Alaska FESC Consortium

Current Activities:

1. Congress established the Frontier Extended Stay Clinic (FESC) Demonstration Project under section 434 of the 2003 Medicare Modernization Act. The Center for Medicare and Medicaid Services (CMS) announced a demonstration of the FESC model and Request for Proposals in the Federal Register on August 25, 2006. The CMS FESC demonstration addresses the needs of seriously or critically ill or injured patients who, due to adverse weather conditions or other reasons, cannot be transferred to acute care referral centers, or patients who need monitoring and observation for a limited period of time. The FESC must be located in a community which is at least 75 miles away from the nearest acute care hospital or critical access hospital, or which is inaccessible by public road. The FESC demonstration will last for three years, and must be budget neutral. The clinics located in Haines, Klawock, Unalaska, Glennallen, and Friday Harbor, Washington have applied to participate and have been accepted into the demonstration.

Inter Island Medical Center in Friday Harbor was the first Frontier Extended Stay Clinic certified by CMS in the nation; triggering the start of the demonstration in April 2010. All clinics were certified by CMS by early 2011, and are billing Medicare for extended stay services. The Alaskan clinics are also billing Medicaid. Medicaid can be billed multiple encounters on the same day at the regular FQHC all-inclusive rate.

Clinics participating in the demonstration formally requested a change in the staffing requirements outlined in the Conditions of Participation (COPs). In January 2009, the COP's were changed to reflect the realities of staffing for frontier health care. They were modified as follows:

"Any time there is an extended stay patient in the FESC, a qualified registered nurse, a qualified licensed practical nurse, nurse practitioner, clinical nurse specialist (as that term is defined in 42 CFR 410.76), physician assistant, or MD/DO must be available for the bedside care of the patient."

In addition, for the Alaska sites only, CMS will allow a waiver that permits facilities that are unable to recruit one of the permitted types of professionals to use instead an Emergency Medical Technician or Mobile Intensive Care Paramedic who has an expanded scope of practice approved by the appropriate professional licensure authorities in Alaska.

Download a copy of the White Paper addressing FESC Staffing Challenges, submitted to CMS in October 2008. (Adobe PDF)

Download a copy of an analysis of Scope of Practice for LPN's, EMT's, paramedics, and community health aides, submitted to CMS in December 2008. (Adobe PDF)

Download a copy of the CMS Self-Attestation Survey required for certification. (Microsoft Word Doc)

Download a copy of Transmittal 66 from the CMS Manual System. (Adobe PDF)

The Alaska Board of Nursing determined in early 2010 that taking x-rays was outside the scope of practice of registered nurses. Three facilities applied for an expanded scope of practice (Cross Road, Alicia Roberts Medical Center, and Haines), documenting training and competency assessment for their nurses. The Board approved the expanded scope of practice for certain nurses at those three facilities only. Read the letter from SEARHC to the Alaska Board of Nursing here.

2. The Alaska FESC Consortium has a Cooperative Agreement with the HRSA Office of Rural Health Policy. The current cooperative agreement extends through August 31, 2012. As the lead agency, SouthEast Alaska Regional Health Consortium (SEARHC) has subcontracted with Iliuliuk Family and Health Services, Cross Road Medical Center, and Inter Island Medical Center to fund actual demonstration sites for the FESC model. Besides acting as the lead agency for the FESC Consortium, SEARHC manages two demonstration sites in southeast Alaska; at the Alicia Roberts Medical Center in Klawock, and the Haines Health Center. The Native Village of Eyak is not actually testing the model, but is participating in the planning process.

Each of the five demonstration sites has increased their staffing and upgraded facilities and equipment to meet the challenges of providing high-quality FESC services. In September 2004, Patricia Atkinson began working for SEARHC as the FESC Program Manager.

Download a copy of the October 2011 report to the Office of Rural Health Policy. (Adobe PDF)

Download a copy of HRSA Expenditures FY04-FY09, collected by SEARHC. (Microsoft Excel XLSX)

3. The Alaska Center for Rural Health, located at the University of Alaska Anchorage, recently transitioned the evaluation of the project to the Institute for Social and Economic Research. The evaluation assesses the impact of FESC in four areas: staffing, services, clinical outcomes, and financial.

Download a sample of the web-based Outcome Log. (Adobe PDF)

Download a copy of the FESC Literature Review, completed by Cecil G. Sheps Center for Health Services Research at UNC Chapel Hill. (Adobe PDF)

Download the 2006 Qualitative Studies, conducted by Alaska Center for Rural Health. (Adobe PDF)

Download a powerpoint of early (2006) financial analyses, conducted by Stroudwater Associates. (Powerpoint PPT)

Download a table showing potential savings on medevac services, conducted by Alaska Center for Rural Health. (Adobe PDF)

Download a copy of Volume I of the Final Evaluation from the UAA Institute of Social and Economic Research. (Adobe PDF)

Download a copy of Volume II of the Final Evaluation from the UAA Institute of Social and Economic Research. (Adobe PDF)

4. The Alaska FESC Consortium Provider Workgroup, composed of doctors, nurses, physician assistants, nurse practitioners, and other health care providers who are experienced at providing FESC services is responsible for the following activities:

Create FESC Vision
Define Minimum Standards
Guide Evaluation Process
Discuss Quality of Care
Describe Scope of Practice
Identify Hazards/Risks/Criticisms
Develop a Quality Assessment and Performance Improvement (QAPI) Plan, as required for the CMS demonstration.

5. The Alaska FESC Consortium Steering Committee, composed of one administrative and one clinical representative from each site, meets monthly by teleconference and twice yearly in a face-to-face meeting. The Steering Committee provides oversight and direction for the entire project.

6. The State of Alaska Department of Health and Social Services has developed regulations which took effect on December 3, 2006. The Department's primary contact person is Pat Carr. The department is also developing a methodology for Medicaid reimbursement for FESC services.

Download a copy of the regulations. (Microsoft Word - to activate links inside document, press ctrl and left click on link)

Download a self-survey tool developed by the State of Alaska Certification and Licensing Unit. (Microsoft Word - to activate links inside document, press ctrl and left click on link)

Download a copy of the application for FESC licensure from the State of Alaska. (Microsoft Word - to activate links inside document, press ctrl and left click on link)

7. On February 11, 2011, the Alaska FESC Consortium distributed an RFP seeking a contractor for policy analysis and evaluation. The RUPRI Center for Rural Health Policy Analysis was selected to lead the evaluation. Dr. Clint MacKinney is the lead researcher on this project. A final report is expected in the spring of 2012.

Download a copy of the RFP. (Adobe PDF)

Download a description of the HRSA funded Haines Health Center. (Adobe PDF)