Tag Archive: Rural health

A Nice Note from our Chief Medical Officer about Data and Care Coordination:

We had a very productive telephone meeting regarding one of our member’s patient care opportunities this morning. The combination of Lightbeam’s data and the ability to collate with the EMR data really illuminated some opportunities for care coordination. Everyone was motivated to work together. Drilling down on individual patients locally, especially the high utilizers, is invaluable.

The two specific patient cases were interesting in that they were both very sick patients, but had very different healthcare barriers:

Patient 1. An end-of-life patient who had multiple admissions, but only 3 visits to her primary care provider.

This patient would have likely benefited from some care coordination between the discharge Planner at the hospital and the outpatient Care Coordinator to facilitate better follow-up with their PCP. This may have led to more in-depth discussions about end of life, Hospice, etc. Even if the patient or family was not interested in palliative care, it would have at least allowed for closer follow-up between hospitalizations for preventative care, medication compliance or dosing adjustments, etc. All of which could have improved the stability of this patient’s health and comfort in the months leading up to her death.

The other patient was very different, but also very sick.

Patient 2.  A chronic disease patient (COPD) who had seen multiple physicians, but was, nonetheless, admitted 8 times for COPD in the first 9 months of 2014.

The opportunities for care coordination here are certainly different, but equally important and achievable. The outpatient chart review was interesting: showing yet another admission since data collection in the spreadsheet. In this subsequent admission, the patient refused follow-up in the 3 days of respiratory worsening leading up to admission. The opportunity for a Care Coordinator to be collating all the discharge information, specialist care/recommendations, communicating with the patient and PCP with the goal of breaking down barriers to outpatient care access or novel methods for and outpatient action plan (ie corticosteroids) or redirecting care away from the ER when appropriate are obvious.

There seem to be many windows of opportunity that were identified and taking the Lightbeam data back to the Care Coordinators, hospital discharge planners and associated PCPs at the local level seems to be an actionable way to improve the patients’ care and also decrease costs.
Paul Krause, MD
Chief Medical Officer

Does CMS Really Hate Rural Hospitals?

We often hear in our travels the opinion that CMS wants to close rural hospitals and have everyone use urban hospitals instead. Many think that CMS believes rural hospitals are too expensive and provide low quality care. They point to the plethora of innovation models focused on urban areas, with almost no rural health system participation, unless the rural member joins as part of an urban system. Sixty percent of rural health systems are supported by local tax dollars and would rather “live free or die.”

Is it that CMS doesn’t care, or is it that they don’t know? Historically, health insurance payment innovation has always come from the private sector first. Commercial insurers created ACOs long before Medicare did. Diagnosis Related Groups (DRGs) were a commercial insurance innovation. Capitation and HMOs were tested in the private sector first. The government needs data and experience before it can implement new payment models, and the private sector is not testing new models in rural America. Furthermore, urban payment models cannot scale down to rural health systems. Everyone remembers when DRGs were implemented in rural hospitals. Hundreds of rural hospitals closed as a result. CMS is wise to be cautious.

As rural healthcare providers, we are going to have to lead innovation if we want to survive. No one else can or will do it for us. We have formed the National Rural Accountable Care Organization so that we can pool our resources, our knowledge, our lives and our ideas to create and test new payment models. The future of our communities depends on us working together. Join us.

Celebrate National Rural Health Day on November 20

This was written by my colleague Bob Humphrey of CSPI and I want to share it with you.  Celebrate Rural Health Day!

National Rural Health Day

November 20th is National Rural Health day. As a former CEO of 3 rural hospitals in Alabama, let me share my thoughts on the important role of our rural healthcare providers, employees and volunteers and their contribution to the fabric of rural America.

In the small, rural hospital we know our patients; we know their first name and their relatives. We know the patient whose grandfather started the town’s feed store. We respect the intent of HIPAA, but we respect our patients even more.

We provide good quality care. We have excellent clinical systems and our quality and patient satisfaction scores rival any medical center. Our employees are knowledgeable and work hard; and many have worked at our facility for decades.

We have been under constant financial pressures lately, mainly due to scale, but we will persevere because the alternative is not acceptable to us or our community.

There have actually been some developments that should offer some encouragement to us and relieve some of this financial pressure….

-adoption and acceptance of telemedicine along with fair reimbursement

-our existing and longstanding rural primary care base will be a strength as we shift the payment model to ACOs and other Value Based Purchasing mechanisms

-our economic value to the local community is being fully realized

-our high quality measurement scores and patient satisfaction scores are being recognized by our community, peers and by payers and leaders on the national level.

All of this give us reason to celebrate Rural Health Day and here are some ways to celebrate…

-Go see the doctor who has been there for 30 years and shake his /her hand.

-Have a cup of coffee with the coworker who has been working at the hospital since they wer 18 years old.

-Take hold of a patient’s hand that you know has been in your hospital several times and assure them that we will always be there to take care of them.

-Thank a volunteer for their special role at the hospital.

-Tell Dietary how good that Peanut Butter pie is and Housekeeping how spotless the patient rooms are.

-Visit the employees out back in the trailer and thank them for their contribution to the mission of the hospital.

Then try to leave work early enough to catch the sunset over your community and reflect how vital your hospital is to you and all of those around you.

Go Rural!

Rural ACO Summit Set for February 2, 2015 in Washington, DC

Fifty-nine Critical Access Hospitals joined ACOs in order to participate in the Medicare Shared Savings Program in 2014. This number will more than double in 2015, representing more than 10% of all CAHs. CMS is providing $114 million in grant funds for up to 300 rural health systems to join the program in 2016. The National Rural ACO is hosting a free educational conference at the Capitol Hilton in Washington, DC on Monday, February 2nd, 2015; the day before the National Rural Health Association’s Policy Institute. Visit www.ruralaco.com to learn more about the conference.

The Rural ACO Summit, sponsored by the National Rural Health Association and the National Rural Accountable Care Organization, will bring together experienced 2012-2014 rural ACOs, new 2015 rural ACO participants and potential applicants for the 2016 Program. Participants will learn the basics of ACO participation — including positive and negative effects on budgets, staffing, billing, and utilization. They will learn about policy issues that must be addressed to fix unique rural issues and the benefits of the ACO program, including important waivers and full access to claims data for your patients.

Who Should Attend?

New or existing ACO participants will not want to miss this opportunity to hear the latest from CMS and the experts in Washington while meeting with other ACO members from across the country looking to share information.

Prospective ACO applicants should attend to gain valuable first-hand knowledge from early adopters and recognized experts in the program. It will be a fantastic opportunity to determine whether you can, or should, join an ACO.

Attendees will also learn how to qualify and apply for the exciting new ACO Investment Model Program, $114 million dollars already allocated by CMS which pre-pays qualifying applicants, providing the start-up capital to fund rural ACO participation.

CMS is at the table. Are you? We look forward to seeing you in Washington, DC!  Click here to register today. There is no cost to register.

Click here for more information about the Policy Institute.  We look forward to seeing you in Washington, DC on February 2, 2015.