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Trump Administration Announces Details of New Rural Health Model

The Centers for Medicare and Medicaid Services (CMS) recently unveiled the details of the Trump Administration’s long-awaited, new rural health payment model, the Community Health and Rural Transformation (CHART) Model. The CHART Model aims to, “[Unleash] innovation through new funding opportunities that will increase access and improve quality,” by allowing a limited number of rural health providers to participate in one of two tracks, the Community Transformation Track and the Accountable Care Organization (ACO) Transformation Track. According to CMS, this new model comes as a response to President Trump’s Executive Order on Improving Rural Health and Telehealth Access that was made on August 3rd, as well as the President’s Medicare Executive Order and CMS’s Rethinking Rural Initiative.

The Community Transformation Track will include up to 15 lead organizations. These lead organizations are entities representing a rural communities comprised of either a single county or a set of contiguous or non-contiguous counties. This track will create a $75 million grant program for the 15 organizations to share. This experimental track aims to give these up-front dollars to providers and allow them greater flexibility to create their own health care programs with a patient focus. 

The ACO Transformation Track builds on the successes the very popular and successful ACO Investment Model (AIM) program. In this model, CMS will select 20 rural-focused ACOs to receive advanced payments to engage in value-based payment efforts aimed at improving outcomes and quality of care for rural beneficiaries. We are supportive of this new and exciting opportunity, but we also want to acknowledge that how CMS currently sets spending benchmarks disadvantages certain rural providers. Currently, CMS compares the per-patient costs of a region’s ACO with the operating expenses of its non-ACO competitors, but rural ACOs are often the only significant provider in their region. Thus, rural ACOs often face a much lower spending benchmark, because urban and suburban regions often have more non-ACO providers. We are calling upon CMS to fix this ‘rural glitch’ within the MSSP. This is a critical and common-sense step towards establishing greater payment for rural providers that are providing high quality care to their communities while decreasing health care spending. Unlike the earlier AIM program, participants in the ACO Transformation Track will enter into two-sided risk arrangements as part of the Medicare Shared Savings Program (MSSP), which could be a barrier to entry for many rural hospitals unwilling to bear risk without being able to define that risk completely. Additionally, a CHART ACO is limited to 10,000 covered lives which could increase actuarial volatility in participating in a dual-sided risk program.

The timeline indicates that a Notice of Funding Opportunity (NOFO) for the Community Transformation Track will be available in September on the Model Website and the Request for Application (RFA) for the ACO Transformation Track will be available in early 2021.  

Status Report of the Alabama Primary Care Physician Workforce, 2019

Summary

Access to care is identified as Alabama’s number one health issue in the 2015 State of Alabama Community Health Improvement Plan, with the most significant and universal barrier being access to a Primary Care Physician (PCP).

In 2019 Alabama needs an additional 126 primary care physicians working 8 hours per day, 5 days per week located in 40 specific population centers to eliminate Alabama’s shortage of PCPs.

Alabama has one Full Time Equivalent (FTE) PCP for every 2,410.6 residents. This ratio globally suggests that Alabama has adequate numbers of PCPs available for its 4,850,771 residents, but in Alabama the PCP shortage is the result of the current distribution of PCPs and the lack of PCP access it creates.

Purpose

This report identifies Alabama’s licensed primary care physicians (PCPs), their spatial distribution and their availability to Alabama residents. This model addresses access to primary care physicians at the community level while at the same time giving direction and allowing coordination at a state level.

The Office for Family Health Education & Research, UAB Huntsville Regional Medical Campus

  • William H. Coleman, MD PhD
  • Kyle Seigrist, PhD
  • Caleb Lenox, Research Associate
  • Alex Kearns, MS III

98% of Alabama’s PCP practices are located in 79 Alabama population centers.

These population centers are towns and cities where most Alabamians currently could or do obtain direct patient access to a PCP(s). These population centers are spatially located such that 96% of Alabama’s 4,850,771 residents are within a 30 minute or less travel time from one of these 79 population centers. The Alabama county map (Figure 1) shows the location of these 79 cities and towns and the practice locations of Alabama’s PCPs (green icons). Counties are geopolitical units, but they are not appropriate boundaries for defining population units (catchment areas) that can be linked to the 79 locations that house Alabama’s current PCP workforce.

Figure1

Figure 2 shows Alabama’s 79 PCP population centers as points of access for residents in their catchment areas (Primary Care Service Areas or PCSAs). The boundaries of these PCSAs place each population center equidistant from all other population centers as measured by Alabama’s road network. PCSAs link PCPs in the network’s 79 towns and cities to their accessible populations in a manner that allows accurate calculation of PCP shortages based on local population demand. Towns and cities with shortages of PCPs in 2019 are denoted in red while centers in blue are population centers with an adequate number or a surplus of PCPs.

Figure2

Using PCSAs instead of counties maintains Alabama’s usual designation of rural and urban areas and results in a more appropriate allocation of residents to rural or urban population centers, and PCPs, based on geographic accessibility. Figure 3 is an Alabama PCSA map color coded to identify rural and urban PCSAs, with 18 PCSAs designated as urban, and 61 designated as rural.

Figure3

The results of Alabama’s PCP workforce analysis is presented in Figure 4. This table quantifies and details the results of Alabama PCP shortages in a concise, easily identifiable format. In summary, 40 population centers have a shortage of PCPs and 37 of these are rural. These population centers need a total of 126.3 additional FTE PCPs to eliminate the PCP shortage for the state as a whole. The other 39 population centers have adequate or surplus PCPs and 24 of these are rural. The PCSAs with a surplus have 493.2 more FTE PCPs than needed. In this table PCP shortages, adequate balance and surpluses are quantified at specific locations to identify not only how many PCPs are needed but also where they are needed.

Figure4

98% of Alabama’s PCP practices are located in 79 Alabama population centers.

These population centers are towns and cities where most Alabamians currently could or do obtain direct patient access to a PCP(s). These population centers are spatially located such that 96% of Alabama’s 4,850,771 residents have 30 minute or less travel time access to PCPs. This map (Figure 5) shows the spatial distribution of Alabama’s towns and cities where Alabama residents have access to 98% of Alabama’s PCPs.

Figure5

Conclusions

Alabama has 79 population centers identified as primary care service points based on PCP availability and population accessibility. The results table (Figure 4) serves as a template for focused needs evaluations, resource determinations and barrier assessment. It allows unique individualized community approaches, regional approaches where common issues among population centers exist, and realistic identification and consideration of issues that can to be addressed a state level.

Alabama population centers with shortages of PCPs are documented. The number of PCPs needed to resolve the shortages at these 40 population centers are documented. In addition Alabama’s FTE PCP statewide workforce is accounted for.

This analysis establishes that Alabama has a data-driven model with the capacity to accurately identify and quantify primary care workforce data, and produce annual updates. It serves as a tool to monitor outcomes and is able to project future needs based on PCP and population demographics. This model matches patient demand, based on average visits per year and average time per visit, with PCP availability, based on a standard physician workweek. Other models lack this specificity, which could result in different need computations, but most of these would identify the same service areas in need.

Recommendation

While this information is basic to understanding, accessing and addressing population center based shortage issues, the fact is, this information is not generally known. Thus the first step is broad-based dissemination of this information.

ARHA Concludes Statewide Listening Sessions | Develops 2020 Policy Agenda

The Alabama Rural Health Association recently concluded its four-part statewide Policy Road Show with a board retreat to develop its 2020 Policy Agenda.

The Policy Road Shows opened opportunities for constituents across Alabama to voice their opinions on major healthcare issues in their communities.  More than 250 attendees were able to provide feedback.  The Road Show events took place in Rainsville, Wetumpka, Livingston, and Enterprise.

ARHA directors and advisory board members gathered after the final Road Show to study results and determine policies and legislation that would best help to accomplish the desires of constituents.  After robust discussion, the following was proposed:

  • Medicaid expansion / increased Medicaid funding
    • Pursue approaches to Medicaid improvements, including considerations of Medicaid expansion and/or increased reimbursement for current Medicaid covered services.
  • Physician and dental rural tax credit bill
    • Pursue a physician tax credit bill to help recruit physicians to rural areas.
  • Behavioral health and oral health improvement
    • Support behavioral health and oral health in Alabama for structural, access, and reimbursement improvements.
  • Health promotion (including health literacy) and focus on social determinants
    • Support health promotion efforts statewide (including health education, health literacy, and health system advocacy and navigation) and policies and legislation that would support or assist with health promotion.
  • Telehealth
    • Support expansion and reimbursability of telehealth statewide. This may include support of a parity law.
  • Public/private insurance reform
    • Support various public/private insurance reform issues.
  • Tax credit bill for physicians who serve in preceptor roles for student physicians.
    • Support for a tax credit bill for physicians / providers who teach students as a preceptor to help with recruitment of physicians in rural areas.
  • Transportation
    • Support for emergency and non-emergency medical transportation support.
  • Vaccinations
    • Support for continued use of immunizations and vaccinations of patients.
  • Advance physician extenders
    • Support for nurse practitioners, physician assistants, and other healthcare providers that extend care into underserved areas and to provide needed care as appropriate.
  • Access to healthy food
    • Support for rural grocery stores, farmers markets, and subsequent nutrition education in rural communities.
  • Social determinants
    • Support for recognition and support of social determinants of health in order to improve patient compliance and outcomes.
  • Broadband support
    • Support for the advancement of broadband in rural Alabama for increased internet speed for electronic medical record systems and telehealth.
  • Chronic disease prevention and compliance
    • Support preventive services related to chronic health conditions as well as treatment services.
  • Encourage additional health system collaboration
    • Encouragement of new partnerships, whether direct or indirect, to increase resources and decrease cost for value-based care and access to care.

The Alabama Rural Health Association would like to thank each member and constituent who participated in the Road Shows, and each board member and advisory board member who participated in the planning and execution of the events as well as worked to develop the 2020 Alabama Rural Health Policy Agenda.

For more information, contact the Alabama Rural Health Association at 334.697.8541 or arha@arhaonline.org.

Jackson County physician selected as ‘Community Star’ for National Rural Health Day

National Rural Health Day is an annual observance that emphasizes the importance of rural America and promotes the need for accessible, high quality health care. National Rural Health Day falls on the third Thursday in November each year and recognizes the efforts of those serving the health needs of over 60 million people across the nation. This year’s observance will be on November 21.

The Alabama Department of Public Health’s Office of Primary Care and Rural Health (OPCRH), the Alabama Family Practice Rural Health Board, the Alabama Hospital Association, the Alabama Primary Health Care Association, the Alabama Rural Health Association, and the University of Alabama at Birmingham Rural Hospital Resource Center are proud to recognize the innovation, quality of care, and dedication of health professionals and volunteers in the state during National Rural Health Day 2019.

This year, Dr. Muhammad Ata of Pisgah, Ala., a true champion of rural health care, has been selected as a “Community Star” for his many contributions in rural communities. The annual “Community Stars” eBook publication honors and gives a personal voice to rural people, providers, advocates and communities across the country. His story will appear in the 2019 eBook that will be available on the PowerofRural.org website, the official hub for National Rural Health Day and the Power of Rural movement, beginning November 21.

Rural health care professionals, hospitals, county health departments, and clinics are dedicated to providing health care in Alabama’s 54 rural counties, which are home to almost 2 million people. These rural communities have unique health care needs and challenges, including the distance to nearest health care facility. In addition, these counties have a population that is generally older, and with health conditions that require a greater need for health care.

Rural hospitals are the economic foundation of many rural communities, but they are being threatened with declining reimbursement rates and disproportionate funding levels that make it more difficult to serve their residents. The OPCRH is dedicated to addressing these issues through a number of programs, such as the following:

·        Loan repayments for physicians, dentists and other health care professionals through the National Health Service Corps
·        No-cost recruitment of physicians using a national recruitment and retention database
·        Adoption of telehealth services to bring distant health care to the local community
·        Designation of physician and dental shortage areas for federal assistance programs
·        Assisting rural clinics in becoming certified to receive enhanced medical payments

In addition, OPCRH works closely with rural hospitals and safety net providers to identify problems and provide needed technical assistance and resources. More than 170 health care providers are presently working throughout the state under programs administered by the office, dispersed among the state’s 154 community health center service delivery sites, 109 rural health clinics, and other providers. The OPCRH’s services are available to any rural health care organization that is dedicated to providing accessible, high quality health care to its community.

Gov. Kay Ivey has issued a proclamation encouraging citizens to recognize the valuable services of rural health practitioners on this day.
To learn more, visit https://nosorh.org/calendar-events/nrhd/