Alaska FESC Consortium

Project Background:

In remote, frontier areas of the country, weather and distance can prevent patients who experience severe injury or illness from obtaining immediate transport to an acute care hospital. For residents in some of those communities, providers offer observation services traditionally associated with acute care inpatient hospitals until the patient can be transferred or is no longer in need of transport. Provision of these services requires additional staffing, equipment, and facility capacity. However, extended stay services are not currently reimbursed by Medicare, Medicaid or other third-party payers. For several years, officials in the State of Alaska and several State Offices of Rural Health, Primary Care Offices, and Primary Care Associations have explored the development of a new provider type that would enable reimbursement of these services. The Frontier Extended Stay Clinic (FESC) model is a result of those discussions.

The Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA) acknowledged the work of FESC supporters by authorizing the Centers for Medicare and Medicaid Services (CMS) to conduct a demonstration program in which FESCs would be treated as Medicare providers. You can download a copy of the MMA authorizing language here (Adobe PDF).

In a separate recognition of the extended care services provided by some frontier clinics, an additional demonstration program to be administered by the Health Resources and Services Administration (HRSA) Office of Rural Health Policy (ORHP) was funded beginning in 2004 and extending to 2011. This demonstration is funding the work of the Alaska FESC Consortium.

The Alaska FESC Consortium is now working to demonstrate the operational viability and financial sustainability of a FESC, under a cooperative agreement with the ORHP. The lead agency for the Alaska FESC Consortium is the SouthEast Alaska Regional Health Consortium, or SEARHC. Other Consortium members include the Iliuliuk Family and Health Services in Unalaska, Cross Road Medical Center in Glennallen, Native Village of Eyak in Cordova, and Inter Island Medical Center in Friday Harbor, Washington. An evaluation of the model is being led by the Alaska Center for Rural Health at the University of Alaska in Anchorage.

Demonstration sites are located at clinics in Haines, Klawock, Unalaska, Glennallen, and Friday Harbor. These sites are participating in an extensive evaluation of the FESC model, which has been ongoing since 2005.