Frontier Community Health Integration Project (FCHIP)

North Dakota Network Meeting

2/23/2012

10am – Noon CT (Video/Audio Conference)

Organizational Participants:

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Ashley Medical Center

Carrington Health Center

Cooperstown Medical Center

Heart of America Medical Center

Jacobson Memorial Hospital and Care Center

Linton Hospital

McKenzie County Healthcare Systems

Nelson County Health System

Southwest Healthcare Services

St. Andrew’s Health Center

Wishek Community Hospital

North Dakota Hospital Association

UND Center for Rural Health

North Dakota Healthcare Review, Inc.

NDSU Telepharmacy

Federal Office of Rural Health Policy

Montana Hospital Association/FCHIP

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I. Meeting Purpose

The meeting’s purpose is to increase project awareness for FCHIP-eligible North Dakota CAHs, and to discuss the vision, goals, and timeframe of the project. Montana will share their FCHIP history and experience. This is also an opportunity for ND CAHs to share ideas, voice concerns, and provide feedback.

II. FCHIP Overview - Tim provided an overview of FCHIP (presentation attached).

FCHIP is a CMS demonstration grant which is currently in the planning phase. It is a proposed new model of integrated health care, service delivery, and reimbursement. The goal is to bring together all essential services under one single provider type and reimbursement system, integrating these services under one umbrella for extremely rural communities. Michelle (ORHP) clarified that there is not discussion of regulatory changes at this time.

The current system is duplicative and fragmented. Plan is for a new model to be integrated, coordinated, and more efficient, however the CAH may not necessarily own all component of the newly formed local health network. FCHIP will be a demonstration project similar to the CAH demonstrations that took place about fifteen years ago. Four states (ND, WY, MT, and AK) are working together to inform and shape the demonstration project, developing a proposal document for CMS to consider as it develops the final model.

FCHIP Eligibility - We continue operating according to an informal definition of frontier eligibility. According to this current definition, 19 of the 36 ND CAHs would be considered FCHIP-eligible. These guidelines could change in final determination. No date for final rule and guidelines has been shared yet although we anticipate late spring or early summer 2012. The duration of the demonstration project is not known.

White Papers – A total of 6 white papers are being written and cover many topics including workforce, reimbursement, quality, transitions of care, long term care, readmissions, and teleheath. Montana is leading this effort and informing their work through regular calls involving representation from all four states. Draft papers are being submitted to the federal Office of Rural Health Policy for review followed by final submission thereafter to CMS. All papers will be complete by the first week of March 2012 and sent to ND CAHs for review and feedback following this meeting.

Application Process – CMS will release the applications and there will likely be about a 30-60 day deadline. We anticipate that hospitals will apply individually however comments were made expressing the hope that regional or statewide application might be considered. Expected release of applications: late spring/early summer 2012.

III. ND CAH Question/Answer & Comments/Concerns

· Eligibility: Question regarding the definition of frontier eligibility requirements, and whether a clinic partially owned by the CAH (51%) would qualify as Physician Services. Montana shared that they have locations that qualify in this manner; ORHP concurred.

· Delivery models: The importance of flexibility was stressed along with examining what can work with different delivery types, not just CAHs. For example, some CAH issues relate to their need to provide more services (hospice, home health, meals on wheels); the problem is inadequate reimbursement.

· Delivery models: Alaska’s FESC Model (Frontier Extended Stay Clinic). We are interested in this model as well because some CAH communities may have too much infrastructure. Can or should they consolidate? And if so, to which facility? Hospital facility may not always be the best choice; consider the nursing home as the hub with a few acute care beds and an emergency department.

· Reimbursement – budget neutral: Definitely a concern – how will this work? Medicare is best ND reimburser. Is there consideration given to including other payers? (It was noted that Alaska has been aggressive in including Medicaid.) Could there be a Medicare mechanism factored into this reimbursement model? A significant issue in ND is the instability of cash flow patterns based on cyclical Medicare paybacks. A consistent revenue stream is needed. Tribal health reimbursement is a significant issue in ND and should be included as well. Another suggestion included addressing licensure/credentialing/regulatory simplification issues to improve reimbursement.

Information was shared from the finance white paper which was written by Stroudwater (Eric Shell) and ACS consultants. Concept is aligned to a CAH version of an Accountable Care Organization where facilities are paid a certain amount per Medicare life in their service area up front and then so much per Medicare patient. The white paper discussing readmissions explained how preventing readmissions in large (non-CAH) facilities due to local care in frontier areas will result in shared savings and improved quality.

· Mental Health: - inability to access mental health services in rural areas was stressed. Question whether regional CAHs could establish cost-based psychiatric unit. Discussion also referenced practicality of telehealth for mental health services and reimbursement of same. There are a limited number of ND CAHs providing direct mental health – the ND Rural Mental Health Consortium may serve as an example (involves St. Aloisius (Harvey, ND) and St. Andrew’s Health Center (Bottineau, ND).

· Oil Impact (Western ND): Many challenges facing CAHs in western ND; for example significant increase in the number of ED visits; significant increase in bad debt. (Eastern MT is experiencing the same issues.)

· Long Term Care: Infrastructure and challenges are different in ND compared to MT. There are many independently owned/operated long term care facilities; not having a closure issue, etc.

· Mid-Levels: ND is different from MT situation; we are not having NPs or Pas running unsupervised for weeks at a time.

IV. Next Steps

· Larry will convene a conference call to discuss ideas regarding reimbursement with Tim and Eric Shell.

· White Papers will be sent to eligible ND CAHs for comment (Tim to send and coordinate responses/feedback).

· Marlene to send minutes from meeting and obtain/share market share information compiled by ACS consultants.

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