By Ryan Kelly –
A delegation from Mississippi, including Michael Nester, Tommy Bartlett, Joanie Perkins, Tasha Brown, Alvin Hoover, Paul Gardner and myself, are in Washington D.C. this week to discuss rural health policy and legislation with fellow rural professionals and elected officials and staff.
We had the pleasure of hearing from Senator Tim Kaine (D-VA) and his experience and work to help with rural health improvement. No doubt, Sen. Kaine has been a rural health champion and has supported good work at improving and supporting many vital programs.
He mentioned a “big idea” program today that I have heard before but not to the depth that he provided. This program, dubbed Medicare X, would be a public insurance offering from Medicare but offered on the healthcare exchange for non-Medicare beneficiaries. So essentially, anyone would be eligible to “buy in” to this policy if they desired to do so.
In brief summary, Medicare X would provide all Medicare benefits plus meet all of the minimum essential benefits provided on the exchange via the requirements of the Affordable Care Act.
I have stated before the concern that we have with the minimum essential benefits of the ACA and the “metal plans” offered through the exchange – which has led to a crisis of “under insurance” in Mississippi. What I see with Medicare X is a related issue. Although the coverage of such a policy would be fantastic, I would be very concerned about the affordability of such a policy.
Currently, Mississippi Medicare beneficiaries cost Medicare $11,021 per year in cost, according to the Kaiser Foundation. This is about the national average. If we round up a bit for the assumed increase with adding the minimum essential benefits, and if nothing changes for the average cost per beneficiary, then we could naturally assume that the monthly premium for such a policy to be approximately $1,000 per month per beneficiary.
I’m not sure about you, but I don’t know many people that would pay $1,000 per month per person for Medicare X.
To Sen. Kaine’s benefit, it’s an effort to shore-up states like Mississippi where there is only one option on the health insurance exchange. I admire the effort and understand that there could be a number of factors that, if implemented, could reduce the cost per person. My recommendation would be to take the minimum essential benefits off of the table, and stagger the cost ratio based on a variety of health-related factors (age, sex, fitness level, etc). This would help to provide better coverage at a more affordable price and encourage people to live healthier.
There are a number of “big ideas” on the table, alongside ideas including complete Medicare expansion, block granting Medicaid to states, and recreating new insurance plans with greater flexibility. I think we need to understand the reality of what people need vs. what Washington wants before we make a decision on what direction to go.
About the All of Us Research Program
The All of Us Research Program began national enrollment on May 6, 2018, inviting people ages 18 and older, regardless of health status, to join this momentous effort to advance individualized prevention, treatment and care for people of all backgrounds. Part of the National Institutes of Health, All of Us is expected to be the largest and most diverse longitudinal health research program ever developed.
Participants are asked to share different types of health and lifestyle information, including through online surveys and electronic health records, which will continue to be collected over the course of the program. Those who join will have access to study information and data about themselves, with choices about how much or little they want to receive.
Data that are collected will be broadly accessible to researchers of all kinds, including citizen scientists, to support thousands of studies across a wide range of different health topics. By doing so, they are hoping to discover how to more precisely prevent and treat other health conditions. Knowledge gained from this research could help researchers improve health for generations to come.
Why All of Us is Important for Patients
Health care is often “one size fits all” and is not able to fully consider differences in individuals’ lifestyles, environments, or biological makeup. This is because we have limited data from past research studies about how those elements interact. The average patient is often prescribed drugs and treatments as if they are all the same. Learning more about the differences between individuals can help researchers develop tailored treatments and care for all people.
How All of Us Benefits Health Care Providers
Today there are too few conditions with evidence and options for individualized care. Too often, patients from underserved communities have not been included in clinical research, and our ability to care for diverse populations is diminished as a result. More data, discoveries, and tools can help providers to give their patients customized care more easily, especially for those communities that are disproportionately impacted by health issues.
Why Diversity Matters
Historically, many segments of the U.S. population have been left behind in medical research, including people of color, sexual/gender minorities, those with lower socioeconomic and educational status, rural communities, and other groups. The result is significant health disparities. The All of Us Research Program seeks to help fill in the gaps of information about those communities that previously have not been well represented.
How to Join the All of Us Research Program
The program is seeking one million or more people from all walks of life to participate in this historic endeavor. Those interested in joining the program can do so by visiting, www.JoinAllofUs.org. Enrollment is open to all eligible adults who live in the United States.
Effective Jan. 1, 2019, the Mississippi Division of Medicaid (DOM) is increasing the number of physician visits it covers for Medicaid beneficiaries, the first of a series of changes the agency plans to roll out in the coming year.
The move is part of the new Medicaid EASE Initiative — Enhancing Access to Services and Engagement — a bundle of programmatic changes aimed at bolstering Medicaid beneficiaries’ access to needed services in the most appropriate setting.
With the first phase of the EASE Initiative, DOM will increase the physician visit limit for beneficiaries from 12 to 16 visits per year. This increase supplements limit flexibility already in place for different populations of Medicaid beneficiaries. Beneficiaries in nursing homes, for instance, can receive up to 36 physician visits annually. Individuals who participate in the MississippiCAN program will continue to be eligible for enhanced services offered by the managed care company with which they are enrolled, which include unlimited physician visits. DOM will also continue to offer unlimited medically necessary physician visits for children up to age 21.
DOM plans to announce additional EASE Initiative reforms in the coming months. These projects are still in development and include increases to the monthly prescription drug limit and home health visit limit, behavioral health and substance use disorder reforms, and an effort to reduce potentially preventable hospital readmissions. DOM will share more information about these projects as they are developed.
HRSA’s National Center for Health Workforce Analysis recently conducted analyses on the adult and pediatric mental health and substance abuse disorder workforce.
They have generated national-level projection estimates for the health workforce for the following behavioral health occupations between 2016 and 2030. Click on the following links to view these estimates.
- Addiction counselors
- Marriage and family therapists
- Mental health and school counselors
- Psychiatric technicians and psychiatric aides
- Psychiatric nurse practitioners and psychiatric physician assistants
- Social workers
- State-Level Estimates of Behavioral Health Workforce
- Estimates of New Behavioral Health Grads, 2016 – 2021
The Mississippi Division of Medicaid recently updated their guidelines after a series of conversations and internal discussions for Nurse Practitioners ordering Durable Medical Equipment (DME). This guideline change is in response to recent CMS reviews of Mississippi’s policies, which were outdated as of the passage of the Affordable Care Act. CMS required that Mississippi comply with ACA guidelines, which prevented NPs from ordering DME without physician approval.
Click here to view Medicaid’s updated guidelines, complete with scenarios to better understand how to comply.
By Ryan Kelly –
I had an opportunity recently to visit the new UMMC Community Care Clinic in Belzoni, MS. Dr. Tonya Moore, a huge driver in the creation of this clinic, provided a guided tour for me through the facility.
The facility was previously used to house the MSU Extension Center in Humphreys County (which has now been moved next door), and the building was completely renovated using largely USDA grant funds to provide what certainly appears to be a completely new look and feel. The clinic has beautiful furniture, bright, clean colors, and excellent equipment highlighted by a top-of-the-line x-ray machine.
Naturally, this clinic is connected back to the main campus using state-of-the-art telehealth connectivity. Tele-urgent services allow the clinic staff to triage patients and connect for additional consultation with Category B and C calls – those being calls that are more urgent in nature. Such could include a gun shot wound or chest pain of unknown origin. The tele-urgent call will allow a physician from the main campus to diagnose and help treat the patient until an ambulance arrives.
This clinic opened on July 16, 2018 and maintains a daily census of 10-20 patients. The clinic is led by Jorri Davis, FNP-C and a small team of experienced providers/staff. Notable about the clinic’s staff is that they are all from the Mississippi Delta. This certainly shows a direct connection to the efforts to better train and employ local providers in our rural communities, and it ties-in well to the Governor’s recent Healthcare Economic Development Summit which showed the financial impact of a quality healthcare facility to a community.
One surprising feature of the clinic is not just the urgent care side, but that it also houses a large educational classroom and fitness center. The classroom will be available for both UMMC-led training as well as health-related classes for local citizens. The fitness center will be staffed by a personal trainer and will be soon open to the community for a small monthly fee.
I firmly believe that rural Mississippi is gaining strength from efforts like this. With the establishment of new clinics like this and the constant improvements in both quality care and infrastructure of our existing clinics and hospitals, Mississippi’s rural health status is improving!