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INTER ISLAND MEDICAL CENTER |
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IIMC headed for Rural Health Clinic designation | ||
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posted 11/19/04
This designation will help Inter Island Medical Center and the San Juan Community in several ways. Medicare and Medicaid will acknowledge the additional cost of providing access to medical services in a remote setting by an improvement in reimbursement (see example below) and when the hospital district chooses to pursue grants and funding for development of services the designation provides an entrée into a preferred access level that would not be available to non-designated entities. For the community this designation provides an additional level of quality oversight similar to the Level 5 Trauma Site designation already in place. Involved in the survey was the incorporation of a 300+ page policies and procedure manual, the ability to demonstrate that those policies and procedures were being followed, and an inspection of the building and equipment for any missing components of the mandated guidelines. It took the entire IIMC staff to make the survey a success, however Cynthia Marsh, RN and Amy Taylor, Medical Records devoted significant time to editing the policies and procedures manual. Also, to maintain RHC status the clinic will have to pass an annual unannounced site survey each year. Unique to this survey (as compared to the state financial audit) is the focus for review is on patient and staff safety and liability risk management policies and procedures. Future scrutiny will include how the medical record is managed and what information is evaluated for quality assurance purposes, how the facility is maintained, how drugs and diagnostic services are developed and accounted for in patient care. In addition, the RHC regulations require a care quality assessment program and annual review of all clinic policies and procedures by a committee that is comprised of clinical, business, and non-medical center employees. This program is already in place for trauma review and will be enhanced to include all levels of patient care. There must also be annual review of medical services provided that correlates to patient diagnosis by volume. An example of the fiscal note implications: Currently IIMC bills an average of $110/pt visit, however because of contractual limitations or the inability to pay the reimbursement for those services is about $62/pt. visit for all payment types. One of the reasons for the discrepancy is that Medicare currently pays an average of $38-40/pt. visit and Medicaid is approx. $25/pt. visit. On the other side, IIMC's cost for providing care (both primary and emergency) is approx. $125/pt. visit (hence the justification for tax based support since there is not enough patient volume to cover the gap). Under RHC our actual costs will be considered in the reimbursement mechanism and Medicare will pay approximately $66-68. With this additional income, while the need to continue to manage cost is critical, the margin for improving fiscal reserves without necessarily having to raise taxes AND the ability to consider improving and providing services to the community becomes a reality. |
What is a Rural Health Clinic?(From the Dept of The Rural Health Clinics program was established by the 1977 Rural Health Clinic Act (Public Law 95-210) to stabilize access to outpatient primary care in underserved rural areas and encourage the use of physicians, physician assistants, nurse practitioners, and certified nurse midwives (CNMs). Under the program the U.S. Center for Medicare and Medicaid Services (CMS) designates private and non-profit clinics meeting certain conditions of participation as Rural Health Clinics. RHCs are eligible for enhanced Medicare and Medicaid reimbursement. In Washington State, the Office of Community and Rural Health provides technical assistance and assesses initial eligibility. CMS contracts with Washington Department of Health's Facility and Services Division (FSL) Office of Health Care Survey to survey clinics to determine whether they meet federal requirements. Medicare reimbursement policies are established through federal legislation and administered by CMS. The Medical Assistance Administration, Washington State Department of Social and Health Services administer enhanced Medicaid reimbursements. Rural Health Clinic (RHC) services are provided by physicians, nurse practitioners, and physician assistants and include primary care as well as other medically needed services. The clinic offers services on site and refers patients to hospitals for referral and admission. Rural Health Clinics are not licensed by the State, but are Medicare certified. Medicare may pay for services provided by Rural Health Clinics who voluntarily seek and are approved for certification by the CMS. CMS contracts with the Department of Health to evaluate compliance with the federal regulations by periodically conducting unannounced surveys of these clinics. |
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