Improving the health of the 62 million who call rural America home. 4.)/(,$/(+,&5!-6 -."/&/01&20&"223/4&2%353&67$089/:&3;3/25<

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Paul Daniel
5 years ago
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National Rural Health Association Membership 4.)/(,$/(+,&5!-6 -.

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1 !"#$%&'()*+,)(,&-.$%/0&1++2.#$/(3.!"#$%&'(&)*+, Improving the health of the 62 million who call rural America home. Brock Slabach, MPH, FACHE Sr. Vice-President National Rural Health Association Leawood, S NRHA is non-profit and non-partisan. National Rural Health Association Membership 4.)/(,$/(+,&5!-6 -."/&/01&20&"223/4&2%353&67$089/:&3;3/25< 6,,"$%&1+,7.#.,*.=!">&?@+)(&)*+,A&B"/&C93:0(&DE!"#$%&-+)2(/$%&8,,+3$/(+,&9"::(/=!">&?@+)(&)*+,A&B"/&C93:0(&DE ;"$%(/<=1%(,(*$%&1+,7.#.,*.=F6.>&++@+G(&)*+, A&H"5%;9..3(&IH!-1=16-&1+,7.#.,*.=B37238J3#&)@)?(&)*+,&A&L"/5"5&D92>(&!M >+%(*<&8,)/(/"/.=N3J#6"#>&@O(&)*+OA&P"5%9/:20/(&CD?()(/&!"#$%-.$%/0'.@A+#B 7+#&C./$(%)&$,C&C()*+",/)A G We live in an era of massive institutional failure. --Dee Hock, founding CEO of Visa When the infrastructure shifts, everything rumbles. --Stan Davis, Author and Management Consultant

!"#"$%&'()*%+, An Era of Transformation?! Population Health! MACRA! Transparency! APM/DSR!"#$%&'()*+,-.,/0"1&2,3$04,(4,0(2,-""56,7/0*,89'$:9$'*,";, 8:(*49(;(:,<*="%$9("46> 7?

2 !"#"$%&'()*%+, An Era of Transformation?! Population Health! MACRA! Transparency! APM/DSR!"#$%&'()*+,-.,/0"1&2,3$04,(4,0(2,-""56,7/0*,89'$:9$'*,";, 8:(*49(;(:,<*="%$9("46> 2$:0,&,1&C"',2A(9:0,;'"1,90*,9'&:5,A*E'*,;&1(%(&',A(90,90&9,";9*4, B;(F*2E,90&9,&,:"1#%*9*,"=*'0&$%G,A0(:0,"4:*,%""5*+,$99*'%., Healthcare Environment! 2016 Election! Healthcare Reform (ACA/MACRA)! ACA Repeal! HIT and Meaningful Use! Reimbursement Shrinking! uality and Safety! Workforce! Technology In a word CHAOS Chaos Theory Chaos theory describes the complex motion and the dynamics of a system. A system can descend into chaos and unpredictably, yet within that state of chaos, the system is held within boundaries that are well ordered and predictable. Organizations as Systems I*4*'"$2,%*&+*'2,(4J$('*,(49",90'**,+"1&(426 H+*49(9. H4;"'1&9("4 <*%&9("420(#2! Chaos and order are complementary partners, not polarities! Chaos is a necessary process for the creation of a new order

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stabilization (Stop the bleeding) Elimination of Medicare Sequestration for rural hospitals; Reversal of all bad debt reimbursement cuts (Middle Class Tax Relief and Job Creation Act of 2012);

5 -+)2(/$%&1%+)"#.&1#()() 23*6J4&"#6-$69>**#6-$9>+'9>(60$ <&6$&>($&>'((L#(HH(A$6&**#0$ FM_H&_HCXBMH(&D_`aCXBB&X]`MHEa&DM Save Rural Hospitals Act Rural hospital stabilization (Stop the bleeding) Elimination of Medicare Sequestration for rural hospitals; Reversal of all bad debt reimbursement cuts (Middle Class Tax Relief and Job Creation Act of 2012); Permanent extension of current Low-Volume and Medicare Dependent Hospital payment levels; Reinstatement of Sole Community Hospital Hold Harmless payments; Extension of Medicaid primary care payments; Elimination of Medicare and Medicaid DSH payment reductions; and Establishment of Meaningful Use support payments for rural facilities struggling. Permanent extension of the rural ambulance and super-rural ambulance payment. Rural Medicare beneficiary equity. Eliminate higher out-of pocket charges for rural patients (total charges vs. allowed Medicare charges.) Regulatory Relief Elimination of the CAH 96-Hour Condition of Payment (See Critical Access Hospital Relief Act of 2014); Rebase of supervision requirements for outpatient therapy services at CAHs and rural PPS See PARTS Act); Modification to 2-Midnight Rule and RAC audit and appeals process. Future of rural health care (Bridge to the Future) `//0;"290/&8043.&R0#&#6#".&%05792".5&1%0&$0/29/63&20&52#6::.3<&& E"/"#.&N+C.%O&1+::",(/<&R"/2$/(.,/&N+C.% )Gb,&383#:3/$>&B3#;9$35 N.3U9J9.92>&20&!332&2%3&H3345&0R&c06#&D0886/92>&2%#06:%&M627"293/2& D"#3S!332&H3345&0R&c06#&D0886/92>&2%#06:%&"&D0886/92>&H3345&E /2S X6#".&_3".2%&D.9/9$ B19/:&J345 H0&7#3$.6590/5&20&%083&%3".2%(&5^9..34&/6#59/:(&9/R6590/5&53#;9$35&0J53#;"290/&$"#3< Ia_EaI_&BXe`DB&EB&XEBMHEfa&DMBIB<=N0#&76#70535&0R&2%95&56J53$290/(&192%&#3573$2&20& g6".9r934&0627"293/2&53#;9$35(&$0525&#3"50/"j.>&"550$9"234&192%&%";9/:&"&j"$^67&7%>59$9"/&";"9."j.3&;9"&"& 23.3$0886/9$"290/5&5>5238&5%"..&J3&$0/5943#34&#3"50/"J.3&$0525<[< 2E>($"8*+,&$*=$J"58(,&$=*'$M+"#4=4(A$*+&J"&4(,&$6('/49(6$46$(M+"#$&*$;NO$ J('9(,&$*=$&>($'("6*,"B#($9*6&6$*=$J'*/4A4,H$6+9>$6('/49(60D _9:%3#&g6".92> _9:%3#&7"293/2&5"295R"$290/ C09/:&80#3&192%&.355 E/&M$20J3#&)*+&5264>&R#08&2%3 MRR9$3&0R&2%3&E55952"/2&B3$#32"#>& R0#&-."//9/:&"/4&;".6"290/&"2& BS X6#".&%05792".5&06273#R0#8&2%39#&6#J"/&$06/23#7"#25&0/&!349$"#3\5&ef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h/9234&B2"235&D0/:#355&$0/5943#9/:& $6##3/2&.3:95."290/&20&56770#2&56#:9$".&$"#3&9/&#6#".& $0886/92935(&2%95&3;943/$3&95&2983.><

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Rebalancing Health Care in the Heartland The Rural Imperative of Population Health Des Moines, IA

Rebalancing Health Care in the Heartland The Rural Imperative of Population Health Des Moines, IA Brock Slabach, MPH, FACHE Sr. Vice-President National Rural Health Association Leawood, KS December 1,