Archive for the ‘Industry News’ Category

AAS: Rural Health Care Problems Won’t Stay on the Farm

Tuesday, July 30th, 2013

Posted: 7:00 p.m. Saturday, July 27, 2013

By Editorial Board / Austin American Statesman

Texas moved to town in the mid-20th century, but Texans cling to the state’s image of itself on horseback. The state became officially urban in the 1950s, when the rush toward its cities that started during World War II finally tipped the population scales.

Even so, romantic visions of Texas rural life still flood the airwaves and our imaginations. Those romantic fantasies, however, mask some unpleasant realities about the availability of health care out yonder.

A life expectancy gap between the state’s urban and rural residents will continue to grow as health care gravitates toward where a majority of Texans live, even as the need for efficient, financially accessible health care grows in the rural areas where the population is older and poorer. In fact, that rural population — usually associated with Texas past — may well yield clues about how to deal with an aged Texas population of the future.

According to a recent comptroller’s report: “By 2040, the Texas state demographer projects that the share of the population aged 65 or older in Texas will nearly double, to 18.0 percent.”

The state’s changing demographics will challenge policymakers to make choices now and in the foreseeable future as fundamental as how big a life expectancy gap is acceptable or whether to devise ways to close it. Those choices will prove expensive.

As the American-Statesman’s Andra Lim reported last week, financial hardships forced 100 rural hospitals to close in the 1980s. Back then, life expectancies of rural and urban residents were virtually the same. Now, rural males in Texas live to an average age of 74.2 years; women to an average age of 79.2 years. Urban males live to an average age of 75.1 and women to 79.8 years.

Old notions about clean air and clean living out in the country collide head on with the reality of a rural population that is older, poorer and less likely to have health insurance. Those who depend on Medicaid assistance take a direct hit when Medicaid payments — a favorite political target — can’t keep pace with increased health care costs. Not expanding Medicaid coverage effectively cuts it.

“Any further reductions in Medicaid payments will strain rural providers. A certain repercussion is decreased rural services or (fewer) providers accepting Medicaid leaving many rural Texans without health care access,” warned the Texas Rural Health Organization in 2012.

“If access to care declines, and access to emergency care declines, that could contribute to shorter life expectancies in rural areas,” Don McBeath, director of government relations at the Texas Organization for Rural & Community Hospitals, told Lim.

That decline in access to health care is compounded by the realities of rural life that challenge cherished myths about it. The National Rural Health Association — which has scheduled an October conference in Austin — reports that rural residents suffer from hypertension on a higher per capita basis than their urban counterparts. Rural residents are more likely to die following heart attacks than urban dwellers. Oh, and that notion that the slower pace of country living is safer? National Rural Health also had this: “Although only one-third of all motor vehicle accidents occur in rural areas, two-thirds of the deaths attributed to these accidents occur on rural roads.”

So much for the simple life.

Texas legislators have taken steps to increase the number of physicians in rural areas that appear to be working. The Legislature approved increased funding for a program that helps doctors repay student loans in exchange for at least four years practice in areas where physicians are in short supply. Legislators appropriated $33.8 million for 2014-15. The program made $5.7 million available in the 2012-13 budget — an amount that quickly evaporated. The Texas Higher Education Coordinating Board had been unable to accept new applications since 2011.

Legislators also authorized nurse practitioners more latitude and authority in providing health care.

But, the Legislature — following Gov. Rick Perry’s lead — refused to expand Medicaid assistance to low income people, which will aggravate problems in obtaining health care, especially in rural areas.

There is also the ongoing dilemma posed by nursing home care, regulation and availability. Nursing home owners have been pleading for years for increased reimbursements. This year, they got some relief, but a funding gap persists. “Of the more than $350 million in biennial (general revenue) we were seeking to ensure Texas seniors’ nursing home care is funded at the level actually deemed necessary by state health officials, the Legislature ultimately approved nearly $100 million — a needed step forward as we work to continue narrowing this funding gap,” said Tim Graves, President of the Texas Health Care Association, the nursing home lobby.

The quality and availability of rural health care deserves increasing focus because some of those rural problems will become urban ones — and sooner than we think.

TORCH Statement on Affordable Care Act Ruling

Saturday, June 30th, 2012

Judey Dozeto
Twitter: @torchnet

AUSTIN – Texas Organization of Rural & Community Hospitals (TORCH) released the following statement after the Supreme Court ruling on the Affordable Care Act:

Now that national health care reform through the Affordable Care Act has basically been upheld and the individual mandate is here to stay, TORCH will continue to monitor the ongoing analysis of yesterday’s Supreme Court ruling.

There are many phases of the health reform process yet to be implemented until it becomes fully effective in 2014. Therefore, we will also continue to watch for any possible negative impact on rural patients and providers.

The ruling yesterday does have one possible negative implication for hospitals. The law, as originally passed by Congress, required states to expand their Medicaid programs to cover all persons – men, women, and children – up to 133 percent of the national poverty level. This would mean a broad expansion of the number of persons in Texas being cover by Medicaid. In fact, the Texas Health and Human Services Commission had predicted that the level of uninsured in Texas could drop from 26 percent to less than 10 percent. Consequently, many more patients entering Texas hospitals would have insurance coverage.

At first blush, the ruling yesterday appears to remove the financial penalty for state’s that refuse to expand Medicaid. Given the Texas state budget situation and the general position of Governor Rick Perry and the Legislature, Texas could very well choose to decline an expansion of Medicaid.

If so, hospitals would be denied one of the real benefits of these reforms. The financial burden of dealing with high levels of uninsured patients would continue to fall upon small hospitals and local communities. Of course, some of the persons that would have been covered in a Texas Medicaid expansion might be picked up in other areas of the mandate, such as small employers of more than 50 people being required to provide coverage. The more likely scenario, however, is that many of the people that would have been covered by Medicaid expansion could remain uninsured.

As we move forward at the state level, TORCH will be watching to see how our state chooses to handle both the Medicaid expansion and insurance exchange issues.


About Texas Organization of Rural and Community Hospitals

Texas Organization of Rural and Community Hospitals (TORCH) is the voice and principal advocate for rural and community hospitals in Texas. We provide leadership in addressing the special needs and issues of these hospitals. We take aim at the struggle rural hospitals have to survive with the rigors of increasing costs, decreasing reimbursements, the added challenges of bringing new information technology into the rural landscape, dealing with a growing number of retirees and uninsured residents and functioning under a national health care system that many agree is broken. TORCH also takes a place on the national stage, serving both as a model of rural hospital organization and an effective voice in our nation’s capital for rural health care here and elsewhere. Learn more about TORCH on our web site or follow TORCH on Twitter.

HHSC Statement on Affordable Care Act Ruling

Thursday, June 28th, 2012

AUSTIN – Texas Health and Human Services Executive Commissioner Tom Suehs released the following statement after today’s Supreme Court ruling on the Affordable Care Act:

“We’ll work closely with Gov. Perry, state leaders and the Attorney to fully analyze the ruling, but I’m pleased that it gives states more ability to push back against a forced expansion of Medicaid. The court clearly recognized that the Affordable Care Act put states in the no-win situation of losing all their Medicaid funding or expanding their programs knowing that they would face billions of dollars in extra costs down the road.

I remain concerned that expanding Medicaid without reforming it only multiplies the tremendous budget pressure the program puts on states. Medicaid already consumes a quarter of the state budget in Texas, and enrollment and costs would mushroom under the Affordable Care Act.

We’ll continue to work with the Legislature to improve the Texas Medicaid program so that it delivers better results at a lower cost. The reforms we’re putting into place through our new transformation waiver will replace an archaic federal Medicaid funding system with one built around local solutions that rewards hospitals for patient care and innovation. This will lay the foundation for true Medicaid reform in Texas and allow us to use existing funding to improve access to care.  The best long-term solution is for Congress to grant states more flexibility to tailor solutions that best meet their needs.”

The Texas Medicaid program covers 3.4 million Texans today, including children, pregnant women, people with disabilities and those over age 65. The Affordable Care Act would have required states to expand Medicaid coverage to other low-income adults. The expansion was scheduled to take place in January 2014. The Supreme Court ruled that the federal government cannot deny Medicaid funds to states that opt not to expand their programs.
Source: HHSC press release

For more information please visit the HHSC web site.

Breaking News from TORCH – SCOTUS Decision

Thursday, June 28th, 2012

In Plain English:

The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters. Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn’t comply with the new requirements, rather than all of their funding.
Source: SCOTUSblog

Download a copy of the decision here

HHSC to Hold Public Hearing on RHP Map on May 17

Wednesday, May 2nd, 2012

The notice and agenda for the May 17, 2012 RHP public hearing will be published in the May 11, 2012 Texas Register. Based on stakeholder feedback, HHSC will soon issue a revised map to be dated May 11, 2012. The public hearing is being held to discuss the May 11, 2012 map, not the one dated March 30, 2012. The public hearing will start promptly at 1:30 p.m. HHSC will hear public testimony until each person who wishes to speak has an opportunity to present. Depending on the amount of public comment during the hearing, the 3-minute presentation rule may be invoked. If testimony ends before 4:30 p.m., the hearing will end early. Those interested in speaking at the public hearing should plan to arrive by 1:30. A conference call line is available for out-of-town stakeholders interested in listening to the hearing. Please note that any stakeholder wishing to testify, needs to attend the hearing in person. Testimony will not be allowed over the conference call line, but to listen in please dial 1-877-226-9790 and use access code 8317345.

The purpose of this hearing is for Executive Commissioner Tom Suehs to hear from entities in RHPs that are still in contention. If there are still counties disagreeing with their RHP placement on the May 11, 2012 map or the RHP anchor is still in question, HHSC wants public input in order to finalize the RHP region development. HHSC requests those counties and anchors in question to please attend the public hearing to voice concerns to the Executive Commissioner. The Executive Commissioner will take these public hearing comments into consideration when developing the final RHP geography and anchors. HHSC will issue the final RHP map shortly following the public hearing based on the Executive Commissioner’s final recommendations and submit to CMS for federal approval. HHSC encourages RHP participants to work together prior to the public hearing to determine RHP geography and anchors. Should participants have questions on RHP development, please contact HHSC.

RHP Hearing Notice [182KB PDF]
RHP Public Hearing_Agenda_5_17_12 [55KB PDF]

Come Take Part in the First TDA Rural Summit

Tuesday, April 24th, 2012

Texas Commissioner of Agriculture, Todd Staples recently invited all rural stakeholders to take part in the first Texas Rural Summit: Rural Texas – Growing Texas. This event is open to the public and will be hosted by Commissioner Staples and the Texas Rural Health and Economic Development Advisory Council. The council was created to identify challenges to the development of rural areas and recommend efficiencies in existing programs to best meet the needs of Texans across the state. This summit is intended to meet that goal. The interactive panel presentations and discussions will address the needs and opportunities in rural Texas that are related to economic development, health care, workforce development and skills training and community infrastructure.

The feedback that is received during the event will likely inform the policy direction for the agency and the council as we head towards the upcoming state legislative session. We would encourage interested TORCH members to attend the event and to take part in the discussion about health care and other areas of interest to your rural community. The event will be taking place on May 8, 2012 from 9:00 a.m. – 4:00 p.m. at the Texas Medical Association on 401 West 15th Street, Austin, Texas 78701. The registration fee is $20, which includes lunch. To make your reservations, please contact Rick Rhodes in the Office of Rural Affairs.

The Texas Institute of Health Care Quality and Efficiency Board Members Announced

Monday, March 19th, 2012

Last year, the Texas Legislature passed Senate Bill 7 during special session. The legislation was authored by State Senator Jane Nelson to control rising healthcare costs and improve patient outcomes. SB 7 eventually included portions of three bills filed by Sen. Nelson during the regular session: one relating to efficiencies, cost-savings and fraud prevention in Medicaid and the Children’s Health Insurance Program, another to achieve savings in Medicaid and CHIP by re-focusing our healthcare dollars on better patient outcomes; and another allowing health care providers to form collaboratives to better coordinate care, free from burdensome federal regulations. In total, SB 7 is supposed to result in at least $467 million in cost savings.

The bill also included the creation of a new Texas Institute of Health Care Quality and Efficiency. Earlier this month, Governor Rick Perry named Dr. Ben Raimer of Galveston as the Institute’s first chairman and appointed 13 members to the Texas Institute of Health Care Quality and Efficiency’s Board of Directors. The language in SB 7 authorizes the institute to work to improve health care quality, accountability, education and cost to the state by encouraging health care provider collaboration, effective healthcare delivery models and coordination of healthcare services.

Raimer is a board certified pediatrician, and senior vice president and professor at the University of Texas Medical Branch at Galveston. He is a member of the American Academy of Pediatrics, Texas Medical Association, Texas Pediatric Society and Texas Rural Health Association. He is also a member and past president of the Galveston County Medical Society, a public representative for the Texas Health and Human Services Commission Task Force on Local Health Care Initiatives and past chairman of the Texas Statewide Health Coordinating Council and the Health Disparities Task Force.

Among the other board members that were recently appointed, is one health system CEO. Joel Allison is president and CEO of Baylor Health Care System. He is also a member of the American College of Healthcare Executives, American and Texas Hospital associations, Healthcare Leadership Council and Texas Association of Voluntary Hospitals. Other notable appointees with hospital ties include:
· Dr. Steven Berkowitz, founder and president of SMB Health Consulting and a former THA Board Member
· Dr. John C. Joe of Houston, physician and chief medical information officer at St. Luke’s Episcopal Health System and former CEO of Prognosis
· Ronald Luke of Austin, president of Research and Planning Consultants and a past member of the Texas Health and Human Services Council.

The balance of the board is made up of clinicians and healthcare industry experts. Half of the board terms will expire on January 31, 2013 and the other half on January 31, 2015. According to the bill, the Institute itself will expire on September 1, 2017, unless the legislature takes steps to continue it. The board has been given a very broad mandate with regard to its ability to study and develop recommendations around creating more effective healthcare delivery models as a result of increased collaboration and coordination. As such, the Institute will definitely have an impact on the hospitals and the other healthcare providers in Texas. There is no truly rural representative, so TORCH will be making every effort to be involved and keep our members informed about the Institute’s activities and work products.