To help assist agricultural workers in learning about diabetes, Migrant Clinicians Network (MCN) has partnered with professional artist and collaborator Salvador Sáenz to create “Mi salud es mi tesoro: Un guía para vivir bien con diabetes,” or, “My Health is My Treasure: A Guide to Living Well with Diabetes.” This second edition comic book explores the topic through the full-color story of an agricultural farmworker whose recent diagnosis of diabetes prompts him to engage in conversations with other agricultural workers on topics of diet, exercise, and illness prevention while facing the unique hurdles of living a life of migration. The comic book is available in Spanish and English. In order to print the right number of comic books, MCN is asking organizations to pre-order in quantities up to 500. The comic book and shipping will be paid for by MCN.

Although compensation stagnated in the first year of the pandemic, doctors saw their salaries rebound by 7% by the end of last year, according to Medscape’s Physician Compensation Report released last week. The report includes financial details from about 13,000 physicians across 29 specialties and found primary care doctors earned $260,000 on average while specialists average $368,000. Of those specialties surveyed, plastic surgery averaged the highest compensation at $576,000 while public health and preventative medicine ranked lowest at $243,000.

Fighting a global pandemic on the frontlines of underserved communities has decimated the health center workforce with unprecedented rates of attrition. A new survey by the National Association of Community Health Centers (NACHC) reveals that 68% of health centers report a loss of workforce of up to 25 % in the last six months alone. Health centers are losing nurses more than any other staff, a trend that has brought into focus a worsening national crisis and an immediate challenge to future pandemic readiness. “The future of the Community Health Center workforce and our readiness to meet public health challenges is uncertain,” said Rachel Gonzales-Hanson, interim President and CEO of NACHC. “We must immediately invest in policies that will retain current health center staff, broaden the pipeline for the future workforce, and foster creative strategies at the community level for short and long-term solutions.” Read the entire press release from NACHC or download the report.

Investing in primary care as a preventative measure is associated with improved medical care quality, fewer hospital visits, and lower spending overall, a study has found. If all California providers spent as much on primary care as the highest investing health systems, they could avoid 25,000 acute hospital stays and 89,000 emergency department visits while saving $2.4 billion in healthcare spending a year, according to a study funded by the California Health Care Foundation, Covered California and the Milbank Memorial Fund. Read more.

On April 18, Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would update Medicare payment policies and rates for the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) for Fiscal Year (FY) 2023.

Payment Rates

In the proposed rule, CMS estimates a 3.2% increase to IPPS payments for FY23. Rural IPPS hospitals with 0-49 beds (348 hospitals) and 50-99 beds (211 hospitals) are expected to experience an increase in payments from FY 2021 to FY 2022 of 2.8% and 2.9%, respectively. These changes are primarily driven by the projected hospital market basket update of 3.1% reduced by a 0.4% productivity adjustment and increased by a 0.5% adjustment required by legislation. This rate is further reduced by a 1.8% outlier payment adjustment and other program expirations. CMS estimates total Medicare spending on acute care inpatient hospital services will decrease by about $300 million in FY 2023 compared to FY 2022.

Wage Index: For Area Wage Index, CMS is continuing its FY 2020 low wage index hospital policy to mitigate wage disparities. Additionally, CMS proposes a permanent 5% cap on any decrease in hospitals’ wage index from the previous year.

DSH Payments: CMS estimates that Medicare disproportionate share hospital (DSH) payments will total $6.54 billion, a $834 million decrease compared to FY 2022, due partially to a decrease in the uninsured population. Additionally, for the Medicaid part of this measurement, CMS proposes to define “regarded as eligible” to include only patients who receive health insurance authorized by a section 1115 demonstration or patients who pay for all or substantially all of the cost of such health insurance with premium assistance authorized by a section 1115 demonstration where state expenditures are matched with federal Medicaid funds.

Low Volume Hospitals: Low volume hospital qualifying requirements and payments will end and revert to statutory requirements in effect prior to FY 2011. CMS proposes that a low volume hospital must have less than 200 total discharges per FY and be located more than 25 road miles from another hospital paid under IPPS.

Medicare Dependent Hospitals: The Medicare-dependent hospital (MDH) program will expire at the end of FY 2022 without any congressional action. Alternatively, MDHs may apply for sole community hospital status by the September 1, 2022, deadline to be paid under that scheme.

Quality Reporting Programs

CMS is continuing its COVID-19 measure suppression policy for the Hospital Acquired Condition (HAC) reduction program, which allows it to not use any data that may have been distorted by the pandemic. CMS will suppress all six measures under the HAC program and consequently, hospitals will not be penalized for FY 2023. However, CMS will publicly report on healthcare associated infection (HAI) measures. CMS proposes to suppress HAI measures for FY 2024 with changes to adjust for COVID-19 diagnoses.

CMS proposes to suppress most Hospital Value-based Purchasing (HVBP) Program measures again. CMS plans to resume Hospital Readmission Reduction Program scoring for FY 2024. The measure is suppressed for FY 2023.

For the Hospital Readmissions Reduction Program (HRRP), CMS proposes to restart scoring hospitals on the pneumonia readmissions measure that is suppressed through FY 2023. CMS will add a COVID-19 diagnosis exclusion to the pneumonia measure, as is used for five other measures in HRRP. Last, for all HRRP measures, CMS plans to add patient history of COVID-19 in the past 12 months in the measures’ risk adjustment models.

CMS proposes ten new measures as part of the Inpatient Quality Reporting (IQR) program, including:

• Hospital Commitment to Health Equality, asking hospitals whether they are implementing certain health equity practices;
• Two measures regarding Social Drivers of Health, showing whether hospitals screen admitted patients for food insecurity, housing instability, transportation problems, utility needs and interpersonal safety;
• Two Electronic Clinical Quality Measures (eCQM) on rates of cesarean section births and severe obstetric complications; and
• Two other eCQMs reflecting hospital performance on opioid-related adverse events and malnutrition.

CMS proposes to continue hospitals’ COVID-19 reporting after the COVID-19 Public Health Emergency expires through April 24, 2024.

Workforce Provisions:

CMS is proposing to allow a rural and an urban hospital in the same Rural Training Program (RTP) to enter a RTP Medicare GME affiliation agreement, giving flexibility to teaching hospitals that cross-train students.

In response to a court striking down CMS’s method of calculating GME payments to teaching hospitals, CMS is proposing a new policy for situations where a hospital’s weighted full-time equivalent (FTE) cap is greater than its FTE cap. This policy would not reduce the weighting factor of residents outside of their initial residency period by more than 0.5.

Requests for Information:

CMS is seeking stakeholder feedback on several topics, including:

• Principles for measuring health care quality disparities;
• How hospitals can prepare for effects of climate change on beneficiaries and what CMS can do to help hospitals understand the effects of climate change on their patients;
• The appropriateness of payment adjustments accounting for the additional costs associated with acquiring NIOSH-approved N95 surgical respirators;
• A hospital quality and safety for maternal care designation awarded to certain hospitals;
• Future adoption of National Health Safety Network (NHSN) Healthcare Associated C. diff. Infection Outcome Measure and NHSN Hospital-Onset Bacteremia & Fungemia Outcome Measure to the IQR program.

Please share any questions or concerns with NRHA staff before the June 17, 2022, deadline. CMS’s FY23 Inpatient PPS NPRM Fact Sheet can be found here. The unpublished version of the proposed rule can be found here. The final rule will be published on or around Aug 1 and take effect Oct. 1.

For further questions, please contact Alexa McKinley, NRHA Government Affairs and Policy Coordinator, at amckinley@ruralhealth.us or another member of the Government Affairs team.

On April 15, 2022, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would update payment rates for the Skilled Nursing Facilities (SNFs) Prospective Payment System (PPS) for Fiscal Year (FY) 2023 and propose changes to SNF Quality Reporting Program (QRP), SNF Value Based Purchasing Program (VBP), and requests information regarding requirements for Long-Term Care (LTC) facilities to establish mandatory minimum staffing levels.

Key proposals include:

• Updated payment rates by 3.9%, reflecting a market basket index percentage change of 2.8%, increased by the forecast error adjustment of 1.5% and reduced by the productivity adjustment of 0.4% required under the Affordable Care Act. However, a 4.6% proposed parity adjustment to ensure budget neutrality results in an approximately $320 million decrease in Medicare Part A payments to SNFs in FY 2023.
• Requesting information on establishing mandatory minimum staffing requirements for LTC facilities. Specifically, feedback on evidence that establishes an appropriate minimum staffing requirement, associated costs, rural considerations including workforce recruiting challenges, and how the minimum staffing requirement should be measured.
• Adopting the Centers for Disease Control (CDC) Influenza Vaccination Coverage among Healthcare Personnel (HCP) measure for the SNF QRP in FY 2025 to report the percentage of HCP that receive the influenza vaccine each season.
• Revising the compliance date to October 1, 2023, for collecting data on Transfer of Health (TOH) Information to Provider-PAC measure, TOH Information to Patient-PAC measure, and certain standardized patient assessment data elements.
• Adopting new SNF VBP quality measures including the SNF Healthcare Associated Infections (HAI) Requiring Hospitalizations measure and the Total Nursing Hours per Resident Day staffing measure in FY 2026 and the Discharge to Community Post-Acute Care (DTC PAC) measure in FY 2027. Currently, hospital readmissions are the only quality measures for VBP.
• Implementing case minimums and measure minimums as eligibility requirements for inclusion in VBP programs and incentive-based payments.

NRHA plans to submit comments on the proposed rule. Please share any questions or concerns with NRHA staff before the June 10, 2022, deadline. CMS’s FY23 SNF PPS Fact Sheet can be found here. President Biden’s remarks on improving nursing home safety and quality can be found here. The proposed rule can be found here.

For further questions, please contact Alexa McKinley, NRHA Government Affairs and Policy Coordinator, at amckinley@ruralhealth.us or another member of the Government Affairs team.

Most children from 5 to 11 years old hospitalized with COVID-19 during the U.S. surge driven by the Omicron variant were unvaccinated, per a Centers for Disease Control and Prevention study published Tuesday. The study of children hospitalized in the U.S. from Dec. 19 to Feb. 28 found the hospitalization rate was 2.1 times higher for those unvaccinated than their vaccinated peers. Read more.

While many people are cheering the lifting of the masking requirement for public transportation, others are fearful that the lax rules now could lead to more cases of COVID-19 infections. Those who face higher risks say they are especially nervous. In interviews, older Americans, people with compromised immune systems, parents with young children, and low-income workers who rely on public transportation worried that they would now be at even greater risk with every bus ride or plane trip.

Pregnancy and those first weeks and months with your child are a beautiful, transformative time. Those times can also be physically and mentally difficult and occasionally overwhelming.

Nearly 60 percent of pregnancy-associated deaths happen between 42 days and one year after giving birth. In Pennsylvania, these pregnancy-related deaths are higher among Black women and women whose births were covered by Medicaid. The most common cause of death in the late postpartum period is heart failure or heart attack. Again, this disproportionately affects Black women and women with low incomes who receive their health coverage through Medicaid.

This is unacceptable. Black mothers deserve better.

Black mothers deserve comprehensive care for the physical and emotional trauma of birth that does not disappear at a six-week postpartum visit. Since taking office, Governor Wolf has prioritized expanding access to health care and supportive services that help parents through pregnancy and the postpartum period and gives children a strong, healthy start that can lead to continued good health, well-being and positive outcomes throughout their lives.

Medicaid Extension of Postpartum Coverage Period

Effective April 1, 2022, under the American Rescue Plan Act, Pennsylvania extended the Medicaid postpartum coverage period for mothers and birthing people who are eligible for the program because of their pregnancy to one year following the birth of a baby. Previously, Medicaid — or Medical Assistance in Pennsylvania — provides coverage for people eligible due to their pregnancy ended 60 days after giving birth. Extending postpartum coverage for those covered through Medicaid will provide continuity in health care by allowing birthing parents to maintain relationships with and access to care providers undisrupted through a critical period in their lives and their babies’ lives.

Press Release: Extension Increases Access to Critical Postpartum Care

Statistics & Facts

• About 3 in 10 births nationwide are paid for through Medicaid, but traditionally, coverage for people who qualify because they are pregnant ends 60 days following the birth of a baby unless their income or circumstances change.

Maternal Mortality

• In Pennsylvania, pregnancy-related deaths grew by more than 21 percent between 2013 and 2018.
• Nationally, about 12 percent of pregnancy-related deaths occur between six weeks and one year postpartum, but almost 60 percent of those are preventable.
• Black women are 3 to 5 times more likely than white women to die after giving birth.
• Statistics from 2020 show the pregnancy-related mortality rate of Black mothers was disproportionate to White and Hispanic mothers:
  • Black Mothers: 55.3 deaths per 100,000 births
  • White Mothers: 19.1 deaths per 100,000 births
  • Hispanic Mothers: 18.5 deaths per 100,000 births

Perinatal Mental Health

• Perinatal depression is the most common complication during pregnancy and the postpartum period.
• 1 in 7 women experience depression during or following a pregnancy, but too often it can go undiagnosed.
• A 2018 study published by the National Institute of Health (NIH) reported that just 1 in 5 women report symptoms of depression or anxiety during or after a pregnancy to a health care provider, but follow through for treatment may be even lower, especially for women of color.

Quality of Care

• People from some racial groups are more likely to be uninsured than non-Hispanic Whites.
• Research indicates that 22 percent of Black women receive a lower quality of care than white women and are subject to discrimination in the health care field.
• According to the American College of Obstetricians and Gynecologists (ACOG), in 2008 only 6.4 percent of obstetricians-gynecologists practiced in rural areas.

Additional Maternal Health Resources

• Health Resources & Services Administration (HRSA) Maternal & Child Health
• Black Mamas Matter Alliance
• March of Dimes
• Strong Start for Mothers and Newborns Initiative — Centers for Medicaid & Medicare Services
• World Health Organization (WHO) response
• Proclamation on Black Maternal Health Week, 2022 — The White House
• The U.S. Surgeon General’s Call To Action to Improve Maternal Health

An initial $200 million in funding from the 2021 coronavirus relief package is supporting the development of a forecasting center for infectious diseases at the Center for Disease Control and Prevention (CDC). The center has awarded $21 million to academic institutions to develop modeling and forecasting methods. Read more.