More Opportunities for Rural Health Education

By Ryan Kelly –

This is one of the very few “quiet” times of the year for us in the MRHA, so I would like to take a pause and encourage you to look at our upcoming events through the summer and fall.

We have some excellent webinars and workshops coming up soon, featuring a workshop in Vicksburg on May 19th with RHC expert Patty Harper with InQuiseek. Patty will discuss an elaborated MIPS/MACRA update and Revenue Cycle Management.  You’ll be sure to want to make that one!

Several new webinars will be announced next week that are very low cost or free to members.  And, remember that all of these events will earn you credit for your Mississippi Rural Health Fellow!

Lastly, make sure to go ahead and mark the date / register for our 22nd Annual Conference on November 16-17 in Jackson.  We are beginning to work on the agenda now, and I assure you that it will be strong in speakers and pointed in focus.  And of course, it’ll be fun!

You can learn more about all of these events and register online at

Will 2018 Bring New Hospital Funding?

By Ryan Kelly –

According to recent reports, CMS is proposing a $3 billion increase in payments to inpatient hospitals beginning in 2018.

Long promoted by groups like the MRHA and NRHA, increase funding for hospitals is critical in order to properly support the struggling safety net in our rural areas.

Along with increased payments, CMS is also looking to alter the funding formulas.  The Medicare Payment Advisory Commission suggested the idea of changing these formulas, saying the change would distribute the funds in a more equitable fashion.

According to ModernHealthcare, ‘the agency will distribute roughly $7 billion in uncompensated care funds in fiscal year 2018. That’s a bump of approximately $1 billion from the prior year. This change reflects the CMS’ proposal to use new data to estimate the rate of uninsurance which calculates the total amount of uncompensated care payments available.’

Safety net hospitals would also see a change in the way they receive DSH payments (disproportionate-share payments). The new formula will lean mostly on the amounts of uncompensated care and charitable care each hospital claims on its Medicare cost report. The current formula uses a formula based on the number of Medicaid, dual-eligible and disabled patients each hospital served.

I have not yet calculated what impact this would make in Mississippi for our facilities, but it is believed that the change would disproportionately benefit non-Medicaid expansive states like ours.  If we receive new data on this proposed change, we will be sure to send it out soon.  For now, though, this appears to be good news for our rural hospitals.

MIPS Letters from CMS

By Ryan Kelly –

Mary Smith, nurse practitioner and administrator for the Starkville Orthopedic Clinic in Starkville, spoke at the Association’s Rural Health Clinic Conference in Jackson on April 7, 2017.  Mary delivered a presentation regarding the CMS process for submitting quality information for the Quality Payment Program (QPP) using MIPS.

Mary stated that CMS will be sending letters during the month of April to all individual providers who meet the MIPS threshold for reporting.  So, if you are a provider, be on the lookout for this letter.  If you are an administrator, make sure and notify your providers that this letter is coming.  For those designated “rural health,” your providers that submit Medicare Part B may still be eligible for MIPS even if your clinic is exempt for being in the legacy fee-for-service model.

Please contact us with any questions at 601.898.3001.

Rumors of a Bi-Partisan Healthcare Bill

By Ryan Kelly –

It hasn’t taken long for the rumors of a bi-partisan healthcare bill to take off.  If you have viewed my previous posts, this was my hope and somewhat my expectation.

A recent news article from Kaiser Health News detailed an honest interview from Rep. Don Young from Alaska admitting that the partisan failure was the parties’ fault:

“The reason why Obamacare failed was because it wasn’t a bipartisan bill,” said Don Young, Republican of Alaska. His party made the same mistake, he said, writing their bill without Democrats. “We were very frankly guilty of that.”

But, several legislators and White House officials are already hinting at the understanding of the need for a bi-partisan bill that thinks through the complexity of our healthcare system and addresses all needs in a manner that improves the current system and doesn’t cause many if any unforeseen problems.  While there was no direction of the path forward, the conversation has already begun…which is a good thing.

I was able to visit with elected officials in DC this week and had some good conversations with them regarding the AHCA.  When discussing the bill and its failure I repeated the same thing that we told them last month…take your time and get it right.

I am hopeful that Round 2 (whenever that occurs) will be slower, more methodical, and substantially better by having the Senate and House bring together both Republicans, Democrats, and constituent groups to provide a collective approach at solving our issues.

Where the ACA somewhat failed because of its highly partisan nature, a new healthcare bill could succeed by actually listening to others.

Of course, time will tell…

Voting on the AHCA

by Ryan Kelly –

Voting was set to take place today by the US House of Representatives on the new healthcare legislation.  But, due to the moderate and libertarian pulls of the GOP not coming to a consensus in time, the vote has been postponed to a later date.

Why is the vote delayed?

As I have been saying, we need to pump the breaks a bit on the specifics of the bill.  There are still details concerning to those that want to reduce the size and scope of government’s involvement in healthcare, as well as those…mainly from Medicaid-expansion states…that want to ensure the guarantees promised to their states for healthcare reform.  Of course, caught in the middle are the healthcare professionals searching for solutions to their many issues.

I expect many of these concerns will be satisfied in the coming days, and the vote in the House may take place next week (good for me, because I’ll be in DC and may be able to see the deliberation and vote in-person).

Even if House approves, not so fast

It is largely assumed that the House will eventually pass the bill and move it to the Senate. This is where the real fun starts, though.  The Senate can only pass this through budget reconciliation by 2 votes.  With the extremes of the party present in the Senate, there will be fierce negotiation and deal-making.

It’s in the Senate where the MRHA will align with other parties to ensure that rural is supported in the final markups.  All we need is to ensure that rural is considered with payment models, particularly the enhanced Medicaid requirement for the legacy fee-for-service clinics such as RHCs.


Since the time of the publish of this post, the House of Representatives withdrew the AHCA from the docket due to a lack of votes needed to pass.

My analysis of the above remains true.  I believe it’s a good thing that our legislators are going to take more time to build a more complete bill that addresses the many complexities and needs of our healthcare industry.  Although the first bill had many good components, it only addressed a fraction of the needs of healthcare professionals.  I anticipate that in the coming weeks or months, conversations with stakeholders like the MRHA / NRHA / NARHC will allow for a better bill which will pass the House easily.  And, possibly will already meet the needs of the Senate and will pass there too.

Time will tell.  For now, we’ll keep up the hard work to support rural health in all language both direct and indirect in the coming legislation.

New Amendments to Health Care Law

By Ryan Kelly –

GOP members released new amendments to the health care law designed to replace the Affordable Care Act.  Clearly expected and not-so-long awaited, these amendments are aimed to help win votes to allow the legislation to pass.  So, what’s in these amendments and what would it do to Mississippi?

If you read mass media, you will get a hint of fact mixed in a flurry of speculation.  One of my pet peeves here lately is a lack of informed content without opinion, so take anything you read from liberal or conservative sources with a big grain of salt.

New amendments include the following:

  • A possible requirement for those on Medicaid to work, participate in job training, or perform community service.
  • A revised option for states to receive Medicaid funds as a “block grant” versus a per capita system, which would allow states to receive a set block of funds per year versus a set amount per enrollee per year.
  • Prevention of any additional states to expand Medicaid coverage as prescribed in the ACA
  • Increased tax credits older enrollees

From here, the bill with amendments goes to the Rules Committee, where additional amendments and discussion is almost assured.  But, some experts think that the bill could receive all markups as early as Thursday of this week…meaning that the process will go much faster than many of us thought.

What does this mean for Mississippi?

It’s still unclear.  As I mentioned in my last analysis of this, it all depends on the specifics of Medicaid.  One very important change that the National Rural Health Association is pushing, and we as the MRHA are supporting, is an exception for rural facilities to continue to receive the enhanced Medicaid and Medicare funding as a federal requirement for Medicaid funding to states.  This amendment would be critical for Mississippi’s many rural facilities.

What is the MRHA doing?

First, we are petitioning lawmakers to consider the NRHA amendment.  Continuing enhanced payments for rural is a blip on the fiscal radar, but it is significant for our providers.

Second, we are preparing a marketing campaign directed specifically at Mississippi lawmakers and policymakers to show the benefit of enhanced rural payments.  When a lawmaker understands how a little extra up-front saves significant dollars in the entire system, it becomes an easy sell on why enhanced rural payments are important.  Without them, our ERs in metro areas become much busier, and the cost to the state increases significantly.  No one wants this…so it’s a message that we will continue to tell.

What can you do?

Right now their may not be enough specific information to make specific asks, but contacting your lawmaker and asking them to consider rural health with this legislation is a huge positive.  This includes both federal and state legislators.

We will continue to keep everyone informed and updated as things progress.  There is certainly more to come…




A Trip to Rural Mississippi

By Ryan Kelly

I took a trip across rural Mississippi this weekend with my family – one of my favorite things to do!

We were driving through some country roads when I came across this metal barn in south central Lamar County.  I grew curious when I saw this barn, “how far would it be to the nearest hospital?”  With my one bar of cell service I searched the distance to the nearest facility.  It was exactly 16 miles to either Merit Health Wesley or Marion General Hospital. Then I searched for the distance to the closest clinic…8.2 miles at Hattiesburg Clinic Bellevue location.

Driving back to Hattiesburg I timed the drive to that clinic.  It took 16 minutes.  So, if someone cut themselves on rusty barbed wire and needed a tetanus shot, or if they were bitten by a rattle snake, it would take them almost 30 minutes to reach a hospital or 16 minutes to reach a clinic.  Such could be a dangerous proposition.

This is a very common example of the distance between medical providers in rural Mississippi.  In many areas, the distance is much, much further.

This is why rural health is so important.  Most Mississippians live in rural areas, and the distance to their nearest medical provider can be great.  This is usually fine for normal procedures or visits, but for emergencies, it can be the difference in life and death.

So keep supporting rural health.  For our providers, know that you are serving a population that needs you.  For patients, trust in your providers that are here for you and use your local services.  For insurers and lawmakers, know that your investment in rural health pays huge dividends in the lives of Mississippians.  Together we will keep Mississippi’s health strong.