Rural and Frontier Hospices

Transcription

1 Rural and Frontier Hospices Advisory Committee on Rural Health and Human Services April 3, 2013 ~ Grand Junction, Donna M. Roberts RN, BSN, DTR, BA Hospice of the Plains Alana Knudson, PhD NORC Walsh Center for Rural Health Analysis Overview Hospice Issues Where are hospice services being provided? perspective perspective What issues impact hospice providers? Discuss Next Steps 1

2 Hospice Partners Hospice and Palliative Care Organization Rural Task Force Hospice Analytics Cordt T. Kassner, PhD Hospice Issues Access Reimbursement Cost of Care in Hospice Length of Stay Mileage Vendors Workforce Quality Recent Regulatory Changes 2

3 2011 Hospice Utilization (Medicare Hospice Deaths / Total Medicare Deaths) 70% 60% CO #8: 50.6% : 42.9% 50% 40% 30% 20% 10% 0% Arizona 1 Florida 2 Utah 3 Iowa 4 Delaware 5 Oregon 6 Rhode Island 7 8 Michigan 9 Ohio 10 Texas 11 Georgia 12 Kansas 13 Wisconsin 14 Nev ada 15 South Carolina 16 Idaho 17 New Mex ic o 18 Missouri 19 Minnesota 20 Illinois 21 Louisiana 22 North Carolina 23 Pennsylvania 24 Washington 25 New J ers ey 26 Nebras k a 27 Maine 28 Massachusetts 29 Alabama 30 Cali fornia 31 Maryland 32 New Hamps hire 33 Connec tic ut 34 Montana 35 Oklahoma 36 Tennessee 37 Indiana 38 Arkansas 39 Virginia 40 West Virginia 41 Hawaii 42 Kentucky 43 South Dakota 44 Mississippi 45 District of Columbia 46 Wyoming 47 North Dakota 48 Vermont 49 New York 50 Alaska 51 m 6 3

4 Defining Metropolitan, Urban, and Rural Counties US Dept. of Agriculture, Economic Research Service 2003 Rural-Urban Continuum Codes* da.gov /data-products/rural-urban-continuum-codes.as px * Note: An update of the Rural-Urban Continuum Codes is planned for mid Code Description Summary 1 Counties in metro areas of 1 million population or more Metropolitan 250,000+ Residents 2 Counties in metro areas of 250,000 to 1 million population 3 Counties in metro areas of fewer than 250,000 population 4 5 Urban population of 20,000 or more, adjacent to a metro area Urban population of 20,000 or more, not adjacent to a metro area Urban 20,000+ Residents OR 6 Urban population of 2,500 to 19,999, adjacent to a metro area 2,500+ Residents and adjacent to metropolitan area 7 Urban population of 2,500 to 19,999, not adjacent to a metro area Rural 8 Completely rural or less than 2,500 urban population, adjacent to a metro area 9 Completely rural or less than 2,500 urban population, not adjacent to a metro area <20,000 Residents and not adjacent to metropolitan area OR <2,500 Residents m 7 Defining Metropolitan, Urban, and Rural Counties Designations Metro Urban Rural 1. Adams 2. Arapahoe 3. Boulder 4. Broomfield 5. Clear Creek 6. Denver 7. Douglas 8. El Paso 9. Elbert 10. Gilpin 11. Jefferson 12. Larimer 13. Mesa 14. Park 15. Pueblo 16. Tel l er 17. Weld 1. Delta 2. Eagle 3. Fremont 4. Garfield 5. Huerfano 6. La Plata 7. Montezuma 8. Morgan 9. Otero 1. Alamosa 2. Archuleta 3. Baca 4. Bent 5. Chaffee 6. Cheyenne 7. Conejos 8. Costilla 9. Crowley 10. Custer 11. Dolores 12. Grand 13. Gunnison 14. Hinsdale 15. Jackson 16. Kiowa 17. Kit Carson 18. Lake 19. Las Animas 20. Lincoln 21. Logan 22. Mineral 23. Moffat 24. Montrose 25. Ouray 26. Phillips 27. Pitkin 28. Prowers 29. Rio Blanco 30. Rio Grande 31. Routt 32. Saguache 33. San Juan 34. San Miguel 35. Sedgwick 36. Summit 37. Washington 38. Yuma m 8 4

5 Defining Metropolitan, Urban, and Rural Counties Number of 2011 Counties in each designation: United States Metro Urban Rural 1,090 (35%) 933 (30%) 1,120 (36%) 17 (27%) 9 (14%) 38 (59%) Number of 2011 Medicare Certified Hospices in each designation: United States Metro Urban Rural 2,508 (71%) 662 (19%) 329 (9%) 37 (71%) 5 (10%) 10 (19%) m 9 Percentage of 2011 Medicare Certified Hospices Located in Metropolitan, Urban, and Rural Counties 100% Rural 80% 60% Urban Metro % % % Counties Hospices Counties Hospices m 10 5

6 2011 Demographics and Medicare Hospice Utilization County-Specific Information Metro Urban Rural Total Population 260,426,327 4,430,992 37,291, ,841 13,792, ,963 Total Deaths 1,927,914 26, ,533 2, ,258 2,599 Medicare Beneficiaries 39,975, ,443 7,402,629 50,800 2,977,421 60,223 Medicare Beneficiary Deaths 1,559,712 20, ,776 1, ,338 2,163 Medicare Hospice Beneficiary Admissions 976,596 15, ,338 1,180 59,205 1,152 Medicare Hospice Beneficiary Deaths 692,039 10, , , Hospice Utilization= % of Medicare Deaths in Hospice 44.4% 52.4% 38.8% 44.4% 33.9% 39.3% m 11 Percentage of 2011 Medicare Hospice Utilization by Beneficiaries Residing in Metropolitan, Urban, and Rural Counties 60.0% 50.0% 40.0% 43.3% 38.1% 51.3% 44.6% 36.8% Metro Urban Rural 30.0% 31.3% 20.0% 10.0% 0.0% m 12 6

7 Percentage of Locations of Care in 2011 Medicare Certified Hospices Located in Metropolitan, Urban, and Rural Counties 100% 90% 80% 70% 60% 50% 40% 1,207, ,124 76,029 93,120 32,529 3, , , ,705 1,690 1, ,539 16,896, ,535 5,880 4, ,415 2,155,090 26,087, ,553 24,231 20,948 5,739,761 1,679,227 56,139, ,047 Metro Urban Rural Metro Urban Rural Hospital Inpatient Hospice Assisted Living Nursing Facility Home m 13 Percentage of Levels of Care in 2011 Medicare Certified Hospices Located in Metropolitan, Urban, and Rural Counties 100% 99% 195,198 24,543 7,186 3, , , , ,146 26,985 Respite Continuous Home Care General Inpatient 1,543,642 27,293 27,550 Routine Home Care 98% 31,815 97% 7,910,252 2,513,588 71,333,001 1,131,765 1,190,332 96% Metro Urban Rural Metro Urban Rural m 14 7

8 Length of Stay in 2011 Medicare Certified Hospices Located in Metropolitan, Urban, and Rural Counties Metro Urban Rural Mean LOS Median LOS Mean LOS Median LOS m 15 m 16 8

9 Northeastern Rural Health Clinic Physician Referral Sources for the Hospice of the Plains Service Area Akron Clinic (Akron) - Provider-Based Brush Family Medicine (Brush) - Provider-Based Family Care Clinic (Sterling) - Provider-Based Family Practice of Holyoke (Holyoke) - Provider-Based Fort Morgan Pediatric Clinic (Fort Morgan) - Independent Kit Carson Clinic (Kit Carson) - Provider-Based Parke Health Clinic (Burlington) - Provider-Based Stratton Medical Clinic (Stratton) - Provider-Based Valley Medical Clinic (Julesburg) - Provider-Based Washington County Clinic (Akron) - Independent Yuma Clinic (Yuma) - Provider-Based 9

10 2011 Statistics Hospice of the Plains Service Area County Square Miles Persons Per Total Deaths Injury, Suicide, Population Square Mile All Causes Drug & ETOH LOGAN 1, *22, MORGAN 1, , PHILLIPS *4, SEDGWICK *2, WASHINGTON 2, *4, YUMA 2, , CO BORDERS 1, TOTALS 10, , * 2011 population is less than the past five year average. Sources: Health Statistics Section, Department of Public Health and Environment State & County QuickFacts, U.S. Dept. of Commerce, United States Census Bureau 10

11 RHC Practitioner Limitation While RHC practitioners are eligible to furnish and bill for hospice services when they are not working at the RHC, they cannot furnish and bill for hospice services as an RHC practitioner because RHCs are not authorized to be attending physicians for hospice. Also, these practitioners cannot bill Medicare Part B while they are working for a Medicare RHC since Medicare is paying the RHC through the Medicare RHC cost report an all-inclusive rate per visit that includes all direct and indirect costs, such as the practitioner s services, space to provide those services, support staff services, related supplies, records costs, and other services. 11

12 Northeastern Critical Access Hospitals East Morgan County Hospital, Brush Haxtun Hospital District, Haxtun Kit Carson County Memorial Hospital, Burlington Melissa Memorial Hospital, Holyoke Sedgwick County Health Center, Julesburg Wray Community District Hospital, Wray Yuma District Hospital, Yuma 12

13 Rural/Frontier Hospice Issues Large Service Area / Exorbitant Windshield Time Lack 24 hr. Pharmacies or Durable Medical Equipment Delivery Rulemaking Lacks Rural / Frontier Perspective Viability - Limited Population Lack Corporate Sponsorship Finite Resources Limited Snowplows N-S HWYs 7p -7a Dirt Roads IDT may include farm, ranch or crop planning Pediatric Waiver Aging Workforce Limited Qualified Personnel Reimbursement Lower than Urban Multi-dimensional Community Resource No Anonymity Calls to Staff s Homes Accessibility of Caregivers Limited Educational Opportunities Traveling Physicians Unfamiliar With Patients and/or Hospice Contact Information Alana Knudson, PhD NORC Walsh Center for Rural Health Analysis knudson-alana@norc.org Donna Roberts, RN, BSN, DTR, BA Hospice of the Plains donna.roberts@hospiceoftheplains.org