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Looking at the new CMS-Pennsylvania model for improving rural hospitals


Farm in Lancaster County, Penn., where many Amish people live.

CMS and Pennsylvania are  collaborating on a new model to improve health and healthcare is rural areas of the state.

Here are  Becker’s Hospital Review’s “eight things to know about the model”:

1. The Pennsylvania Rural Health Model is being administered through the CMS Innovation Center and  the state’s health department.

2. The goal  “is not only to improve health and healthcare in rural areas of Pennsylvania, but also to reduce the growth of hospital expenditures across payers — including Medicare — and improve the financial viability of the state’s rural hospitals, according to CMS.”

3. “The model is broken up into seven performance years, according to CMS. It  began  Jan. 12, 2017 and will end Dec. 31, 2023.”

4. “CMS said Pennsylvania rural hospitals participating in the model will receive all-payer global budgets — funded by all participating payers — to cover inpatient and outpatient services they provide. In exchange, these hospitals will use the money ‘to deliberately redesign the care they deliver to improve quality and meet the health needs of their local communities,’ the agency added”.

5. ”Pennsylvania, during each performance year, will prospectively set the all-payer global budget for each participating hospital, CMS said. The all-payer global budget will primarily be based on hospitals’ historical net revenue for inpatient and outpatient hospital-based services from all participating payers, according to CMS.”

6. ”Participating hospitals will also detail a plan to improve care quality by preparing a Rural Hospital Transformation Plan that must be approved by Pennsylvania and CMS.”

7. ”CMS said it will provide Pennsylvania with $25 million, which is a portion of the funding to begin implementing the model”.

8. Any critical-access hospital or acute-care hospital in rural Pennsylvania may participate in the model.

To read the CMS report on the model, please hit this link.

For more information from Becker’s, please hit this link.


Study details Penn. hospitals’ ‘super-utilizers’


The Pennsylvania Healthcare Cost Containment Council reports that 3 percent of patients hospitalized in Pennsylvania in fiscal 2014 were “super-utilizers” — admitted five or more times in a year. Those 21,308  patients accounted for 11 percent of total admissions and 14 percent of hospital days. Those 21,308  patients accounted for 11 percent of total admissions and 14 percent of hospital days.

Michael Consuelos, senior vice president of clinical integration for the Hospital and Healthsystem Association of Pennsylvania, told The Philadelphia Inquirer that the report was “no surprise for us folks who work in the quality improvement arena.”

The paper said: ”He said super-utilizers were often people with complex needs and limited access to primary and specialty care. The degree to which behavioral health was a factor was one of the more striking aspects of the report, he said. That illustrated the need to address the social determinants of health …{such as} poverty – and better coordination of mental and physical care.”

”Consuelos said some health systems were experimenting with putting mental-health and medical providers in the same office.”



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