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KHA Small Rural and CAHForum

July 14, 2016

Agenda

• Welcome

• Federal Policy Update– MACRA

– HR 5273

– Other Important Rural Legislation

– CMS Request for Comments on Cutting CAH Payment

• MedPAC Report

• State Waiver Update

• Smoke Free Policy

Federal Policy Update - MACRA

MACRA Proposed Rule

• Released April 27, comments due June 27

• Replaces SGR with a permanent payment mechanism for physicians

Importance

• Physicians: Impact on payment, performance measurement requirements

• Hospitals: May bear cost of implementation and compliance with new payment and performance measurement system by employed physicians

• Continued shift in hospital-physician relationships

MACRA• Outlines newly established Quality Payment

Program for physicians and other providers.

– Consolidates: • PQRS (Physician Quality Reporting Program

• VM (Value Based Payment Modifier)

• Medicare EHR Incentive Program for EPs

• Establishes two new mechanisms for physicians to fall into:

– Merit-based Incentive Payment System (MIPS) • 4% of Medicare payment beginning in 2019

– Alternative Payment Models (APMs)• Requires risk-based model of care, EHR

• No downside adjustment to PFS, can qualify for 5% bonus in 2019

5

Physician Payment Transition

6

Implications for Hospitals and Health Systems

• Hospitals must begin planning/preparing now.

• Stronger drive to move to hospital owning/managing physician practices

• Independent providers and small practices will have a difficult time managing

• Will drive older physicians to retire early

• May result in physician shortage, especially in rural settings

• Providers will likely not be able to pilot/experiment before moving into risk-based payment arrangements

7

Resources

• Succeeding in the Age of MACRA (webinar). July 21, 2016

www.kyha.com – EVENTS Page

• AHA Physician Payment Reform Website http://www.aha.org/advocacy-issues/physician/index.shtml

• Proposed Rule -https://www.gpo.gov/fdsys/pkg/FR-2016-05-09/pdf/2016-10032.pdf

8

Federal Policy Update

H.R. 5273

• Addresses Readmissions Penalty –Would adjust for socio-demographic differences

Other Legislation

• Direct Supervision (S. 257, H.R.5164,

S.3129/H.R.5613)

• 96 Hour Rule for CAHs (S.258/H.R.169)

• MDH/LVA (S.332/H.R.663)

9

Federal Policy Update – CMS/CAH

June 14 Call – Rural Open Door Forum

• Address President’s budget proposal to change CAH reimbursement from 101 to 100% of cost – How would it impact your hospital

• Comments were due June 30

• Note that legislative action would be required to make this change.

10

MedPAC Report

• June 2016 Report to Congress: Medicare and Health Care Delivery System

• Chapter 7 – Improving Efficiency and Preserving Action to Emergency Care in Rural Areas

– Discuss to alternative models for isolated rural hospitals

• Outpatient/ED only

• Clinic/Ambulance only

– Discuss value and effectiveness of cost-based care and other Medicare Programs (SCH, MDH, LVH)

– Quality in low volume facilities

11

State Waiver Update

• June 22, 2016, Governor Bevin released proposed Section 1115 demonstration waiver -Kentucky HEALTH (Helping to Engage and Achieve Long Term Health)

• Public Comments through July 22

• CMS Comments for 30 days

• KHA Waiver program on July 28

12

Wayne Meriwether, MHA, CEO, Twin Lakes Regional Medical Center

Ellen J. Hahn, PhD, RN, FAAN, Professor, UK College of Nursing and Director, Kentucky Center for Smoke-free

Policy and BREATHE team

Smoking is Killing Us and Bankrupting Us Kentucky leads the nation in smoking Nearly 9,000 deaths per year from smoking in KY

Estimated 1,000 deaths attributable to secondhand smoke each year in KY alone

KY spends $1.92 billion annually on healthcare costs caused by smoking

“Those regions (and the states in them) that have implemented public policies to reduce smoking have

substantially lower medical costs.” – Lightwood & Glantz, PLOS Medicine, 2016

Rewards & Risks of Smoke-free Workplace Laws

Partial laws don’t work

Leave many unprotected

Legal risk

Create health disparities

Do not improve population health

Cause confusion

They are ‘sticky’

Comprehensive laws work

Protect all workers and patrons from secondhand smoke

Help smokers quit

Lower hospital readmissions

Reduce ambulance calls

Save money Partial laws are no different than what we have now. Having no law is better than a partial law.

Get the Biggest Bang for Your Buck!

Comprehensive smoke-free workplace laws reduce:

hospitalizations for COPD

heart attacks

emergency department visits for asthma

smoking rates

Money saved on healthcare costs - $21 million saved annually in Lexington (16,500 fewer smokers)

Reduced readmission rates

KCSP can help! Share resources, tools, and strategies that work

County level data

Print media templates

Legal resources

Community trainings & presentations

Assess each community’s readiness for a smoke-free policy and tailor strategies based on that assessment

www.breathe.uky.edu

What can hospitals do?

Add smoke-free workplace ordinance to your Action Plan

Become a visible member of a local smoke-free coalition

Host a forum on the benefits of smoke-free policy

Sign a resolution or letter of support for smoke-free policy

Use marketing dollars to educate on the dangers of secondhand smoke and the benefits of smoke-free laws as the solution

Why get involved?

Community benefit that works

Respected voice that elected officials listen to

Leave a legacy of health for future generations

We have the choice where we go out to eat with our families, but breathing smoke-free air

Promote a Healthier Community

Health Hazards of Secondhand Smoke

CHNA Priority

Hospital Mission

Local vs State Issue

Public Buildings

Workplaces

eCigarettes

Local Smoking Survey

Social Media

Letters to Editor/Print Ads

Medical Staff

High School Students

Kentucky Center for Smoke-free Policy at UK

Elected Official Champion

Calling/email Campaign

Booklet of Facts/Statistics

Local Endorsements

For More InformationKentucky Center for Smoke-free Policy Wayne Meriwether

www.breathe.uky.eduwmeriwether@tlrmc.com kcsp00@lsv.uky.edu

270-259-9512

859-257-2358