Memorial Health System Anthony Medical Center Ashland Health Center Atchison Hospital Rawlins County Health Center

Republic County Hospital Mitchell County Hospital Health Systems Sumner County District #1 Hospital Neosho Memorial Regional Medical Center

Clay County Medical Center Citizens Medical Center Comanche County Hospital Mercy Hospital Columbus Cloud County Health Center

Morris County Hospital Lane County Hospital Ellinwood District Hospital Ellsworth County Medical Center Newman Regional Health

Greenwood County Hospital Fredonia Regional Hospital Anderson County Hospital Girard Medical Center Goodland Regional Medical Center

Kiowa County Memorial Hospital Hanover Hospital Harper Hospital District #5 Herington Municipal Hospital Hiawatha Community Hospital

Graham County Hospital Hillsboro Community Hospital Clara Barton Hospital Holton Community Hospital Horton Community Hospital

Sheridan County Health Complex Stevens County Hospital Allen County Regional Hospital Hodgeman County Health Center

Stanton County Hospital Kingman Community Hospital Edwards Co. Hosp. and Healthcare Ctr. Kiowa District Healthcare

Rush County Memorial Hospital Kearny County Hospital Pawnee Valley Community Hospital Wichita County Health Center Lincoln County Hospital

Lindsborg Community Hospital Hospital District #1 of Rice County Jewell County Hospital St. Luke Hospital and Living Center

Community Memorial Healthcare, Inc. Meade District Hospital/Artesian Valley Health System Medicine Lodge Memorial Hospital

Ottawa County Health Center Minneola District Hospital Wilson Medical Center Ness County Hospital District #2 Norton County Hospital

Logan County Hospital Decatur Health Systems, Inc. Community HealthCare System, Inc. Osborne County Memorial Hospital

Oswego Community Hospital Phillips County Health Systems Rooks County Health Center Gove County Medical Center

Grisell Memorial Hospital District #1 Russell Regional Hospital Sabetha Community Hospital Cheyenne County Hospital

Satanta District Hospital, Clinics & LTCU Scott County Hospital Sedan City Hospital Nemaha Valley Community Hospital

Smith County Memorial Hospital Stafford County Hospital Hamilton County Hospital

Greeley County Health Services Trego County-Lemke Memorial Hospital Wamego Health Center Washington County Hospital

F.W. Huston Medical Center William Newton Hospital

New Rural Health Model

Change is Scary

Change is Inevitable

Phone: 913.449.1354 Roger Barnhart E-Mail: rbarnhartconsulting@gmail.com

Comparing approximately 70 metrics from previously closed rural hospitals:

• Market Position

• Balance Sheet

• Costs

• Charges

• Outcomes

673 rural hospitals (1 out of 3) are under financial duress

210 are at high risk of closing

Source: iVantage Analytics

Change Must Happen

• Rural hospitals make a substantial imprint on local economies

• Often the largest employers and economic drivers

• The American hospital institution is in the midst of massive and disruptive change

• America must bring down its crippling health care costs

Source: American Hospital Association

Change is Happening

• Creation of Quality Reporting Requirements

• Creation of the Payroll Based Journal Staffing Reporting System

• Creation of Alternate Payment Models

• Value Based Purchasing (VBP)

• Accountable Care Organization

Source: Kansas Foundation for Medical Care

Affordable Care Act

Protecting Access to Medicare Act of 2014

• Mandated that the 30 day all cause readmission quality measure begins Oct. 1, 2015 (FY ‘16)

• Mandated that Post Acute Care (PAC) Assessment alignment between all post-acute providers

• Foundation for Value Based Purchasing and Quality Reporting requirements

• 42 CFR 483; CMS-1622-F -Enacts the 30 All-Cause Readmission Quality Measure

• First time Critical Access Hospitals (CAHs) are included in readmission reporting

• Aligns the SNF VBP Program with the National Quality Strategy

• Data will be collected from Inpatient PPS claims from the hospital and claims submissions

Source: Kansas Foundation for Medical Care

CMS Requirements for Rural Health

• Quality Reporting requirements begin in Oct. 1, 2016 (FY 2017)

• The first year of reporting will be voluntary

• If data isn't reported up to a 2% reimbursement penalty

• Imposed in FY 2018 (Oct. 1, 2017)

• Current measures used include the 30 Day All Cause Readmission rate for each nursing home

• Very conservative/economic driven model

• Pays high performers, average stays the same, poor performers could receive reduced payments

Source: Kansas Foundation for Medical Care

CMS Requirements for Rural Health

Source: 2010 U.S. Census BureauProjected Percentages of 65+ Population 2015 Source: : 2010 U.S. Census Bureau

Source: 2010 U.S. Census BureauProjected Percentages of 65+ Population 2025 Source: : 2010 U.S. Census Bureau

• Collaboration among two or more rural providers

• Including all continuum providers – public health, home health, LTC, EMS,

assisted/independent living, etc

• Also to include other community resources – schools, government, faith based

organizations and other mental and social services

• Project activities and goals based on locally identified needs, interests and priorities through

discussion with members of the community

• Projects with the purpose of improvement of the health of the service area, by moving the

healthcare system toward care that is safe, effective, efficient, patient/community- centered,

timely and equitable for the entire service area as well as individual patients

Source: National Rural Health Association

Rethinking Rural Health

Patient__

Family

Urban

Hospital Rural

Community Hospital

Post-Discharge Clinic

Mental Health

Transportation

Pharmacy

Senior Services

Area Agency on AgingRehab

Assisted

Independent Living

Durable Medical

Equipment

Physician

Long Term Care

Skilled Nursing

Family Care Provider

Home Health/Hospice

Phone: 913.449.1354 Roger Barnhart E-Mail: rbarnhartconsulting@gmail.com

• Properly utilized, the patient would follow a well-coordinated path of increasing and/or decreasing

levels of service(s) throughout the continuum until reaching a level of self-sufficiency

• Expanded healthcare services

• Enabling rural communities expanded services otherwise unavailable

• Improves care coordination

• Quality of care improves

• Cost of care declines – efficiencies of services

• Less outmigration for healthcare services

Continuum of Care Collaboration

Derived from one of three fundamental payment approaches:

• Service-based payment/fee-for-service mechanism

• Bundled-based payment, which aggregates different services and providers

• Ex: hospitals, physicians and post-acute providers bundling cost for hip replacements

• Population-based payment

• Seeking to aggregate total care and costs across the continuum

• An ACO for a defined population

Risk adjustments and incentives that drive care quality and efficiency include:

• Patient safety and experience

• Socioeconomic adjustment of the population served

Transforming to Value Based Care

Source: 2015 AHA Committee on Research