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Proposed legislation in Oklahoma would establish a pilot program to attract physicians to rural parts of the state, according to The Journal Record. If signed into law, the bill would provide an income tax credit of up to $25,000 annually for up to five years for doctors who set up practices in communities of less than 25,000 people. To qualify for the income tax credit, doctors would have to have completed their medical training or medical residency in Oklahoma and would have to live in the same rural counties where they practice.
The Oklahoma State Department of Health was awarded a five-year grant from the U.S. Health Resources and Services Administration totaling more than $890,000 to improve access to healthcare services for people who are uninsured, isolated or medically vulnerable, reports The Oklahoman. The health department will work with the federal agency to produce a statewide primary care needs assessment, identify unmet healthcare needs and barriers to care (like workforce shortages) and advance strategies which improve access to comprehensive primary healthcare services in Oklahoma.
In 2010 Maryland, for some rural hospitals, replaced fee-for-service payment with a global budget approach called Total Patient Revenue (TPR) to incentivize hospitals to manage resources more efficiently. A study in Health Affairs found evidence consistent with both the incentive to provide care more efficiently and the incentive to provide less care during the 2010-2013 study period. For TPR hospitals, service use fell sharply – ED admissions declined 12 percent, direct (non-ED) admissions fell 23 percent, ambulatory surgery center visits fell 45 percent and outpatient clinic visits/services fell 40 percent. The authors conclude that most of the drop in inpatient admissions at TPR hospitals was offset by higher admissions at Maryland hospitals outside the global budget or moved to neighboring states. Since hospital revenues are maintained under TPR, if care that is no longer provided within budget moves off budget, total healthcare costs could rise. The authors found evidence of higher overall healthcare spending for the FFS Medicare population. Unfortunately, no published studies have examined the effect of TPR on population health or on overall healthcare costs. In 2014, Maryland replaced the limited TPR program with Global Budget Revenue (GBR) for all Maryland Hospitals. The authors conclude that capitation models require strong oversight to ensure that hospitals do not respond by shifting costs to other providers.
Georgia law makers passed House Bill 186, which revamped the state's Certificate of Need laws. According to Atlanta News Now, the bill was enacted to ease the restrictions on hospital businesses, and will allow hospitals to provide services to all patients that walk through their doors, without concern of cherry-picking by smaller healthcare start-ups. This bill will regulate smaller outpatient ambulatory and cancer centers at a county level.
Cherokee tribal land in Oklahoma will soon be home to the largest Native American health facility in the U.S, according to FOX 25 News. The facility will include the country’s first tribally affiliated medical school with the goal of training more future doctors in Oklahoma and getting them to stay. Cherokee officials hope the medical school will help bridge the gap when it comes to doctor shortages, which are a serious issue in rural communities.
Total spending on Vermonters’ healthcare surpassed the $6 billion mark in 2017, but the rate at which that number is growing slowed, reports the VTDigger. Expenditures for Vermont residents grew 1.7% from 2016-2017, a significant improvement from recent years, as spending grew an average of 3.2% annually from 2012-2017. Vermont’s 2017 spending growth was also far below the national growth of 3.8%. Nevertheless, out-of-pocket costs for Vermonters’ healthcare ($776 million in 2017) continues to rise, increasing 1.8% from 2016. Out-of-pocket expenses also were a concern raised in a recent state health insurance survey, which found a low number of uninsured but a rising number of “underinsured” residents. About 36% of Vermonters under age 65 don’t have insurance policies that can adequately cover their needs based on their income.
The Washington Health Alliance has released several new reports on negotiated reimbursements from commercial payers, reports State of Reform. One report shows that reimbursement for a vaginal delivery at one medical center varies from $7,196 to $19,402, depending on the commercial payer. Another report reveals that overall inpatient utilization from 2015-2016 was down enough ($51.2 million) to offset price growth ($21.7 million). A third report analyzing “how well health plans are meeting the needs of their members and working to improve quality and reduce the cost of healthcare" identified Kaiser's HMO product as the overall top rated insurance plan, with Regence the top rated PPO plan.
A new bill proposed in the Texas Senate would direct the state health commissioner to develop a method to ensure that rural hospitals get full Medicaid reimbursement, according to an editorial in the Orange Leader. Since 2013, 21 rural hospitals have closed in Texas. Legislators believe that a major reason for these closures is an underpayment for Medicaid reimbursements. Over three million people live in the state’s 170 rural community—a population that tends to be older, poorer and less healthy than urban communities. About 50 percent of infants in the state are delivered to patients covered by Medicaid and in rural regions that rate is about 70 percent—demonstrating a need for rural hospitals. Though a budget provision requiring reimbursement for the full allowable cost of a service for Medicaid patients exists, managed care organizations omitted the budget provision after they began administering the Medicaid program in 2012. Legislators emphasized the need for coordination between agencies to agree on what rural hospitals are owed to avoid future hospital closures.
Legislators in Oregon have called for the development of plan to achieve a “predictable and sustainable” annual growth rate for statewide healthcare spending, according to Milbank Memorial Fund. The plan would be developed by a public-private advisory group and implemented, at least initially, by the Oregon Health Authority within existing laws. Enforceable limits on cost growth will take effect in 2022. Other states, like Massachusetts, Rhode Island, and Delaware, have already implemented healthcare cost growth benchmarking.
There is momentum and support to continue to build telehealth commercial coverage. Massachusetts legislators filed five new telehealth bills for consideration, according to the National Law Review. Four of these proposed bills directly compete with each other, so it will be important to monitor their progress through committee and reconciliation. All of the bills state that insurers (including Medicaid MCOs, Massachusetts Group Insurance Commission, Individual plans, Hospital service plans, HMOs and PPOs) must not decline to provide coverage for health care services solely on the basis that the services were delivered through telemedicine. While it is not yet clear which bill will prevail, it is clear that Massachusetts is continuing to explore ways for policy to drive innovation in health technology, while balancing patient safety and the insurance industry.