Alaska FESC Consortium

Project Background:

Summary

In frontier regions of the country, weather and distance can prevent patients who experience severe injury or illness from obtaining immediate transport to a hospital. For residents in many of those communities, providers in the local health clinic offer services traditionally associated with hospitals, until the patient can be transferred or is no longer in need of transport. Provision of extended stay 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, rural health advocates have explored the development of a new provider type that would enable reimbursement for these very costly, essential services. The Frontier Extended Stay Clinic (FESC) model is a result of those discussions.

Legislation

The Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA) authorized 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).

Per the MMA, a Frontier Extended Stay Clinic is described as:

located in a community where the closest short-term acute care hospital or critical access hospital is at least 75 miles away from the community or is inaccessible by public road; and
designed to address the needs of –
1. seriously or critically ill or injured patients who, due to adverse weather conditions or other reasons, cannot be transferred quickly to acute care referral centers; or
2. patients who need monitoring and observation for a limited period of time.

The Center for Medicare and Medicaid Services (CMS) announced a demonstration of the FESC model and a Request for Proposals in the Federal Register on August 25, 2006. The FESC demonstration will last for three years, and must be budget neutral. Alaskan clinics located in Haines, Klawock, Unalaska, and Glennallen; and other frontier clinics located in Friday Harbor, Washington and Broadus, Montana, applied to participate and were accepted into the demonstration. Each of the clinics are currently working to meet the established Conditions of Participation. The demonstration will begin in 2009. Medicare reimbursement will be available to the participating sites for extended stays between 4 – 48 hours.

Funding

In a separate recognition of the extended stay services provided by frontier clinics, an additional demonstration program 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.

Project Partners and Sites

The Alaska FESC Consortium is now working to demonstrate the effectiveness and appropriateness 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, and Inter Island Medical Center in Friday Harbor, Washington. An evaluation of the model is being conducted by the Alaska Center for Rural Health (Alaska’s AHEC) at the University of Alaska in Anchorage.

Demonstration sites for both the HRSA and the CMS demonstration are located at clinics in Haines, Klawock, Unalaska, Glennallen, and Friday Harbor. These sites have been participating in a detailed evaluation of the FESC model, since 2005. Each of the five demonstration sites have increased their staffing and upgraded facilities and equipment to meet the challenges of providing high-quality FESC services.