Effective Collaboration Between Critical Access Hospitals and Federally Qualified Health Centers

Transcription

1 Effective Collaboration Between Critical Access Hospitals and Federally Qualified Health Centers National Rural Health Association Conference May 20, 2010 Department of Health and Human Services Health Resources and Services Administration Office of Rural Health Policy

2 Acknowledgements The Collaboration Manual project was a continuation and expansion of prior activities supported by the Federal Office of Rural Health Policy on CAH and FQHC collaboration. A 14 member workgroup provided guidance on materials developed by the HMS Associates Project Team, January through August

3 Key Participants Manual Workgroup Membership HRSA -Office of Rural Health Policy -Tom Morris, Jerry Coopey, Julia Bryan - Project Officer HRSA Bureau of Primary Health Care -Cicely Nelson, Amanda Reyes State Office of Rural Health -Pat Carr, Alaska National Association of Community Health -Pamela Byrnes, Susan Walters National Rural Health Association - Brock Slabach National Rural Health Clinic Association - Bill Finerfrock Federally Qualified Health Centers - Ted Koler, Steve Hansen Critical Access Hospitals - Wayne Hellerstedt, Ed Perlak 3

4 HMS Associates Project Team Gregory Bonk, Project Director; Jack Dennis, Scot Graff, Terry J. Hill, Tom Pause, Kim E. Sibilsky Major CAH/FQHC Collaborative Sites Minnie Hamilton Health System (Combined CAH and FQHC), West Virginia Fairview Hospital (CAH), an affiliate of Berkshire Health Systems, Inc., and Community Health Center of the Berkshires (FQHC), Massachusetts Early Memorial Hospital (CAH) & John D Archbold Memorial Hospital, Inc. (Managing Hospital) and Primary Care of Southwest GA, Inc. (FQHC), Georgia 4

5 Six Key Questions Why was this manual developed? Who was it developed for? How was it developed? What does it contain? How has collaboration worked? What were the financial impacts to and their communities? 5

6 Why was this manual developed? There are 1,302 CAHs and 3,442 FQHC service sites in rural communities across the nation. They provide services to residents of an estimated 2,043 rural counties across the nation. They differ from other types of hospitals or outpatient clinics., receive enhanced reimbursement for healthcare services as well as federal grant funds. Those enhanced rates and grant funds are also intended to provide greater financial stability and strengthen local health care services financial base as a result. An estimated 397 of these rural counties have both CAHs and FQHCs. Yet, less than 15% of with similar service areas share resources and benefit from working collaboratively. 6

7 Due to the recent growth of, and their specific types of shareable Federal support, the focus of the manual was on CAH/FQHC collaboration. Other providers are also critical components of rural health in many communities and represent potential collaborative opportunities. Many concepts in the manual also apply to small rural hospitals and FQHCs serving similar communities. 7

8 Co-location of 8

9 Tangible Benefits = Successful Collaboration The manual documents the experiences of several rural CAH/FQHC collaborations. These relationships unequivocally facilitate service operation and development. Primary and preventive health services Inpatient care 24 hour emergency care and Access to specialty care Collaboration also enhanced their financial stability. $2,225,000 in direct grant or financial support for numerous needed programs and $1,083,000 in annual operational savings. 9

10 Who was it developed for? Multiple levels of leadership and key stakeholders Demonstrate how local rural delivery systems can be maintained and strengthened. Develop an understanding of each organizations unique features and importance to the community Get attention by highlighting how federally supported financial incentives can be shared to reduce the potential of deficit operations. Federal and state grants for service development and operation Federal Claims Tort Act (FCTA) medical malpractice coverage Recruitment and retention of health care professionals 10

11 How was it developed? The project examined, augmented and focused information on collaboration and CAH, FQHC and community benefits. A national workgroup with representation from different national associations and was formed. Literature was reviewed. Site visits and telephone interviews were conducted. Emphasis was on documented community benefits and cost savings associated with their collaborative actions. Results were summarized and discussed at four meetings of the workgroup which took place between January and August

12 What does it describe? The manual has five sections. 1. Importance of Collaboration 2. FQHCs from A to Z 3. CAHs from A to Z 4. Collaborative Potential of 5. Examples of Successful Collaboration 12

13 How has collaboration worked? Lessons Learned Leadership, Continuity, and Commitment Compelling Needs and Solutions Collaboration Instead of Competition Regional Linkages for Frontier Counties and Tribal Health Services The Pay-off: Significant Benefits 13

14 Lesson 1 - Leadership, Continuity and Commitment The importance of leadership at the state, community and provider level cannot be underestimated. Traits of effective leadership include: recognition that local networks or systems of services are essential to meet healthcare needs and realization that individual actions must take into account the potential impacts of those actions on needed partners and services. Continuity of leadership and technical capacity throughout the development of collaborative actions was also a critically important variable. 14

15 Lesson 2 - Compelling Needs and Solutions The initial collaborative actions undertaken addressed current or emerging compelling needs. For two of the three communities reviewed, the compelling need was the impending loss of primary care capacity. The actual closure of a small rural community hospital was the driving force behind collaboration in the third area For all three sites, there was clear recognition that primary care and hospital care needs are interdependent and that both needs must be met for either type of care to be effective. The best approach to meeting the compelling need included the stabilization of both primary care and hospital capacities. 15

16 Lesson 3 - Collaboration Instead of Competition Community, administrative, and medical leadership recognized that the local system of health services is best served through collaborative approaches rather than competitive ones. The community benefit perspective indicates that both providers can benefit in different ways The community, the CAH and the FQHC all win. It is a synergistic rather than competitive scenario. 16

17 Lesson 4 -Regional Linkages for Frontier Counties and Tribal Health Services Attributes of rural areas also very considerably by the remoteness or frontier nature and the presence of various Native American Tribes and tribal programs. Strong CAH linkages with regional hospital systems and strong FQHC linkage/ownership to regional FQHC capacities has been show to be effective in some remote communities. A consortium of Tribes operates both FQHCs and CAHs in Alaska. Communities benefit from this joint corporate level management of FQHCs and CAHs, especially in terms of telehealth, telemedicine, HIT, and shared back-office administrative support. 17

18 Lesson 5 - The Pay-off: Significant Benefits Communities benefit when collaboration results in a local network of needed high quality sustainable health care services. Access to care is maintained and strengthened through shared use of health care resources such as grants and cost reduction mechanisms. benefitted through reduced deficit operations. 18

19 Benefits of Collaboration Between Each provider contributes unique resources to the collaboration that foster infrastructure, access, and quality of care improvements. FQHCs benefited through sharing CAH unique resources CAHs benefited through association with the FQHCs The local rural health infrastructure made up of - benefited 19

20 What are the Financial Implications? Twelve areas of collaboration with financial impact were noted across the three sites. Six areas had quantifiable cost savings or new financial resources. $2,225,000 was obtained for one or two year related costs such as start-up and time-limited grants for three collaborative areas and $1,083,000 were identified as annual savings for the other three collaborative areas. Cost savings were also noted in six other areas but estimates of the actual amounts were not available. benefited financially in different ways. 20

21 Other Findings Successful collaboration was found in many different types of rural healthcare delivery systems. King-of-the-hill mentalities, duplicative service capacities, referral patterns which bypass local hospital capacities, broken promises and conflicting corporate philosophies were often cited as collaboration deal breakers. Discussions of needs, benefits and financial and continuity of care implications of action or inaction can be starting points or a foundation for revisiting collaborative potential. 21

22 A Critical Access Hospitals and Federally Qualified Health Centers HTTP// - Specific Questions: References Julia Bryan, Public Health Analyst, Office of Rural Health Policy, jbryan@hrsa.gov, (310) Greg Bonk, Project Director and Lead Consultant, President, HMS Associates, gregbonkhms@locanet.com, (716)