Transcript PowerPoint Presentation - Challenges For Hospitals Serving

Rural Health Trends:
Opportunities/Threats
Tim Size
Executive Director
RWHC
Sauk City, Wisconsin
Rural Wisconsin
Health Cooperative
Overview
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Why Should You Care?
Ongoing Myths Undermine Rural Health
Medicare Modernization - Gorilla Wakes Up?
Health Insurance Changes Makes Price Matter
Quality Accountability/Transparency For Real
Workforce Problems Drive Education Reform
Community Collaboration Gets Real
“Say ‘Yes, if …’ rather than ‘No, because…’ ”
Rural Wisconsin
Health Cooperative
Keeping Care Local Makes Healthier Local Economy
•
Over 90 percent of Sauk County providers receive the majority of
their revenue from payers outside of Sauk County – primarily
private and public insurance companies.
•
Re hospital services, 66 percent of Sauk County inpatients use
local services and 71 percent of outpatients using local services.
•
�Every two dollars of revenue generated by the health care will
generate an additional 80 cents of revenue in other Sauk County
industries.
•
�Every two jobs created (or lost) in Sauk County health care
will cause the number of jobs in other sectors to increase (or
decrease) by one job.
The Economic Value of the Health Care Industry In Sauk County, Wisconsin, Center for
Community Economic Development, University of Wisconsin-Extension, November 2000
Rural Wisconsin
Health Cooperative
Old Myths Continue To Undermine Rural Health
 Rural health care should be cheaper
than urban health care.
RW HC Eye O n He alth
Rural?
Pay them less.
They grow their
own vegetables.
 Bigger is better; urban healthcare
quality is better.
 Rural residents don’t care/need
local healthcare
 Rural America is a homogenous
healthy agrarian society
 Rural populations are disappearing
Medicare Reform, A Rural Perspective, The 2001 NACRH Report to the
Secretary U.S. Dept. of Health and Human Services.
Rural Wisconsin
Health Cooperative
Medicare Is By Far The Major Payer
RW HC Eye O n He al th
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Equitable rural payments don't threaten
or distort Medicare's primary P P S focus.
 The Medicare Modernization Act of
2003 had more $ to address historic
inequities in rural health than in the
history of Medicare.
 But also big changes: a pharmacy
benefit that could eliminate rural
pharmacists and a major push to
move Seniors into private plans.
 Caused “health care fatigue” re any
additional changes in 2005*
 Fight against remaining anti-rural
biases in Medicare is NOT over.
*Lisa Kidder, AHA Fed. Relations at NRHA Annual Conference, 5/27/04
Rural Wisconsin
Health Cooperative
Medicare HMOs/PPOs: The Big Sleeper Issue
RW HC Eye O n He alth
Hometown
Rural Clinic
"Why is it legal for our only doctors to be denied
payment from our only insurance? "
• If providers do not accept
what they are offered by
Medicare Advantage private
health plans (HMOs, PPOs),
beneficiaries will be incented
or steered away from area
hospitals and physicians.
• KEY RURAL STRATEGYISSUE: Assure that Medicare
strongly enforces current
access rule that plans must
“reflect usual medical travel
times within the community.”
Rural Wisconsin
Health Cooperative
Consumers: Shift To Focus On Provider Charges
RW HC Eye O n He alth
 Increased overall health care costs
leading to concern re hospital
charges being “transparent,” i.e.
easily available.*
 Increased number of uninsured
leading to law suits re hospital
collection & billing practices*
"He's a third generation Conservative but his
firm's health care costs just outstripped payroll."
 Increased overall scrutiny leading
to concern re community benefit &
not for profit status*
*Lisa Kidder, AHA Fed. Relations at NRHA Annual Conference, 5/27/04
Rural Wisconsin
Health Cooperative
Health Insurance: Current Cost Trend Unsustainable
RW HC Eye O n He al th
Private
Markets
P ublic
Control
Wishful
Thinking
 Average health care insurance
premium headed to $12,000
per capita in 2006.
 Responses: shift costs to
employees, more low-wage
workers uninsured, abandon
health benefits for employees
or to cut employee positions.
 Some saying it will be
impossible to sustain the
employer-based health care
system in the future.
Wisconsin Economic Summit IV, Health Care Workgroup, 10/03
Rural Wisconsin
Health Cooperative
Shift from Defined Benefit to Defined Contribution
RW HC Eye O n He alth
 Important addition to mix of
insurance products available.
 But not a silver bullet for health
care costs.
 Problem is 80% of population uses
only 20% resources while the 20%
who use 80% of care “blow” past
high deductibles and still may not
get needed case management.
"He says our insurance this month only allows him
to treat body parts in the first half of the alphabet."
 Poorly designed plans may
discourage preventive care,
actually increasing costs over time.
Rural Wisconsin
Health Cooperative
Quality: Growing Consensus Re Public Accountability
RW HC Eye O n He alth
Quality & Cost Data
"I'll drop 'don't let perfection be the enemy of the
good' when you stop saying 'just trust me.' "
 Rural confronts same quality
challenges as urban; health care
quality is seen as too variable and
falling short of what is possible.
 Lower quality seen as cost driver.
 Quality infrastructure needed:
(1) leadership and quality
improvement knowledge, (2)
practice guidelines and local
protocols, (3) standardized
performance measures, (4)
measurement, data feedback and
(5) quality improvement programs
Rural Wisconsin
Health Cooperative
Quality: Information Technology
RW HC Eye O n He alth
 IT is critical element of
quality reporting to public.
 Move from episodicinstitutional care treating
illnesses to greater
consumer involvement in
the prevention and
management of illness
across the life-span.
The Information Technology (IT) highway needs to
improve quality, not digital monopolies.
 IT provides immediate
access to clinical
knowledge, specialized
expertise, and services not
readily available.
Rural Wisconsin
Health Cooperative
Quality: Health Literacy
RW HC Eye O n He alth
 Nearly half of all American
adults, 90 million, have difficulty
understanding and using health
information causing significant
demand for preventable care.
 Increasing consumer role makes
this issue increasingly critical.
"Don't tell me, but we really don't have the
least idea what each other is saying, do we? "
 Responsibility for improving
health literacy must be borne not
only by the health system, but
also by educators, employers,
community organizations…
Health Literacy: A Prescription to End Confusion, IOM, 4/04
Rural Wisconsin
Health Cooperative
Workforce: Shortage & Maldistribution
RW HC Eye O n He alth
 Recruit, enroll and train in schools
individuals likely to practice in
underserved areas
 Develop care models that enhance,
leverage practitioner resources
 Create policy/practices to
encourage retention, return to WI
"The 'rurals' have a point, we should just call
ourselves a Med School for suburban specialists."
 Provide adequate/targeted funding
for education.
 Develop statewide Council to guide
WI medical education policy.
WARM hopefully on the way!
Wisconsin Academy of Rural Medicine
WHA/SMS 2004 Task Force on Wisconsin’s Future Physician Workforce
Rural Wisconsin
Health Cooperative
Community Focus: Population Health
RW HC Eye O n He alth
"Your test results confirm that you are more careful
about what you put in your car than your mouth."
*Wisconsin County Health Rankings 2003,
Wisconsin Public Health and Health Policy Institute
 Growing awareness that we need to
reduce future need for services
 Health outcomes (mortality and
general health status) are driven by
health determinants as follows:
 Access to Health Care (10%)*
 Health Behaviors (40%)* e.g.
smoking, physical inactivity,
overweight, sexually transmitted
disease, motor vehicle crashes.
 Socioeconomic factors (40%)* e.g.
education, poverty, divorce rates.
 Physical environment (10%)*
Rural Wisconsin
Health Cooperative
Community Focus: Collaboration
RW HC Eye O n He al th
 Increasingly limited
resources make it more
appropriate than ever.
 It is the only way to address
population health threats
 It a traditional approach in
many rural communities
 Basis of most major rural
health grant opportunities
"The collaboration makes sense, but it will take a while to understand them."
Rural Wisconsin
Health Cooperative
“Say ‘Yes, if …’ rather than ‘No, because…’ ” *
RW HC Eye O n He alth
"OK. I understand a lot is going to change.
But how do I stay the same? "
*Anne Woodbury, Chief Health Advocate for Newt Gignrich’s Center for Health
Transformation in her keynote address at the WHA 2004 Annual Conference
Rural Wisconsin
Health Cooperative