Southern West Virginia News

Washington, D.C. – Yesterday, Congresswoman Carol Miller (R-WV) participated in a Ways and Means Health Subcommittee Hearing to discuss the challenges rural health care providers face when participating in value-based care models and potential improvements.

Congresswoman Miller commended Dr. Sarah Chouinard, Chief Medical Officer of Main Street Health, for her extensive experience and dedicated service to patients in West Virginia communities.

"[Dr. Chouinard is] a very special woman who grew up in Huntington, West Virginia. She was schooled there and [received medical training at Marshall University Joan C. Edwards School of Medicine] and practiced [medicine] in West Virginia for such a long time. She’s been a tireless advocate for the people in West Virginia and has [served as the Medical Director] for West Virginia’s Public Employees Insurance Agency (PEIA). She served as the Chief Medical Officer at the state’s second largest Federally Qualified Health Center. In that role she oversaw clinics across the central part of the state that is so mountainous," said Congresswoman Miller.

Miller asked Dr. Chouinard to explain why rural providers participate less in Medicare’s value-based payment systems compared to non-rural providers.

“I have worked endlessly on rural health care because it can take you five hours to get to the hospital if that’s where your physician is. I’ve dedicated my time on the Health Subcommittee to help rural West Virginians and rural patients all over the country. People who live in urban areas don’t really comprehend the difference. Unfortunately, with Medicare’s value-based care models, we have seen multiple instances of rural providers being left behind and unable to participate. According to a 2021 report from the Government Accountability Office, rural providers participate in value-based care programs at lower rates than non-rural providers. Dr. Chouinard, in your opinion, what are some of the primary factors preventing our rural physicians from participating in value-based payment systems?” asked Congresswoman Miller.

“Administrative burden comes to the top of the pile. When you’re in small practices it becomes very difficult to dedicate a team to be able to understand what the opportunity is, and then the tracking that goes along with it, the reporting that has to go along with it. At Main Street, what we’re trying to do is take some of that burden off so that rural clinicians have a better glide path to participate. Primary Care Associations are another great stopping place for people to find information and really be able to figure out how to participate. I think on top of that, we’re just so busy; the demand for care is so high that in order to make that change, there are a lot of technology tools that we need to use. One of my fears is that we lose rural clinicians because it’s just too darn hard. If we can support them in those ways, I think that’s really the most important thing we can be thinking about right now,” responded Dr. Chouinard.

Congresswoman Miller highlighted how some value-based care models like Centers for Medicare & Medicaid Innovation’s (CMMI) Emergency Triage, Treat, and Transport (ET3) model do not adequately consider rural realities when creating participation guidelines.

"One particular example of a value-based care model that failed to adequately consider rural providers was CMMI's ET3 model," said Congresswoman Miller." The ET3 model was launched as a voluntary five-year payment model providing greater flexibility for Emergency Medical Services (EMS) providers following a 911 call."

Many EMS providers were excited about treating certain conditions at scene or transporting patients outside typical emergency rooms but found themselves excluded due to lack of alternate sites within their regions.

"I along with rest of West Virginia delegation sent letter last year highlighting these issues asking CMS Administrator consider allowing statewide demonstration treat-in-place model since state couldn’t participate ET3," added Congresswoman Miller." Not only did CMS deny request but decided end ET3 two years early rather remedy issues prevented EMS participation."

Dr.Chouinard suggested solutions regarding CMMI's integration approach: “One problematic aspect volume thresholds example given had ‘X’ numbers transports order participate only Kanawha County met threshold,” explained Dr.Chouinard." Served rural ER lots patients come didn’t need ER again law no choice.”

Dr.Chouinard further noted importance addressing social isolation loneliness engaging seniors proactive preventive measures design principles future models integrating unique scenarios geographic distances volumes faced by rural communities.

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