F e de ra l Ro le in Rura l He a lth: Ce nte rs fo r Me dic a re & Me dic a id Se rvic e s Ca ra V. Ja me s Dire c to r, CMS Offic e o f Mino rity He a lth Co -c ha ir, CMS Rura l He a lth Co unc il No ve mb e r 2018
CMS Rura l He a lth Stra te g y CMS Rura l He a lth Stra te g y Clic k to e dit Ma ste r title style Clic k to e dit Ma ste r title style Ma king he a lth c a re in rura l Ame ric a Ma king he a lth c a re in rura l Ame ric a a c c e ssib le , a ffo rda b le , a nd a c c o unta b le a c c e ssib le , a ffo rda b le , a nd a c c o unta b le
CMS Rura l He a lth Stra te g y CMS Rura l He a lth Stra te g y May 2018 - CMS launc he s Age nc y’s first rural he alth strate gy to impro ve ac c e ss and quality o f c are fo r rural Ame ric ans
F F e e db a c k fro m L e e db a c k fro m L iste ning Se ssio ns iste ning Se ssio ns • I mpro ving re imb urse me nt • Ada pting a nd impro ving q ua lity me a sure s a nd re po rting • I mpro ving a c c e ss to se rvic e s a nd pro vide rs • I mpro ving de live ry a nd pa yme nt mo de ls • E ng a g ing c o nsume rs • Re c ruiting , tra ining , a nd re ta ining the wo rkfo rc e • L e ve ra g ing pa rtne rships/ re so urc e s • I mpro ving a ffo rda b ility a nd a c c e ssib ility o f insura nc e o ptio ns
CMS Rura l He a lth Stra te g y CMS Rura l He a lth Stra te g y Ob je c tive s Ob je c tive s 1. Apply a rura l le ns to CMS pro g ra ms a nd po lic ie s 2. I mpro ve a c c e ss to c a re thro ug h pro vide r e ng a g e me nt a nd suppo rt 3. Adva nc e te le he a lth a nd te le me dic ine 4. E mpo we r pa tie nts in rura l c o mmunitie s to ma ke de c isio ns a b o ut the ir he a lth c a re 5. L e ve ra g e pa rtne rships to a c hie ve the g o a ls o f the CMS Rura l He a lth Stra te g y
Qua lity Pa yme nt Pro g ra m: Qua lity Pa yme nt Pro g ra m: Clic k to e dit Ma ste r title style Clic k to e dit Ma ste r title style Sma ll, Unde rse rve d, a nd Rura l T Sma ll, Unde rse rve d, a nd Rura l T e c hnic a l e c hnic a l Assista nc e Assista nc e
T T e c hnic a l Assista nc e fo r e c hnic a l Assista nc e fo r Clinic ia ns Clinic ia ns CMS has free resources and organizations to provide help to clinicians who are included in the Quality Payment Program:
Pa tie nts Ove r Pa pe rwo rk Pa tie nts Ove r Pa pe rwo rk Clic k to e dit Ma ste r title style Clic k to e dit Ma ste r title style Putting Pa tie nts F Putting Pa tie nts F irst irst
Re mo ving Re g ula to ry Ob sta c le s • Me a ning ful Me a sure s • Co mpre he nsive initia tive la unc he d in 2017. Ba la nc ing the va lue o f q ua lity da ta with e ffo rts to limit pro vide r b urde n. • CAH 96- Ce rtific a tion Re quire me nt • Dire c te d QI Os, MACs, SMRC, a nd RAC to ma ke the 96 ho ur c e rtific a tio n re q uire me nt a lo w prio rity fo r me dic a l re c o rd re vie ws c o nduc te d o n o r a fte r 10/ 1/ 2017 • Dire c t Supe rvision for Outpa tie nt T he ra pe utic Se rvic e s • Re insta te d the no n-e nfo rc e me nt fo r dire c t supe rvisio ns re q uire me nts fo r o utpa tie nt the ra pe utic se rvic e s fo r CAHs a nd sma ll rura l ho spita ls ha ving 100 o r fe we r b e ds fo r CY 2018 a nd 2019
Me dic a re Physic ia n F Me dic a re Physic ia n F e e Sc he dule F e e Sc he dule F Y Y 2019 F 2019 F ina l Rule ina l Rule • Doc ume nta tion – E limina te s re q uire me nt to do c ume nt the me dic a l ne c e ssity o f a ho me visit in lie u o f a n o ffic e visit. – F o r e sta b lishe d visits, pro vide rs c a n c ho o se to fo c us the ir do c ume nta tio n o n wha t ha s c ha ng e d sinc e the la st visit o r o n pe rtine nt ite ms tha t ha ve no t c ha ng e d. • E / M Visits – F o r CY 2021, the re will b e a sing le ra te fo r E / M o ffic e visits le ve ls 2- 4, while ke e ping the pa yme nt ra te fo r le ve l 5. – Ado pte d ne w “e xte nde d visit” a dd-o n c o de fo r E / M o ffic e le ve l 2-4 visits to a c c o unt fo r a dditio na l re so urc e s ne e de d whe n pra c titio ne rs spe nd e xtra time with a pa tie nt.
Clic k to e dit Ma ste r title style Clic k to e dit Ma ste r title style T T e le he a lth e le he a lth
CY 2019 Me dic a re Physic ia n F CY 2019 Me dic a re Physic ia n F e e e e Sc he dule F Sc he dule F ina l Rule ina l Rule • T e le he a lth – Adde d ne w c o de s to the te le he a lth list fo r 2019 fo r pro lo ng e d pre ve ntive se rvic e (s) – Adde d re na l dia lysis fa c ilitie s a nd the ho me s o f E SRD b e ne fic ia rie s re c e iving ho me dia lysis a s o rig ina ting site s. – Adde d mo b ile stro ke units a s o rig ina ting site s fo r dia g no sis, e va lua tio n, o r tre a tme nt o f a n a c ute stro ke . • Communic a tion T e c hnolog y- Ba se d Se rvic e s – Adde d ne w c o de s fo r se rvic e s pro vide d using c o mmunic a tio n te c hno lo g y: • Brie f c o mmunic a tio n te c hno lo g y-b a se d se rvic e (e .g . virtua l c he c k-in) • Re mo te e va lua tio n o f re c o rde d vide o a nd/ o r ima g e s sub mitte d b y a nd e sta b lishe d pa tie nt (e .g . sto re a nd fo rwa rd).
T T e le he a lth Utiliza tio n in Me dic a re e le he a lth Utiliza tio n in Me dic a re • Ana lyze d Me dic a re F F S c la ims da ta a nd fo und use o f te le he a lth inc re a se d b e twe e n 2014 a nd 2016, tho ug h the o ve ra ll ra te o f a do ptio n is still ve ry limite d. • I n 2016, a lmo st 90,000 (0.25%) Me dic a re F F S b e ne fic ia rie s utilize d 275,199 te le he a lth se rvic e s. • Sig nific a nt g ro wth in utiliza tio n a mo ng the o lde st po pula tio n— b e ne fic ia rie s 85 ye a rs a nd o lde r. • Psyc ho the ra py is a mo ng the se rvic e s mo st c o mmo nly furnishe d thro ug h te le he a lth. • Sta te s with the hig he st utiliza tio n a re T e xa s, I o wa , Ca lifo rnia , Misso uri, Mic hig a n, Minne so ta , Wisc o nsin, Ge o rg ia , Virg inia , a nd K e ntuc ky.
Clic k to e dit Ma ste r title style Clic k to e dit Ma ste r title style Addre ssing the Opio id E Addre ssing the Opio id E pide mic pide mic
Rura l Be ha vio ra l He a lth: Opio ids T ho ug h o pio id a b use a nd o pio id-re la te d de a th ha s b e e n o n the rise na tio na lly, rura l c o mmunitie s fa c e uniq ue c ha lle ng e s Opio id-re la te d o ve rdo se de a ths in rura l a re a s inc re a se d mo re tha n 10% fro m 2015 to 2016 Rura l re side nts a re mo st like ly to b e pre sc rib e d, a nd o ve rdo se o n, pre sc riptio n pa inkille rs Rura l re side nts with o pio id use diso rde r te nd to b e yo ung e r, le ss we a lthy a nd e duc a te d, un o r uninsure d Mo re tha n 60% o f rura l c o untie s la c k a sing le physic ia n tha t c a n pre sc rib e b upre no rphine , < 10% o f o pio id tre a tme nt pro g ra ms in rura l 15
CMS Opio id Ro a dma p CMS Opio id Ro a dma p We bsite : https:/ / www.c ms.g o v/ b lo g / c ms-o pio ids-ro a dma p 3
Re c e nt E Re c e nt E ffo rts to Addre ss the Opio id ffo rts to Addre ss the Opio id E E pide mic pide mic • Inte g ra te d Ca re for Kids (InCK) mo de l – A mo de l a ime d a t re duc ing c o sts a nd impro ving c a re fo r c hildre n thro ug h pre ve ntio n, e a rly ide ntific a tio n, a nd tre a tme nt o f prio rity c o nditio ns like sub sta nc e a b use . • Ma te rna l Opioid Misuse (MOM) mo de l – F ive ye a r mo de l a ime d a t inc re a sing a c c e ss to tre a tme nt fo r o pio id use diso rde r a nd to impro ve o utc o me s fo r pre g na nt a nd po stpa rtum wo me n a nd the ir c hildre n. • Me dic a id de monstra tion to e xpa nd me nta l he a lth tre a tme nt fo r a dults with SMI a nd kids with SE D, thro ug h a utho rity to pa y fo r sho rt-te rm re side ntia l tre a tme nt se rvic e s.
Unde rsta nding a nd Addre ssing Rura l Unde rsta nding a nd Addre ssing Rura l Clic k to e dit Ma ste r title style Clic k to e dit Ma ste r title style He a lth Dispa ritie s He a lth Dispa ritie s
Offic e s o f Mino rity He a lth Within HHS
CMS OMH He a lth E q uity F ra me wo rk I nc re a sing De ve lo ping I mple me nting a nd unde rsta nding susta ina b le disse mina ting a nd a wa re ne ss a c tions o f dispa ritie s solutions
E me rg ing Rura l Dispa ritie s - Po te ntia lly E xc e ss De a th In 2014, a hig he r ra te of pote ntia lly e xc e ss de a ths oc c urre d a mong rura l Ame ric a ns tha n urba n Ame ric a ns from: • He a rt dise a se • Uninte ntional injur ie s • Mo re tha n 25,000 e xc e ss • Mo re tha n 12,000 e xc e ss de a ths de a ths • 57.5% in rura l a re a s; 39.2% in • 42.6% in rura l a re a s; 27.8% urb a n a re a s in urb a n a re a s • Appro x. 50% highe r in rura l a re a s • Appro x. 50% highe r in rura l tha n urb a n (a g e -a djuste d a re a s tha n urb a n b e twe e n 1999-2014) • Ca nc e r • Chr onic lowe r r e spir a tor y dise a se • Mo re tha n 11,000 e xc e ss de a ths • Mo re tha n 19,000 e xc e ss de a ths • 54.3% in rura l a re a s; 30.9% in • Ove ra ll c a nc e r de a ths urb a n a re a s de c line d 1.5%/ ye a r • Appro x. 50% highe r in rura l a re a s b e twe e n (2003-2012); tha n urb a n • de c line d le ss in rura l vs. urb a n a re a s 21
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