a final rule to complete the adoption of an initial set of Standards, Implementation Specifications, and Certification Criteria, to align with the requirements of the Centers for Medicare and Medicaid Services (CMS) Meaningful Use Incentive Stage 1 objectives and measures. The rule establishes the specifications to attain Certified Electronic Health Record (EHR) Technology, either as complete systems or modules, to meet the CMS Stage 1 requirements. The Complete EHRs and/or EHR Modules will be tested and certified according to adopted certification criteria to ensure proper implemented adoption standards and implementation specifications comply with the certification criteria. Learn more here.

Providing Medical Homes

PubHub has made the following report available:

Colorado Children's Healthcare Access Program: Helping Pediatric Practices Become Medical Homes for Low-Income Children

Describes a nonprofit improving access to care for children enrolled in Medicaid by helping pediatric practices become medical homes, offering administrative support, and assisting with referrals to community groups and agencies. Includes lessons learned.

Technology Tools and Resources

Click here to read a document containing the Top 10 Health Information Technology (HIT) Tools and Resources identified by the Rural Hospital Performance Improvement (RHPI) Program. Careful planning and the right tools can mean the difference between electronic health delivery systems that are burdensome, and those that achieve value. The purpose of this document is to provide rural-relevant tools that will help rural hospitals plan for and implement HIT without having to reinvent the wheel.

The attached document supplies a variety of tools for use at different points in HIT adoption. Each tool includes a:

    * Brief statement describing when to use the tool and what it can achieve
    * Description on how the resource can be utilized in your state
    * List of the specific components of the tool 

From One State to Another

PubHub has made the following reports available:

What Is the Evidence on Health Reform in Massachusetts and How Might the Lessons From Massachusetts Apply to National Health Reform?

Examines the gains in health coverage, healthcare access, use, affordability, and quality Massachusetts has seen as a result of health reform, as well as the challenges in sustaining reform as provider capacity remains limited and healthcare costs rise.

Medicare Advantage 2010 Data Spotlight: Plan Enrollment Patterns and Trends

Provides data on nationwide enrollment trends in Medicare Advantage plans by plan type, area, region, and firm or affiliate. Also examines trends in enrollment in group and special needs plans, market concentration, and premiums.