Medicare Utilization of FQHCs and RHCs in Wyoming: Current Status - - PowerPoint PPT Presentation

Medicare Utilization of FQHCs and RHCs in Wyoming: Current Status and Future Opportunities June 6, 2019

Nick Zucconi, Regional Administrator Office of Regional Operations-Denver Health Resources and Services Administration (HRSA)

HRSA Strategic Plan

Goal 1: Improve Access to Quality Care and Services Goal 2: Foster a Health Care Workforce Able to Address Current and Emerging Needs Goal 3: Enhance Population Health and Address Healthy Disparities through Community Partnerships Goal 4: Maximize the Value and Impact of HRSA Goal 5: Optimize HRSA Operations to Enhance Efficiency, Effectiveness, Innovation, and Accountability

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Health Resources and Services Administration (HRSA) Overview

Supports more than 90 programs that provide health care to people who are geographically isolated, economically or medically vulnerable. The agency funds grants and cooperative agreements to more than 3,000 awardees, including community and faith-based organizations, colleges and universities, hospitals, state, local, and tribal governments, and private entities Every year, HRSA programs serve tens of millions of people, including people living with HIV/AIDS, pregnant women, mothers and their families, and those otherwise unable to access quality health care

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HRSA FY 2018 Funding: $11.5 Billion

*Administered by the HHS Office of the Assistant Secretary of Health, rs.

HRSA Program FY 2018 National (in millions) FY2018 Wyoming (in millions) Primary Health Care $5,511 $9.4 HIV/AIDS $2,319 $1 Health Workforce $1,516 $2.2 Maternal and Child Health $1,293 $1.7 Rural Health $291 $1.3 Family Planning* $286 Program Management $155 Healthcare Systems $112 Vaccine Injury Compensation $9 TOTAL $11,492 $15.6

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HRSA Office of Regio ional Operations (ORO)

Ten Regions - One HRSA

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To improve health equity in underserved communities through on-the-ground outreach, education, technical assistance and partnering with local, state and federal

• rganizations.

Office of Regional Operations Mission

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Office of Regional Operations 2019 Priorities by Core Functions

Str Strategi gic St Stak akehol

• lder

Par artnership ips

• HRSA Bureau & Office Collaboration
• HRSA Priorities ( see slide 7)
• Special Initiatives (region-specific)

Ex External Af Affairs & & Out Outreach Regi egion

• nal

l Ma Management

• Building Strong Teams
• Ergonomics & IT
• Emergency Preparedness

Regi egion

• nal

l Su Surv rveill llance

• Information Collection and Dissemination

Ex External Af Affair airs & & Out Outreach Regi egion

• nal

Su Surv rveillance Regi egion

• nal

Man Management Str Strategi gic St Stakehold lder Par artnership ips

• HRSA Outreach & Education
• State, Local, & Tribal Government Affairs

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Office of Regional Operations Network

ORO STAKEHOLDERS

• HRSA Grantees
• State Leadership
• Tribal Organizations
• Community & Faith-Based

Organizations

• Colleges/Universities
• Private Sector Organizations &

Foundations

• HHS Regional Directors/Regional

Health Administrators

• HHS Operating Divisions
• Federal Departments or

Agencies

Office of Regional Operations: The Denver Team

Name Title Areas of Focus CAPT Debra Scott, RN, MS, MA Regional Nurse Consultant Community Engagement, Tribal Health, Initiatives to Advance the Role of Nurses, Veterans, Special Populations Montana Kim Patton, PsyD Regional Behavioral Health Liaison Behavioral Health, Tribal Health, Regional Federal Collaboration Colorado CAPT Christina Mead, PharmD Regional Pharmacy Consultant Opioid Abuse, Public Health and Primary Care Integration, Special Populations, Grantee Partnerships, Quality Improvement Utah Dianna Frick, MPH Public Health Analyst Maternal & Child Health, Outreach & Education, Tribal Health Wyoming Mike Shenkel, MPH Public Health Analyst/HRSA Scholar Currently working on several projects and activities aligned with the Regional Operations Plan CAPT Alisha Acker, RN, BSN, PHN, M.P.H. Deputy Regional Administrator Nursing, Public Health, Tribal Health, Maternal & Child Health, Diabetes Prevention & Management North Dakota Nicholas Zucconi, MPA Regional Administrator Outreach and Education, State Engagement, Tribal Health, Rural Health South Dakota

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• Combating the Opioid Crisis (https://www.hrsa.gov/opioids)
• Behavioral Health (https://www.hrsa.gov/behavioral-health)
• Value-based care delivery and quality improvement initiatives (CMS

Value Based Care)

• Transforming the workforce- targeting the need

(https://www.hrsa.gov/about/organization/bureaus/bhw/index.html)

• Telehealth (https://www.hrsa.gov/rural-health/telehealth/index.html)
• Childhood Obesity (https://mchb.hrsa.gov/)
• Maternal Mortality (https://www.hrsa.gov/maternal-mortality/index.html)

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HRSA Priorities for 2019

Rural Health Clinic Program

• Currently over 4400 Rural Health Clinics (RHC) across the U.S.
• The median number of RHC visits by a Medicare beneficiary was 3 per

year while the mean was 4.8

• The median distance Medicare patients traveled one way to an RHC was

6.2 miles

• Medicare patients utilizing RHCs were an average age of 71
• 22% of Medicare patients seen at RHCs were under the age of 65, 38%

were 65–74, 27% were 75-84 and 13% were 85 and above

• 58% of RHC Medicare patients were female

Source: North Carolina Rural Health Research and Policy Analysis Center: Profile of Rural Health Clinics: Clinic & Medicare Patient Characteristics; March 2013

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Health Center Program

• Nearly 1,400 HRSA-funded community health centers (CHC) operate

approximately 12,000 service delivery sites across all U.S. states and territories

• More than 27 million people, or 1 in 12 nationwide, rely on a HRSA-

funded health center for affordable, accessible primary health care, including:

• 1 in 3 people living in poverty
• 1 in 9 children
• 1 in 5 rural residents
• More than 355,000 veterans
• Health centers employ more than 233,000 medical, dental, and

behavioral health clinicians and staff

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RHCs- CHCs-

Wyoming RHC and CHC Locations

Primary Care HPSA’s in Wyoming

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RHC Clinical Quality: Annual Program Evaluation

• To become certified as a Rural Health Clinic, clinics must meet federal

Conditions of Participation. Once certified, RHC’s are subject to survey and certification.

• The current CMS Conditions of Participation require RHCs to conduct an

annual program evaluation of the clinic’s total operation and utilization.

• Purpose: to determine if utilization of services is appropriate; if policies and

procedures are being followed; and recommend necessary changes.

• A clinic must have a written "Program Evaluation Plan" that identifies who is

responsible for ensuring that the plan is completed, what is to be reviewed, and what is to be done with the findings.

• A policy and procedure review is required as part of the program evaluation,

as well as a chart review of a representative sample of both active and closed clinic records.

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CHC Clinical Quality: Statutory Requirements

• The health center must have an ongoing QI/QA system that includes clinical services

and clinical management.

• The health center must maintain the confidentiality of patient records.
• The health center must have an ongoing QI/QA system that assures:
• Organizational arrangements to support the quality assurance program and the provision of high

quality patient care;

• Periodic assessment of the appropriateness of the utilization of services and the quality of

services provided to individuals served by the center.

• Federal Tort Claims Act - annual submission of a deeming application:
• Has implemented policies and procedures to reduce the risk of malpractice and the risk of

lawsuits arising out of health-related functions;

• Has reviewed and verified the professional credentials, references, claims history, fitness, and

license status of its physicians and other licensed or certified health care practitioners;

• Has no history of claims under section 224 of the PHS Act or, if so, fully cooperates with the

Attorney General in defending against any such claims, and takes necessary steps to assure against claims in the future

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Challenges to Meeting the Health Care Needs of Older Adults

• The number of older adults is increasing: 30,000 geriatricians needed by 2030

– as of 2014 there were 7,400 practicing geriatricians

• Chronic disease affects two out of every three older Americans. Common

conditions: arthritis, heart disease, cancer, diabetes, hypertension

• Patients with chronic conditions and functional disabilities require more time

to tailor approaches to care, coordinate with family, other providers

• In 2014, 60.5% of Americans age 65 or older also had difficulty with an ADL,

compounding barriers to access and contributing to depression which affects approximately 9% of elderly patients

• More than 15 million older adults (30 %) had incomes below 200% of poverty

in 2017 (1 person =$25,000; 2 people=$34,000); that number increases to 21 million (42.0%) based on the Supplemental Poverty Measure.

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Essentials to Meeting the Health Care Needs of Older Adults

• Nutrition for Older Adults (particularly with Diabetes)
• Medication Management for Older Adults: understanding and communicating

complex medication regimes

• Individual Case Management: primary care, medications, nutrition, transport
• Oral Health and the Geriatric Patient: the connection between oral healthcare

and general health

• Recognizing Signs of Depression, Mental Illness, and Anxiety in Older Adults
• Educating Patients about Alzheimer’s and Connecting them to Resources:
• Managing Patients with Multiple Chronic Conditions
• Team Based Approach to Care: the case for integrated care for patients and

families

• Social Determinants of Health: the association between the social

determinants and health status of older adults.

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Major Changes (Opportunities?) Affecting Rural Health Care

• Changes in payment and financing: RHCs and FQHCs assuming risk

during the transition from volume-based to value-based payment.

• Quality and value measurement: Measuring value (better care,

improved population health, and lower per capita cost) emphasizes quality reporting and using data to improve patient outcomes

• Workforce: More flexibility needed in the types of providers that could

provide and bill Medicare at the FQHC and RHC rates, e.g., licensed professional behavioral health counselors

• New healthcare care models: Community Health Needs Assessment

(CHNA) for non-profit hospitals an opportunity to assess local rural needs in partnership with RHCs, FQHCs, and local public health agencies

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HRSA Programs to Support RHCs, FQHCs and Medicare Beneficiaries: Oral Health

• Grants to States to Support Oral Health Activities: States match at least

40% of federal funds through cash or in-kind contributions. Allowable activities cover a variety of areas such as:

• expanding oral health services and facilities,
• community-based prevention services,
• teledentistry,
• pipeline program development,
• workforce training,
• recruitment and retention efforts
• Rural Oral Health Toolkit: https://www.ruralhealthinfo.org/toolkits/oral-

health

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HRSA Programs to Support RHCs, FQHCs and Medicare Beneficiaries: Behavioral Health

• Behavioral Health Workforce Education and Training (BHWET) Program:

establishes field placement programs that include interdisciplinary training for students/interns, faculty, and field supervisors to provide quality behavioral health services to communities in need.

• Eligibility: schools of social work, substance use disorder prevention and treatment,

marriage and family therapy, occupational therapy, school counseling, or professional counseling.

• Graduate Psychology Education (GPE) Program: the purpose of this program

is to train doctoral health psychology students, interns, and post-doctoral residents to provide integrated, interdisciplinary, behavioral health in high need and high demand areas.

• Eligibility: the county of experiential training site location has less than 10 licensed

psychologists per 100,000 population. The experiential training site is located in a Mental Health Professional Shortage Areas (HPSAs) or that are Facility Mental HPSAs with a score of 16 or above.

• Eligible entities: doctoral schools and programs of psychology, doctoral internships in

professional psychology, and post-doctoral residency programs in practice psychology.

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Recent CHC Funding Opportunities: Behavioral Health & Oral Health

Behavioral Health

• Behavioral Health Integration Funding (Awarded FY 2014-2015)
• Substance Abuse Service Expansion (SASE) (Awarded 2016)
• Access Increases for Mental Health and Substance Abuse Services (AIMS) (Awarded

2017)

• Expanding Access to Quality Substance Use Disorder and Mental Health Services

Supplement Awards (SUD-MH) (Awarded 2018)

• Enhancing Behavioral Health Workforce Supplement Awards (Awarded 2018)

Oral Health

• Integrated Oral Health Care Services (2016)
• Oral Health Infrastructure (NOFO currently open)

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HRSA Programs to Support RHCs, FQHCs and Medicare Beneficiaries: Workforce, Clinical Training, Recruitment & Retention

• Advanced Nursing Education –Nurse Practitioner Residency (NPR):

supports clinical and academic-focused, 12-month NPR programs that prepare new nurse practitioners (NPs) for primary care practice in community-based settings (preference for rural or underserved pops.)

• Eligibility: schools of nursing, nurse managed health clinics/centers, academic

health centers, state or local governments and other private or public nonprofit entities determined appropriate by the Secretary.

• Nurse Education, Practice, Quality and Retention (NEPQR): 4-year

training program to recruit and train nursing students and current RNs to practice in community-based primary care teams (emphasis on chronic disease prevention and control, including MH/SA)

• Eligibility: accredited schools of nursing, as defined by section 801(2), health care

facilities, or a partnership of such a school and facility.

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HRSA Programs to Support RHCs, FQHCs and Medicare Beneficiaries: Geriatrics

Geriatrics Workforce Enhancement Program: The purpose is to establish and operate geriatrics education centers to develop a healthcare workforce that maximizes patient and family engagement and improves health outcomes for older adults by integrating geriatrics and primary

• care. Special emphasis on:
• providing the primary care workforce with the knowledge and skills to care for
• lder adults and partnering with community-based organizations (CBOs) to

address gaps in healthcare for older adults,

• promote age-friendly health systems and dementia friendly communities,
• address the social determinants of health.

Eligibility: accredited health professions schools and programs.

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HRSA Federal Office of Rural Health Policy: Grants for Rural Communities

• Rural Health Care Services Outreach Grant Program: supports rural health

care services outreach projects utilizing evidence-based or promising practice models in order to address community-specific health concerns.

• Rural Health Network Development Planning: supports the development of

formal and integrated health care networks such as business plan development, community needs assessment, network organizational assessment, health information technology (HIT) readiness assessment.

• Rural Health Network Development Program: supports mature networks of

rural health care providers and community health partners to integrate administrative, clinical, technological and financial functions to improve access to quality health care in rural areas.

• Small Health Care Provider Quality Improvement Program: supports

networks of rural health care providers engaged in quality improvement initiatives to improve patient care and chronic disease outcomes using evidence-based quality improvement models and HIT to collect/report data

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HRSA Programs to Support RHCs, FQHCs and Medicare Beneficiaries: Telehealth

• Telehealth Network Grant Program: the purpose of this program is to

demonstrate the use of telehealth networks to improve healthcare services for medically underserved populations in urban, rural, and frontier communities. Networks can be used to:

• Expand access to, coordinate, and improve the quality of health care services;
• Improve and expand the training of health care providers; and/or
• Expand and improve the quality of health information available to health care

providers, patients, and their families.

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Contact Information

Nick Zucconi Regional Administrator, Office of Regional Operations Health Resources and Services Administration (HRSA) Denver, CO Email: nzucconi@hrsa.gov Phone: 303-844-7879 Web: hrsa.gov Twitter: twitter.com/HRSAgov Facebook: facebook.com/HHS.HRSA

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Questions?

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To learn more about our agency, visit www.HRSA.gov

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