MHA's Center for Rural Health

CMS updates EHR program guidance for CAH physicians

The Centers for Medicare & Medicaid Services has issued updated guidance that explains how certain physicians who provide services in the outpatient departments of critical access hospitals can participate in the Medicare Electronic Health Record Incentive Program beginning this year. The affected physicians are those for whom a CAH bills Medicare for their outpatient department services using optional Method II.

Under this method, the CAH bills Medicare on behalf of the physician for services covered under the Medicare Physician Fee Schedule. Due to system constraints, CMS did not include these Method II claims when it identified which physicians were eligible for its incentive programs.

As a result, Method II physicians were inappropriately excluded from the EHR incentive program because they were designated as "hospital-based" when they are not. In response to concerns raised by the American Hospital Association and others, CMS is implementing system changes to allow these physicians to participate.

September 2012: Medicare Advantage Enrollment Update

In September 2012, rural enrollment in Medicare Advantage (MA) and prepaid plans increased to nearly 1.8 million, accounting for over 17% of the rural Medicare population and representing a 1.5 percentage point increase from the previous year. Nationally, nearly 27% of the Medicare population is enrolled in an MA or other prepaid plan (approximately 13.6 million).

Read more here.

Where Critical Access Hospitals Fit in Healthcare Reform: Q&A With West Park Hospital CFO Pat McConnell

For the state of Wyoming, healthcare may seem rather simple.

It is the least-populous state in the country, with only 576,000 people living within its borders, and there are less than six people for every square mile — second to only Alaska.

With such a small population, delivering and coordinating healthcare services does not seem like such a difficult task, but that couldn't be farther from the truth. Just ask Pat McConnell, CFO of West Park Hospital in Cody, Wyo. — a city with less than 10,000 people but one of Wyoming's top 15 most-populous areas.

Here, he explains why rural health care is such a big part of his life, why critical access hospitals are just as vital as large tertiary centers and what other rural hospital CFOs need to concentrate on.

The wages of recruiting rural docs

Bisbee, Ariz., is a former mining town of about 6,700 people, some 12 miles north of the Mexican border and nearly two hours southeast of Tucson. It's now known as an enclave of sorts for artists and hippies and was even a one-time runner-up as the “quirkiest” town in America. But while it has attracted galleries and coffeehouses, it has struggled to find healthcare providers.

Read the full story from Modern Healthcare here.

Rural provider shows size no barrier to EHRs

Some small, rural health care organizations have become health information technology front-runners and their leaders techno mavens, despite the digital divide that separates the larger, urban health IT have-nows from the smaller, rural IT have-not-yets.

Read more from Modern Healthcare here.

How do we provide hospital services in rural areas?

How does a society provide hospital care for people located in remote, sparsely-populated areas? What role does government play in providing financial support to keep the doors open for small rural hospitals? These are questions of long-standing concern to policy makers. An approach has been the creation of special reimbursement categories for these hospitals under the Medicare program -- such as the critical access hospital (CAH) designation, among others. In this issue of The Journal of Rural Health, there are three articles looking at the financial performance and quality issues related to critical access hospitals.

Read more from the American Hospita Association Resource Center blog here.

Critical Access Hospitals Strive to Improve Outcomes in MT

Mergers and acquisitions are rampant in healthcare these days as large health systems get larger and use their size and market share to improve efficiencies, coordinate care, reduce costs, and leverage terms with vendors and insurers.

At the other end of the spectrum are critical access hospitals. These tiny, isolated providers by their mission and geography aren't able to tap into the advantages of this bigger-is-better delivery model. So they improvise.

Read more from HealthLeaders Media here.

Risk & Reward: Challenges Facing Rural Hospitals

Demographic, geographic and financial constraints pose some daunting challenges for rural hospitals. Rural leaders also have to figure out where their institutions fit in a more integrated delivery system. In this exclusive interview, the University of Iowa's Clint MacKinney, M.D., discusses the risks and rewards facing rural hospitals.

Watch the video here.

Senators urge support for Medicare/children’s GME, rural hospitals

Several senators on April 17 urged the administration to increase funding for the Children’s Hospital Graduate Medical Education program and showed support for Medicare GME and critical access hospitals during a Senate Finance Committee hearing on the administration’s proposed Health and Human Services budget for fiscal year 2014. Sen. Bob Casey (D-PA) noted that the budget includes just $88 million in funding for the CHGME program, which trains nearly half of all pediatricians.

“I think that’s a mistake,” he told HHS Secretary Kathleen Sebelius at the hearing. “I don’t know how we’re going to get the trained pediatricians we need.”

Sens. Bill Nelson (D-FL), Robert Menendez (D-NJ) and Maria Cantwell (D-WA) also expressed concern about proposed Medicare GME cuts. “We can’t keep cutting graduate medical education, which is Medicare’s subsidy for residents,” Nelson said.

Sen. Pat Roberts (R-KS) expressed concern that the budget takes a “Lizzie Borden whack” at Medicare reimbursement for critical access hospitals and proposes a CAH mileage requirement. “I hope we’re not going to go back to that,” Roberts said. “I wish you would take a look at the critical access situation.”

[ via AHA News Now ]

Rural doctors slow to adopt electronic medical records

The 2009 Recovery Act actually set aside $20 billion to help health care providers ditch the paper records and go electronic. The idea was to cut soaring health care costs in the U.S. But while physicians backed by large health care groups can afford the system, many rural physicians are struggling to make that transition.

Read more from Marketplace Health Care here.