Replay the Webinar on

Chronic Care Management and Medicare Requirements for Chronic Care Management


Held Live On Thursday, July 21 at 10:00-11:00 am


Presented by:

                   Care 24/7 (Knoxville, TN)

                   ARHA Sponsor, HealthMed  (Alabaster, AL)

                   The Alabama Rural Health Association



Audience:  Rural Health Clinics

                   Federally Qualified Health Centers

We hope you enjoyed the Chronic Care Management demo.

To learn more or get answers to any questions please contact,

Ryan Moore at







Alabama AAFP logo-new blue






THE ISSUE:  Alabama Medicaid Cut to Physicians Will Endanger Patient Care

Physician Groups Issue Joint Statement on 2016 Special Session Announcement

July 27, 2016 MONTGOMERY – Our organizations applaud the Governor and are encouraged that he has taken the first step toward fully funding Alabama Medicaid by (calling a special session).

As for his proposal for a lottery, we support the passage of new revenue that will provide for a long-term fix for Medicaid. As with any legislation, we will need to see the details of what he is proposing to ensure that it does in fact fully fund Medicaid’s needs for the long term before we can take a formal position.

In addition to the need for long-term funding, there is also a critical need to fix the $85 million shortfall in the 2017 budget, which the lottery will not do because of the time necessary for implementation. Consequently, it is important that the Governor and lawmakers find both a solution for 2017 and a long-term a revenue stream for Alabama Medicaid. We are concerned that the Governor did not address a short-term funding solution in his announcement today.

Alabama Medicaid is the backbone of our state, supporting the health and welfare of the young and elderly citizens that physicians have pledged to protect during their medical careers. Consequently, we cannot support any solution other than fully funding a program that touches so many lives. Allowing Alabama Medicaid to continue with adequate funding is a smart investment in Alabama and her citizens.

Physician practices, hospitals and nursing homes are among the economic engines driving many Alabama communities. Closure of these health care providers will have a devastating impact on the state of Alabama and the health and prosperity of its citizens. The ripple effect will be felt from Mobile to Huntsville.

Our organizations strongly believe that Medicaid matters … to all Alabamians.

For more information or comment, please contact:
Mark Jackson, Medical Association of the State of Alabama, (334) 954-2500
Linda Lee, Alabama Chapter American Academy of Pediatrics, (334) 954-2543
Jeff Arrington, Alabama Academy of Family Physicians, (334) 954-2570

Medicaid and You – One Physician’s Musings

By R. Allen Perkins, M.D. - Academic Family Physician, Medical School Department Chair, and Immediate Past President of the Alabama Rural Health Association

I will be appearing at a press conference on Friday, August 5th as a representative of the Alabama Academy of Family Physicians. Beside me will be representatives from the Alabama Academy of Pediatrics, the Alabama Hospital Association, and the community. We will share the following message. This message is being shared in across the state in a series of press conferences beginning Monday:

On August 1st, Alabama began applying cuts to the state’s Medicaid system that will impact the quality of care all Alabamians receive. In Alabama, Medicaid:

·         Provides health coverage for eligible children, pregnant women, and severely disabled and impoverished adults

·         About 1 million Alabamians

·         More than half the births in Alabama

·         About 47 percent of Alabama’s children

·         About 60 percent of Alabama’s nursing home residents


These cuts are devastating and dangerous. Because Alabama already operates a bare bones program, the following will occur:

·         Reduction of payments per visit to primary care physicians by 50% beginning August 1

·         Reduction of reimbursement rates for ambulatory surgical centers, all other specialty physicians, dentists, optometry, hearing and other programs

·         Elimination of the prescription drug coverage for adults for the first time

·         Elimination of adult eyeglasses

·         Elimination of outpatient dialysis

·         Elimination of prosthetics and orthotics

·         Elimination of Health Home and Physician case management fees

·         Consideration of a pharmacy preferred provider program


As a result of the Medicaid cuts put in place August 1, my colleagues in primary care are being put between a rock and hard place. Medicaid rates will not cover the cost of keeping the practice open. My primary care colleagues will either accept fewer Medicaid patients, limit the number of office locations, lay off staff – including nurses and other clinical staff. In some cases they will make the very tough decision of closing their practice and moving to a state that has a more hospitable practice environment.

So what? Turns out primary care doctors are the economic engines of small communities and provide economic vitality to all communities.  Combined, we support 83,095 jobs and generating $11.2 billion in economic activity, according to a report by the Medical Association and the American Medical Association. Specifically:

·         Jobs: Each physician supported an average of 9.5 jobs, including his/her own, and contributed to a total of 83,095 jobs statewide.

·         Output: Each physician supported an average of $1.3 million in economic output and contributed to a total of $11.2 billion in economic output statewide.

·         Wages and Benefits: Each physician supported an average of $758,744 in total wages and benefits and contributed to a total of $6.7 billion in wages and benefits statewide.

·         Tax Revenues: Each physician supported $46,148 in local and state tax revenues and contributed to a total of $404.9 million in local and state tax revenues statewide.

When these cuts take effect, doctors will leave. Consequently it much more difficult for any patient in the state – including those on private insurance like Blue Cross/Blue Shield – to make an appointment with a doctor of their choice at a time convenient for their schedule. Jobs will leave these towns, towns will die.

Isn’t Medicaid full of fraud? Turns out, not. In fact state lawmakers recently conducted an extensive review of Medicaid’s funding and operations that can be seen by selecting the button below. Our program is one of the most frugal health plans available.

What needs to happen? In order to protect the state’s fragile healthcare system from collapse and ensure that all Alabamians have access to the doctor of their choice, legislators must find a long-term, sustainable solution to fund Medicaid, and shore up funding for the coming year.

How can you help?  Using the buttons below, visit for more information and go HERE to contact state leaders to let them know how you feel.  Encourage them to protect Alabama’s healthcare system by fully funding Alabama Medicaid. Let them know that you are concerned and you vote!

Small Rural Hospitals – Can These Provide Part Of The Solution In Rural Alabama?

Alabama currently has eight counties (Chilton, Cleburne, Coosa, Henry, Lamar, Lowndes, Macon, and Perry) with no hospital.  Over the past six years, Alabama has had five rural hospitals close.  This is tied with Georgia for the second highest number of rural hospital closings among all 50 states.  Texas, with nine, has had the most rural hospital closings.  Unfortunately, the fact that more rural Alabama hospitals are experiencing threatening financial difficulties is well known. 


Many rural residents and others interested in rural health care are asking if there is a model of health care facility that can provide care similar to that received in a hospital in counties with no hospital.  This need is being studied by the Alabama Hospital Association and widely discussed by many others, including the Alabama Rural Health Association.


One possibility is the Freestanding Emergency Department which is a new type of health care facility that is now authorized in Alabama.  This is basically a hospital emergency department that is not attached to the hospital.  Two requirements for this facility limit its possibilities in meeting the needs in rural counties.  It cannot be located more than 35 miles from the parent hospital and must be directed by an Emergency Medicine physician.


A second possibility is the Critical Access Hospital (CAH) which was first authorized under federal law in 1997.  A CAH is certified under Medicare conditions that differ from those for acute care hospitals.  A CAH cannot have more than 25 inpatient beds; must maintain an annual average length of stay of no more than 96 hours for acute inpatient care; must offer 24-hour, 7-day-a-week emergency care; and must be located in a federally-recognized rural area. 


Critical Access Hospitals are encouraged to focus on providing care for common conditions and outpatient care, while referring patients with other conditions to larger hospitals.  In return, this type of hospital receives cost-based reimbursement from Medicare, instead of standard fixed reimbursement rates.  This can enhance the financial status of many rural hospitals with larger percentages of Medicare patients.


Critical Access Hospitals have not been as financially feasible in Alabama as in many other states.  Alabama currently has only four critical access hospitals:  Red Bay Hospital in Red Bay, Choctaw General Hospital in Butler, Washington County Hospital in Chatom, and St. Vincent’s Blount in Oneonta. There are 30 Critical Access Hospitals in Georgia and 32 in Mississippi.


Currently, there is a state requirement in Alabama that acute care hospitals must have a minimum of 15 beds.  Given current restrictions on inpatient stays, many rural hospitals do not have a daily census of patients that would require 15 inpatient beds.  The federal requirement for critical access hospitals is that there be 25 or fewer authorized beds.  There is no required minimum number of beds. 


There is a federal requirement that a critical access hospital must first be an acute care hospital and then convert to a critical access hospital. A new hospital cannot be opened as a critical access hospital.  With Alabama’s requirement that acute care hospitals must have 15 or more authorized beds, a new hospital must be constructed with a minimum of 15 beds, even if there is no need for so many beds.


The current financial crisis among many of Alabama’s rural hospitals may make the time right for Alabama to take a look at our regulatory requirements for acute care hospitals to consider allowing our rural areas to have hospitals with fewer than 15 beds.  These facilities could operate as acute care hospitals or convert to critical access hospitals without being required to have more beds than they can realistically expect to need.  This could be done as a change in regulatory requirements for acute care hospitals or by authorizing a new type of hospital – the Small Rural Hospital.  Either of these approaches would require approximately a year to complete the legal procedure if there is no opposition, possibly more time if there is opposition.


Several states already have rural hospitals with small numbers of authorized beds, including Tennessee and Mississippi.  The Johnson County Community Hospital in Mountain City, Tennessee is a 2-bed critical access hospital with 78 employees that operates at a profit when the annual critical access hospital payment is received.  The emergency department at this facility treats patients with minor conditions and sends then home, stabilizes patients with more serious conditions for transfer to a larger hospital, or keeps those who should be observed overnight.  The emergency department utilizes tele-medicine and an emergency department staffing service.  There is a certified rural health clinic affiliated with this hospital.  Major services such as radiology, other scanning, laboratory, and therapy is provided.  This small hospital even provides obstetrical service.


The Greene County Hospital in Leakesville, Mississippi is currently a 3-bed critical access hospital that is being expanded to seven beds in a county that does not have a single physician, like Coosa County here in Alabama.  This hospital has 55 employees and is also operating at a profit.  There is a 60-bed nursing home attached to this hospital and it has a certified rural health clinic.  The services provided at this hospital are quite similar to those in Mountain City except that tele-medicine is not being utilized and the emergency department is staffed by four advanced practice nurses (Certified Registered Nurse Practitioners) who commute from Mobile, Alabama to provide this coverage.  Advanced practice nurses cannot provide this coverage in Alabama, though there is some discussion about considering this coverage to hold down costs during early morning hours when patient traffic is light.


Can small rural hospitals like these provide part of the solution to our rural hospital crisis in Alabama?  One thing for certain is that continuing to allow rural hospitals to close is not part of the solution.

Telemedicine:  Ready or Not, Here It Comes!

The provision of health care is constantly changing to meet the varying needs of those it serves and to take advantage of ever changing technology.  Another dramatic change in the provision of and receiving of health care may be on the horizon in Alabama, especially in rural areas.  This involves the availability of telemedicine.


What is telemedicine?  There are currently three major types of telemedicine:  store and forward, remote (or high-risk) patient monitoring, and live video.  Store and forward technology has been available and widely used for some time.  An example of this technology is having technicians in many of Alabama’s rural hospitals complete x-rays, various types of scans, etc. and transmit these electronically to services staffed by radiologists and other professionals, some even in other countries, where there is a rapid analysis and reporting of findings.


Remote or high-risk patient monitoring has been tested in rural Alabama and is in current use.  An example of this technology is the current monitoring of vital signs for over 700 home care consumers by the Alabama’s Department of Public Health’s Bureau of Home and Community Services.  Regularly scheduled telephone calls are made to or received from these consumers with special needs.  They have selected vitals monitored using special equipment and the telephone to identify whether special attention is needed or not.  This can help in avoiding unnecessary travel for patients in remote areas or with difficult transportation concerns.  This can also identify potentially serious conditions requiring fast intervention or treatment.


Live video is an emerging and rapidly advancing technology that involves a health care provider in one location examining or providing other care for a patient in another location – possibly thousands of miles away.  This is done through the use of special equipment, sometimes located on a cart, including a screen and phone connection allowing the provider and patient to see and communicate with each other.  There are numerous attachments such as a digital stethoscope, otoscope, etc., depending upon the specialty or sub-specialty of care that is being provided, that can be used with this equipment in examining patients or specific conditions. 


With the use of high quality broadband connectivity, the services of another health care provider who is with the patient to follow the provider’s instructions in using the equipment, and high technology medical instrument attachments, a health care provider can examine the patient and offer instruction on the required treatment.  The special attachments allow the provider to see images that can sometimes provide much greater detail than is seen in face-to-face visits.  This explanation of telemedicine is very basic and offers limited detail in comparison to all services which are currently possible using this technology.


Georgia is a leader in adopting the use of telemedicine.  Patients in Georgia can currently receive care involving more than 40 specialties or sub-specialties through telemedicine.  Primary care is available in many retirement facilities, often avoiding unnecessary transport by ambulance for basic care.  Children who may rarely or even never see a physician have the ability to receive care through school based clinics.


Georgia, Tennessee, and Mississippi have all passed legislation mandating that private insurance companies reimburse for telemedicine services.  Private insurance reimbursement is not being mandated through legislation in Alabama.  This has been a major barrier to the use of this promising technology.  A second barrier is the need for high quality broadband access throughout Alabama.  High quality broadband access is a critical need for the expansion of remote patient monitoring.


The lack of reimbursement by private insurance companies in Alabama is being decreased as a barrier.  Alabama’s largest private insurance company, Blue Cross and Blue Shield, has announced that it will voluntarily start reimbursing for selected services involving cardiac care, neurological care or stroke, dermatology, infectious diseases, and behavioral health on December 1.  Medicare already reimburses for telemedicine services nationally.  Alabama’s Medicaid program currently provides reimbursement for some telemedicine services.


Even without private insurance reimbursement, several types of telemedicine are already being practiced in Alabama.  Alabama currently has tele-stroke care available in several rural emergency departments where patients are examined by a distant neurologist with local providers being instructed in what time-sensitive care should be administered.  Tele-wound care is being provided at the Washington County Hospital in Chatom to help local patients possibly avoid having to travel more than 70 miles one-way for this care.  Tele-anesthesiology, tele-cardiology, tele-HIV medicine, tele-psychiatry, and tele-child psychology are all being utilized in Alabama. 


The Alabama Department of Corrections is utilizing telemedicine in several prison clinics to avoid transporting expenses for general care.  The Alabama Department of Public Health is providing strong support for the expansion of telemedicine by placing telemedicine carts in nine county public health departments that can be used by local providers.  Tele-HIV medicine is being provided in some of these locations.  Others locations are being considered for telehealth applications such as tele-prenatal care.


Positive potential abounds for all involved parties.  This technology can allow health care providers to be more like other businesses by exporting their health care services.  Insurers have the potential to reimburse for earlier and lower cost care administered through telemedicine, possibly avoiding greater expenses for treatment received later.  Consumers have the option of receiving care more conveniently and earlier.   


What the future of telehealth and telemedicine will become is yet to be seen.  However, the current utilization is very exciting and promising, especially for such needs as providing specialty and sub-specialty care to patients in our rural areas.  Talk with your health care providers and encourage them to utilize this very promising technology.

ARHA Announces Drive to Establish Student Chapters

                             Funding For New Student Chapter Available


Your Alabama Rural Health Association has received funding that will be used to establish new chapters of the Alabama Student Rural Health Association on campuses of Alabama's public and private colleges, universities, and community colleges.  


Student membership in ASRHA is a bargain at a cost of only $25 per school year.  Included in this membership is annual membership in the campus ASRHA chapter (on campuses with ASRHA chapters), a full annual membership in the Alabama Rural Health Association, and a school year student membership in the National Rural Health Association.  For additional information on student memberships and benefits, select "Join ARHA".


Student members can also seek election as an officer in their campus chapter or seek election to the student position on the ARHA Board of Directors.


Campus ASRHA chapters will have regular meetings during which information of value to students pursuing health related careers will be provided.  A listing of possible program topics and speakers is currently being developed.  Chapters will also conduct health related community projects.  Each campus chapter must have a faculty/staff sponsor to oversee the chapter activities.  


To assist in establishing campus chapters of ASRHA, the following are being sought:

     Students with an interest in helping to establish a chapter at their school.

     Faculty/staff at Alabama schools interested in serving as a campus sponsor.

     Potential speakers on topics of interest to health related program students.


Please contact ARHA to assist with this program or if you have questions or recommendations.