In partnership with the CMS Innovation Center, Pennsylvania’s Department of Health developed the Pennsylvania Rural Health Model to test whether care delivery transformation and hospital global budgets can increase access to high-quality care, improve health, reduce the growth of hospital expenditures across payers, and improve the financial viability of rural Pennsylvania hospitals.  Under this model, CMS and other participating payers pay rural hospitals on a global budget—a fixed amount of revenue, set in advance, to cover all inpatient and hospital-based outpatient services.  In the brief, the Rural Health Value team explains their process for working one-on-one with rural hospitals to prepare a Transformation Plan (TP) with measurable goals for addressing potentially avoidable utilization, operational efficiency, and unmet community needs. This brief is intended for those exploring or considering global budget or other transformation models for rural hospitals (e.g., state governments considering global budgeting models, hospital associations, rural hospital administrators, federal policymakers, etc.).  Rural Health Value was created in a cooperative agreement with the Federal Office of Rural Health Policy to provide rural-centric expertise and assistance to support high performance rural health systems.  The brief can be accessed here.

During the week of September 23, 2019, CMS released detailed files to explore the 2020 Medicare Advantage and Prescription Drug plan offerings as well as state-level Fact Sheets detailing premiums and plan offerings for the coming year.  It is estimated that there will be about 1,200 more Medicare Advantage plans operating in 2020 than in 2018 and a 14 percent decrease in the average monthly Medicare Advantage premium compared to 2019.  About one-quarter of rural Medicare beneficiaries were enrolled in Medicare Advantage in 2018.

Becker’s Healthcare:  Tuesday, September 24, 2019

CMS has issued a final rule detailing how $4 billion in cuts to Medicaid Disproportionate Share Hospital payments will be implemented beginning Oct. 1.

Under the Medicaid DSH program, hospitals that serve a large number of Medicaid and uninsured patients receive payments to help cover the costs of caring for them. Assuming that uncompensated care costs would decline as the number of insured people increased under the health law, the ACA lowered Medicaid payments to hospitals that serve a disproportionate share of low-income patients.

CMS issued a final rule in 2013 to implement cuts to DSH funding, but subsequent legislative efforts have delayed the federally required cuts.

A $4 billion reduction in DSH payments is scheduled for the start of fiscal year 2020.

Now, Congress again is considering a delay of the cuts. According to the American Hospital Association, the U.S. House has approved a resolution that would delay the cuts through Nov. 21, and the U.S. Senate is expected to take up the issue this month.

CMS said its final rule “delineates the methodology to implement” the cuts.

On September 26, 2019, the Senate voted 82-15 to pass a stopgap spending bill (HR 4378) that would fund the federal government through Nov. 21, including funding extensions for community health centers, teaching hospital programs, and more. The measure now goes to President Trump who is expected to sign it before the Oct. 1 deadline to prevent a federal shutdown. (Source: Politico, 9/26)

The U.S. Census Bureau today released a new set of estimates from the American Community Survey for the year 2018, providing new data for a variety of demographic and economic topics for the nation, states, and other areas with populations of 65,000 or more.  Access the data on the Bureau’s new data dissemination platform, data.census.gov.

September 19, 2019

Stratis Health announced eight critical access hospital (CAH) staff who will serve as national Virtual Quality Improvement Mentors through a new initiative that aims to broadly transfer knowledge from leading CAH quality improvement staff to others across the country. The initiative is organized through Rural Quality Improvement Technical Assistance (RQITA), a program of Stratis Health supported by the Federal Office of Rural Health Policy (FORHP).

These eight outstanding mentors were selected from a pool of candidates across the country who were nominated by their respective state Flex programs as quality improvement leaders. They each successfully report and use data to support quality improvement activities in their small rural hospitals. They represent the diversity of CAHs across the nation, with varying rural locations, service lines, and patient volumes which average 2.5 to 16 patients per day and 1,300 to 13,000 emergency room visits annually.

“Critical Access Hospital” is a Centers for Medicare & Medicaid Services (CMS) designation given to eligible rural hospitals, with 25 beds or less, to reduce the financial vulnerability and improve access to health care by keeping essential services in rural communities.

“Quality improvement initiatives are essential to improve outcomes and provide the highest quality care to every patients,” said Sarah Brinkman, Stratis Health rural quality expert. “These Quality Improvement Mentors work with limited resources and hold many roles within their hospital, all the while looking for ways to provide the best care for their patients. We believe other small rural hospitals can learn from their experience and be inspired by their drive.”

Of the 1,343 CAHs across the U.S., more than 1,320 were participating in FORHP’s Medicare Beneficiary Quality Improvement Project (MBQIP) at the end of 2016.

The new Virtual Quality Improvement Mentors are:

• Amy Arnett, Horizon Health – Paris Community Hospital, Paris, IL,
• Cindy Gilman, Carroll County Memorial Hospital, Carrollton, MO
• Mariah Hesse, Sparrow Clinton Hospital, St. Johns, MI
• Karen Hooker, Kit Carson County Health Service District, Burlington, CO
• Christy Mintah, Avera Holy Family Hospital, Estherville, IA,
• Ben Power, Barrett Hospital & Healthcare, Dillon, MT
• ArvaDell Sharp, Pembina County Memorial Hospital, Cavalier, ND
• Brenda Stevenson, Titusville Area Hospital, Titusville, PA

The Virtual Quality Improvement Mentors will share their examples and advice on how to address common quality improvement challenges that occur in CAHs. RQITA will capture these strategies, tips, and ideas to disseminate them broadly to others serving in CAH quality roles. Articles and podcasts will be made available to advance the quality improvement work of others.

The initiative kicked off September 18 at the 2019 National Rural Health Association CAH Conference, in Kansas City, Missouri.

The Academy of Nutrition and Dietetics, American Academy of Pediatric Dentistry, American Academy of Pediatrics, and American Heart Association recommend breast milk, infant formula, water, and plain milk as part of a new set of comprehensive beverage recommendations for children, outlined by age (birth through age 5). They caution against beverages with added sugars such as flavored milks, caffeinated beverages, and low-calorie sweetened beverages.

Click here to view the report.
Click here to view the infographic.

The National Conference of State Legislatures (NCSL) recently released an article addressing children’s dental screening laws in schools. Dental screening programs can use the screening procedure as an opportunity to establish a child’s dental home. It is also an opportunity to collect data on childhood caries.   Click here to read the article.

The Federal Drug Administration ‘s (FDA) online Safety Reporting Portal (SRP) is a tool that provides a standardized way for users—including consumers, health care professionals, manufacturers, and researchers—to tell the FDA about unexpected health or safety issues with various products, including e-cigarettes and other tobacco products believed to not be working properly or causing an unexpected health problem.

Harrisburg, PA (September 23, 2019 ) – Department of Human Services (DHS) Secretary Teresa Miller today submitted public comment to the Trump Administration opposing its proposal to drastically reduce Broad Based Categorical Eligibility (BBCE) for the Supplemental Nutrition Assistance Program (SNAP). The changes would jeopardize food access for more than 200,000 people and would adversely affect children, seniors, and people with disabilities.

“The Wolf Administration vehemently opposes any changes that would risk more Pennsylvanians going hungry. Forcing already-struggling families to choose between putting food on their table or covering child care, rent, or other basic needs is unconscionable and traps people in a cycle of poverty,” said Secretary Miller. “We strongly oppose any and all attacks on SNAP and will continue to fight against any attempt to take the program away from Pennsylvanians who need it.”

SNAP, previously known as food stamps, helps more than 1.8 million Pennsylvanians access nutritional meals and puts food on their tables. BBCE is a policy that gives states, including Pennsylvania, the flexibility to determine appropriate income thresholds and extend SNAP benefits to low-income families and individuals who would otherwise struggle to afford food.

With BBCE, a Pennsylvania family of four is eligible for SNAP if they earn no more than about $40,000 a year. If BBCE is reduced, that family of four’s SNAP income limit will drop from about $40,000 a year to no more than $32,000 a year. For elderly single-person households, the income limit would change from approximately $24,000 a year to about $15,000. Reducing BBCE will have the direct opposite effect of promoting economic mobility and employment and will destabilize families, making it harder for them to move out of poverty.

Reducing BBCE would also jeopardize free lunches for nearly 22,600 households whose children who currently qualify. This would not only cause more students to go hungry at schools – it also risks access to programs that provide nutritious meals for children after school and during summer months.

Reduced BBCE would increase Medicaid spending and reduce long-term health outcomes due to the direct connection between food security, proper nutrition, and good health. Additionally, reduced BBCE could yield a loss of over $200- $250 million per year to Pennsylvania retailers, as purchases made through SNAP go directly back into the local economy and food providers. Over 10,000 authorized retailers participate in SNAP across Pennsylvania. These retailers redeemed about $2.6 billion in SNAP benefits in 2018 according to the United States Department of Agriculture.  

“Our mission at DHS is to help people achieve a better life without public assistance. Attacks on SNAP make it harder for us to make people’s lives better,” said Secretary Miller. “These mean-spirited changes to SNAP do nothing to help people get off public assistance. They will only increase hunger across Pennsylvania and will disproportionately impact working families, individuals with disabilities, and seniors. It is cruel and unacceptable.”

Read DHS’ comments to the Trump Administration here.

For more information on SNAP and DHS services, visit http://www.dhs.pa.gov/citizens/supplementalnutritionassistanceprogram.