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Bureau of Primary Health Care Update

Bureau of Primary Health Care Update. June 21, 2012. Sarah Samuel Branch Chief, East Atlantic Branch Central Southeast Division U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Primary Health Care. Primary Health Care Mission.

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Bureau of Primary Health Care Update

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  1. Bureau of Primary Health Care Update June 21, 2012 Sarah Samuel Branch Chief, East Atlantic Branch Central Southeast Division U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Primary Health Care

  2. Primary Health Care Mission Improve the health of the Nation’s underserved communities and vulnerable populations by assuring access to comprehensive, culturally competent, quality primary health care services

  3. Health Center Program Overview Calendar Year 2010 • 19.5 Million Patients • 93% Below 200% Poverty • 38% Uninsured • 62% Racial/Ethnic Minorities • 1,052,000 Homeless Individuals • 863,000 Farmworkers • 173,000 Residents of Public Housing 77 Million Patient Visits • 1,124 Grantees • 8,100+ Service Sites • Over 131,000 Staff • 9,592 Physicians • 6,362 NPs, PA, & CNMs 3 Source: Uniform Data System, 2010, Service Sites: HRSA Electronic Handbooks Scope Repository 12/31/2010

  4. Health Center Program National Presence – October 2011 4

  5. Health Center Program Overview National Impact Source: Health Center Data:Uniform Data System, 2010. National Data: U.S. Census Bureau, 2010 Current Population Reports and Current Population Survey. 5

  6. Health Center Performance Calendar Year 2010 Among Health Center Patients: 69% entered prenatal care in the first trimester Rate of low birthweight babies (7.4%) continues to be lower than national estimates (8.15%) 74% of children received all recommended immunizations by 2nd birthday 63.2% Hypertensive Patients with Blood Pressure<= 140/90 71% Diabetic Patients with HbA1c <= 9 $630 Total Cost per Patient $139 per Medical Visit For more information: http://www.bphc.hrsa.gov/policiesregulations/performancemeasures/index.html Source: Uniform Data System, 2010. National Birthweight Data: 2010. Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2010. National vital statistics reports web release; vol 60 no 2. Hyattsville, MD: National Center for Health Statistics. 2011. 6

  7. Over 80% reported the overall quality of services received at the health center were “excellent” or “very good.” Over 80% reported that they were “very likely” to refer friends and relatives to the health center. Over 75% reported the main reason for “going to the health center for healthcare instead of someplace else” was because it was convenient (28%), affordable (25%), and provided quality healthcare (22%). Health Center Performance 2009 Health Center Patient Survey

  8. 27 State Health CentersCalendar Year 2010 North Carolina State Health Center Grantees In 2010, 27 Health Centers Served 409,709 patients: • 52.0% were uninsured • 95.2% were at or below 200% of poverty • 56.9% Female • 58.8% nationally • 22.6% Children < age 18 • 32.1% nationally • 8.7% Seniors age 65+ • 6.8% nationally • Served by (FTEs): • 166.74 Physicians • 130.50 Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives Source: Uniform Data System, 2010

  9. North Carolina State Health CentersCalendar Year 2010 - Fiscal Year 2011 PERFORMANCE FUNDING $84.2 M base operational grants (FY ‘11) $21.3 M New ACA grants $1.3 M – New Access Points $160 K – Planning Grants $99 K – Beacon Community $630 K – Quality Improvement & Patient-Centered Medical Home Program $19.1M – Capital Development Grants Among North Carolina State Health Center Patients: • 66.1% entered prenatal care in the 1st trimester • Rate of low birth rate 9.0% • 69.3% of children have received all recommended immunizations by second birthday • 75.4% Diabetic Patients with HbA1c <= 9 • 53.9% Hypertensive Patients with Blood Pressure <= 140/90 • $490 Cost per Patient; $147 per Visit Source: Uniform Data System, 2010 and HRSA Electronic Handbooks

  10. Bureau of Primary Health Care (BPHC) Organizational Structure OFFICE OF THE ASSOCIATE ADMINISTRATOR Office of Administrative Management Office of Special Population Health Office of Training &Technical Assistance Coordination Office of Policy and Program Development Office of Quality and Data Southwest Division Division of National Hansen’s Disease Program Central Southeast Division North Central Division Northeast Division 10

  11. BPHC Organizational Structure:Primary Health Care Divisions 11

  12. Five Branches: East Atlantic Branch: North Carolina and South Carolina Gulf Coast Branch: Alabama and Florida Mid-South Branch: Kentucky and Tennessee Midwest Branch: Iowa, Kansas, Missouri, and Nebraska Southeast Branch: Georgia and Mississippi Central Southeast Division Regions: 4 and 7 12

  13. Primary Health CareOur Focus 13

  14. Primary Health CareMeasures of Success 14

  15. Primary Health Care 2011 Grantee Satisfaction State/Regional PCA TTA 76 Application Process TA - Secondary (Change vs. 2010) 0.1 72 +2 0.3 Grantee – Project Officer Relationship +3 74 80 Helpfulness of BPHC UDS Technical Assistance 1.7 73 0.3 74 BPHC Training and Technical Assistance Customer Satisfaction Index 74 4.9 Policy Information Notices 1.2 75 0.8 FTCA Program Information 83 74 Likelihood to Use TA Again 0.2 UDS Program Report 70 0.4 Overall satisfaction with BPHC program managementHow well the BPHC compares to your expectations How close BPHC is to the ideal process Application Process TA - Primary 73 3.4 0.2 Overall Continued Funding Application 69 0.8 Policy Information Notices Technical Assistance 74 0.5 Farmworker Health Network TA National Association of CHC TA 86 81 -- -- NCA Training and Technical Assistance Public Housing Coop. Agreements TA 85 68 -- -- National Healthcare for Homeless Council TA Overall Training and Technical Assistance 81 75 -- -- Health Center Controlled Network 84 --

  16. Percentage of EHR Adoption by State 2010 Source: Uniform Data System, 2010 data as of 5/10/11. 16

  17. Health Center EHR Adoption National and North Carolina 2010 2012 Goal: 50% of Health Centers use EHR at All Sites Source: 2010 UDS

  18. Health Center PCMH RecognitionNational and North Carolina 2012 Goal: 13% of Health Centers Recognized as PCMH Data as of March 2012; PCMH Recognized Includes: NCQA, Joint Commission, and AAAHC

  19. Current Program Impact: Key National Indicators % of Health Center Meeting/Exceeding Healthy People 2020 Goals: 56% Meet/Exceed Hypertension Control Goal of 61% 12% Meet/Exceed Diabetes Control (HbA1c ≤9)Goal of 85% 35% Meet/Exceed Childhood Immunization Goal of 80% 35% Meet/Exceed Early Entry into Prenatal Care Goal of 78% 58% Meet/Exceed Low Birthweight Goal of 7.8% 2% Meet/Exceed Cervical Cancer Screening Goal of 93% % of Health Centers Achieving Patient Centered Medical Home Recognition 22% of all health centers are participating in Patient Centered Medical Health Home Initiatives (PCMHHI) and 8% have achieved Patient Centered Medical Home (PCMH) recognition. % of Health Centers with EHR Implementation 51% have EHRs at all sites used by all providers 14% have EHRs at some sites used by some providers 19

  20. Current Program Impact: Key State Indicators % of Health Centers Meeting/Exceeding Healthy People 2020 Goals: 31% Meet/Exceed Hypertension Control Goal of 61% 15% Meet/Exceed Diabetes Control (HbA1c ≤9)Goal of 85% 42% Meet/Exceed Childhood Immunization Goal of 80% 17% Meet/Exceed Early Entry into Prenatal Care Goal of 78% 40% Meet/Exceed Low Birthweight Goal of 7.8% 0% Meet/Exceed Cervical Cancer Screening Goal of 93% % of Health Centers Achieving Patient Centered Medical Home Recognition 26% of 28 State health centers are participating in Patient Centered Medical Health Home Initiatives (PCMHHI) and 7.4% have achieved Patient Centered Medical Home (PCMH) recognition. % of Health Centers with EHR Implementation 7% have EHRs at all sites used by all providers 70% have EHRs at some sites used by some providers 20

  21. 2010 National and North Carolina Health Center Performance and Healthy People 2020 Goals 2012 Goal: 10+% of Health Centers Meet or Exceed HP 2020 Goals 21 Source: 2010 UDS and Healthy People 2020

  22. National and North Carolina Health Center Financial Performance Source: 2010 UDS and Health Center Audit Reports Data as of: March 12th 2012 22

  23. Primary Health Care 2012 Strategic Priorities Grantee Satisfaction BPHC External Technical Assistance & Training Strategy Employee Satisfaction BPHC Internal Staff Training & Development Timeliness/Quality Service Area Definition & Program Collaboration Impact Quality Strategy (includes Meaningful Use & Patient-Centered Medical Home) Recovery Act Close-Out 23

  24. Policy Updates

  25. Recently Released Policies • Approved Uniform Data System Changes for 2012 • CY 2013 Requirements for Federal Tort Claims Act (FTCA) Medical Malpractice Coverage for Health Centers • Proposed Uniform Data System Changes for 2012 • Sites, Scope of Project, and Capital Projects • Process for Becoming Eligible for Medicare Reimbursement under the FQHC Benefit • Health Center Collaboration • FTCA Health Center Policy Manual • HRSA Patient-Centered Medical/Health Home Initiative • HIV/AIDS Care and Treatment in Health Centers To Access these and other policies, visit: http://www.bphc.hrsa.gov/policiesregulations/policies/index.html

  26. Initiating and Maintaining Medicare FQHC Reimbursement CMS requires ALL permanent and seasonal sites within a health center’s approved scope of project to be enrolled INDIVIDUALLY in Medicare. • Each site must also indicate its unique Medicare Billing Number (also known as a PTAN or CCN) on claims for all services rendered at that site. • Please ensure that your health center has all of its correct Medicare Billings Numbers listed in EHB as soon as possible, for each of their permanent and seasonal sites. For more information about the requirements and process for enrolling sites in Medicare, review PAL 2011-04 http://www.bphc.hrsa.gov/policiesregulations/policies/pal201104.html.

  27. 2012 Anticipated Policy Topics • DRAFT Sliding Fee Discount Program • DRAFT Sub-Recipients/Sub-Contracts • DRAFT Quality Improvement/Assurance Final and draft policies open for comments will be posted at: http://www.bphc.hrsa.gov/policiesregulations/policies/index.html

  28. Funding Updates

  29. Fiscal Year 2012Spending Plan • $150 Million for Health Center New Access Points (~220 to 230 awards) • $15 Million for Expanded Services, including Expanded HIV Services and Support for Health Center Recruitment and Retention Strategies, including the Health Center Veterans Hiring Challenge • $20 million for Health Center Controlled Networks (~25 to 30 Awards)

  30. Fiscal Year 2012 Spending Plan • $600 Million for Capital Development: Building Capacity (~125 to 150 awards) • $100 Million for Capital Development: Immediate Facility Improvements (~ 250 to 300 awards) • $75 Million for School-Based Health Center Capital program (~150 awards)

  31. Fiscal Year 2012 Continuation Funding Opportunities Health Centers: • FY 2012 Budget Period Progress Report (BPR) Technical Assistance: http://www.bphc.hrsa.gov/policiesregulations/continuation/index.html • FY 2012 Service Area Competition (SAC) Technical Assistance: http://www.hrsa.gov/grants/apply/assistance/sac/ Cooperative Agreements: • National • State/Regional Primary Care Associations

  32. Fiscal Year 2012 Primary Care Association Requirements Statewide/Regional Health Center T/TA Activities B. Performance Improvement Goals: XX% of Health Centers that Meet/Exceed Healthy People 2020 Goals on One or More Clinical Performance Measures XX% of Health Centers with PCMH Recognition XX% of Health Centers with Cost Increase Less than National Average XX% of Health Centers Financially Strong (No Going Concern Issues) T/TA Focus Areas: Clinical Performance Measures Financial Performance Measures A. Program Requirements Goal: • XX% of Health Centers with No Program Conditions T/TA Focus Areas: • Need • Services – QI/QA Systems • Management and Finance – Fiscal Operations/Systems • Management and Finance – Workforce Recruitment and Retention • Governance

  33. Fiscal Year 2012 Primary Care Association Requirements Statewide/Regional Program Assistance Workplan • Information on Available Resources • Annual T/TA Needs Assessment • Special Populations • Collaboration • Emergency Preparedness • Regional/Statewide Surveillance Analysis • Newly Funded Health Centers

  34. Quality and Data Updates

  35. Patient Centered Medical/Health Home Initiative (PCMHHI) • Encourages and supports health centers to transform their practices and participate in the PCMHH recognition process to: • improve the quality of care and outcomes for health center populations; • increase access; and • provide care in a cost effective manner. • HRSA/BPHC will cover recognition process fees and provide technical assistance resources for practice transformation. • Participation is strongly encouraged and provides an opportunity for health centers to achieve PCMH recognition. For further information on the PCMHH Initiative: • PCMHH Initiative PAL: http://www.bphc.hrsa.gov/policiesregulations/policies/pal201101.html • BPHC Helpline: bphchelpline@hrsa.gov or 1-877-974-BPHC (2742) • PCMHH email: PCMHHinitiative@hrsa.gov 35

  36. FTCA Program • FTCA Consolidated Policy Manual • Primary source for information on FTCA grantees and related stakeholders • Consolidates, clarifies and synthesizes existing FTCA policy documents and statutory language • Available at: http://bphc.hrsa.gov/policiesregulations/policies/pin201101.html • Application Review/Deeming in EHB • 2013 Requirements for FTCA Deeming available in PAL 2012-02: http://www.bphc.hrsa.gov/policiesregulations/policies/pal201202.html • For Programmatic of Technical TA on FTCA contact: Email: BPHCHelpline@hrsa.gov Phone: 1-877-974-2742

  37. 2012 UDS Reporting Changes to CY 2012 UDS Report announced in the Federal Register Notice (FRN) on June 30, 2011 are now FINAL. • New staff tenure table; • Three new clinical measures; • Coronary Artery Disease (CAD): Lipid Therapy • Ischemic Vascular Disease (IVD): Aspirin Therapy • Colorectal Cancer Screening • Reporting on all (versus primary) diagnoses for selected conditions; and • Questions about electronic health record capabilities and national quality recognition Refer to the UDS website for more information: http://bphc.hrsa.gov/healthcenterdatastatistics/index.html

  38. Technical Assistance Resources

  39. Technical Assistance (TA) Resources • National and state-based support for training and technical assistance: • National Cooperative Agreements • State/Regional Primary Care Associations • State Primary Care Offices • Federal TA Support: • Project Officer • TA Calls/Trainings • Onsite Consultant Support • BPHC TA Website-New Search Engine Feature Added For more information visit the BPHC TA Website: http://www.bphc.hrsa.gov/technicalassistance/index.html

  40. Bureau of Primary Health Care Help Line Single point of contact to assist grantees and stakeholders with information in the following areas: • BHCMIS – System in EHB (Electronic Handbook) • Health Center Quarterly Reporting (HCQR)/ARRA 1512 • Reporting Uniform Data System (UDS) • Federal Torts Claims Act (FTCA) for Health Centers and Free Clinics Phone: 1-877-974-BPHC (2742) Email: bphchelpline@hrsa.gov. Available Monday to Friday (excluding Federal holidays), from 8:30 AM – 5:30 PM (ET), with extra hours available during high volume periods.

  41. UDS Web Tools UDS Website: http://www.hrsa.gov/data-statistics/health-center-data/index.html. • Data analysis tools • Data download functionality • UDS Grantee/State/National Summaries • Health Center Trend Reports • State and National Roll-up Reports • Reporting and Training Resources UDS Mapper:www.udsmapper.org • HRSA has developed a mapping and support tool driven primarily from data within the Uniform Data System (UDS) • Webinar trainings on using Mapper functionality available: http://www.udsmapper.org/webinars.cfm

  42. Risk Management and Patient Safety Web Resources ECRI risk management and patient safety resources are available to Health Center Program grantees and Free Clinics.  Resources include: • Risk management courses • Continuing medical education (CME) credits at no cost to health care providers • Links to archived audio-conferences/webinars to supplement evidence-based risk management training • Guidance articles, self-assessment tools, ready-made training materials on patient safety, quality and risk management for the health center and free clinic setting • Risk & Safety E-news Visit: www.ecri.org/clinical_RM_program. 

  43. Primary Health Care and Public Health Leadership All Health Center and Primary Care Associations are encouraged to explore and participate in the following key HHS public health initiatives: • National Quality Strategy http://www.ahrq.gov/workingforquality/nqs/ • HHS Action Plan to Reduce Racial and Ethnic Health Disparities http://minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf • National Prevention Strategy http://www.healthcare.gov/prevention/nphpphc/strategy/index.html • National HIV/AIDS Strategy http://www.whitehouse.gov/sites/default/files/uploads/NHAS.pdf

  44. Primary Health Care and Public Health Leadership • National Oral Health Initiatives http://www.hrsa.gov/publichealth/clinical/oralhealth/ • Behavioral Health Initiatives http://bphc.hrsa.gov/technicalassistance/tatopics/clinicalcareservices/index.html#Behavioral • Healthy Weight Collaborative http://www.collaborateforhealthyweight.org/ • Million Hearts Campaign http://millionhearts.hhs.gov/ • Text4baby http://www.cdc.gov/women/text4baby/index.htm • Viral Hepatitis Initiative http://www.hhs.gov/ash/initiatives/hepatitis/index.html

  45. Thank You!Questions? 45

  46. Sarah Samuel Branch Chief, Central Southeast Division U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Primary Health Care 5600 Fishers Lane Rm. 17-61 Rockville, MD 20857 Telephone: 301.594.4439 Email: SSamuel@hrsa.gov

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