Update from the CEO: Change and Transition

Two weeks ago during the Forum an attendee asked me “how are we going to do all of this and still have time to see the patient?” We both nervously laughed and said “well that’s a great question.” These are tough times and recent reports suggest rural quality is lacking. Last week the President released his budget for FY 2014 which proposes budget cuts to critical access hospital reimbursement in addition to the cuts that are taking place as part of sequestration. Meanwhile, more is being asked of our providers, clinics, and hospitals. Rural healthcare is all about relationships and person centered care so the thought of incorporating new requirements is daunting. Although the rural population makes up only nine percent of the state’s population, 17 percent of people between 65 and 84 live in rural counties along with 40 percent of Colorado residents older than 84. Nielsen Claritas, a consumer trending organization, projects that the 65 and over population in Colorado will grow by 24.32 percent by 2017 (CHI Data Repository). Collaboration has become a vital need in meeting the current needs of the aging populations while also preparing for the increasing demands of the future.

During the Forum we had the opportunity to hear from the Prowers County collaboration through the Community Health Needs Assessments (CHNAs). The Federally Qualified Health Center, High Plains Community Health Center, Prowers County Public Health, the hospital, Prowers Medical Center, and Southeast Mental Health Center together conducted a CHNA as an alternative to the traditional independent assessment. The desired outcome was to develop a plan that integrated public health and clinical services into a holistic approach that would maximize the access for their residents while also improving the overall health of their community. This is a model that is being encouraged statewide to bridge the gap between public health, clinical and behavioral health services.

Critical Access Hospitals (CAHs) have also been submitting data to the Centers for Medicare and Medicaid Services Hospital Compare voluntarily, but often their contributions are omitted from the website due to suppressed data, meaning the numbers are statistically insignificant when compared to the metropolitan contributions. Statistical analysis is frequently based off incidences per 100,000 people, which eliminates the ability to measure data in communities of less than 50,000. In late 2011 HRSA initiated a program called the Medicare Beneficiary Quality Improvement Program (MBQIP). MBQIP focuses on aggregating 1,121 CAHs’ data that is submitted through Hospital Compare and using this aggregated data to demonstrate the great quality work being conducted by CAHs throughout the country. Of the CAHs’ in Colorado reporting MBQIP data from fourth quarter 2011 through third quarter 2012 data shows:

Heart Failure Measures Set Average Data Score: 72%

Pneumonia Measures Set Average Data Score: 86%

Half of the state’s CAHs are engaged in CRHC’s Improving Communications and Readmissions (iCARE) program and this year we have added twelve rural clinics. The clinics are focused on the diabetic population and working in collaboration with the hospital team to improve care transitions. Some of our clinics will be starting a pilot test with a tool to assist clinics in communicating with specialists.

All of this work is being connected through a team based approach of addressing our rural communities’ needs in workforce, quality, health information technology or basic business operations and education. While you are learning to see and do things differently, so are we. We will continue to provide our valued members the most current information in healthcare reform and offer programs relevant to your needs.

A Word from our Classic Sponsor: Peck Shaffer & Williams LLP

Tax-exempt finance is helping to build Healthcare and Infrastructure in Colorado
By Mary Groves

Heart of the Rockies Regional Medical Center has been providing medical care in the mountains of central Colorado for more than 125 years. Today, it serves a region of nearly 20,000 people. Thanks to tax-exempt financing and the government status that it enjoys, Heart of the Rockies is providing that care in a new state-of-the-art facility offering advanced medical technology and practices.

In fact, Heart of the Rockies expects to save more than $16 million in interest payments over the 30-year period of the $30.2 million bond issue for the new facility, thanks to the lower interest rates made possible by the tax exemption on municipal bonds.

Throughout Colorado, health care facilities tell the same story. Rangely District Hospital and Yuma District Hospital both recently built new facilities, also with the benefit of tax-exempt financing. Senior living facilities, such as Christian Living Communities, Shalom Park, and Frasier Meadow have also completed building projects using tax-exempt bonds.

In fact, tax-exempt financing for local governments has helped build our nation’s hospitals, clinics, schools, roads, bridges, water and sewer systems, libraries, airports and other infrastructure for more than a century. It is a critical tool for the country’s economic development. Local officials, elected by local voters, driven by local concerns, are making the decisions about these local projects. And they are paying for them with local money.

However, as our nation’s lawmakers lurch from fiscal crisis to fiscal cliff – from debt ceiling debates to “fiscal cliffs” to sequestration – budget hawks are suggesting eliminating the tax-exempt status of municipal bonds. They view this tax exemption as a “loophole” depriving the U.S. Treasury of as much as $37 billion.

Tax-exempt municipal bonds finance infrastructure critical to our economy and communities. Basic utilities such as water and sewer are financed with tax-exempt bonds, as are public buildings, hospitals, clinics, schools, roads, bridges, jails, police and fire equipment (computers, fire trucks, emergency communications systems), libraries and airports. Three-quarters of the country’s public spending on roads, highways, water and sewer systems and other infrastructure is paid for by state and local governments, who are also solely responsible for building most of the country’s educational facilities.

As with Heart of the Rockies, government-owned healthcare providers and nonprofit institutions such as hospitals and museums also rely on tax-exempt bonds. Hospitals have tremendous capital needs to keep up with ever-changing technology, and most of that comes through tax-exempt bonds. The bond market provides access to the market that is not otherwise available. Taxable issues are too small to compete in the corporate bond market, leaving hospitals and museums with banks as their only other source for borrowing money, and banks generally have more difficult loan terms.

Tax-advantaged housing finance is one of the main sources of capital for “affordable housing,” another public benefit which should not be taken away.

Middle class, domestic households are the largest category of municipal bond investors, and retail investors as a whole own approximately 70 percent of municipal bonds. According to the IRS, in 2010 52 percent of all bond interest paid to individuals went to those with incomes of less than $250,000. Moreover, according to the same data, 57 percent of tax exempt income is reported by people over the age of 65, often on fixed incomes.

The real benefit of tax-exempt bonds is to state and local governments, including public hospitals, nonprofit healthcare providers and local taxpayers. If tax-exempt borrowing goes away, costs of local borrowing will go up and those costs are ultimately borne not only by local taxpayers, but also by hospital patients, renters, students and public utility ratepayers.

Tax-exempt finance is not a budget gimmick or a loophole. It’s essential for repairing, expanding and building the infrastructure our economy needs in the future.

Mary Groves is the managing partner of the Denver office of Peck Shaffer & Williams LLP, a national leader in public finance law. She has more than 30 years' experience in a broad range of traditional and conduit public financings, including projects for private schools, colleges, senior housing, healthcare providers, charter schools, cultural institutions and faith-based service providers. She is called on by many non-Colorado borrowers who use the multi-jurisdictional authority of Colorado's statewide health and education issuers.

Member of the Month: Sedgwick County Health Center

Julesburg, CO located in the most northeast corner of Colorado is the first town in our state to greet travelers heading west to the Rocky Mountains. With a population of 2,341, it is a small town, but is the hub of the healthcare community for the county. Sedgwick County Health Center is the umbrella organization for five distinct business lines: Sedgwick County Memorial Hospital (25-bed Critical Access Hospital), Sedgwick County Memorial Nursing Home, Valley Medical Clinic (Rural Health Clinic), Jacob J. and Anne B. Walter Memorial Living Center, and Valley Medical Clinic in Big Springs, NE. This health center is the largest employer in the county and works closely with its community to provide quality and compassionate healthcare to its residents.  

Sedgwick County Health Center participated in many innovative and exciting programs with Colorado Rural Health Center this past year! Some highlights of their activities include two Healthy Clinic Assessments where their overall score improved from 87% to 96% - a huge accomplishment! Both the hospital and clinic are participating in iCare, Improving Communication and Readmission and have completed a process mapping as part of this project.

"We are using the iCARE diabetic collaborative as not just a gathering of information but to make a definite change for a diabetic patients to improve their overall care." Deb Nail, Clinic/Business Office Manager

In 2012, Sedgwick hospital and the community of Julesburg participated in a Community Health Needs Assessment (CHNA). A CHNA uses data sets to identify needs within the community.  Community stakeholders identify issues they feel are important and develop solutions in which they want to participate. Key positive findings of Sedgwick County’s CHNA are:

• Up to 20% of the health center’s patient population come from outside of Sedgwick County
• Between 2012 and 2017 it is predicted that there will be a 11.91% increase in population of individuals ranging in age from 65-74
• Sedgwick County ranks in the top 25 counties for overall health in Colorado
• Sedgwick County ranks 1 in Colorado for least amount of tobacco use, 1 in best environmental quality and 7 in lowest unemployment rate.
• Violent crimes were at a rate of 1.8 per 1,000 people between 2007-2009 compared to 3.5 in Colorado overall
• Between 2006 and 2010, Julesburg had a population of 10% of people who smoked. Healthy People 2020’s goal is at 12% and Colorado has a percentage of 17.2.

If you are interested in learning more about Sedgwick County Health Center, click here to visit their website. Sedgwick County Health Center is a close collaborator and has been a Colorado Rural Health Center Member for nearly 10 years.  We thank them for their support and continue to work closely with this amazing health center and community. 

Nonprofit SORHs Strengthen Collaboration

    In February, directors and staffers from nonprofit State Offices of Rural Health (SORHs) met in Colorado to collaborate and exchange information. “For the last ten years, every other year or so, we get together and talk about the trials and tribulations of being a nonprofit SORH,” said John Barnas, executive director of the Michigan Center for Rural Health. The meeting was sponsored by NOSORH as an Educational Exchange program.

    There are three nonprofit SORHs—Michigan, Colorado and South Carolina. These are independent, 501c3 membership-based organizations with their own board of directors (of the other 50 SORHs, 10 are university-based, and the rest are located in their state’s health department).

    Michelle Mills, CEO of the Colorado Rural Health Center, which sponsored the meeting, said the event allowed participants to “share membership, revenue opportunities and structure of our SORHs.” Topics included revenue-generating strategies, policy initiatives, team and staff organization, membership structure, developing relationships with potential sponsors, and working with Rural Health Clinics. Click HERE to read more.

CRHC Sponsored Events

THE FORUM

Thanks to everyone who participated in the 2013 Forum conference.  Two hundrend participants gathered at the Sheraton Denver West in Lakewood, CO April 3-5 for this annual event hosted by CRHC and ClinicNET.  Dr. Winston Wong set the stage, with his keynote discussion on Wednesday morning and was followed by Bill Finerfrock who covered federal healthcare policies.  In all, over 30 speakers presented at the Forum, sharing their knowledge and expertise with attendees.  

We would also like to thank our event sponsors for their support. Without their generous contributions, we would be unable to host these events.  We would especially like to thank our Gold Sponsor...Kaiser Permanente for hosting Dr. Wong. 

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SAVE THE DATE

22nd Annual

October 17-18, 2013

Crowne Plaza Hotel - Colorado Springs, CO

Click here to register.

Opportunities to sponsor and exhibit at this conference are now available. Click here for more information and to register.

See if Your County is Considered Rural by HRSA!

Click here to see if your county is considered rural by HRSA.

Colorado Provider Recruitment Quarterly News!

    Spring is here and that means residency and school presentations are in full swing. Colorado Provider Recruitment (CPR) presented at Rocky Vista University for Family Medicine Physicians and presented for Practice Essentials.  Two more Practice Essentials Workshops are in the works as well as a Family Nurse Practitioner Program presentation at Regis University!

    CPR placed four provider this quarter (January-March) including a family physician, physician assistant, dentist and a family nurse practitioner to practice all over rural Colorado.  This brings CPR’s total number of placements since the program’s inception in 2001 to 169 total providers placed.  152 of these placements were in Health Professional Shortage Areas (HPSAs).

    For more information about the CPR Program, please contact Sara Leahy, CPR Program Manager at sl@coruralhealth.org. 

The Rural Health Virtual Training Gateway

    The Rural Health Virtual Training Gateway newsletter was developed for the State Flex Programs, rural hospital contacts, rural networks, and those involved in rural health care across the country. The Newsletter highlights upcoming distance-learning educational opportunities that can be found on the National Rural Health Resource Center's Rural Health Virtual Training Gateway.

    If you have any questions, or any educational opportunities that you would like posted, please contact Kate Stenehjem at 218-727-9390 ext 236.

Post Deployment Care Integration for Rural

    RHPI continues its emphasis on working with our civilian provider partners in bringing this live broadcast event on caring for today’s returning combat Veterans. Dr. Lucille Burgo and Dr. Stephen Hunt, two highly recognized VHA experts on providing post deployment care to Iraqi and Afghanistan theater combat Veterans, will speak with you about what to expect in the families, communities, and medical practices that embrace our returning warriors (whether it is a VA based practice or a local community provider), as well as how to make the best use of VA resources and supporting programs in caring for their needs.

    This is a great way to build on your knowledge of a very special patient population, pick up extra CME/CEU, is available for your participation inside or outside the VA firewall, and as always will allow interaction with both of the presenters and with other participants. And of course, this is available at no cost to you. Take a moment right now to register for this broadcast by selecting the following link . If you need any assistance at all in either enrolling with MyVeHU Campus, or registering for the event, please feel free to contact their support team at support@myvehucampus.com We look forward to having you with us once again. The event will be held on Thursday, April 25, 2013, 1:00 - 2:10 pm ET

ACA's Opportunities for Improving Care Quality & Efficiency: A Three-Part Series

    HIMSS has developed a three part series exploring how the healthcare reform bill will transform mandates into real world patient care. Each session builds on the content from past sessions, which are available on demand.

Part 1
Wednesday, October 3, 2012
The Impact of the Affordable Care Act on Health IT: An Update
12:00 p.m. - 1:00 p.m. Central Time

Part 2
Wednesday, April 3, 2013
Quality Measures Development: An Update
12:00 p.m. - 1:00 p.m. Central Time

Part 3
Wednesday, May 15, 2013
Administrative Simplification and Operating Rules: An Update
10:00 a.m. - 10:45 a.m. Central Time
Gaining ROI By Implementing Federal Operating Rules
11:00 a.m. - 11:45 a.m. Central Time
Consumer Access to Data and the State Insurance Exchanges: An Update
12:00 p.m. - 12:45 p.m. Central Time

Click here for more information.