R URAL H EALTH C HALLENGES AND THE R EMEDIAL P ROSPECTS OF T - - PowerPoint PPT Presentation

RURAL HEALTH CHALLENGES

AND THE REMEDIAL PROSPECTS OF

TECHNOLOGY

AZALEA HEALTH LEADERS SUMMIT 2016

• Rural areas score higher than urban areas on appropriate provision of

preventive services related to breast exams, family history of cancer, flu immunization...

• Hospitals in rural area have significantly higher ratings on HCAHPS

measures than those located in urban areas

• Rural hospitals match urban hospitals on performance at a lower

price

Stats courtesy of Alan Morgan, CEO of National Rural Health Association

• Sample rural GA hospital versus statewide averages (HCAHPS):
• Pain control: 86% satisfied vs. 71% state average
• Physician communication: 95% satisfied vs. 83% state average
• 82% gave hospital a score of 9 or 10 vs. 71% state average

RURAL

URAL IS IS D

DIFFERENT

IFFERENT – N

– NOT

OT W

WORSE

ORSE

WHA

HAT’S A

AILING

ILING R

RURAL

URAL H

HEAL

EALTHCARE THCARE?

Half of Americans live in the red counties, half live in the

• range counties…

dadaviz.com via @conradhackett

• More likely to report fair to poor health
• Rural counties 19.5%
• Urban counties 15.6%
• Higher obesity rates: Rural counties 27.4% vs. urban counties 23.9%

Stats courtesy of National Rural Health Association

• More chronic disease:
• Sample rural hospital vs. GA state averages:
• 26% higher cardiovascular disease mortality
• 16% higher cancer mortality
• 1/5 of Americans live in rural areas, but 1/10 of physicians practice

there (The Atlantic, Aug. 28, 2014)

WHA

HAT’S A

AILING

ILING R

RURAL

URAL H

HEAL

EALTHCARE THCARE?

Recent legislation including the Af Recent legislation including the Affor fordable Car dable Care Act e Act has placed many bur has placed many burdens on hospitals dens on hospitals

• Medicare / Medicaid reimbursements cuts
• E.g. sequestration
• Current and looming disproportionate share cuts
• Quality-oriented penalties (e.g. readmissions)
• CBO projects 10.4% decline

10.4% decline in Medicare reimbursement by 2020

• Even among newly insured, higher deductibles have led to increased

uncompensated care

• One half of all non-elderly, non-poor households do not

have enough liquid assets to meet deductibles over $2,500

• Increased compliance costs

WHA

HAT’S A

AILING

ILING R

RURAL

URAL H

HEAL

EALTHCARE THCARE?

IF U.S. COSTS OF COMPLYING WITH HEALTHCARE REGULATIONS ($1.863 TRILLION) WERE A COUNTRY, IT WOULD BE THE WORLD’S 10TH

LARGEST ECONOMY!

¡

Source: Kaiser Family Foundation

WHA

HAT’S A

AILING

ILING R

RURAL

URAL H

HEAL

EALTHCARE THCARE?

? MEDICAID EXPANSION WAS INTENDED TO OFFSET ACA’S CUTS: : MORE PAYING PATIENTS, LESS UNCOMPENSATED CARE. BUT....

• U.S. Supreme Court

made expansion optional

• 23 states, including

Georgia, have declined

• Georgia’s Medicaid

program remains closed

• ff to all childless adults,

and parents making more than 40% of federal poverty level ($8,000 annually = too wealthy for Medicaid)

CONSEQUENCES

ONSEQUENCES OF OF C

CLOSURE

LOSURE ACCESS TO CARE

• Increased travel time to nearest

hospital – costly during emergencies

• Travel limitations for poor and

elderly populations

• Pungo Hospital, Bellhaven, NC
• Closed in 2014; 20,000 people

now in counties without ER

• Six days after closing, 48-year-old woman died of heart attack waiting

for helicopter

• “If someone has a stroke, and we can’t get a CT on them to administer

treatment, or if they have trauma and they can’t get fluid replacements, they’re going to die.” - Belhaven physician Mark Beamer

Sources: Kaiser Health News, Charlotte Observer

CONSEQUENCES

ONSEQUENCES OF OF C

CLOSURE

LOSURE ACCESS TO CARE

• North Georgia Medical Center,

Ellijay, GA

• Closed in 2016
• “[Physician’s offices] have been

treated like an emergency room… We have people walking in with

• pen knees requiring stitching, and

people are coming in weak and fragile and passing out in the waiting room.”

Source: Times Courier

CONSEQUENCES

ONSEQUENCES OF OF C

CLOSURE

LOSURE ACCESS TO CARE

CONSEQUENCES

ONSEQUENCES OF OF C

CLOSURE

LOSURE ECONOMIC IMPACT

• Three years after a rural hospital

community closes, it costs about $1000 in per capita income

• On average, 14% of total

employment in rural areas is attributed to the health sector.

• One rural physician generates an

average of 23 jobs in the local economy

Sources: National Rural Health Association; Rural Health Works; Mark Holmes, UNC Professor

CONSEQUENCES

ONSEQUENCES OF OF C

CLOSURE

LOSURE ECONOMIC IMPACT

• Hancock Memorial Hospital,

Sparta, GA

• Closed in 2001
• “When [trying] to recruit a new

industrial employer, one of the first things they ask is, ‘Do you have a hospital?’” – Hancock County Commission Chair Sistie Hudson

• Source: “When Rural Hospitals

Close, Towns Struggle to Stay Open” – Marketplace, 2014

TECHNOLOGY AS A REMEDY?

Past à Presentà Future

Inpatient- Inpatient- Center Centered ed Car Care Outpatient Outpatient

• Center
• Centered

ed Car Care Tech- ech- Driven Driven Car Care

• E-visits increased by 400% between 2012 and 20141 – still rising
• Rural communities dwindling -- telemedicine can extend access to

specialty services to underserved areas

• Rise of direct-to-consumer health puts increased pressure on

institutional providers to maintain market share

• Technological advancements make telemedicine more affordable

than ever

• Shift to value-based care places greater emphasis on routine,

convenient, preventive care

1Deloitte, http://www2.deloitte.com/content/dam/Deloitte/global/Documents/Technology-Media-Telecommunications/gx-

tmt-2014predictionevisits.pdf

WHY

HY TELEHEAL ELEHEALTH TH’S T

TIME

IME IS IS H

HERE

ERE

WHY

HY TELEHEAL ELEHEALTH TH’S T

TIME

IME IS IS H

HERE

ERE

21% ¡ 17% ¡ [PERCENTAGE] ¡ [PERCENTAGE] ¡ 9% ¡ 44% ¡

What ¡Op8ons ¡Consumers ¡Would ¡Select ¡for ¡Middle-­‑of-­‑the-­‑ Night ¡Care ¡

Video ¡Visits ¡ 24 ¡Hour ¡Nurse ¡Line ¡ Online ¡Symptom ¡Checker ¡ Ambulance ¡ Other ¡ ER ¡

Source: ¡Kaufman ¡Hall ¡& ¡Associates ¡

TELEHEAL

ELEHEALTH TH AND AND P

POPULA

OPULATION TION H

HEAL

EALTH TH

Atlanta Journal-Constitution Forbes Becker’s Hospital Review Modern Healthcare

Regarding per-patient-per-month reimbursement under CPC+ model, “practices might offer telemedicine visits or simply provide longer office visits for patients with complex needs.”

• Traditional Hub-and-Spoke “Access” Model

TECHNOLOGY ECHNOLOGY AS AS A R

REMEDY

EMEDY

HUB

SPOKE

Specialty services w/out MD travel Increased services at rural spoke – keeping patients in keeping patients in their communities their communities Life-saving emergency care without lengthy patient travel Coordinated care for superior quality Continuous care reducing ER visits and readmissions Shared reimbursement for live two-way care Transfers of cases not clinically appropriate for spoke PR and marketing advantages

HEALTH SYSTEM

Greater access to care – relieves travel burdens and work absences for employees and parents Keeps student and employee populations healthier Allows on-site staff to provide more varied, meaningful care Encourages patients to receive routine care where otherwise avoided (e.g. due to high deductibles) Reduces unnecessary ER visits and readmissions Developing relationships with families – PR and marketing advantages

TECHNOLOGY ECHNOLOGY AS AS A R

REMEDY

EMEDY

• School- or Employer-Based Population Health Model

TECHNOLOGY ECHNOLOGY AS AS A R

REMEDY

EMEDY

• Consumerism/mHealth Model
• Development of direct-to-patient

health apps

• Offer as premium service to self-pay

patients

• Contract with commercial payers to

include e-visits in plans

• Some health providers are white-labeling

mobile health services to better reach their patient populations (e.g. Piedmont Hospital)

TECHNOLOGY ECHNOLOGY AS AS A R

REMEDY

EMEDY

• Home-Health Model
• Remote patient monitoring and follow-up

Reduced readmissions Optimal efficiency and quality

• Telemedicine-equipped ambulances

Reduced unnecessary ER visits Lives saved in remote areas

• Physician-Led Models
• Standalone specialty practices
• Concierge Medicine
• Back-up to urgent care centers, rural clinics
• Back-up to hospital emergency rooms, ICUs

(e.g. telepsychiatry) Mercy Virtual Care Center in Chesterfield, MO, launched in fall of 2015, featuring more than 300 providers serving 38 hospitals in areas such as stroke care and ICU monitoring. Since launching, Mercy claims to have sent home 1,000 ICU patients who otherwise would have been expected to die, and saved $40 million. Photo and story via U.S. News and World Report

REIMBURSEMENT

EIMBURSEMENT – P

– PRIV

RIVATE TE P

PAY

AY

...every health benefit policy that is issued, amended, or renewed shall include payment for services that are covered under such health benefit policy and are appropriately provided through telemedicine...and generally accepted health care practices and standards prevailing in the applicable professional community at the time the services were provided. GEORGIA

EORGIA T

TELEMEDICINE

ELEMEDICINE A

ACT

CT OF OF 2005 (“P

2005 (“PARITY

ARITY L

LAW

AW”)

”) O.C.G.A. § 33-24-56.4 O.C.G.A. § 33-24-56.4