20142015 RWJF Health Policy Fellow 114 th Congress Medicare Reimbursement Challenges for Underserved C ommunities Objectives Medicare Overview Urban vs Suburban vs Rural Health ID: 528326
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Slide1
Colleen Leners, DNP, APRN2014-2015 RWJF Health Policy Fellow114th Congress
Medicare Reimbursement Challenges for Underserved
C
ommunities Slide2
Objectives Medicare
Overview
Urban vs
Suburban vs Rural
Health
Medicare Alternative Payment Models
S
takeholders
Introduction to South Dakota
Current Legislation
SummarySlide3
Medicare Costs Slide4
Medicare SpendingSlide5
Geographic Division:
# of Areas
Total Population
Percent of U.S. Total
Total U.S. Population
285,230,516
100
Population living in Urban Areas
23,629225,956,06079.219Population living in Rural Areas 59,274,45620.781Urban Area Categories: 1. Urbanized Areas over 200,000 population153166,215,88958.2742. Urbanized Areas 50,000 - 199,999 population31029,584,62610.3723. Urban Clusters 5,000 - 49,999 population183825,438,2758.9184. Urban Clusters 2,500 - 4,999 population13284,717,2701.654
Census 2000 Population Statistics Slide6
Rural
A
frontier state is a state in which at least 50 percent of the counties are frontier counties
; population per square mile is less than 6
Urban
Metropolitan Statistical Areas (MSAs). MSAs are urban areas with more than 50,000 residents and surrounding
suburbs; (1,000
people per square mile)
Definitions from ACA
Suburban A residential or a mixed use area, either existing as part of a city or urban area or as a separate residential community, within commuting distance of a citySlide7
RURAL
SUBURBAN URBAN
Younger Mixed
ages
Employed Low employment
Insured Less insured
Healthier Chronic Conditions
Access to health care Mixed Access
Better prenatal care Infant Mortality
Analysis of Challenges OlderPoorerLess insured More Chronic ConditionsSmokersObesityIncreased infant mortality, Children, Young adults MVA, Unintentional Less Active Less access to health careSlide8
2014 GAO ReportMedicare Payment, Management, and Program IntegrityIn 2014, Medicare covered approximately 54 million people at an estimated cost of about $600 billion.
CMS
,
which administers Medicare, faces major challenges
in
implementing payment methods that encourage efficient service
delivery.
M
anaging the program to serve beneficiaries.S
afeguarding the program from loss due to fraud, waste, and abuse.Slide9
Alternative Medicare ModelsSlide10
Quality Link to ACOSlide11
Challenges in CMS Rules, Urban - Rural ACO’sRural Providers and
ACOs
Provisions to Allow FQHCs and RHCs to Fully Participate in the Shared Savings
Program
Modification to Beneficiary Assignment Rules for FQHCs and
RHCs
Critical Access Hospitals and ACOs Slide12
House Rep. Adrian Smith (R-NE) (Ways & Means) and Rep Mike McIntyre
(D-NC)
(Armed
Services)
49 representatives are signed up on rural caucus just 11% of the House
Senate
Sen
. Pat Roberts (R-KS)
(Finance, HELP, AG, Rules)
Sen.Al Franken(D-MN) (HELP, Judiciary, Indian Affairs)48 senators are 48% of the Senate Rural Healthcare Caucus Slide13
Mission Statement The bipartisan Congressional Rural Caucus was established to ensure a voice for rural communities and work toward educating other members
of
Congress.
Rural
Caucus Members work to strengthen our way of life by helping rural communities prepare for the future.
Our
goal
is to jumpstart initiatives to rejuvenate rural communities struggling under today’s difficult economic conditions. Slide14
South Dakota Diverse and BeautifulSlide15
South Dakota Statistics
Party
Active Voters
AME
11
CON
583
DEM
175,448
IND87,005LIB1,455REP242,286Other606NPA18,465Total Active Voters525,815Population (2010 Census): 814,180Square Miles: 77,047State Capitol: PierreSlide16
Senator John ThuneSouth DakotaSlide17
Committee Assignments Chairman Committee on Commerce, Science & Transportation
Committee on Agriculture, Nutrition & Forestry
Committee on
Finance
Conference ChairmanSlide18
Legislation S. 1456A bill to amend title XVIII of the Social Security Act to improve the way beneficiaries are assigned under the Medicare shared savings program by also basing such assignment on primary care services furnished by Federally qualified health centers, rural health clinics, nurse practitioners, physician assistants, and clinical nurse specialists
.
Sponsors
:
Sen. Cantwell, Sen. Thune, Sen. MurraySlide19
Stakeholders American Medical Association AMDA – The Society for Post-Acute and Long-Term Care Medicine
American Academy of Allergy, Asthma & Immunology
American Academy of Dermatology Association
American Academy of Family Physicians
American Academy of Home Care Medicine
American Academy of Pediatrics
American Association of Clinical Endocrinologists
American College of Emergency Physicians
American College of Osteopathic Internists American College of Osteopathic Surgeons
American College of Physicians American College of Radiology American Gastroenterological AssociationAmerican Geriatrics Society American Medical Group Association American Academy of Nurse Practitioners American Society for Clinical Pathology American Society of Hematology American Society of Nephrology America’s Essential Hospitals Association of American Medical Colleges Catholic Health Association of the United States Collaborative Health Systems, a subsidiary of Universal American Federation of American Hospitals Heart Rhythm Society Infectious Diseases Society of America Medical Group Management Association National Association of ACOs, National Rural Health Association Premier healthcare alliance Society for Vascular Surgery Society of General Internal Medicine Trinity HealthSlide20
Summary Know your leversKnow who has jurisdiction(Committee, Seniority of member)
Know your stakeholders (pro & con)
Good legislation is the goal
How you get there is an
Art
Slide21
“All politics is local” Tip O’NeillThis is where
Congress
can find common ground!
When the need for taking care of constituents (friends & family) is more important than idealistic differences, you can find compromise! Slide22
Acknowledgements
Jane Lucas Legislative Director
Dennis D'Aquila Health LA
Colleen
L
eners RWJF Health Fellow
Health Team Thune!Slide23
Thank you RWJF/IOM For Transformational Experience!