Defining Rural: Too Many Definitions Cause Problems

Too many federal definitions of "rural" make it hard for local officials to figure out what programs they qualify for, so Ag Secretary Tom Vilsack said he will ask the White House Rural Council and Congress to try to reduce the number.

After a participant in the Council on Foundations conference on rural philanthropy said that variations in qualifications for various rural development programs make it difficult for communities to participate, Vilsack said he would be glad to take the issue to the White House Rural Council, an Obama administration innovation composed of Cabinet officers and leaders of other federal agencies.

Vilsack jokingly asked the audience if they were bothered that USDA has 11 different definitions of rural America. The varying definitions, which depend on population and other characteristics, "provide a convenient excuse not to do something," he said.

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Operations Assistant Position at CRHC

The Operations Assistant provides organizational support for human resources administration, contact database management, and administrative assistance for the Operations department in order to make certain CRHC meets its obligations to its members, Board of Directors and grantors.

The Colorado Rural Health Center (CRHC) is a nonprofit organization that serves as the State Office of Rural Health. CRHC’s mission is to enhance healthcare services in Colorado by providing information education, linkages, tools and energy toward addressing rural healthcare issues.

Read more about the position responsibilities, requirements and how to apply. Start date is open. Application deadline: August 15, 2011.

Share Your Opinion About Buying Health Insurance in Colorado

Health Insurance Exchanges are online marketplaces where consumers can shop and buy health insurance products in the independent and small business markets. Given the high number of ranchers, farmers and small business owners in rural areas, it is crucial the experiences and ideas of rural Coloradans are heard in order to ensure the Exchange works for residents from all parts of the state. The Colorado Center on Law and Policy is hosting focus groups around the state to better understand the consumer needs, opinions and perspectives of the Exchanges. This is a great opportunity to provide the rural voice in the process. A list of the meetings outside the Denver-metro area is below.

Check out the flyer or find more information on Facebook at: Colorado Insurance Exchange Focus Groups.

• Grand Junction, August 1st and 2nd


• Time: 6-8 pm


• Place: Mesa County Workforce Center


• Address: 2897 North Avenue

• Sterling, August 8


• Time: 6-8pm


• Place: CSU Extension Room


• Address: 508 S. 10th Avenue

• Greeley, August 1st


• Time: 6-8pm


• Place: Centennial Park Library


• Address: 2227 23rd Avenue

• Pueblo, August 3rd


• Time: 6-8pm


• Place: Rawlings Library (Thurston Room)


• Address: 100 E. Abriendo Ave

NHSC: Now Accepting Site Applications Online

Today, the National Health Service Corps (NHSC) begins accepting applications from sites interested in becoming NHSC approved through an online application process. Qualifying sites interested in becoming an NHSC-approved site can apply online. Interested sites are strongly encouraged to read the NHSC Service Site Reference Guide before applying to the Corps.

To apply to become an NHSC approved site, follow these steps:

1. Visit the website and click on the "Apply Here" button.


2. Click "Create a Site Administrator Account."


3. Complete the required fields and click "Register."


4. The site will receive an email with account information. You will need to click the link in the email to activate your account. If you do not see this email in the inbox, check the junk or spam folder.


5. Upon clicking the link, you will be redirected to the login page. Use the account credentials previously entered to login to the NHSC site portal. Make note of these login credentials for future use.


6. Click the "Apply for a New NHSC Site" button, in the "Apply for a New NHSC Site" section.
7. Follow the screen-by-screen instructions to complete and submit the official NHSC site application for review.


8. The application will be processed and the applicant will be notified electronically once their application is approved.

Prospective NHSC sites may contact the NHSC Recruitment, Training, and Support Center (RTSC) at 877-313-1823, Monday-Friday 8:00 a.m. to 6:00 p.m. EST (except Federal holidays) with questions regarding the online site application.

CRHC’s Partner Program Featured in HealthLeaders Media

CRHC’s new Partner Program and first Partner-level sponsor, Centura, were featured in an article by HealthLeaders Media. Writer Alexandra Wilson Pecci noted, “If the road to economic viability, meaningful use, and accountable care organizations is a rocky one for most healthcare facilities, it’s perhaps even bumpier for rural ones. That’s why the Colorado Rural Health Center (CRHC) has created the “Partnership Program,” which will allow larger organizations to invest in a fund that will be used to provide free support services to small, rural health facilities.”

To read the full article, click here.

Centura Health Partners with Colorado Rural Health Center

A new partnership between Centura Health and CRHC enhances management and administration of healthcare in rural Colorado.

With more than 70 percent of Colorado counties classified as rural or frontier, the challenge to extend quality, accessible, affordable health care beyond city boundaries is growing. Changes in reimbursement models, regulatory and compliance issues, electronic health management and clinical services have never been more challenging.

Centura Health, Colorado’s largest health care provider, is committed to building systems of care that connect its operating entities and rural health partners via a seamless network of excellence. By coordinating efforts across the state, they are enhancing the health status of all Coloradans, delivering health care at the right time, in the right place.

In 2011, CHRC created the exciting new “Partnership Program” to provide organizations with an opportunity to support rural health care in Colorado in a meaningful and direct way. As the first official “Partner,” Centura Health is investing in the expansion of CRHC programs that positively improve the impact of rural health care providers and facilities including clinical assessments, billing/coding assistance, health information technology, quality improvement, policy and advocacy support and much more.

“The Rural Health Center has been a key resource for rural health in Colorado since 1991,” said Bob Wallace, Centura Health’s service line director for health outreach. “Our common vision and commitment to improving the delivery of health care allows us to combine resources in a targeted fashion knowing that critical needs in rural communities will be met. ”

About Centura Health
Centura Health, Colorado’s health care leader, is focused on connecting Coloradans to affordable, world-class care in every corner of the state. Centura Health’s integrated statewide network includes 13 hospitals, seven senior living communities, medical clinics, affiliated partner hospitals, Flight For Life® Colorado, and home care and hospice services. Approximately 14,500 of the best hearts and minds in medicine, along with 6,000 physician partners, have access to the most technologically advanced tools available. For Coloradans, this means the top expertise and technology is right where you need it – close to where you are. We reach beyond hospital walls to connect with people at every stage of life to bring them life-enriching compassion and life-affirming hope. Connections that only Centura Health can make. For information on Centura Health or any of the facilities in our network, please visit www.centura.org.

COO Update

By their response to the Colorado Rural Health Center’s “Cultivate Rural Health” campaign, Centura Health has joined with us at the Partner level. Centura has made a substantial investment in support of CRHC’s programs that positively improve the impact of rural health care. Click here to read more about this exciting news.

The Partnership level is for hospital systems, foundations, corporations, and other organizations interested in making a significant investment in rural healthcare.

You can join Centura Health in supporting Colorado's most trusted resource for rural healthcare! Click here for information on becoming a Member, Sponsor or Partner through CRHC’s “Cultivate Rural Health” campaign.

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CRHC Has a Close Encounter with CMS

Three staff members from CRHC had the pleasure of meeting face-to-face last month with Dr. Don Berwick, Centers for Medicare & Medicaid Services Administrator. Dr. Berwick requested the meeting, hosted at the Regional CMS offices in Denver. The discussion centered on rural-specific healthcare issues, including innovative access to care programs, regulatory barriers to providing care, and coordinated quality improvement activities happening in rural facilities.

Dr. Berwick was very impressed and requested more information on several innovative practices and quality improvement efforts going on in Colorado including CRHC’s iCare program, the HIT Meaningful Use initiative, and the Community Paramedic program. Regulatory barriers CRHC shared included: the limitations on the Accountable Care Organization proposed rules for rural facilities; mileage limitations for cost-based ambulance services and the frontier extended stay clinic demonstrations: and physician supervision requirements.

Dr. Berwick is gathering rural information from across the nation to determine what positive changes can be made at CMS to increase access in rural areas. He indicated that the Innovation Center will produce multiple opportunities to show promising practices to increase quality, decrease cost and increase access to care in rural areas. The Innovation Center is currently accepting innovative ideas to address access issues by visiting their website. Once ideas have been culminated, the Innovation Center will submit Requests for Applications (RFAs) for facilities to apply to receive funding as a demonstration site. We highly suggest for those of you who have great projects or ideas to submit those to the Innovation Center, and we will be sure to keep you apprised when RFAs are released.

Colorado HealthStory Launches

The Colorado Rural Health Center, in partnership with ClinicNET and the Colorado Coaltion for the Medically Underserved (CCMU), were awarded a grant by The Colorado Trust and the Colorado Health Foundation as part of their public will-building campaign.

After receiving the grant last fall, the three partners began building a program modeled after the award winning StoryCorps, a project funded by the Corporation for Public Broadcasting.

Colorado HealthStory aims to capture health stories as personal histories and as treasures of the local community in 21 communities across Colorado. Knowing everyone has a health story to tell; the joyous birth of a baby, the moving experience of sitting with a dying parent, a journey of remarkable healing, the daily reality of living with diabetes, the perspective gained from providing care, HealthStory invites Coloradans across the state to tell their health stories and join the conversation about health in their communities.

Once a body of stories has been collected, HealthStory staff gathers with community members for a local forum and listening session to share the health stories and local health data. The forums are a place to facilitate conversations about the story of access to health in the community and explore shared health priorities. Getting everyday Coloradans involved in the conversation about health is critical, because those decisions are too important and too personal to be made only by someone else.

After collecting stories in Aurora for two months, Colorado HealthStory held its first community forum in Aurora last night. The forum was attended by storytellers, city officials, community activists and community-based organizations. Attendees listened to a few of the stories collected in Aurora, shared issues related to health and discussed key health data specific to Aurora, as well as identified local efforts to address these issues. The next community forum will be held in Summit County, followed by Rocky Ford, both later in the summer

In tandem with its first forum, the website for Colorado HealthStory was launched yesterday at www.coloradohealthstory.org. There, visitors can find out more about the project, hear the stories and find out when HealthStory will be in their community.

Find Colorado HealthStory on:

• Facebook


• Twitter


• Vimeo

Colorado Health Benefit Exchange

One feature of the Patient Protection and Affordable Care Act passed in 2010 is the development of a state run or federally run exchange prior to 2014. An exchange is an insurance marketplace, available online, designed to provide a place where individuals and businesses can shop for coverage at competitive rates. The Colorado Rural Health Center supports the creation of an exchange as a mechanism to increase access, affordability and choice for individuals and small employers purchasing health insurance in Colorado. During the 2011 legislative session a bill was introduced and ultimately passed allowing Colorado to appoint a health benefits exchange board, assign legislators to a legislative oversight committee and create an exchange for Coloradans.

With the support of its Policy and Legislation Committee and approval by the Board of Directors, CRHC decided to support the development of the Colorado Health Benefit Exchange for the following reasons:

• Many rural families have been forced to choose between a few powerful insurance companies and, as a result, paid more for their coverage. The Exchange will give rural consumers more control, quality choices and better protections when buying insurance;


• Small businesses and self-employed individuals such as farmers and ranchers make up a substantial percentage of the rural population. The Exchange will allow small business owners and families to make informed choices when purchasing health insurance; and


• Historically the small businesses and self-employed individuals in rural areas have the highest likelihood of being uninsured due to the high cost. Through the Exchange, these workers will have more choices for affordable private insurance plans.

Shortly after the passage of Senate Bill 11-200, the Colorado Health Benefits Exchange The Colorado Health Benefits Exchange Board of Directors was announced by the Governor on June 29th. To see the full press release and Executive Order, click here.

Shortly after the announcement of the exchange board appointments, the first board meeting was held. They met on July 11th in a meeting that was well attended by both consumer advocates as well as the business community. The next meeting will be held on July 25th. For more information on the board’s meeting schedule and agendas, visit the Colorado Health Institute website.

Recently, CRHC signed onto a letter of support as a member of the Health Advocates Alliance, a broad coalition of consumers, providers and healthcare advocates committed to healthcare that is affordable, sustainable, timely, safe, equitable, effective efficient and patient-centric. The letter of support urged board members to be diligent in ensuring that there is full transparency and accountability in all board actions. A full text of the letter can be found here.

CRHC is actively participating in the development of the Exchange by attending the board meetings, taking part in the workgroups and monitoring the Legislative Oversight Committee, as well as identifying opportunities to provide input and expertise on behalf of rural Coloradans. With the creation of an Exchange, Colorado has the opportunity to create a solution that works for Coloradans, particularly those in rural areas. We will continue to monitor its progress and keep membership abreast of the developments.

Please Take Action Today in Support of Rural Healthcare

All of us have heard of the tense budget negotiating in Washington as our political leaders discuss options for raising the nation’s debt ceiling limit by August 2nd and cutting federal spending to address the deficit. Medicare and Medicaid are under consideration for substantial spending and benefit cuts, including proposals to cut $14 billion in Medicare funding for rural hospitals, reducing the federal Medicaid matching rate to the states, and limiting or eliminating the Medicaid hospital provider fee that supports expansion of coverage to the uninsured and the hospitals that care for the medically vulnerable.

These proposed cuts will disproportionately impact rural and underserved communities, destabilizing rural healthcare providers and facilities and severely limiting access to care in rural Colorado. CRHC has been communicating with Colorado’s members of Congress about the critical role that Medicare and Medicaid play in rural communities and we encourage you to do the same.

Please take a few minutes today and no later than Monday, July 18 to contact Senator Bennet, Senator Udall, and your Representative with this message: “Please oppose deficit plans that cut rural healthcare programs and Medicare funding for rural hospitals. Rural communities rely on these programs and significant cuts will threaten access to care and economic growth in rural Colorado.” Feel free to personalize your message with how Medicare and Medicaid impact your community.

Please contact your legislators by phone and email:

• Senator Michael Bennet, 202.224.5852 (ask for Rohini Ravindran)


• Senator Mark Udall, 877.768.3255 (ask for Jake Swanton)


• Capitol Switchboard, 202.224.3121 (ask for your Representative's office and to speak with the staff who handles health issues)

Click here for a list of Colorado's members of Congress and email addresses for their healthcare staff.

CME Locums Tenens Scholarships Available!

The Colorado Rural Health Center is offering Physicians, PA’s, Nurse Practitioners, and Dentists with an opportunity to get scholarship money for locums tenens pay, and/or travel costs associated with attending local, statewide, or national conferences or additional trainings. Funding cannot be used to pay for the cost of attending the conference, or registering for the program.

Criteria & Eligibility

• Applicants must be located in a rural, or non-metropolitan county in Colorado.


• The applicant organization can be a public or private entity, including FQHC’s.


• All awards are paid to the organization, and not the scholarship recipient.


• You can apply for Locums Tenens costs(no limit, but within reason), travel (up to $1,500 dollars) or both.


• Available to Physicians, Physician Assistants, Nurse Practitioners, & Dentists.


• Applications may be submitted for retro expenses dating back to March 2011 to the present.

Applications will be accepted throughout the year, but reviewed and awarded on a quarterly basis. The next cycle due date is September 15th, 2011. Applications can be downloaded online.

Questions? Contact Erica at ep@coruralhealth.org, by phone at 303.996.9698 or fax 303.832.7496.

Shortage of Family Doctors in Colorado Intensifies

Colorado doesn’t have enough primary care physicians. And the shortage is expected to worsen in coming years. “In Colorado, we need 194 primary care docs in underserved communities – now,” said Steve Holloway, director of the Office of Primary Care of the Colorado Department of Health and Environment. “In the next three years, that number will more than double.”

Medical professionals and administrators statewide are grappling with a big crunch – because there aren’t enough graduating primary care physicians to replace the family doctors about to retire. The average age of a primary care physician in Colorado is 55. Many of them will be hanging up their stethoscopes in as little as 10 years.

The shortage is expected to worsen in 2014 when the federal health care law is due to add 32 million people to health insurance. Treating their postponed health problems will require more time from primary care doctors. If they don’t have one now, Coloradans might want to find their own family doctor soon, Holloway suggested.

Currently, the state has 3,271 licensed primary care physicians. Most of them work in affluent areas of Douglas, Arapahoe and El Paso counties. Poorer – often urban – areas have the most critical need for primary care, including inner city Denver and Adams County. Enormous swaths of rural Colorado also are facing severe shortages, including the San Luis Valley and non-resort areas of the mountains. There is no primary care physician at all in Jackson County in north-central Colorado. In the southeastern towns of Rocky Ford and Ordway,patients are largely monitored by nurse practioners, who handle everything from prescribing psychiatric medicine to setting bones.

Read more and listen here to Dr. Ozzie Grenardo's unique approach to practicing in both urban and rural areas of Colorado.

Flex Monitoring Team responds to JAMA report on quality of care at CAHs

The Flex Monitoring Team, the nation's leading experts on rural health care quality, has prepared a detailed analysis of last week's JAMA report on quality of care at critical access hospitals (CAH) which concluded that compared with non-Critical Access Hospitals (CAH), CAH’s had fewer clinical capabilities, worse measured process of care, and higher mortality rates for patients with AMI, CHF or Pneumonia. “The report is simply deficient when it comes to understanding the basic role of a Critical Access Hospital within a rural community,” said Alan Morgan, National Rural Health Association CEO. “The current quality measurement systems available do not adequately reflect the core work of what rural hospitals do on a daily basis.”

Funded by HRSA, the Flex Team has provided detailed national and state reports on CAH quality for the past six years. Their numerous reports document the substantial progress in quality improvement that CAHs have made during that time frame, as well as areas in which there is still room for improvement. Click here to view the Flex Team's response to the JAMA report.

CRHC has been working with the 29 CAHs in Colorado for over 10 years on quality improvement activities including the Quality Network, 100,000 Lives Campaign, 5 Million Lives Campaign, Quality Health Indicators (QHi) Benchmarking, and iCARE (Improving Communication & Readmission). For more information on CRHC’s CAH quality improvement programs, contact Jen Dunn, CAH Program Manager at jd@coruralhealth.org.

Annual Conference Agenda Released

The detailed agenda for the 20th Annual Rural Health Conference August 11-12 has been posted online! Review the pertinent, imformative topics that will be covered and and see who is scheduled to speak at the event.

Sponsorship and exhibitor opportunities are still available but space is limited! See the benefits and fill out the packet to reserve a spot! Contact Nadine Gressett at ng@coruralheath.org with questions.

Don’t Miss the Opportunity to Offer Loan Repayment to Your Healthcare Providers!

Do you have a healthcare provider at your facility who is interested in loan repayment? Let them know that the Primary Care Office has announced that the Colorado Health Service Corps (CHSC) Loan Repayment Program summer 2011 application cycle will be open until July 31st.

Up to $105,000 for a 3-year commitment is available to your primary care healthcare providers!

CHSC provides loan repayment to fully trained primary care providers in exchange for a three-year full-time service obligation in an underserved community. After completing their initial years of service, loan repayors may apply for additional years of support! Eligible providers include primary care Family Physicians, Internists, OB/GYNs, Pediatricians, Dentists, Psychiatrists, Physician Assistants, Nurse Practitioners, Certified Nurse Midwives, Dental Hygienists and licensed mental health professionals.

Many types of health care facilities are CHSC eligible sites including Critical Access Hospitals, Rural Health Clinics, Community Health Centers, and safety-net clinics.

To find out more about the CHSC Loan Repayment Program, go online.

Would you like to speak with someone to find out if your facility is eligible for loan repayment? Contact Colorado Provider Recruitment (CPR) at cpr@coruralhealth.org or 303.832.7493.

Don't Miss Out on Our 20th Anniversary Celebration!

CRHC is celebrating it’s 20th Anniversary as the State Office of Rural Health - we are pleased to announce a special reception during our annual conference the evening of August 11th to commemorate this milestone!

Held on the 12th floor of the Hyatt Regency in the Denver Tech Center, this event promises to be an evening to remember. Enjoy panoramic views of the Rocky Mountains and Denver skyline while indulging in hors d’oeuvres and cocktails (cash bar).

The annual Rural Health Excellence Award will be announced, as well as a video presentation commemorating CRHC's 20 years of history with rural Colorado. And the best part - it's included in your annual conference registration! If you haven't already, register now online.

Wyoming Department of Health seeks Public Health Division Senior Administrator

The Wyoming Department of Health, Public Health Division (PHD) is seeking a Senior Administrator to determine and create policies, rules, regulations and provide overall direction of federal, state and local government division related activities as they pertain to the expectation and requirements of sections located within PHD. This includes Community and Public Health; Preventive Health and Safety; Rural and Frontier Health; the State Health Officer; Emergency Medical Services; Public Health Emergency Preparedness; and the State Epidemiologist. Plans, directs and coordinates operational activities at the highest level of management in coordination and collaboration with program administrators and the Department Director. Develops and implements the Department Strategic Plan to be one cohesive division to best serve the citizens of Wyoming.

For more information and to apply online, visit their website.