Medicare Utilization of FQHCs and RHCs in Wyoming: Current Status and Future Opportunities June 6, 2019 Nick Zucconi, Regional Administrator Office of Regional Operations-Denver Health Resources and Services Administration (HRSA)
HRSA Strategic Plan Goal 3: Enhance Goal 5: Goal 2: Foster a Population Optimize HRSA Goal 1: Improve Health Care Goal 4: Health and Operations to Access to Workforce Able Maximize the Address Healthy Enhance Quality Care to Address Value and Disparities Efficiency, and Services Current and Impact of HRSA through Effectiveness, Emerging Needs Community Innovation, and Partnerships Accountability 2
Health Resources and Services Administration (HRSA) Overview Supports more than 90 programs that provide health care to people who are geographically isolated, economically or medically vulnerable. The agency funds grants and cooperative agreements to more than 3,000 awardees, including community and faith-based organizations, colleges and universities, hospitals, state, local, and tribal governments, and private entities Every year, HRSA programs serve tens of millions of people, including people living with HIV/AIDS, pregnant women, mothers and their families, and those otherwise unable to access quality health care 3
HRSA FY 2018 Funding: $11.5 Billion HRSA Program FY 2018 FY2018 National Wyoming (in millions) (in millions) Primary Health Care $5,511 $9.4 HIV/AIDS $2,319 $1 Health Workforce $1,516 $2.2 Maternal and Child Health $1,293 $1.7 Rural Health $291 $1.3 Family Planning* $286 Program Management $155 Healthcare Systems $112 Vaccine Injury Compensation $9 TOTAL $11,492 $15.6 * Administered by the HHS Office of the Assistant Secretary of Health, rs. 4
HRSA Office of Regio ional Operations (ORO) Ten Regions - One HRSA 5
Office of Regional Operations Mission To improve health equity in underserved communities through on-the-ground outreach, education, technical assistance and partnering with local, state and federal organizations. 6
Office of Regional Operations 2019 Priorities by Core Functions Str Strategi gic St Stak akehol older Ex External Af Affairs & & Par artnership ips Outreach Out • HRSA Bureau & Office Collaboration • HRSA Outreach & Education Str Strategi gic Ex External • HRSA Priorities ( see slide 7) • State, Local, & Tribal Government Affairs • Special Initiatives (region-specific) Affair Af airs & & St Stakehold lder Out Outreach Par artnership ips Regi egion onal Regi egion onal Su Surv rveillance Man Management Regi egion onal l Su Surv rveill llance Regi egion onal l Ma Management • Information Collection and Dissemination • Building Strong Teams • Ergonomics & IT • Emergency Preparedness 7
Office of Regional Operations Network ORO STAKEHOLDERS • HRSA Grantees • State Leadership • Tribal Organizations • Community & Faith-Based Organizations • Colleges/Universities • Private Sector Organizations & Foundations • HHS Regional Directors/Regional Health Administrators • HHS Operating Divisions • Federal Departments or Agencies 8
Office of Regional Operations: The Denver Team Name Title Areas of Focus CAPT Debra Regional Nurse Consultant Community Engagement, Tribal Health, Initiatives to Advance the Scott, RN, MS, Role of Nurses, Veterans, Special Populations MA Montana Kim Patton, Regional Behavioral Health Behavioral Health, Tribal Health, Regional Federal Collaboration PsyD Liaison Colorado CAPT Christina Regional Pharmacy Opioid Abuse, Public Health and Primary Care Integration, Special Mead, PharmD Consultant Populations, Grantee Partnerships, Quality Improvement Utah Dianna Frick, Public Health Analyst Maternal & Child Health, Outreach & Education, Tribal Health MPH Wyoming Mike Shenkel, Public Health Analyst/HRSA Currently working on several projects and activities aligned with MPH Scholar the Regional Operations Plan CAPT Alisha Deputy Regional Nursing, Public Health, Tribal Health, Maternal & Child Health, Acker, RN, Administrator Diabetes Prevention & Management BSN, PHN, North Dakota M.P.H. Nicholas Regional Administrator Outreach and Education, State Engagement, Tribal Health, Rural Zucconi, MPA Health South Dakota 9
HRSA Priorities for 2019 • Combating the Opioid Crisis (https://www.hrsa.gov/opioids) • Behavioral Health (https://www.hrsa.gov/behavioral-health) • Value-based care delivery and quality improvement initiatives (CMS Value Based Care) • Transforming the workforce- targeting the need (https://www.hrsa.gov/about/organization/bureaus/bhw/index.html) • Telehealth (https://www.hrsa.gov/rural-health/telehealth/index.html) • Childhood Obesity (https://mchb.hrsa.gov/) • Maternal Mortality (https://www.hrsa.gov/maternal-mortality/index.html) 10
Rural Health Clinic Program • Currently over 4400 Rural Health Clinics (RHC) across the U.S. • The median number of RHC visits by a Medicare beneficiary was 3 per year while the mean was 4.8 • The median distance Medicare patients traveled one way to an RHC was 6.2 miles • Medicare patients utilizing RHCs were an average age of 71 • 22% of Medicare patients seen at RHCs were under the age of 65, 38% were 65 – 74, 27% were 75-84 and 13% were 85 and above • 58% of RHC Medicare patients were female Source: North Carolina Rural Health Research and Policy Analysis Center: Profile of Rural Health Clinics: Clinic & Medicare Patient Characteristics; March 2013 11
Health Center Program • Nearly 1,400 HRSA-funded community health centers (CHC) operate approximately 12,000 service delivery sites across all U.S. states and territories • More than 27 million people, or 1 in 12 nationwide, rely on a HRSA- funded health center for affordable, accessible primary health care, including: • 1 in 3 people living in poverty • 1 in 9 children • 1 in 5 rural residents • More than 355,000 veterans • Health centers employ more than 233,000 medical, dental, and behavioral health clinicians and staff 12
Wyoming RHC and CHC Locations RHCs- CHCs- 13
Primary Care HPSA’s in Wyoming 14
RHC Clinical Quality: Annual Program Evaluation • To become certified as a Rural Health Clinic, clinics must meet federal Conditions of Participation. Once certified, RHC’s are subject to survey and certification. • The current CMS Conditions of Participation require RHCs to conduct an annual program evaluation of the clinic’s total operation and utilization. • Purpose: to determine if utilization of services is appropriate; if policies and procedures are being followed; and recommend necessary changes. • A clinic must have a written "Program Evaluation Plan" that identifies who is responsible for ensuring that the plan is completed, what is to be reviewed, and what is to be done with the findings. • A policy and procedure review is required as part of the program evaluation, as well as a chart review of a representative sample of both active and closed clinic records. 15
CHC Clinical Quality: Statutory Requirements • The health center must have an ongoing QI/QA system that includes clinical services and clinical management. • The health center must maintain the confidentiality of patient records. • The health center must have an ongoing QI/QA system that assures: • Organizational arrangements to support the quality assurance program and the provision of high quality patient care; • Periodic assessment of the appropriateness of the utilization of services and the quality of services provided to individuals served by the center. • Federal Tort Claims Act - annual submission of a deeming application: • Has implemented policies and procedures to reduce the risk of malpractice and the risk of lawsuits arising out of health-related functions; • Has reviewed and verified the professional credentials, references, claims history, fitness, and license status of its physicians and other licensed or certified health care practitioners; • Has no history of claims under section 224 of the PHS Act or, if so, fully cooperates with the Attorney General in defending against any such claims, and takes necessary steps to assure against claims in the future 16
Challenges to Meeting the Health Care Needs of Older Adults • The number of older adults is increasing: 30,000 geriatricians needed by 2030 – as of 2014 there were 7,400 practicing geriatricians • Chronic disease affects two out of every three older Americans. Common conditions: arthritis, heart disease, cancer, diabetes, hypertension • Patients with chronic conditions and functional disabilities require more time to tailor approaches to care, coordinate with family, other providers • In 2014, 60.5% of Americans age 65 or older also had difficulty with an ADL, compounding barriers to access and contributing to depression which affects approximately 9% of elderly patients • More than 15 million older adults (30 %) had incomes below 200% of poverty in 2017 (1 person =$25,000; 2 people=$34,000); that number increases to 21 million (42.0%) based on the Supplemental Poverty Measure. 17
Recommend
More recommend
