Rural Hospital Issues

Notes from April 28 Medicaid Waiver hearing with Jason Helgerson in Amherst, NY pertaining to rural hospitals and provider networks:

50 SYSTEMS STATEWIDE AN ‘IDEAL’ NUMBER

At the Buffalo hearing, Dr. Gregory Young, director of the state Health Department's Western Regional Office asked how many “Performing Provider Systems/Networks” are being considered an ideal number by DOH; state Medicaid Director Jason Helgerson replied that 50 such networks would be a good number.  After the presentation Helgerson elaborated to say he would not like to see quite as many as 50 provider networks (Performing Provider Systems, or PPS’) in the New York City/Long Island area and would not like as many as 25 networks upstate. He is hoping that the Finger Lakes area might have just one network on its application, but allowed that it’s unlikely Western New York would have just one network/system.

STATE OPEN TO DISCUSSION ON SOUTHERN TIER & RURAL CHALLENGES

The challenges of the rural areas in the Southern Tier were discussed in questions and answers. Performance matrix scoring would be terribly skewed in areas with small numbers of Medicaid patients and could have a seesaw effect on payments for smaller rural providers. When confronted with the cross-border issues affecting some of our member hospitals, he suggested that there is no prohibition against an application including a Pennsylvania or Ohio provider — there is no requirement that the provider be New York State-based, only that the patients addressed be NYS residents. Therefore it is likely some out-of-state data will need to be collected if Medicaid patients travel across state lines for care. Mr. Helgerson is open to discussion on the difficulties of including rural hospital providers and rural providers in general in the DSRIP portion of the Waiver.

·         RURAL PROVIDERS SHOULD INCLUDE THEIR TERTIARY PROVIDERS IN APPLICATIONS, HELGERSON SAID

Q-Gail Speedy of SNAPCAP/STHCS, who has a rural FQHC, asked about standards for rural PPS’s given the small numbers.

A-Helgerson replied that if a provider is too small, it will be difficult to prove success on specific metrics and these little variations based on small numbers of patients will impact a provider system’s payments significantly under the system set up by the state.  He added that rural providers should consider having tertiary centers included in their Performing Provider System/network and included as part of the DSRIP discussion.  He added that this complex issue may merit more discussion regarding rural providers.

WNYHA ROLE IDENTIFIED

He also said he is open to including the WNY Healthcare Association as an information source for putting together hospitals with other providers. This will have to happen soon, as the Letter of Intent is due in May and the initial planning applications are due in mid-June. The applications will be returned with comments by July with formal, final applications due in December 2014. Names and numbers of providers included in each application can be changed up until the final application, but the sooner the list of applicants is finalized, the better, as DOH offered to preliminarily score such applications before December.

Another potential role for the Association is in convening groups of providers much as the NYS Partnership for Patients does now, to address specific approaches to identified issues being addressed successfully in one area, i.e. hospital admissions for asthmatics.

COMMENTS WELCOME ON POTENTIAL DUPLICATE REPORTING MECHANISMS WITH PARTNERSHIP FOR PATIENTS/OTHER MEASURES FOR HOSPITAL PERFORMANCE

Helgerson was also open to discussion about duplicative reporting for providers and said quite pointedly that he would ‘welcome comments’ to that effect — it was noted that the reporting mechanism for this program is nearly identical to that for the NYS Partnership for Patients and measures many of the same items, but could create a double burden for providers participating in both programs.