Transcript Bureau of Primary Health Care Update

Bureau of Primary Health Care Update
for the
South Carolina Primary Health Care Association
October 12, 2012
John Cafazza
Division Director
Central Southeast Division
U.S. Department of Health and Human Services
Health Resources and Services Administration
Bureau of Primary Health Care
Primary Health Care Mission
Improve the health of the
Nation’s underserved
communities and
vulnerable populations
by assuring access to
comprehensive,
culturally competent,
quality primary health
care services
2
Health Center Program Overview
Calendar Year 2011
20.2 Million Patients
 93% Below 200% Poverty





Health Center Serve
All Ages
36% Uninsured
62% Racial/Ethnic Minorities
1,087,000 Homeless Individuals
863,000 Farmworkers
188,000 Residents of Public Housing
Health Center Revenue Sources
ARRA Grants
5%
BPHC Grants
17%
Other
Federal
Grants
2%
Medicaid
38%
State/Local/O
ther
17%
Self
-Pay
6%
Other 3rd Party
7%
Medicare
Other Public 6%
65 and up
7%
Under 5
11%
5 to 12
13%
25 to 64
51%
13 to 17
8%
18 to 24
10%
80 Million Patient Visits
 1,128 Grantees
 8,500+ Service Sites
Over 138,000 Staff
 9,937 Physicians
 6,934 NPs, PA, & CNMs
Insurance
2%
Source: Uniform Data System, 2011, Service Sites: HRSA Electronic Handbooks
3
Health Center Program
National Presence – May 2012
4
Health Center Program Overview
National Impact
Source: Health Center Data: Uniform Data System, 2011. National Data: U.S.
Census Bureau, 2010 Current Population Reports and Current Population Survey.
5
Health Center Program Growth:
National Impact 2008 - 2011
Patients
Sites
Jobs
21,000,000
8,800
150,000
20,500,000
8,600
145,000
8,400
140,000
20,000,000
135,000
8,200
19,500,000
130,000
8,000
19,000,000
125,000
7,800
18,500,000
120,000
7,600
18,000,000
17,500,000
17,000,000
115,000
7,400
110,000
7,200
105,000
7,000
2008
2009
2010
2011
100,000
2008
2009
2010
2011
2008
2009
2010
2011
2008
2009
2010
2011
Growth from 2008-2011
(% Increase)
Patients
17,122,535
18,753,858
19,469,467
20,224,757
3,102,222 (18.1%)
Sites
7,518
7,892
8,156
8,501
983 (13.1%)
Jobs
113,059
123,012
131,660
138,403
25,344 (22.4%)
Source: Uniform Data System, 2008-2011 and HRSA Electronic Handbooks
6
Health Center Program Performance
Calendar Year 2011
Among Health Center Patients:
• 70% entered prenatal care in the first trimester
• 7.4% low birthweight rate continues to be lower than national
estimates (8.2%)
• 44% of children received all recommended immunizations by 2nd
birthday
• 63% of hypertensive patients with blood pressure ≤ 140/90
• 71% of diabetic patients with HbA1c ≤ 9
• $654 total cost per patient
• $144 cost per medical visit
For more information: http://www.bphc.hrsa.gov/policiesregulations/performancemeasures/index.html
Source: Uniform Data System, 2011. National Birthweight Data: 2010. Hamilton BE, Martin JA, Ventura SJ.
Births: Preliminary data for 2010. National vital statistics reports web release; vol 60 no 2. Hyattsville, MD: 7
National Center for Health Statistics. 2011.
Health Center Performance
2009 Health Center Patient Survey
o Over 80% reported the overall quality of services
received at the health center were “excellent” or
“very good.”
o Over 80% reported that they were “very likely” to
refer friends and relatives to the health center.
o Over 75% reported the main reason for “going to
the health center for healthcare instead of
someplace else” was because it was convenient
(28%), affordable (25%), and provided quality
healthcare (22%).
8
South Carolina Health Centers
Calendar Year 2011
South Carolina
Health Center Grantees
In 2011, 20 Health Centers served
326,829 patients:
• 39.7% were uninsured
• 93.9% were at or below 200% of
poverty
• 61.2% Female
•
•
•
Source: Uniform Data System, 2011
•
58.7% nationally
30.6% Children < age 18
•
32% nationally
9.1% Seniors age 65+
•
6.9% nationally
Served by (FTEs):
–
–
170.31 Physicians
108.99 Nurse Practitioners, Physician
Assistants, and Certified Nurse Midwives
9
South Carolina Health Centers
Calendar Year 2011 - Fiscal Year 2012
PERFORMANCE
Among South Carolina
Health Center Patients:
•
•
•
•
•
•
•
59.0% entered prenatal care in the 1st
trimester
8.2% rate of low birth weight
49.5% of children have received all
recommended immunizations by
second birthday
71.2% of diabetic patients with
HbA1c ≤ 9
62.5% of hypertensive patients with
blood pressure ≤ 140/90
$570 total cost per patient
$159 cost per visit
Source: Uniform Data System, 2011 and
HRSA Electronic Handbooks
FUNDING
• $51.3 M base operational
grants (FY ‘12)
• $19.6 M New ACA grants
• $ 2.9 M – New Access Points
• $ 0.2 M – HIV Supplemental
Funding
• $14.4 M – Capital Development –
Building Capacity Grant
• $ 1.6 M – Capital Development –
Immediate Facility
Improvement Grant
• $ 0.5 M – School Based Health
Center Capital Grant
10
Primary Health Care
Our Focus
Primary
Health
Care/
Public Health
Leadership
Performance Improvement:
- Outreach/Quality of Care
- Health Outcomes/Disparities
- Cost/Financial Viability
Program Requirements:
- Need
- Services
- Management and Finance
- Governance
11
Primary Health Care
2012 Strategic Priorities
– Grantee Satisfaction
• BPHC External Technical Assistance & Training Strategy
– Employee Satisfaction
• BPHC Internal Staff Training & Development
– Timeliness/Quality
• Service Area Definition & Program Collaboration
– Impact
• Quality Strategy (includes Meaningful Use & Patient-Centered
Medical Home)
• Recovery Act Projects Close-Out
12
National Priority Training and Technical
Assistance Support Areas
What additional TA resources or tools would enhance the performance of
your organization?
60%
Patient-Centered Medical Home
53%
52%
52%
50%
50%
Quality Improvement
Risk Management
Behavioral Health Service Integration with Primary Care
39%
FTCA
39%
33%
39%
41%
35%
38%
35%
44%
34%
Governing Board Training
Billing
HIT
Capital/Growth Planning
N/A
34%
38%
31%
37%
28%
32%
28%
34%
24%
27%
22%
27%
19%
30%
18%
18%
Needs Assessments
Strategic Planning
Fiscal
Staff Retention and Recruitment
School-Based Health Centers
EHR
Teaching Health Centers
Outreach to Special Populations
13%
15%
Patient Safety
Note: Multi-select.
Percents will not add to 100.
Other TA resource or tool
None
46%
2%
4%
3%
4%
2011
2010
13
Current Program Impact:
Key National Indicators
% of Health Centers with EHR Implementation (UDS 2011)
 65% have EHRs at all sites used by all providers
 15% have EHRs at some sites used by some providers
% of Health Centers Achieving Patient-Centered Medical Home Recognition
(as of Septebmer 1, 2012)
 28% of all health centers are participating in Patient-Centered Medical
Health Home Initiatives (PCMHHI)
 11% have achieved Patient-Centered Medical Home (PCMH)
recognition
% of Health Center Meeting/Exceeding Healthy People 2020 Goals
(UDS 2011)
 57% Meet/Exceed Hypertension Control Goal of 61%
 10% Meet/Exceed Diabetes Control (HbA1c ≤9) Goal of 85%
 36% Meet/Exceed Early Entry into Prenatal Care Goal of 78%
 61% Meet/Exceed Low Birthweight Goal of 7.8%
14
Current Program Impact:
Key South Carolina Indicators
% of Health Centers with EHR Implementation (UDS 2011)
 47% have EHRs at all sites used by all providers
 16% have EHRs at some sites used by some providers
% of Health Centers Achieving Patient-Centered Medical Home Recognition
(as of September 1, 2012)
 47% of South Carolina State health centers are participating in PatientCentered Medical Health Home Initiatives (PCMHHI)
 0% have achieved Patient-Centered Medical Home (PCMH) recognition
% of Health Centers Meeting/Exceeding Healthy People 2020 Goals
(UDS 2011)
 50% meet/exceed hypertension control goal of 61%
 0% meet/exceed diabetes control (HbA1c ≤9) goal of 85%
 8% meet/exceed early entry into prenatal care goal of 78%
 42% meet/exceed low birthweight goal of 7.8%
15
Percentage of EHR Adoption by State
UDS 2011
Source: Uniform Data System, 2011
16
Health Center EHR Adoption National and
South Carolina, UDS 2011
100%
2015 Goal:
100% of
Health Centers
use EHR at All
Sites
90%
80%
70%
15%
60%
16%
50%
40%
30%
65%
47%
20%
EHR at Some
Sites
EHR at All
10%
0%
Sites
National
Source: Uniform Data System, 2011
2012 Goal:
50% of Health
Centers use
EHR at All
Sites
South Carolina
17
South Carolina EHR Adoption
UDS 2011 Data
South Carolina Health Centers have not met
the 2012 HRSA EHR goal based on UDS 2011 data.
All Sites/Providers
Some Sites/Providers
No EHR
HRSA, BPHC, Central Southeast Division (June 2012)
Impact-BPHC Quality Strategy
Better Care ⃘ Healthy People & Communities ⃘ Affordable Care
Strategy Implementation
INTEGRATED
HEALTH SYSTEM
Priorities & Goals
1.
Implementation of QI/QA Systems
All Health Centers fully implement their
QI/QA plans
2.
Adoption and Meaningful Use of EHRs
All Health Centers implement EHRs
across all sites & providers
3.
Patient-Centered Medical Home
Recognition
All Health Centers receive PCMH
recognition
4.
Improving Clinical Outcomes
All Health Centers meet/exceed
HP2020 goals on at least one UDS
clinical measure
5.
Workforce/Team-Based Care
All Health Centers are
employers/providers of choice and
support team-based care
19
1. Programs/Policies
2. Funding
3. Technical Assistance
INTEGRATED
SERVICES
4. Data/Information
5. Partnerships/Collaboration
COMPREHENSIVE
SERVICES
ACCESS
HRSA’s PCMH Investments
• Patient-Centered Medical Health Home Initiative
• Accreditation Initiative
• PCMH supplemental grant funds
• Partnership with the CMS Primary Care
Demonstration
20
Why PCMH?
• Demonstrates the quality of care provided in health centers
and provides opportunity for continuous quality improvement.
• Positions health centers at an advantage for the changing
health care landscape.
• Invests in the health center workforce resulting in reduced
staff turnover and improved recruitment.
• Transforms patient care to help health centers achieve the
three part aim of: Better care, Better health and communities,
and Affordable care.
• Federal DHHS Priority
o Goal: 13% of health centers PCMH recognized by 9/30/2012
o Goal: 25% of health centers PCMH recognized by 9/30/2013
21
Patient-Centered Medical/
Health Home Initiative (PCMHHI)
• Encourages and supports health centers to transform their practices
and participate in the PCMHH recognition process to:
– improve the quality of care and outcomes for health center populations;
– increase access; and
– provide care in a cost effective manner.
• HRSA/BPHC will cover recognition process fees and provide
technical assistance resources for practice transformation.
• Participation is strongly encouraged and provides an opportunity for
health centers to achieve PCMH recognition.
For further information on the PCMHH Initiative:
•
PCMHH Initiative PAL:
http://www.bphc.hrsa.gov/policiesregulations/policies/pal201101.html
•
BPHC Helpline: [email protected] or 1-877-974-BPHC (2742)
•
PCMHH email: [email protected]
22
Alignment of Health Center Requirements
with PCMH Domains
Section 330 Program Requirement
1.
NCQA PCMH Domain
Alignment of Health Center Program
Needs Assessment
Identify and
Manage Patient
Requirements with• PCMH
Domains
Populations
2. Required and Additional Services:
Primary, preventive and enabling
services
•
Provide Self-Care Support and
Community Resources
4. Accessible Hours of
Operation/Locations
5. After Hours Coverage
•
Enhance Access and Continuity
6. Hospital Admitting Privileges and
Continuum of Care
•
Plan and Manage Care
7. Quality Improvement/Assurance
Plan
•
Measure and Improve Performance
11. Collaborative Relationships
15. Program Data Reporting System
•
Track & Coordinate Care
23
FY 2011 PCMH Supplemental Funding
Domains of Focus
South Carolina Health Centers
80%
73.3%
70%
60%
50%
40%
30%
20%
10%
0%
33.3%
26.7%
33.3%
26.7%
13.3%
2012 Health Center PCMH Recognition
National and South Carolina
70%
PCMHHI
Participants
PCMH
60%
Recognized
47%
50%
40%
30%
20%
2013 Goal:
25% of Health
Centers
Recognized
as PCMH
28%
11%
10%
0%
0%
National
Data as of September 1, 2012
PCMH Recognized Includes: NCQA, Joint Commission, and AAAHC
South Carolina
2012 Goal:
13% of Health
Centers
Recognized
as PCMH
25
PCMH Resources
• PCMH Comparison Chart
– http://bphc.hrsa.gov/policiesregulations/poli
cies/pcmhrecognition.pdf
• Fact Sheet: Quality Improvement
Initiatives Available to HRSA Supported
Health Centers
– http://bphc.hrsa.gov/policiesregulations/poli
cies/qioverview.pdf
26
2011 National and South Carolina Health Center
Performance and Healthy People 2020 Goals
100%
Percentage of Health Centers Meeting or
Exceeding Healthy People 2020 Goals
90%
80%
70%
60%
61%
57%
50%
50%
42%
36%
40%
30%
20%
10%
10%
0%
0%
Hypertension Control
8%
National
2012
Goal:
10+% of
Health
Centers
Meet or
Exceed
HP 2020
Goals
South Carolina
Diabetes Control
Early Entry to Prenatal Care
Low Birthweight
27
Source: 2011 UDS and Healthy People 2020
South Carolina:
Hypertensive Patients with Blood Pressure < 140/90
UDS 2011 Data for Federally-Support Health Centers
100%
Healthy People 2020 Goal = 61.2%
90%
78.1%
80%
70%
60%
80.0%
77.1%
74.3%
67.1%
68.6%
64.0%
55.7%
62.9%
60.5%
57.5%
65.7%
61.4%
60.0%
54.6%
51.8%
50%
40%
54.3%
51.1%
44.2%
38.6%
30%
20%
10%
0%
HRSA, BPHC, Central Southeast Division (June 2012)
28
South Carolina:
Diabetic Patients with HbA1c ≤ 9%
UDS 2011 Data for Federally-Supported Health Centers
100%
Healthy People 2020 Goal = 85.4%
90%
85.4%
80.0%
80%
70%
60%
72.9%
78.6%
72.9%
66.5% 67.1%
65.7%
78.6%
74.3%
72.7%
74.3%
75.7%
73.0%
68.5%
64.3%
61.4%
56.1%
53.8% 52.9%
50%
40%
30%
20%
10%
0%
HRSA, BPHC, Central Southeast Division (June 2012)
29
Policy Updates
30
Recently Released Final Policies
• Approved Uniform Data System Changes for 2012
• CY 2013 Requirements for Federal Tort Claims Act
(FTCA) Medical Malpractice Coverage for Health Centers
• Sites, Scope of Project, and Capital Projects
• Process for Becoming Eligible for Medicare
Reimbursement under the FQHC Benefit
• Health Center Collaboration
• FTCA Health Center Policy Manual
• HRSA Patient-Centered Medical/Health Home Initiative
• HIV/AIDS Care and Treatment in Health Centers
To Access these and other policies, visit:
http://www.bphc.hrsa.gov/policiesregulations/policies/index.html
31
Initiating and Maintaining Medicare
FQHC Reimbursement
CMS requires ALL permanent and seasonal sites within a
health center’s approved scope of project to be enrolled
INDIVIDUALLY in Medicare.
• Each site must also indicate its unique Medicare Billing
Number (also known as a PTAN or CCN) on claims for all
services rendered at that site.
• Please ensure that your health center has all of its correct
Medicare Billings Numbers listed in EHB as soon as
possible, for each of their permanent and seasonal sites.
For more information about the requirements and process
for enrolling sites in Medicare, review PAL 2011-04
http://www.bphc.hrsa.gov/policiesregulations/policies/pal201104.html.
32
2012-2013 Anticipated Policy Topics
• DRAFT Sliding Fee Discount Program Policy
– Released July 10, 2012 for Public Comment
– Comments due to HRSA by September 28, 2012
• DRAFT Sub-Recipients/Sub-Contracts
• DRAFT Quality Improvement/Assurance
Draft policies open for comments are posted at:
http://www.bphc.hrsa.gov/policiesregulations/policies/draftsforcomment.html.
33
Funding Updates
34
Fiscal Year 2013
Spending Plan
o $19 Million for Health Center New Access Points (25 awards)
o $20 million for Health Center Controlled Networks
(~25 to 30 Awards)
o $75 Million for School-Based Health Center Capital program
(~150 awards)
35
Fiscal Year 2013
Continuation Funding Opportunities
Health Centers:
– FY 2013 Budget Period Progress Report
(BPR) Technical Assistance:
http://www.bphc.hrsa.gov/policiesregulations/continuation/index.html
– FY 2013 Service Area Competition (SAC)
Technical Assistance:
http://www.hrsa.gov/grants/apply/assistance/sac/
Cooperative Agreements:
– National
– State/Regional Primary Care Associations
36
Fiscal Year 2012
Primary Care Association Requirements
Statewide/Regional Health
Center T/TA Activities
A. Program Requirements
Goal:
•
% of Health Centers with No Program
Conditions
T/TA Focus Areas:
•
Need
•
Services – QI/QA Systems
•
Management and Finance – Fiscal
Operations/Systems
•
Management and Finance – Workforce
Recruitment and Retention
•
Governance
B. Performance Improvement
Goals:
•
% of Health Centers that
Meet/Exceed Healthy People
2020 Goals on One or More
Clinical Performance Measures
•
% of Health Centers with PCMH
Recognition
•
% of Health Centers with Cost
Increase Less than National
Average
•
% of Health Centers Financially
Strong (No Going Concern
Issues)
T/TA Focus Areas:
•
Clinical Performance Measures
•
Financial Performance Measures
37
Fiscal Year 2012
Primary Care Association Requirements
Statewide/Regional Program Assistance Workplan
o
o
o
o
o
o
o
Information on Available Resources
Annual T/TA Needs Assessment
Special Populations
Collaboration
Emergency Preparedness
Regional/Statewide Surveillance Analysis
Newly Funded Health Centers
38
Quality and Data Updates
39
FTCA Program
• FTCA Health Center Policy Manual
o Primary source for information on FTCA grantees
and related stakeholders
o Consolidates, clarifies and synthesizes existing
FTCA policy documents and statutory language
Available at: http://bphc.hrsa.gov/policiesregulations/policies/pin201101.html
• Application Review/Deeming in EHB
o 2013 Requirements for FTCA Deeming available in PAL
2012-02:
http://www.bphc.hrsa.gov/policiesregulations/policies/pal201202.html
o For Programmatic of Technical TA on FTCA contact:
Email: [email protected] Phone: 1-877-974-2742
40
Technical Assistance Resources
41
Technical Assistance (TA)
Resources
• National and state-based support for training and
technical assistance:
o National Cooperative Agreements
o State/Regional Primary Care Associations
o State Primary Care Offices
• Federal TA Support:
o Project Officer
o TA Calls/Trainings
o Onsite Consultant Support
o BPHC TA Website-New Search Engine Feature
Added
For more information visit the BPHC TA Website:
http://www.bphc.hrsa.gov/technicalassistance/index.html
42
Bureau of Primary Health Care
Help Line
Single point of contact to assist grantees and stakeholders
with information in the following areas:
• BHCMIS – System in EHB (Electronic Handbook)
• Health Center Quarterly Reporting (HCQR)/ARRA 1512
• Reporting Uniform Data System (UDS)
• Federal Torts Claims Act (FTCA) for Health Centers and
Free Clinics
Phone: 1-877-974-BPHC (2742)
Email: [email protected].
Available Monday to Friday (excluding Federal holidays),
from 8:30 AM – 5:30 PM (ET), with extra hours available
during high volume periods.
43
UDS Web Tools
UDS Website:
http://www.hrsa.gov/data-statistics/health-center-data/index.html.
•
•
•
•
o Data analysis tools
o Data download functionality
UDS Grantee/State/National Summaries
Health Center Trend Reports
State and National Roll-up Reports
Reporting and Training Resources
UDS Mapper: www.udsmapper.org
• HRSA has developed a mapping and support tool driven
primarily from data within the UDS
• Webinar trainings on using Mapper functionality available:
http://www.udsmapper.org/webinars.cfm
44
Risk Management and
Patient Safety Web Resources
ECRI risk management and patient safety resources are
available to Health Center Program grantees and Free
Clinics. Resources include:
– Risk management courses
– Continuing medical education (CME) credits at no cost to
health care providers
– Links to archived audio-conferences/webinars to
supplement evidence-based risk management training
– Guidance articles, self-assessment tools, ready-made
training materials on patient safety, quality and risk
management for the health center and free clinic setting
– Risk & Safety E-news
Visit: www.ecri.org/clinical_RM_program.
45
Primary Health Care and
Public Health Leadership
All Health Centers and Primary Care Associations are
encouraged to explore and participate in the following key HHS
public health initiatives:
• National Quality Strategy
http://www.ahrq.gov/workingforquality/nqs/
• HHS Action Plan to Reduce Racial and Ethnic Health Disparities
http://minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf
• National Prevention Strategy
http://www.healthcare.gov/prevention/nphpphc/strategy/index.html
• National HIV/AIDS Strategy
http://www.whitehouse.gov/sites/default/files/uploads/NHAS.pdf
46
Primary Health Care and
Public Health Leadership
• National Oral Health Initiatives
http://www.hrsa.gov/publichealth/clinical/oralhealth/
• Behavioral Health Initiatives
http://bphc.hrsa.gov/technicalassistance/tatopics/clinicalcareservices/index.html#Behavioral
• Healthy Weight Collaborative
http://www.collaborateforhealthyweight.org/
• Million Hearts Campaign
http://millionhearts.hhs.gov/
• Text4baby
http://www.cdc.gov/women/text4baby/index.htm
• Viral Hepatitis Initiative
http://www.hhs.gov/ash/initiatives/hepatitis/index.html
47
John Cafazza
Director, Central Southeast Division
U.S. Department of Health and Human Services
Health Resources and Services Administration
Bureau of Primary Health Care
5600 Fishers Lane Rm. PKLN/17-61
Rockville, MD 20857
Telephone: 301.594.4420
Email: [email protected]
48
Thank You!
Questions?
49