Letter From the CEO

As the new CEO of the Colorado Rural Health Center, I have been overwhelmed by the positive feedback I have received about the organization and mission we serve. Prior to accepting this position, I had a strong appreciation for the quality of CRHC, but I did not realize the vast reach of the organization and the extent of the services we provide to rural communities. It has been wonderful getting to know our partner organizations and catching up with friends from organizations that I previously worked with and now have the opportunity to collaborate with in a different capacity. I thank everyone for the warm welcome that I have received and the outpouring of messages of congratulations on the position I now have the honor of serving. For those of you I have yet to meet, I look forward to getting to know you soon.

As you are all aware, one of the biggest challenges facing CRHC and rural healthcare providers are the imminent cuts to our national budget. Critical Access Hospitals and other important healthcare programs face significant decreases to revenue as policymakers in Washington work on reducing the deficit and cutting federal spending. The Budget Control Act of 2011 calls for $1.2-$1.5 trillion reduction in federal expenditures over the next ten years. A bipartisan “Super Committee” of 12 members of Congress has been created to develop recommendations for reaching the $1.2+ trillion goal. If this Committee cannot produce a proposal to Congress by November 23, or if Congress fails to approve any proposal by December 23, automatic 2% cuts, or sequestration, will be applied to Medicare provider rates, defense, and other programs.

One of CRHC’s top priorities is ensuring Congress understands the devastating impact these cuts could have on our state’s most vulnerable populations and the facilities who serve them. Colorado’s Congressional delegation needs to hear from you about the impact these cuts will have on rural providers and access to care in rural communities. We have several resources on our website and in this Special Delivery for more information to assist you with making your voice heard. We will continue to keep you updated continually as November 23rd approaches.

Rural communities are known for their “can do” attitude and their ability to rally together in times of need. Thank you for joining CRHC in this time of need and helping us provide the support that allows all Coloradans, rural and urban, to have access to high quality healthcare services. Our mission during the past 20 years has been to support rural healthcare by meeting the needs proactively and immediately and we will continue to keep one step ahead to ensure our members can continue to serve their communities.

Colorado Health Benefit Exchange Board Update

The Colorado Health Benefit Exchange (COHBE) Board recently approved a planning grant proposal for funds to continue developing the Exchange. The enacting legislation passed last year required the Legislative Implementation Review Committee to review and approve any grants prior to their submission. Due to concerns regarding the state’s ability to create a Colorado-specific Exchange and the proposed salaries of the COHBE staff, the Review Committee, split evenly between Democrats and Republicans, was unable to come to an agreement about the terms of the grant. The arguments played out in the Denver Post after their editorial board accused the Republicans of "politicking" and Colorado Republican Senator Kevin Lundberg responded to the editorial stating the grant would require Colorado to conform to federal requirements.

Currently, the COHBE Board, and the Review Committee are working together with the hope that a grant can be submitted by December 30th, but in the meantime, the Governor’s office requested supplemental funding from the current grant in order to support the COHBE activities until an agreement can be reached.

The COHBE Board continues to meet and is in the process of creating their by-laws, defining their relationship with the Attorney General’s office and hiring an Executive Director.

Dr. Jonathan Gruber of Wakely Associates presented data on the profile of the Exchange customers, as well as anticipated premiums. He received feedback from the Data Advisory Workgroup (DAWG), the Board and other stakeholders, and is in the process of compiling a final report. To view those findings, click here.

The Institute of Medicine recently released guidance on the Essential Health Benefits (EHB). The Affordable Care Act requires that insurance plans participating in the exchanges cover, at a minimum, a package of EHBs. The ESBs will likely be available for comment to HHS by late spring 2012.

For more information on the Exchange, the COHBE Board, workgroups of the Review Committee, you can visit www.ColoradoHealthInstitute.org or contact Alicia Haywood of the Colorado Rural Health Center at ah@coruralhealth.org.

CROP Application Deadline Oct. 31

Do you have a healthcare provider at your facility who is interested in loan repayment, or would you like to recruit a provider through loan repayment incentives? The Colorado Rural Outreach Program (CROP) Loan Repayment Program fall 2011 application cycle will be closing on October 31, 2011. Spring applicants who were not awarded are invited to reapply. CROP is a CRHC grant program for healthcare facilities to apply for on behalf of a healthcare clinician. Funding for the fall cycle is generously supported by Caring for Colorado and the El Pomar Foundation.

Eligibility requirements for facilities:

• Public, non-profit or private healthcare facility.
• Located in a designated rural county.
• Ability to contribute a monetary award: Colorado Rural Health Center (CRHC) will “match” this award amount up to $10,000, making the total amount awarded to the clinician $20,000. Award may be funded through other avenues in the community, e.g., a local business, community college, fundraiser, etc.
• Retention grant - facility may apply for CROP on behalf of a clinician already employed.
• Recruitment grant – facility may apply for CROP to assist in recruitment by guaranteeing loan repayment.
• Award may be used for a different financial incentive to a clinician if they do not have loan debt, e.g., a bonus or other community request.

Eligibility requirements for healthcare providers:

• Any clinician providing medical, dental or mental healthcare. Must be providing direct patient care.
• Clinician may be employed at facility or be in the process of being hired

Facility may re-apply for same clinician for up to three years. Facility may apply for more than one clinician, but preference will be given to only one applicant. Awardees will be notified four weeks after application cycle closes.

Please download the application packet and coversheet for more information. Please complete and save the coversheet in Microsoft Word. You may submit your application via e-mail or postal mail. If submitting via e-mail, please make the narrative and all attachments ONE inclusive document. The coversheet may be separate. To resubmit your application please send an email along with healthcare professionals' updated loan repayment documents to rp@corrualhealth.org.

Please send your CROP application to:
Attn: Grants Manager
Colorado Rural Health Center
3033 S. Parker Rd., Suite 606
Aurora, CO 80014
rp@corrualhealth.org
Main: 303.407.2031
Fax: 303.832.7496
http://www.coruralhealth.org/programs/loanrepayment/crop.htm

Rural Facilities and Healthcare Programs Targeted in Deficit Reduction Activities

Critical Access Hospitals and other important healthcare programs face significant challenges as policymakers in Washington work on reducing the deficit and cutting federal spending. The Budget Control Act of 2011, passed earlier this summer, calls for $1.2-$1.5 trillion reduction in federal expenditures over the next ten years. A bipartisan “Super Committee” of 12 members of Congress has been created to develop recommendations for reaching the $1.2+ trillion goal. If this Committee cannot produce a proposal to Congress by November 23, or if Congress fails to approve any proposal by December 23, automatic 2% cuts, or sequestration, will be applied to Medicare provider rates, defense, and other programs.

Rural hospitals and Medicaid have been targeted in various proposals to the Super Committee and to Congress as a whole. Proposals include eliminating the Critical Access Hospital (CAH) program, removing CAH designation for any facility within 10 miles of another hospital, reducing CAH reimbursement to 100% of costs, lowering the federal matching rate for Medicaid to the states, and reducing the Medicaid Hospital Provider Fee. Earlier this month, CRHC co-hosted a webinar with the Area Health Education Centers that outlined the proposals under consideration by the Super Committee and the potential impacts of these proposals and sequestration. If you could not attend, a recording of the webinar and the presentation is available online.

Colorado’s Congressional delegation needs to hear from constituents about the impact these cuts will have on rural providers and access to care in rural communities. Please contact the healthcare staff for your representative, Senator Udall, and Senator Bennet today with these messages:

• Cuts in federal healthcare programs may be inevitable, however, certain deficit reduction proposals being discussed are disproportionately harmful to rural communities and will impact access to care.
• Medicare payments to rural safety net providers, including cost-based reimbursement for critical access hospitals, should be shielded from cuts.
• Ask them to share their concerns with members of the Super Committee and their caucus leaders and encourage them to reach agreement to avoid sequestration.
• Across-the-board cuts required by sequestration will fall harder on rural communities.

CRHC has posted several resources on its website to assist you and thank you for your efforts on behalf of rural providers and communities. Please contact us if you have any questions.

CME Locum Tenens Scholarship Available

The Colorado Rural Health Center is offering Physicians, PA’s, Nurse Practitioners, and Dentists with an opportunity to get scholarship money for locum 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 Locum 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 December 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.

CRHC Offers Free Lean/Six Sigma and QI Education to CAHs

Through CRHC’s iCARE (Improving Communication and Readmission), Colorado CAHs have access to free training in Lean/Six Sigma concepts and Quality Improvement Practices education. Participating CAHs receive technical assistance through webinars, online modules, and one-on-one consultations to help guide them through process improvement related to one of the iCARE projects three primary goals: Improving Communication in Transitions of Care; Maintaining Low Readmission Rates, and Improving Clinical Processes that contribute to readmissions, particularly for heart failure and pneumonia patients.

For more information about participating in iCARE , contact Jen Dunn at jd@coruralhealth.org or Michelle Mills at mm@coruralhealth.org.

CRHC Hosts Rural Health Works Community Health Needs Assessment and Economic Impact Training

CRHC and Colorado STRIDES are hosting the only Rural Health Works Western U.S. regional training slated for 2011-2012. Rural Health Works, which operates out of Oklahoma State University, trains in economic impact studies, community health needs assessment, and budget studies for new or expanded services. Training will take place at CHRC on Tuesday, December 13.

Click here or more information, or to register.

Centura Health Presents Injury Prevention Summit on Friday, November 11th

If you’re interested in injury prevention, come join us for Centura Health’s Injury Prevention Summit on Friday, November 11th at the Julie Penrose Health and Education Center in Colorado Springs. This one-day event promises to be a day of networking and learning with trauma experts and others in the field from around the state. Continuing education credits will be available. Anyone is invited to RSVP and attend.

When: Friday, November 11, 8 a.m. to 4:30 p.m.
Where: Julie Penrose Health and Education Center, next to the St. Francis Medical Center North Care Building (6071 E. Woodmen Rd., Colorado Springs)
Details: Lunch and CE credits provided
Cost: $25 registration fee

Topics include:

• Injury Prevention – How Far We Have Come
• Data Collection – A Necessary Evil
• How Do You Assess Your Community
• Implementation – Getting to Work
• A Program That Works – Case Study
• It Takes a Village! Tapping Into Existing Resources & Building Community Partners
• Show Me the Money!
• Navigating the Federal and State Grant Process
• Are We Making a Difference?

For more information about the event, visit www.centuratrauma.org or see the flyer. To register, please contact Sherrie Rozwick, sherrierozwick@centura.org or 719-776-5926.

About the Centura Health Trauma System
Centura Health’s Trauma System provides an integrated network of specialty care designed to deliver optimal care of the trauma patient through dedicated leadership, expertise and best practices. With our 14 designated trauma centers, Flight For Life® Colorado and the state’s largest EMS support system, our patients have access to a dedicated network of hospitals and operating entities that provide the highest level of care at the most critical time of need. We partner with the communities we serve to provide inter-facility transport, quality and trauma designation review assistance, along with a wide variety of educational, injury prevention and research opportunities. This robust system of care promotes both our pre-hospital and facility partners’ success while providing optimal care to those we serve across the state of Colorado.

Dr. Don: The life of a small-town druggist

In the southwestern corner of Colorado, where the Uncompahgre Plateau descends through spruce forest and scrubland toward the Utah border, there is a region of more than four thousand square miles which has no hospitals, no department stores, and only one pharmacy. The pharmacist is Don Colcord, who lives in the town of Nucla. More than a century ago, Nucla was founded by idealists who hoped their community would become the “center of Socialistic government for the world.” But these days it feels like the edge of the earth. Highway 97 dead-ends at the top of Main Street; the population is around seven hundred and falling. The nearest traffic light is an hour and a half away. When old ranching couples drive their pickups into Nucla, the wives leave the passenger’s side empty and sit in the middle of the front seat, close enough to touch their husbands. It’s as if something about the landscape—those endless hills, that vacant sky—makes a person appreciate the intimacy of a Ford F-150 cab.

Don Colcord has owned Nucla’s Apothecary Shoppe for more than thirty years. In the past, such stores played a key role in American rural health care, and this region had three more pharmacies, but all of them have closed. Some people drive eighty miles just to visit the Apothecary Shoppe. It consists of a few rows of grocery shelves, a gift-card rack, a Pepsi fountain, and a diabetes section, which is decorated with the mounted heads of two mule deer and an antelope. Next to the game heads is the pharmacist’s counter. Customers don’t line up at a discreet distance, the way city folk do; in Nucla they crowd the counter and talk loudly about health problems.

Read the full article published in The New Yorker here.