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How to Support Patient Access to Care in Frontier Communities

AHA has released a guidebook proposing a medical home model that will supplement patient access to care in frontier communities.

patient access to care frontier communities

Source: Thinkstock

By Sara Heath

- Healthcare policymakers should consider a new payment strategy to help support patient access to care in frontier communities, said AHA in a new guidebook on the topic.

Published by the AHA Task Force on Ensuring Access in Vulnerable Communities, the guidebook details the challenges patients living in frontier communities face when accessing care.

Although there is no formal definition for a frontier community, AHA said industry experts generally agree that frontier regions are those with six or fewer individuals per square mile. A 2011 analysis from the State Office of Rural Health (SORH) found that 46 percent of the country’s land is considered frontier land, and 5.6 million people lived in frontier lands in 2010.

Patients living in frontier communities face many barriers to healthcare, AHA explained. Geographic isolation, weather events, road conditions, distance, and low population and provider density all keep patients from having easy access to healthcare services.

The AHA Task Force proposed a new payment and medical home model that could support providers in frontier communities, making it more feasible for patients to access care. The Frontier Health System (FHS) could serve a similar role to a traditional patient-centered medical home (PCMH).

“The FHS model would include frontier health care providers that join together to provide preventive and primary care, inpatient and outpatient care, extended care, and emergency services across local, secondary and tertiary settings,” AHA stated in the guidebook.

In addition to those traditional PCMH duties, the FHS would also provide transportation services that can assist patients with limited means or extraordinary travel barriers to easily access their providers. Additionally, the FHS would provide care services such as swing bed, rural health clinic, ambulance, home-based care, and expanded visiting nurse services.

The FHS does not currently exist as a care model in frontier lands, AHA explained. However, the trade group did use the guidebook to urge Congress to launch an FHS Demonstration Program, which would test the waters for the care model.

The Demonstration Program should align payment structures for FHS participants. Currently, different rural health providers get paid using different payment models. Visiting nursing services receive fee-for-service payments, for example, while critical access hospitals (CAHs) are paid a “reasonable cost” for certain service packages.

This discordance between care providers makes for a poorly coordinated payment system in frontier areas. AHA recommended CMS adopt an aligned payment system for all members for an FHS, making it easier for different types of care providers to participate in a medical home model.

That payment methodology should be a hybrid of three different payment systems: advanced payments, cost-based reimbursement, and pay-for-performance reimbursement or shared savings.

These payment models will allow frontier land providers to maintain their ongoing services, such as chronic disease management and health IT investments. The payment models would also create financial stability even during low patient volume times. Organizations would be incentivized to provide high-quality and coordinated care.

The FHS would require numerous CMS waivers to be successful, AHA explained. Organizations will likely need waivers to increase the 25-bed maximum to 35 beds in CAHs, and waiving the 35-mile ambulance rule will allow FHS participants to serve their entire patient populations. Additionally, organizations will need telehealth restriction waivers.

FHS participants would also need waivers from the physician self-referral and antikickback statutes. These fraud and abuse safeguards would otherwise prevent FHS participants from making the relationships necessary to create a healthy medical home model, AHA explained.

As previously noted, the FHS is not currently a healthcare model. AHA simply has offered its seal of approval for a demonstration project testing the feasibility of the FHS.

Until federal policymakers create new practice and payment models that benefit frontier region providers, rural organizations should build better relationships with one another. Community conversations will be key in determining the specific needs of a frontier patient population.

Stronger care coordination and community health projects will also benefit frontier land organizations wanting to facilitate stronger patient access to care.

This guidebook was released as a part of the AHA Task Force’s efforts to support better healthcare access in vulnerable and rural communities. AHA also recently released a guidebook about leveraging urgent care centers to supplement rural healthcare access.

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