NEBRASKA RURAL HEALTH ASSOCIATION

Nebraska Rural Health Association 
July 2009



 





Health Reform Update
Health reform continues to make progress in Congress. The House is working to combine the three bills reported by the Ways & Means, Energy & Commerce and Education & Labor Committees into one health reform bill as an important Senate committee continues its markup. The Senate Finance Committee is considering Chairman Max Baucus' (D-MT) America's Healthy Future Act of 2009 and expects to head to debate on the floor the week of October 12. A number of important rural amendments have been accepted, and NRHA continues to work to ensure that health reform works in rural America.

Because electronic records are a health reform priority - and because Nebraska's shovel-ready initiative has outpaced other statewide efforts - participants anticipate an infusion of federal stimulus funds to speed development of a national model.

"We are - from what we can see - the first statewide health information exchange," project consultant Deb Bass said. Actually, full state coverage won't occur for some time, but the elements of the system have proved themselves.

"The pilot far exceeded expectations," Bass said.


During the 90-day Omaha-area pilot of the Nebraska Health Information Initiative that ended June 30, the budding system took in 1,012,455 patient records, which allowed it to fill 82,978 records requests in less than 2 seconds. The system's usefulness will grow with the records history and the numbers of users.  The pilot involved Alegent Health, Children's Hospital and Medical Center, Methodist Health System, Nebraska Medical Center, BlueCross BlueShield of Nebraska, plus about 100 physicians and pharmacists. Software was developed by Axolotl out of Silicon Valley.

Success occurred on a number of levels, not the least of which was public acceptance, Bass said. Patients could voluntarily opt out of electronically sharing their records, but only 11,690, or 1.2 percent, of those approached did so. And of those, 526 later opted back in.

Bass said informational campaigns will accompany the spread of the records system as it hops into Nebraska communities. Next in line are Mary Lanning Memorial Hospital in Hastings and Great Plains Regional Medical Center in North Platte. Full deployment could take years.

Ultimately, Nebraska health care providers - hospitals, physicians, pharmacies, labs, imaging centers - expect the system will save time, lives and millions of dollars. A patient's prior X-rays will be immediately available to ER doctors. Full prescription records will travel instantly to pharmacies. Patients won't have to repeatedly fill out the same forms and answer the same questions.

The beauty of the system is its simplicity, said Roger Hertz, chief information officer of Methodist Health System. Physicians can be trained on the system in half an hour. It was the policies and politics, not the technology, that absorbed the bulk of efforts. Hertz said he hopes organizations in other states will build upon the heavy lifting done by Nebraskans.


Most of the politics were addressed prior to the pilot. What the 90-day test told participants, Lawonn said, is how much work is involved in running the system - a reasonable amount, less technical and more verification.


-- Lincoln Journal Star, July 10, 2009

"A source close to the negotiations said a deal was struck after discussions about the "shared responsibility" of the entire health-care system -- including doctors, insurers, individuals and the government -- and an understanding that each part of the system would sacrifice to make it work,"

The agreement is "the latest step in an on-going effort by the White House to win concessions from major industry groups" to pay for an overhaul expected to cost around $1 trillion, the New York Times reports. "In addition to controlling costs and helping [President] Obama achieve his goal of providing coverage to more than 40 million uninsured Americans, the administration's tentative agreements with drug companies and providers, including hospitals and doctors, are also intended to bring pressure on the private health insurance industry."

The hospital groups involved - the American Hospital Association, the Federation of American Hospitals and the Catholic Health Association - had earlier protested Obama's plan to slash $220 billion from their payments over a decade, Kaiser Health News reports. In exchange for their support, the hospitals negotiated the smaller cut and assurances from the administration and Senate officials that the cuts would be "timed to coincide with expanded insurance coverage. However, the pact doesn't prevent the House from demanding bigger cuts, according to people who are familiar with the negotiations

-- Washington Post 7-7-09

Hospitals, White House Reach Accord On Cuts To Pay For Reform
Major hospital groups reached an agreement Monday with the White House and Senate Democrats to accept $155 billion in payment cuts over ten years, a concession that would help pay for proposed health care reforms, the Washington Post reports.
Government savings would come mainly from lower Medicare and Medicaid payments to the hospitals, and smaller subsidies for providing care to the uninsured. Hospitals expect to make up some of the losses by increasing their volume as anticipated reforms bring health insurance to many of the 47 million Americans who don't have coverage.
Rural Health Clinic Legislation Introduced 

Senator John Barrasso (R-WY) and Ron Wyden (D-OR) have joined forces to introduce the Rural Health Clinics Patient Access Improvement Act of 2009 (S. 1355).

Below is a Section-By-Section analysis of this legislation for your review.

If we want to strengthen and change the RHC program to enhance your ability to provide quality, cost-effect healthcare for your patients, then we must get behind this legislation.

The Nebraska Rural Health Association urges you to contact Senators Nelson and Johanns and ask them to COSPONSOR S. 1355, the Rural Health Clinic Patient Access Improvement Act of 2009!


Broadband Telecommunications Notice Of Funds Availability Released!

The U.S. Departments of Agriculture and Commerce have just released the first joint Notice of Funds Availability (NOFA) for grants authorized under the American Recovery and Reinvestment Act. Titled the Broadband TechnologyOpprotunities Program, this NOFA will make available up to $1.4 billion in grant funds. 

One of the goals of this initiative is to "provide broadband access, education, awareness, training, equipment, and support to community anchor institutions (e.g., schools, libraries, medical facilities)".

For purposes of this initiative, a "rural area" is defined as: any area, as confirmed by the latest decennial census of the Bureau of the Census, which is not located within: 1. a city, town, or incorporated area that has a population of greater than 20,000 inhabitants; or 2. an urbanized area contiguous and adjacent to a city or town that has a population of greater than 50,000 inhabitants.  The funding instruments will be grants, loans, and loan/grant combinations.

The following entities are eligible to apply for assistance:
States, local governments, or any agency, subdivision, instrumentality, or   political subdivision thereof
A non-profit foundation, a non-profit corporation, a non-profit institution, or a non-profit association
Other non-profit entities
For-profit corporations
Limited liability companies; and
Cooperative or mutual organizations
You are encouraged to share this with others in your community, particularly local government officials to determine whether you might qualify for a grant or loan.

The full NOFA is available here.

 


HHS rescinds harmful Medicaid regulations

On June 29, the Health and Human Services Department rescinded three controversial Bush Administration regulations governing Medicaid and said it would postpone and possibly change or rescind a fourth. These regulations are among seven that were proposed by the Bush Administration and rigorously opposed by NRHA. Congress placed a moratorium on the regulations last summer in the War Supplemental Bill, but it was set to expire on June 30, allowing the regulations to go into effect.

One of the regulations the department rescinded would have narrowed the definition of "outpatient services" under Medicaid to medical treatment performed outside a hospital or clinic. Another would have prohibited Medicaid reimbursement for administrative costs incurred by schools and for transporting Medicaid-eligible children to school. A third would have narrowed Medicaid payments for what are called "case management services" that some states offer to Medicaid clients, and the regulation that was postponed would limit taxes that some states assess on health providers to help pay the state portion of Medicaid expenses.

The regulations now cannot go into effect before June 20, 2010, allowing HHS time to consider alternative approaches.

Secretary Sebelius Releases New State by State Reports Highlighting Urgent Need for Health Reform

HHS Secretary Kathleen Sebelius today released a series of new reports on the health care status quo that highlight the urgent need for health reform across the nation.

The new reports are available here and include information on health care cost and quality in all fifty states. "In states across the country, health care costs are going up and families are struggling to get the quality care they need and deserve," Secretary Sebelius said. "We cannot wait to pass reform that protects what works about health care and fixes what's broken."

Each report includes data regarding the health care status quo such as:

•Percent increase in family premiums since 2000.

•The hidden tax individuals and families pay as a result of subsidizing care for the          uninsured.

•Percent of state residents without insurance.

•Overall quality ratings for health care in each state.

•The impact of failing to adequately invest in preventative measures that could                        prevent disease and illness.