President’s ReportWashington UpdatePhysician RecruitmentND HEN Regional WorkshopsND Substance Use Data ResourceND Flex Programs Preconference to the Dakota ConferenceNavigating the 340B Existing & Proposed Guidance & Possible Impacts

Clink on link to view attachments:http://www.ndha.org/resources/informerND HEN Regional Workshops Invitation

Phone: 701-224-9732Fax: 701-224-9529Web Site: www.ndha.org

Jerry Jurena, PresidentTim Blasl, Vice PresidentCallen Cermak, Finance ManagerLori Schmautz, Executive AssistantPam Cook, Education Director

A portion of this publication is supported by The Center for Rural Health’s Medicare Rural Hospital Flexibility Program. Visit their site at http://rural-health.und.edu/projects/flex/.

The Informer

President’s Report ~ Jerry JurenaIn This Edition:

Attachments:

NDHA Contacts

April 15, 2016

Last week I sent out information on AHA’s 123 Equity Pledge, to eliminate health care disparities. This week I have had two calls commenting/asking about making a commitment to the program. Comments were “we do not have any issues or dispari-ties in our community, so what do I do”. I did some checking and disparities can be with any social demographic. Questions that were posed to me were: are kids getting the same availability to care as adults, is the hospital treating frequent flyers and are they getting the same attention as everyone else, has a community assessment been completed and are there issues regarding the access or delivery of care. There may be some communities that do not have an issue; the point of the Pledge is to take a look at the service area and determine if there are differences in how access and treatment of health care is provided if so then to make a plan to correct. I did not receive a simple answer, that has to come from each community. Below is additional information from CMS.

CMS BLOG https://blog.cms.gov/2016/04/11/mapping-medicare-disparities/ April 11, 2016, By: Cara V. James, Ph.D., Director of the Office of Minority Health at the Centers for Medicare and Medicaid Services Mapping Medicare Disparities

In 2014, two-thirds of Medicare beneficiaries had multiple chronic conditions and accounted for 94 percent of Medicare spending.1 Racial and ethnic minorities experi-ence disproportionately higher rates of disease, inferior quality of care, and reduced access to care as compared to their white counterparts.2 Understanding disparities and their geographic variations is important to inform policy decisions and to identify populations and localities to target for interventions. As health care delivery system reform continues, the Centers for Medicare and Medicaid Services (CMS) has an important opportunity and a critical role to play in promoting health equity. In September 2015, the CMS Office of Minority Health (OMH) released the first CMS Equity Plan for Improving Quality in Medicare. In March 2016, CMS OMH launched a newly developed interactive tool to increase understand-ing of geographic disparities in chronic disease among Medicare beneficiaries. The Mapping Medicare Disparities (MMD) Tool presents health-related measures from Medicare claims by sex, age, dual eligibility for Medicare and Medicaid, race and eth-nicity, and state and county. It provides users with a quick and easy way to identify ar-eas with large numbers of vulnerable populations to target interventions that address racial and ethnic disparities. The MMD Tool is expected to help government agencies, policymakers, researchers, community-based organizations, health providers, quality improvement organizations, and the general public analyze chronic disease dispari-ties, identifying how a region or population may differ from the state or national aver-age.

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Please, take a moment to explore the MMD Tool. Investigate what health care disparities look like in your county or state, then pick a priority and develop a plan that could be used to help provide better care for every individual in the United States. 1. Centers for Medicare & Medicaid Services (CMS). Chronic Conditions among Medicare Beneficiaries, Chartbook, 2014 edition. Baltimore, MD: CMS, 2014. 2. Agency for Healthcare Research and Quality (AHRQ), 2014 National Healthcare Quality and Disparities Report, Publication No. 15-0007. Rockville, MD: AHRQ, May 2015.

President’s Report continued.....

Washington Update ~ John Flink It was another light week on Capitol Hill as the Senate worked through a series of amendments to legislation to reauthorize the Federal Aviation Authority and the House worked on a number of relatively minor bills.

Of note, however, is that 60 senators – including North Dakota’s John Hoeven – this week urged the Centers for Medicare &Medicaid Services to delay the April 21 release of overall hospital quality “star ratings” on its Hospital Compare website. More than 200 members of the House of Representatives – including North Dakota’s Kevin Cramer – are sending a similar letter.

In a letter to Acting CMS Administrator Andy Slavitt, the senators said the delay is needed “to provide the necessary time to more closely examine the star rating methodology, analyze its impact on different types of hospitals, and provide more transpar-ent information regarding the calculation of the ratings to determine accuracy.”

“While we support the public reporting of provider quality data, we are concerned that the Star Ratings system may not ac-curately take into account hospitals that treat patients with low socioeconomic status or multiple complex chronic conditions,” the senators wrote.

In other news, it appears House Republican leaders are looking forward to a busy 2017 session of Congress. House Speaker Paul Ryan (R-WI) this week told attendees at a fund-raiser that Republicans continue to develop policy options for health care, trade and tax policies that they can roll out prior to the fall election campaign and will serve as their 2017 agenda.

Specifically, he said a special Republican work group is making significant progress toward developing an alternative to the Affordable Care Act. Specifics remain unclear, however, it is thought that the GOP would repeal the individual and employer mandates and use tax policies to encourage coverage. Stay tuned.

Finally, Tim and I are wrapping up preparations for the AHA Annual Washington meeting May 1 – 4. Congress will not be in session that week, but we have lined up meetings with key staff from the congressional delegation. In addition, as always, AHA will bring in leaders from Congress and the Obama administration.

I’m sure there also will be a healthy dose of political prognosticating from the commentators and political journalists on the agenda. Should be fun!!

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Physician Recruitment ~ Kevin MaleeTime Sensitive

Once you have received and reviewed a CV (the physician candidate’s curriculum vitae) turnaround time is very important. Time can be your biggest enemy, because the longer it takes to schedule a phone call interview; then coordinate a site visit, our response from the selection committee and responding to the candidate follow-up questions, the less our chances of hiring the candidate. The market is very competitive and our quick response to the candidate’s interest in our opportunity is critical. Keep in mind many employers are recruiting (hospitals, clinics and physician groups) and the longer it takes us to respond quickly to our candidate, the greater the probability of not placing the physician

The search for most physician candidates is short in duration; the time candidates begin and conclude their search is gen-erally about 90 days. I always encourage candidates to visit five (5) sites before making their decision about where to prac-tice. However, it has been my experience that most candidates do not visit 5 sites, generally they visit only 2-3 sites before choosing where to practice. The window of opportunity closes very quickly for most candidates, they choose sites to visit and generally shortly thereafter, identify their top practice site.

The best way to demonstrate our level of interest, is responding quickly to our physician candidates. Our rapid response to the candidate is paramount; if we want to be successful in placement.

I can be reached at northdakotarec@comcast.net or 701-320-2109

ND HEN Regional Workshops ND HEN Regional Meetings will be held on April 21st and 22nd in Bismarck and Grand Forks respectively. Our topic – Patient and Family Engagement (PFE). Tanya Lord, PFE expert with HRET, will join our meetings to share her experience and expertise. We encourage each hospital to bring a Patient and Family Advisor (PFA) to the meeting; if your hospital doesn’t have a PFA in place, we encourage you to bring a community member who you believe could/will be helpful in building your hospital’s PFE program!

The flyer in this week’s attachments provides detail and a registration link.

ND Substance Use Data Resource Three new data briefs are available and cover the topics of Substance Use and Mental Illness, Underage Alcohol and Crime, and Adult Alcohol and Crime. Please feel free to use them for your own use or pass them on to your other partners, groups, or coalitions. You can order preprinted copies from the Prevention Resource and Media Center by utilizing the new ordering feature on the prevention.nd.gov website or by calling 701-328-8919.

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Register Now for the North Dakota Flex Program’s Preconference to Dakota ConferenceDate: Monday, May 16, 2016Time: 8 – 11:30amLocation: Alerus Center, Grand Forks, NDRegistration: $15To Register: https://ruralhealth.und.edu/dakota-conference/registration

Flex Preconference agenda will include the following topics:• 340 B Program – CAH Updates | Eide Bailly • Workforce | David Schmitz, MD/Family Medicine Residency of Idaho & Stacy Kusler/Center for Rural Health • Opioid Abuse in Rural Communities | John Gale/Maine Rural Health Research Center• HCAHPS Experience Sharing | Brenda Rask/CHI Carrington Health

Nursing CEUs and LTC credits will be offered.

For more information, contact:Angie Lockwood, Project Coordinator | angela.lockwood@med.und.edu | (701) 777-5381

Navigating the 340B Existing & Proposed Guidance & Possible Impacts Several critical access hospitals in our state have expressed a need for further information around proposed changes to the 340B Drug Pricing Program. In response, the North Dakota Flex Program is offering a one-hour session on this topic at the upcom-ing Flex CAH PreConference to Dakota Conference on 5/16 in Grand Forks. Rene Gravalin of Eide Bailly will present the following:

Title: Navigating the 340B Existing and Proposed Guidance and Possible Impacts

Objective 1: Understand the 340B existing guidance, general terminology, and compliance requirementsObjective 2: Review the proposed “Mega Guidance” issued in 2015 and understand the significant proposed changes and the implications those changes may have on facilities.

Presentation Description: We will review the existing 340B guidance, especially those items that have the most impact on criti-cal access hospitals. We will also review the compliance requirements that need to be followed to ensure continued participation in the 340B program. Recently, the proposed “Mega Guidance” was issued and there are several changes that have significant implications to the 340B program – some very specific to critical access hospitals. We will also review those proposed changes and discuss the possible impacts.