Rural Spotlight

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.

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.

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.

Updated Reports

PubHub has made the following reports available:

Training Strategies: EHR Deployment Techniques
 
Based on the California Networks for Electronic Health Record Adoption (CNEA) initiative designed to speed EHR implementation in safety-net clinics, explores approaches to training, their influence on implementation strategy, and streamlining effects.

HITECH Revisited
 
Assesses the 2009 Health Information Technology for Economic and Clinical Health Act, which offers incentives to adopt and meaningfully use electronic health records. Recommendations include revised criteria, incremental approaches, and targeted policies.
 
Standardized Performance Measurement and Reporting in Emergency Departments (EDs)
 
Describes the RWJF-funded Urgent Matters Learning Network, a collaborative of six hospitals working to develop strategies to improve patient flow and reduce crowding. Outlines seven standardized performance measures they are piloting and reporting on.

Payment Reform: Creating a Sustainable Future for Medicaid
 
Outlines elements of Medicaid payment reform that saves costs while improving access to quality care, including accommodating patient acuity, encouraging data collection, and supporting medical homes, bundled payments, and accountable care organizations.

Medicaid Expansion and Performance Research

PubHub has made the following reports available:

Medicaid Coverage and Spending in Health Reform: National and State-by-State Results for Adults at or Below 133% FPL
 
Estimates state and national cost increases from the 2010 health reform law's expansion of Medicaid to adults under age 65 with incomes up to 133 percent of the federal poverty line, in relation to enrollment increases under two outreach scenarios.

Enhancing the Capacity of Community Health Centers to Achieve High Performance
 
Based on a survey of community health centers, assesses access to care, care coordination, quality improvement efforts, health information technology adoption, and ability to serve as patient-centered medical homes. Suggests policy to strengthen clinics.

Medicare Changes

PubHub has made the following report available:

Explaining Health Reform: Key Changes in the Medicare Advantage Program
 
Summarizes changes to Medicare Advantage resulting from the 2010 healthcare reform law, including eliminating high payments to private plans, rewarding high-quality plans, and increasing consumer protections. Examines implications for the program.

SGR Update

From: Bill Finerfrock

On March 2, 2010 the Senate passed by a vote of 78-19 the 30 day extension of the SGR freeze.  The bill will now go to the President for his signature. The legislation extends the Medicare payment freeze (thereby temporarily voiding the 21% reduction) through March 31.  In addition, the legislation extends the Therapy Cap exception process through March 31. Because this is only a temporary, stop-gap measure, Congress will have to pass either another extension or a permanent fix for both of these issues otherwise the 21% cut and resumption of the Therapy Cap for all will occur on April 1.

Senate Jobs Bill Includes AHA-Backed HIT Provision

From: AHA News Now, February, 2010

WASHINGTON—A jobs bill being drafted by Senate negotiators would clarify the definition of hospital-based physician under the American Recovery and Reinvestment Act’s HITECH provisions to allow physicians who practice in hospital-owned outpatient centers and clinics to qualify for federal payment incentives for health information technology.

Don May, American Hospital Association Vice President of Policy, said the association “strongly supports” the provision, which would clarify the ARRA language and ensure that CMS does not inappropriately exclude physicians serving patients in outpatient centers from receiving Medicare and Medicaid HIT incentive payments. The draft bill also would delay through September 30 a 21 percent Medicare payment cut for physicians and extend premium assistance for COBRA benefits through May 31.

Among other provisions, the bill would make a technical correction to reimburse critical access hospitals at 101 percent of their reasonable costs for Method 2 outpatient services, and extend through 2010 expiring Medicare payment provisions related to rural hospitals, long-term care hospitals, the technical component of certain physician pathology services, mental health services and ambulances.

Defining ‘Meaningful Use’ and Setting Standards for Electronic Health Record Incentive Program

The Centers for Medicare & Medicare Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) encourage public comment on two regulations that lay a foundation for improving quality, efficiency and safety through meaningful use of certified electronic health record (EHR) technology. The regulations will help implement the EHR incentive programs enacted under the American Recovery and Reinvestment Act of 2009 (Recovery Act).

A proposed rule issued by CMS outlines proposed provisions governing the EHR incentive programs, including defining the central concept of “meaningful use” of EHR technology. An interim final regulation (IFR) issued by ONC sets initial standards, implementation specifications, and certification criteria for EHR technology.  Both regulations are open to public comment.
Read more about it by clicking here.

View the CMS rule by clicking here.

To view the ONC Standards and Certification final rule, click here.

CMS Details About 1135 Waiver

The Secretary of Health and Human Services has invoked her waiver authority under Section 1135 of the Social Security Act.  This allows for the waiver or modification of certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements to ensure that sufficient health care items and services are available to meet the needs of individuals enrolled in Social Security Act programs in the emergency area and for the time periods covered by the 1135 authority. 

Requests by providers to operate under the flexibilities afforded by the waiver should be sent to the state survey agency or CMS regional office.  Please visit this website for a detailed paper outlining the 1135 waiver process.

Further information on the 1135 Waiver process can be found by clicking here.