F e de ra l Ro le in Rura l He a lth: Ce nte rs fo r Me dic a re - - PowerPoint PPT Presentation

Ca ra V. Ja me s

Dire c to r, CMS Offic e o f Mino rity He a lth Co -c ha ir, CMS Rura l He a lth Co unc il No ve mb e r 2018

F e de ra l Ro le in Rura l He a lth: Ce nte rs fo r Me dic a re & Me dic a id Se rvic e s

Clic k to e dit Ma ste r title style Clic k to e dit Ma ste r title style

CMS Rura l He a lth Stra te g y

Ma king he a lth c a re in rura l Ame ric a a c c e ssib le , a ffo rda b le , a nd a c c o unta b le

CMS Rura l He a lth Stra te g y

Ma king he a lth c a re in rura l Ame ric a a c c e ssib le , a ffo rda b le , a nd a c c o unta b le

May 2018 - CMS launc he s Age nc y’s first rural he alth strate gy to impro ve ac c e ss and quality o f c are fo r rural Ame ric ans

CMS Rura l He a lth Stra te g y CMS Rura l He a lth Stra te g y

• I

mpro ving re imb urse me nt

• Ada pting a nd impro ving q ua lity me a sure s a nd

re po rting

• I

mpro ving a c c e ss to se rvic e s a nd pro vide rs

• I

mpro ving de live ry a nd pa yme nt mo de ls

• E

ng a g ing c o nsume rs

• Re c ruiting , tra ining , a nd re ta ining the wo rkfo rc e
• L

e ve ra g ing pa rtne rships/ re so urc e s

• I

mpro ving a ffo rda b ility a nd a c c e ssib ility o f insura nc e o ptio ns

F e e db a c k fro m L iste ning Se ssio ns F e e db a c k fro m L iste ning Se ssio ns

• 1. Apply a rura l le ns to CMS pro g ra ms a nd

po lic ie s

• 2. I

mpro ve a c c e ss to c a re thro ug h pro vide r e ng a g e me nt a nd suppo rt

• 3. Adva nc e te le he a lth a nd te le me dic ine
• 4. E

mpo we r pa tie nts in rura l c o mmunitie s to ma ke de c isio ns a b o ut the ir he a lth c a re

• 5. L

e ve ra g e pa rtne rships to a c hie ve the g o a ls

• f the CMS Rura l He a lth Stra te g y

CMS Rura l He a lth Stra te g y Ob je c tive s CMS Rura l He a lth Stra te g y Ob je c tive s

Clic k to e dit Ma ste r title style Clic k to e dit Ma ste r title style

Qua lity Pa yme nt Pro g ra m: Sma ll, Unde rse rve d, a nd Rura l T e c hnic a l Assista nc e Qua lity Pa yme nt Pro g ra m: Sma ll, Unde rse rve d, a nd Rura l T e c hnic a l Assista nc e

T e c hnic a l Assista nc e fo r Clinic ia ns T e c hnic a l Assista nc e fo r Clinic ia ns

CMS has free resources and organizations to provide help to clinicians who are included in the Quality Payment Program:

Clic k to e dit Ma ste r title style Clic k to e dit Ma ste r title style

Pa tie nts Ove r Pa pe rwo rk Putting Pa tie nts F irst Pa tie nts Ove r Pa pe rwo rk Putting Pa tie nts F irst

• Me a ning ful Me a sure s
• Co mpre he nsive initia tive la unc he d in 2017. Ba la nc ing the

va lue o f q ua lity da ta with e ffo rts to limit pro vide r b urde n.

• CAH 96- Ce rtific a tion Re quire me nt
• Dire c te d QI

Os, MACs, SMRC, a nd RAC to ma ke the 96 ho ur c e rtific a tio n re q uire me nt a lo w prio rity fo r me dic a l re c o rd re vie ws c o nduc te d o n o r a fte r 10/ 1/ 2017

• Dire c t Supe rvision for Outpa tie nt T

he ra pe utic Se rvic e s

• Re insta te d the no n-e nfo rc e me nt fo r dire c t supe rvisio ns

re q uire me nts fo r o utpa tie nt the ra pe utic se rvic e s fo r CAHs a nd sma ll rura l ho spita ls ha ving 100 o r fe we r b e ds fo r CY 2018 a nd 2019

Re mo ving Re g ula to ry Ob sta c le s

Me dic a re Physic ia n F e e Sc he dule F Y 2019 F ina l Rule Me dic a re Physic ia n F e e Sc he dule F Y 2019 F ina l Rule

• Doc ume nta tion

– E

limina te s re q uire me nt to do c ume nt the me dic a l ne c e ssity o f a ho me visit in lie u o f a n o ffic e visit.

– F

• r e sta b lishe d visits, pro vide rs c a n c ho o se to fo c us

the ir do c ume nta tio n o n wha t ha s c ha ng e d sinc e the la st visit o r o n pe rtine nt ite ms tha t ha ve no t c ha ng e d.

• E

/ M Visits

– F

• r CY 2021, the re will b e a sing le ra te fo r E

/ M o ffic e visits le ve ls 2- 4, while ke e ping the pa yme nt ra te fo r le ve l 5.

– Ado pte d ne w “e xte nde d visit” a dd-o n c o de fo r E

/ M o ffic e le ve l 2-4 visits to a c c o unt fo r a dditio na l re so urc e s ne e de d whe n pra c titio ne rs spe nd e xtra time with a pa tie nt.

Clic k to e dit Ma ste r title style Clic k to e dit Ma ste r title style

T e le he a lth T e le he a lth

CY 2019 Me dic a re Physic ia n F e e Sc he dule F ina l Rule CY 2019 Me dic a re Physic ia n F e e Sc he dule F ina l Rule

• T

e le he a lth

– Adde d ne w c o de s to the te le he a lth list fo r 2019 fo r

pro lo ng e d pre ve ntive se rvic e (s)

– Adde d re na l dia lysis fa c ilitie s a nd the ho me s o f E

SRD b e ne fic ia rie s re c e iving ho me dia lysis a s o rig ina ting site s.

– Adde d mo b ile stro ke units a s o rig ina ting site s fo r dia g no sis,

e va lua tio n, o r tre a tme nt o f a n a c ute stro ke .

• Communic a tion T

e c hnolog y- Ba se d Se rvic e s

– Adde d ne w c o de s fo r se rvic e s pro vide d using

c o mmunic a tio n te c hno lo g y:

• Brie f c o mmunic a tio n te c hno lo g y-b a se d se rvic e (e .g . virtua l c he c k-in)
• Re mo te e va lua tio n o f re c o rde d vide o a nd/ o r ima g e s sub mitte d b y

a nd e sta b lishe d pa tie nt (e .g . sto re a nd fo rwa rd).

• Ana lyze d Me dic a re F

F S c la ims da ta a nd fo und use o f te le he a lth inc re a se d b e twe e n 2014 a nd 2016, tho ug h the o ve ra ll ra te o f a do ptio n is still ve ry limite d.

• I

n 2016, a lmo st 90,000 (0.25%) Me dic a re F F S b e ne fic ia rie s utilize d 275,199 te le he a lth se rvic e s.

• Sig nific a nt g ro wth in utiliza tio n a mo ng the o lde st po pula tio n—

b e ne fic ia rie s 85 ye a rs a nd o lde r.

• Psyc ho the ra py is a mo ng the se rvic e s mo st c o mmo nly furnishe d

thro ug h te le he a lth.

• Sta te s with the hig he st utiliza tio n a re T

e xa s, I

• wa , Ca lifo rnia ,

Misso uri, Mic hig a n, Minne so ta , Wisc o nsin, Ge o rg ia , Virg inia , a nd K e ntuc ky.

T e le he a lth Utiliza tio n in Me dic a re T e le he a lth Utiliza tio n in Me dic a re

Clic k to e dit Ma ste r title style Clic k to e dit Ma ste r title style

Addre ssing the Opio id E pide mic Addre ssing the Opio id E pide mic

T ho ug h o pio id a b use a nd o pio id-re la te d de a th ha s b e e n o n the rise na tio na lly, rura l c o mmunitie s fa c e uniq ue c ha lle ng e s

15

Rura l Be ha vio ra l He a lth: Opio ids

Opio id-re la te d o ve rdo se de a ths in rura l a re a s inc re a se d mo re tha n 10% fro m 2015 to 2016 Rura l re side nts a re mo st like ly to b e pre sc rib e d, a nd

• ve rdo se o n, pre sc riptio n pa inkille rs

Rura l re side nts with o pio id use diso rde r te nd to b e yo ung e r, le ss we a lthy a nd e duc a te d, un o r uninsure d Mo re tha n 60% o f rura l c o untie s la c k a sing le physic ia n tha t c a n pre sc rib e b upre no rphine , < 10%

• f o pio id tre a tme nt pro g ra ms in rura l

CMS Opio id Ro a dma p CMS Opio id Ro a dma p

3

We bsite : https:/ / www.c ms.g o v/ b lo g / c ms-o pio ids-ro a dma p

• Inte g ra te d Ca re for Kids (InCK) mo de l – A mo de l

a ime d a t re duc ing c o sts a nd impro ving c a re fo r c hildre n thro ug h pre ve ntio n, e a rly ide ntific a tio n, a nd tre a tme nt o f prio rity c o nditio ns like sub sta nc e a b use .

• Ma te rna l Opioid Misuse (MOM) mo de l – F

ive ye a r mo de l a ime d a t inc re a sing a c c e ss to tre a tme nt fo r

• pio id use diso rde r a nd to impro ve o utc o me s fo r

pre g na nt a nd po stpa rtum wo me n a nd the ir c hildre n.

• Me dic a id de monstra tion to e xpa nd me nta l he a lth

tre a tme nt fo r a dults with SMI a nd kids with SE D, thro ug h a utho rity to pa y fo r sho rt-te rm re side ntia l tre a tme nt se rvic e s.

Re c e nt E ffo rts to Addre ss the Opio id E pide mic Re c e nt E ffo rts to Addre ss the Opio id E pide mic

Clic k to e dit Ma ste r title style Clic k to e dit Ma ste r title style

Unde rsta nding a nd Addre ssing Rura l He a lth Dispa ritie s Unde rsta nding a nd Addre ssing Rura l He a lth Dispa ritie s

Offic e s o f Mino rity He a lth Within HHS

I nc re a sing

unde rsta nding a nd a wa re ne ss

• f dispa ritie s

De ve lo ping a nd disse mina ting

solutions

I mple me nting susta ina b le

a c tions

CMS OMH He a lth E q uity F ra me wo rk

21

• He a rt dise a se
• Mo re tha n 25,000 e xc e ss

de a ths

• 42.6% in rura l a re a s; 27.8%

in urb a n a re a s

• Appro x. 50% highe r

in rura l

a re a s tha n urb a n

• Ca nc e r
• Mo re tha n 19,000 e xc e ss

de a ths

• Ove ra ll c a nc e r de a ths

de c line d 1.5%/ ye a r b e twe e n (2003-2012);

• de c line d le ss in rura l vs.

urb a n a re a s

• Uninte ntional injur

ie s

• Mo re tha n 12,000 e xc e ss de a ths
• 57.5% in rura l a re a s; 39.2% in

urb a n a re a s

• Appro x. 50% highe r

in rura l a re a s

tha n urb a n (a g e -a djuste d b e twe e n 1999-2014)

• Chr
• nic lowe r

r e spir a tor y dise a se

• Mo re tha n 11,000 e xc e ss de a ths
• 54.3% in rura l a re a s; 30.9% in

urb a n a re a s

• Appro x. 50% highe r

in rura l a re a s

tha n urb a n

In 2014, a hig he r ra te of pote ntia lly e xc e ss de a ths oc c urre d a mong rura l Ame ric a ns tha n urba n Ame ric a ns from:

E me rg ing Rura l Dispa ritie s - Po te ntia lly E xc e ss De a th

Rura l-Urb a n Dispa ritie s in Me dic a re Rura l-Urb a n Dispa ritie s in Me dic a re

Ove ra ll Ho spita l Ra ting b y Co unty, 2016

23

Pa tie nt E xpe rie nc e a t Bo n Se c o urs St. F ra nc is Ho spita l vs. All So uth Ca ro lina Ho spita ls

24

T he wo rd ‘ rura l’ o fte n e vo ke s…

But sho uld a lso e vo ke … But sho uld a lso e vo ke …

F a ir o r Po o r He a lth Sta tus Amo ng Rura l Adults b y Ra c e & E thnic ity, 2012-2015 F a ir o r Po o r He a lth Sta tus Amo ng Rura l Adults b y Ra c e & E thnic ity, 2012-2015

20% 19% 29% 28% 10% 29%

All Adults White Black Hispanic Asian or NHOPI American Indian/ Alaska Native

Percent Reporting Fair or Poor Health

SOURCE: James, Moonesinghe, Wilson‐Frederick, et al., Racial/Ethnic Health Disparities Among Rural Adults – United States, 2012‐2015. MMWR Surveill Summ 2017; 66(No. 23): 1‐9.

Ag e Distrib utio n o f Rura l Adults b y Ra c e a nd E thnic ity, 2012-2015 Ag e Distrib utio n o f Rura l Adults b y Ra c e a nd E thnic ity, 2012-2015

40% 37% 44% 66% 61% 49% 37% 37% 39% 25% 32% 37% 24% 26% 17% 9% 8% 14%

Total White Black Hispanic Asian or NHOPI American Indian/ Alaska Native 18‐44 years 45‐64 years 65 or Older

28

SOURCE: James, Moonesinghe, Wilson‐Frederick, et al., Racial/Ethnic Health Disparities Among Rural Adults – United States, 2012‐2015. MMWR Surveill Summ 2017; 66(No. 23): 1‐9.

I nc o me Distrib utio n o f Rura l Adults b y Ra c e a nd E thnic ity, 2012-2015 I nc o me Distrib utio n o f Rura l Adults b y Ra c e a nd E thnic ity, 2012-2015

36% 32% 62% 53% 29% 56% 30% 31% 25% 28% 26% 25% 16% 17% 7% 11% 10% 19% 21% 6% 9% 29% 9%

Total White Black Hispanic Asian or NHOPI* American Indian/ Alaska Native Less than $25,000 $25,000‐$49,999 $50,000‐$74,999 $75,000 or More

29

NOTE: * Estimates not reported because relative standard error was >30%. SOURCE: James, Moonesinghe, Wilson‐Frederick, et al., Racial/Ethnic Health Disparities Among Rural Adults – United States, 2012‐2015. MMWR Surveill Summ 2017; 66(No. 23): 1‐9.

Re g io na l Distrib utio n o f Rura l Adults b y Ra c e a nd E thnic ity, 2012-2015 Re g io na l Distrib utio n o f Rura l Adults b y Ra c e a nd E thnic ity, 2012-2015

8% 9% 1% 3% 9% 4% 32% 37% 4% 15% 26% 25% 49% 44% 94% 59% 37% 33% 11% 10% 1% 23% 29% 38%

Total White Black Hispanic Asian or NHOPI* American Indian/ Alaska Native Northeast Midwest South West

30

NOTE: * Estimates not reported because relative standard error was >30%. SOURCE: James, Moonesinghe, Wilson‐Frederick, et al., Racial/Ethnic Health Disparities Among Rural Adults – United States, 2012‐2015. MMWR Surveill Summ 2017; 66(No. 23): 1‐9.

Unite d Sta te s (7.7% L E P) Ca lifornia (22.2% L E P) Ha wa ii (18.6% L E P) Ne w York (16.0% L E P) T e xa s (13.0% L E P) South Ca rolina (1.14% L E P)

Spa nish (52%) Spa nish (48%) I lo c a no Spa nish (43%) Spa nish (84%) Spa nish (36%) Chine se T a g a lo g Ja pa ne se Chine se Vie tna me se Russia n Vie tna me se Chine se T a g a lo g Russia n Chine se Ge rma n T a g a lo g Vie tna me se K

• re a n

I ta lia n K

• re a n

Vie tna me se K

• re a n

K

• re a n

Chine se F re nc h Cre o le T a g a lo g Guja ra ti Russia n Ca nto ne se T ruke se Ca nto ne se Guja ra ti T a g a lo g I ta lia n Pe rsia n Ca nto ne se K

• re a n

Pe rsia n Ca nto ne se Ca nto ne se Arme nia n Vie tna me se Gre e k Ca nto ne se K

• re a n

F re nc h Cre o le Russia n Ha wa iia n Po lish Urdu Po lish Othe r L a ng ua g e s Ja pa ne se Sa mo a n T a g a lo g Ma la ya la m Hindi

T

• p 10 L

a ng ua g e s Spo ke n b y Me dic a re Be ne fic ia rie s with L imite d E ng lish Pro fic ie nc y b y Sta te

SOURCE : Unde rsta nding Co mmunic a tio n a nd L a ng uag e Ne e ds o f Me dic a re Be ne fic iarie s. Ce nte rs fo r Me dic a re & Me dic a id Se rvic e s, 2017.

Clic k to e dit Ma ste r title style Clic k to e dit Ma ste r title style

Co ntinuing to L iste n, E ng a g e , & Pa rtne r Co ntinuing to L iste n, E ng a g e , & Pa rtne r

Co nne c te d Ca re Re so urc e s Co nne c te d Ca re Re so urc e s

• Informa tion for He a lth Ca re

Profe ssiona ls

• Ac c e ss re so urc e s a nd to o ls

e xpla ining the b e ne fits o f CCM a nd ho w to imple me nt this se rvic e

• Informa tion for Pa tie nts
• Ac c e ss e a sy-to -re a d info rma tio n o n

the b e ne fits o f CCM fo r Me dic a re b e ne fic ia rie s living with two o r mo re c hro nic c o nditio ns

• Ca mpa ig n Pa rtne rship Re sourc e s
• Ac c e ss info rma tio n a b o ut

pa rtne ring to b ring a wa re ne ss to CCM thro ug h the Co nne c te d Care c a mpa ig n Visit g o.c ms.g ov/ CCM

F ro m Co ve rage to Care (C2C)

Re so urc e s

F ro m Co ve rage to Care (C2C)

Re so urc e s

• Ro a dma p to Be tte r Ca re a nd a He a lthie r Yo u
• 5 Wa ys to Ma ke the Mo st o f Yo ur Co ve ra g e
• Ma na g ing Yo ur He a lth Ca re Co sts
• A Ro a dma p to Be ha vio ra l He a lth
• Vide o s
• E

nro llme nt T

• o lkit
• Pre ve ntio n Re so urc e s
• Pa rtne r T
• o lkit
• Co mmunity Pre se nta tio n

Visit http:/ / g o.c ms.g ov/ c 2c

• Innova tion Ce nte r Re que st for Informa tion - So ug ht

fe e db a c k o n a ne w dire c tio n to pro mo te pa tie nt-c e nte re d c a re a nd te st ma rke t-drive n re fo rms tha t e mpo we r b e ne fic ia rie s a s c o nsume rs, pro vide pric e tra nspa re nc y, inc re a se c ho ic e s a nd c o mpe titio n to drive q ua lity, re duc e c o sts, a nd impro ve o utc o me s.

• L

iste ning Se ssions

• He a lth pla ns
• T

rib a l T e c hnic a l Adviso ry Gro up

• Me dic a re Physic ia n F

e e Sc he dule NPRM – So ug ht

c o mme nt o n pric e tra nspa re nc y a nd c re a ting a b undle d e piso de o f c a re fo r ma na g e me nt a nd c o unse ling tre a tme nt fo r sub sta nc e use diso rde rs.

• Me dic a id Ma na g e d Ca re NPRM – Co mme nts a re due

Ja nua ry 14, 2019

E ng a g ing Sta ke ho lde rs

• E

nha nc e d Pa yme nts thro ug h Me dic a re a nd Me dic a id

• Pilo ts a nd De mo nstra tio ns
• Priva te I

nsura nc e Sub sidie s (Ma rke tpla c e )

• Wo rkfo rc e T

ra ining

• Clinic ia n Pla c e me nt (Na tio na l He a lth Se rvic e Co rps,)
• T

a rg e ting Re so urc e s b y De sig na ting Sho rta g e Are a s

• Pub lic He a lth (mo stly via b lo c k g ra nts)
• Ac c e ss to Ca pita l
• I

nve stme nts in T e c hno lo g y

• T

e le he a lth

• Bro a db a nd
• E

le c tro nic He a lth Re c o rds

36

Rura l Ba sic s: T he F e de ra l I nve stme nt

• Suppo rting Ac c e ss via …

• Cha rg e d with a dvising the Se c re ta ry o f HHS o n the

e ffe c t tha t fe de ra l he a lth c a re po lic ie s a nd re g ula tio ns ma y ha ve o n rura l c o mmunitie s.

• K

e y a re a s o f wo rk:

• F

unding Oppo rtunitie s

• Rura l He a lth Po lic y
• Rura l He a lth Pro g ra ms
• Rura l Co mmunity Pro g ra ms
• T

e le he a lth

• Rura l He a lth Re se a rc h
• Na tio na l Adviso ry Co mmitte e o n Rura l He a lth & Huma n Se rvic e s
• Rura l He a lth Re se a rc h Ga te wa y -

www.rura lhe a lthre se a rc h.o rg

• Rura l He a lth I

nfo rma tio n Hub - www.rura lhe a lthinfo .o rg

F e de ra l Offic e o f Rura l He a lth Po lic y (F ORHP)

• Rura l He a lth Innova tion a nd T

ra nsforma tion T e c hnic a l Assista nc e - 02/ 22/ 2019

• Rura l Ve te ra ns He a lth Ac c e ss Prog ra m - 02/ 12/ 2019
• Rura l Communitie s Opioid Re sponse Prog ra m – Pla nning -

01/ 15/ 2019

• Sma ll Rura l Hospita l Improve me nt Prog ra m (SHIP) -

01/ 03/ 2019

• Rura l He a lth Ne twork De ve lopme nt Pla nning Prog ra m -

11/ 30/ 2018 L e a rn mo re a t: https:/ / www.hrsa .g o v/ rura lhe a lth/ pro g ra mo ppo rtunitie s/ fu nding o ppo rtunitie s/

Curre nt F e de ra l Offic e o f Rura l He a lth Po lic y F unding Oppo rtunitie s

F

• r Mo re I

nfo rma tio n: F

• r Mo re I

nfo rma tio n:

g o.c ms.g ov/ rura lhe a lth