Colleen Leners, DNP, APRN - PowerPoint Presentation

Colleen Leners, DNP, APRN
Colleen Leners, DNP, APRN

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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 Download Presentation


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Colleen Leners, DNP, APRN2014-2015 RWJF Health Policy Fellow114th Congress

Medicare Reimbursement Challenges for Underserved


ommunities Slide2

Objectives Medicare


Urban vs

Suburban vs Rural


Medicare Alternative Payment Models



Introduction to South Dakota

Current Legislation


Medicare Costs Slide4

Medicare SpendingSlide5

Geographic Division:

# of Areas

Total Population

Percent of U.S. Total

Total U.S. Population




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



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


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



Younger Mixed


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.



which administers Medicare, faces major challenges


implementing payment methods that encourage efficient service



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


Provisions to Allow FQHCs and RHCs to Fully Participate in the Shared Savings


Modification to Beneficiary Assignment Rules for FQHCs and


Critical Access Hospitals and ACOs Slide12

House Rep. Adrian Smith (R-NE) (Ways & Means) and Rep Mike McIntyre




49 representatives are signed up on rural caucus just 11% of the House



. 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




Caucus Members work to strengthen our way of life by helping rural communities prepare for the future. 



is to jumpstart initiatives to rejuvenate rural communities struggling under today’s difficult economic conditions. Slide14

South Dakota Diverse and BeautifulSlide15

South Dakota Statistics


Active Voters







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


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




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



“All politics is local” Tip O’NeillThis is where


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


Jane Lucas Legislative Director

Dennis D'Aquila Health LA



eners RWJF Health Fellow

Health Team Thune!Slide23

Thank you RWJF/IOM For Transformational Experience!

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