MHA's Center for Rural Health

What Should Rural Health Care Look Like After Reform?

Numerous proposals in the various reform bills under discussion in Congress are designed to improve health care for rural communities. But one issue that seems critical in the eyes of some advocates is that of insurance coverage, whether it is public or private.

Read more here.

Physician Shortage Worries Rural Communities But Gets Little Attention In Health Bills

Garfield Memorial Hospital in Pomeroy, Wash., has been struggling to make ends meet for years – through patient revenues and property taxes that helped cover a $70,000 roof repair – the Seattle Times reports. Many rural hospitals face similar problems, and in the case of Pomeroy, if the hospital closed, residents would have to travel miles to find other choices.

Hospital administrators and residents are wary of federal efforts to reform health care that could include changes to Medicare payments. "If Medicare pays us less for treating people, we'll be down the tubes," one nurse said.

Read more here.

The Provider-Based Rule for Critical Access Hospitals

The Centers for Medicare and Medicaid Services (CMS) has proposed a new rule to limit the ability of your Critical Access Hospital to operate off-site provider based facilities. The NRHA is very concerned that this proposal would ban "necessary provider" Critical Access Hospitals from operating any offsite facilities and placing a severe and undue burden on all other Critical Access Hospitals from operating provider based facilities.

The new rule is significant since it not only provides clarification of existing provider-based regulations, but also appears to implement new requirements not previously addressed in existing regulations or otherwise.

Your Critical Access Hospital is considered to be a hospital within the provider-based rule (PBR). In this webinar, the overall purpose and function of the provider-based rule is addressed as well as critical information concerning physician supervisory changes. While CMS claims these are not changes, but simply clarification, hospitals must take appropriate action to maintain compliance. Additionally, the overall compliance issues surrounding provider-based status will also be discussed in the context of conducting an audit.

If the new interpretations are not changes, then will the RACs be able to apply the clarified interpretations back to October 1, 2007? 

The Mississipp Hospital Association is hosting a LIVE Webinar at 1 p.m. CST on Thursday, October 15, 2009, on this topic. Learn more here. Register online here. For more information, contact Diane Clift at (800) 289-8884, (601) 368-3217 or dclift@mhanet.org.

Report Highlights Rural Health Care Challenges

A new report highlights the health care challenges in rural America.

"Rural residents have even more cause to support a public health insurance plan than those living in cities, advocates of such a plan said Thursday," The Omaha World-Herald reports. "The Center for Rural Affairs in Lyons, Neb., and the Center for Community Change issued a joint report highlighting the particular health care challenges faced by those living in rural parts of the country."

The report says that one key factor "is the reliance of rural economies on self-employment and small businesses. That creates a lack of employer-sponsored health insurance and means more people are left to seek out their own individual insurance coverage.

The report cites statistics showing that rural areas have twice as many underinsured individuals as their urban counterparts and that rural residents pay 22 percent more of their total health care costs than people living in or near metropolitan areas." Participants in a Capitol Hill event Oct. 1 "said that opinion polling and anecdotal evidence indicate that substantial support for a public option exists among rural residents" (Morton, 10/2).

The Daily Yonder, a daily multi-media source of rural news and commentary,reports on the health disparities between urban and rural America. "The difference between the death rates in rural and urban America has been increasing since 1990.

Mortality rates have declined in both the cities and the countryside, but since 1990 urban death rates have improved at twice the rate of rural." The higher rates of rural mortality are "another example of a health penalty paid by rural residents. Last year, researchers at Harvard University found that life expectancy for women living in nearly 1,000 mostly rural counties had declined from 1983 to 1999."

In a 2008 issue of the American Journal of Public Health, Mississippi State University sociologist Arthur Cosby wrote that a "possible explanation for the emergence of the nonmetropolitan mortality penalty is based on the observation that access to health care is the most pervasive health disparity in the nonmetropolitan United States. … If healthcare is becoming significantly more effective in prolonging life, then limited access to healthcare is becoming profoundly harmful to the nonmetropolitan US population, hence, the nonmetropolitan mortality penalty" (Bishop, 9/30).

[ via Kaiser Health News ]

Commentary: A Rural Health Reform Shopping List

With key members of the Senate Finance Committee and the Blue Dog Democrats hailing from predominantly rural states, advocates for non-urban regions are more hopeful than ever that they are finally getting their message across. Here are some essential reform measures that hospitals, physicians, community clinics, and other care providers in rural parts of the country say are needed to correct inequities for providers in low-population areas of the country.

DoD issues final TRICARE rule for CAHs

The U.S. Department of Defense on Aug. 31 published a final payment rule for critical access hospitals under TRICARE, which covers uniformed service members and their families. Effective Dec. 1, the rule adopts Medicare’s reimbursement methodology for CAHs, paying 101% of reasonable costs for inpatient and outpatient care.

As recommended by the American Hospital Association, the department dropped a proposal to pay CAH’s the lesser of costs or charges. Instead, the agency will place threshold limits on the cost-to-charge ratio for CAHs by using the method Medicare uses to identify outliers in the outpatient prospective payment system. TRICARE will use historical data to calculate the cost-to-charge ratios and payments.

DoD said it was “not administratively feasible” to make interim payments or conduct retroactive cost settlements, since TRICARE is a relatively small payer and hospitals do not file cost reports with the program.

Ambulance Coding, Billing & Reimbursement for Critical Access Hospitals

On Sept. 17, the Mississippi Hospital Association will host a Webinar on ambulance coding, billing and reimbursement for CAHs from 1 p.m. until 2:30 p.m.

Objectives:

• To review the levels and types of ambulance services that are generally in use
• To discuss documentation issues and associated charge capture issues for ambulance services
• To review compliance issues such as medical necessity, the use of ABNs (Advance Beneficiary Notices) and the EMTALA interface
• To review the ChargeMaster setup and associated coding requirements for claims development
• To review the payment process for ambulance services for the Critical Access Hospital
• To work through a series of exercises to discuss typical situations in the use of ambulance services
• To briefly compare the way in which the Medicare Ambulance Fee Schedule (AFS) pays for ambulance services

Register online here.

Nursing Students Learn About Rural Healthcare

A divide commonly exists between rural communities and health care access, but a grant will soon allow University of Virginia nursing students to be in closer reach. Fourth-year nursing students will travel to some of the state's rural communities to devise interventions for the locations' largest health problems.

Learn more here.

Doctors Create Program To Help Providers Adjust To Rural Work Settings

A group of doctors has created a post-doctorate program to provide rural communities with a pipeline of providers, The Iowa Independent reports.

Conference attendees this week in Sioux Falls, S.D., discussed rural health physician shortages and difficulties, especially in mental health and helping doctors adjust to the special needs of rural communities. The program aims to help that, The Iowa Independent reports.

"Dr. Jeffrey Leichter, one of five founding members of the Minnesota Consortium for Advanced Rural Psychology Training, told conference attendees on Tuesday that one of the major challenges associated with bringing behavioral health care providers into rural areas is that few are adequately prepared for the realities of practicing there." Because of the problems of poor, uninsured residents living in isolated areas, "Leichter and four other local providers accepted a $23,000 Minnesota state grant and began writing a curriculum that would specifically provide post-doctorate psychologists with first-hand experiences of practicing in a rural setting. Since accepting its first psychology resident in 2006, MCARPT has graduated three students, all of whom have gone on to provide services in underserved areas of Minnesota."

Also in the news, Sen. Dick Durbin introduced a bill this week that would allow certified registered nurse anesthetists to be reimbursed by Medicare - a measure designed "to help rural hospitals," The Associated Press/Chicago Tribune reports.

[ via Kaiser Daily Health Policy Report ]

Smaller Rural Hospitals Face Unique Health IT Challenges, Report Finds

According to a new report from research firm KLAS, many small rural hospitals are unsatisfied with the availability of health IT tools tailored to their needs. The report also identified widespread interest in computerized physician order entry systems

Learn more here.