The Environment for Health Centers Federal Policy Update

Report
NACHC UPDATE
National Association of Community Health Centers
Health Choice Network
20th Annual Education Session and Health Care Quality
Institute
Saturday June 28, 2014
2011 Biggest Internal Challenges ???
 To integrate with other providers
(including other CHCs)
 To coordinate patient care to assure
sharing of clinical data/information.
 To coordinate service delivery and
match capacity while linking patients
with enabling services.
 Re-engineering our health center
operations (data and insurance
focused)
 Workforce (all levels)
2011: Biggest External Challenges ???
External Challenges
Greatest Challenges: Appropriations and Medicaid
Competition from
managed care
organizations.
Forming partnerships
without losing mission focus
& autonomy (CAHs)
TODAY’S AGENDA
• THE ENVIRONMENT FOR HEALTH CENTERS
• FEDERAL POLICY UPDATE:
• MEDICARE PPS
• HEALTH CENTER TRANSFORMATION
• QUESTIONS?
THE ENVIRONMENT
The Environment in Washington – the BAD
• Political Polarization
• ACA is as divisive as ever
• “Must-pass” bills pass, but not much else
• Heightened scrutiny of federal programs
• Budget caps and future funding uncertainty
THE ENVIRONMENT
The Environment in Washington – the GOOD
• Bipartisan support for Health Centers’
Program, Model and Mission
• Both sides looking for solutions
in the health care arena
• Health Centers are at the
center of the conversation
HEALTH CENTERS IN A POST-ACA WORLD
• Access to primary care is vital for cost savings and improved outcomes (Transformation)
• Increased demand, among newly insured and uninsured (MA experience)
• Federal support, through 330 grant and Medicaid payment, crucial to model of care
• We will have to advocate louder than ever
• New funding essential for base grant adjustments, expanded capacity, service expansion,
new access points
• Since ACA, funding comes two ways:
HEALTH CENTER FUNDING STREAMS – SINCE ACA ENACTED
•
•
•
•
DISCRETIONARY
Annual, up to Congress to
determine amount
Prior to ACA, the only funding for
CHC program
Cut in 2011, backfilled with
mandatory funds
Currently $1.5 billion (FY14)
•
•
•
•
MANDATORY
Required spending, unless
Congress changes the law
Special Fund created in ACA to
boost Health Center Capacity
Currently 2.2 billion (FY14)
Expires in FY2016 (more on that
in a moment)
HEALTH CENTERS FUNDING CLIFF
• Mandatory funding
expires at the end of
FY15
• Without action by
Congress, up to 70%
cut to Health Center
grants
• NHSC, THCs in same
position (though ALL
mandatory)
FIXING THE CLIFF – OUR PLAN
•
Extends, grows mandatory
funding
•
$20b over 5 years
•
Grow from current 22m
patients to 35m
•
Continue funding for
NHSC, Teaching Health
Centers
•
Message: Act Now!
THE CLIFF – KEY POINTS
1. This is real. Health Centers have had success in gaining
new funding, but even our biggest champions can’t
predict the outcome here.
2. Estimate the impact. What would a 70% cut to your
grant mean in your community, to your patients?
3. Raise the drumbeat for a fix. We have a long fight
ahead, but our best hope is the understanding that this
is a “must-do”.
ADVOCACY: THE BOTTOM LINE
HEALTH CENTERS SUCCESS - OUR COLLECTIVE FUTURE
- DEPEND ON THE STRENGH OF OUR ADVOCACY.
• Local connections are the key to policy change – build relationships and
demonstrate impact over time
• Advocacy requires ACTION - the key is to develop a sustained culture of
advocacy in your center
• The challenges and opportunities ahead are huge. Let’s take them on
TOGETHER.
• Campaign Website: www.saveourchcs.org
REGULATORY UPDATE
Medicare PPS – GAME CHANGER!
•
•
•
•
•
Greatest opportunity to mover into Medicare ever!
The PPS base rate for October 1, 2014, through
December 31, 2015, is $158.85 (roughly a 35% increase)
Transition to new FQHC PPS begins on the 1st day of cost
reporting period on or after 10/1/14 (updated annually)
• Increased rates for new patients: can bill for
subsequent illness/injury visits and mental health visits
on same day
FQHCs must now use “G” Codes and must create
appropriate charges for the new codes
Do your charges reflect your real costs?
Medicare PPS cont….
•
When was the last time your FQHC reviewed your charges?
• Cost of care isn’t decreasing
• Do nothing? - THIS RULE HURTS! – Medicare rate may go down
• Rule will have HUGE impact on sliding fee scale policies if it isn’t
reviewed and adjusted on a regular basis
•
Huge potential for Medicare Advantage Plans!
•
NACHC will be rolling out national trainings shortly
• First trainings to focus on Sept, Oct, Nov due dates - 150
CHCS, Jan - >300 CHCs
Transformation – VC2
VC2 – A vision started by NACHC Chair Dr. Gary Wiltz
• Strategy to enhance CHC capacity in transformation and a means
to cope with the enormous shifts we are now facing.
• EHRs: Identify needed performance improvements, implement solutions,
and measure the effects of those solutions.
•
clinical quality, cost control, operational effectiveness, financial
performance, and patient experience.
• Develop systems integrated with other providers in the community.
• Provide organization-wide focus and team training
• A continual performance strategy, “This is how we do business.”
• Create system to share proven ways to improve quality and lower cost.
• Disseminate methods to all health centers
Transformation
•
•
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It is all up to the Health Centers, HCCNs and PCAs
• NACHC can’t lead this – its all local/regional
• Convener, collect and spread
HCCN’s are the key to success!
• Health Choice Network is a best practice model!
• OCHIN and Clinical Informatics tools
• Medicare ACOs
• Managed care products
ACA changed everything for health care delivery (more business
less politics)
• Local, regional and state work will dominate for business success
• PCAs and HCCNs must work together
The Future
•
•
Health Centers are one of the critical pieces of health
care delivery moving forward
• ACA provided unparalleled growth and opportunities
• Capital
• Growth
• Medicaid Expansion and Marketplace Exchanges
• Medicare PPS
Health Centers must start taking risk – more business
thinking less grant dependence
• NACHC tools (ACO/IPA toolkits)
Today
•
NACHC must work closer with HCCNs and PCAs
recognizing the new roles we are now have
• Ohio
•
We must continue to advocate for our cause
• The Primary Care Cliff is real!
• Never forget FY’11 - $600M decrease
NATIONAL HEALTH CENTER WEEK
Invite Your Members of Congress to Visit During NHCW –
August 10th-16th
More info updated regularly at www.healthcenterweek.org
QUESTIONS and CONTACT INFO
QUESTIONS?
Shawn K. Frick
Associate Vice President, PCA & Network Relations
National Association of Community Health Centers
Direct:301-347-0447
E-Mail: [email protected]

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