Update from the CEO: Change is in the air and certainly a theme for 2013

As the latest administrative healthcare event occurred recently with sequestration, I’m left wondering how our history has encountered the various changes throughout the last one hundred years. Perhaps identifying how we got here will help us determine how to effectively handle our future. In 1900, the healthcare options were few – but cheap. The average American spent five dollars a year (an equivalent of $100 today) on their healthcare expenditures. A person didn’t need to budget for catastrophic events, insurance was of no use, and government intervention wasn’t a necessity.

With the development of antibiotics and the trend of maternity wards, hospitals replaced poorhouses, and healthcare administrators realized that people would pay for treatment when very ill. Baylor University located in Dallas invented the first insurance model that paid Baylor hospital on a per person per month (PMPM) basis. Baylor University employees received adequate healthcare, and the hospital was paid on a risk-sharing concept. After the Great Depression hit, hospitals around the country found themselves with empty beds and the Baylor model, now Blue Cross, became very appealing. Thus, the birth of our current insurance system was born and capitalism was linked with medicine.

In more recent years the government has initiated multiple reforms – some successful, others not. In 1965, President Johnson introduced Medicare and Medicaid. The Consolidated Budget Reconciliation Act (COBRA) of 1985 gave employees health coverage options after termination from employment. In 1997, the State Children’s Health Insurance Program (SCHIP) was created to cover children in poverty. A large healthcare reform movement was attempted during the Clinton administration, but ultimately failed. In 2010, the PPACA was passed and healthcare administrators and clinicians have been vivaciously working to accommodate the new mandates since. And just this week, the Colorado Medicaid expansion was signed into law by Governor Hickenlooper.

Our country has a long history that is continuously evolving to meet the demands of our citizens, accommodate new technology, and we must evolve ourselves. One group, one community, or one individual can create change. By building a foundation for coping with change transformation can occur. Fear, frustration and avoidance will be replaced with hope, energy and innovation. So, as we look at the impending consequences of sequestration and other changes in our healthcare system, let’s look at the opportunity to innovate. CHRC looks forward to working with you on innovating through programs like iCARE, Healthy Clinic Assessments and Community Health Needs Assessments. To learn more visit our website at www.coruralhealth.org

News You Need to Know

Featured articles include... A Closer Look: Filling the Rural Provider Gap... Primary Physician Shortage Calls for Intervention...Translating Veterans’ Medical Skills into Nursing Careers... The Aging Workforce: Challenges for the Health Care Industry Workforce... Aging U.S. to Drive Up Heart-Related Health Costs: Study... Oregon's Medicaid Lottery: A Participant's View... Profile of Rural Health Clinics: Clinic & Medicare Patient Characteristics... Rural Areas See Increase in Immigrants

A Closer Look: Filling the Rural Provider Gap

By Emily Berger @Colorado Rural Health Center

May 2013

Meet Katja Austin: a wife, mother, volunteer and rural health care provider! Katja works at Middle Park Medical Center located in Kremmling, Colo. as a Family Nurse Practitioner. She practiced as a Registered Nurse for several years, but recently went back to school to further her education and earn an Advanced Practice Nurse degree. 

Her broader scope of practice as a nurse directly benefits the community by reducing patient wait time and enabling the clinic to serve more patients. Unfortunately though, it left Katja and her family with significant loan debt. Working at a rural facility with salaries averaging twenty to thirty percent less than their urban counterparts did not make the financial burden any easier for Katja. Looking for ways to ease her loan debt without having to leave Grand County, Katja applied for loan repayment from the Colorado Rural Outreach Program (CROP) and was awarded in June of 2011. Read the full story here.

Primary Physician Shortage Calls for Intervention

By Politico

May 8, 2013

The American approach to primary health care is one of the more glaring failures of a dysfunctional health care system that costs almost twice as much per capita as that of any other major country — often with worse results.

Tragically, some 45,000 Americans die each year because they don’t see a doctor until it’s too late. Many others unnecessarily end up in hospitals at great cost and suffering because their illnesses were not diagnosed and treated at the appropriate time. Every day, tens of thousands of men, women and children who lack a primary care medical home flood emergency rooms across the country for nonemergency care at 10 times the cost of a visit to a primary-care facility.

Instituting major reforms in primary care and enabling people to see a doctor when they need one will save lives, ease suffering and save billions of dollars in wasteful health care costs. What should we do? Find out by clicking here.

Translating Veterans’ Medical Skills into Nursing Careers

By RacOnline

April 29, 2013

Today, at the White House Forum on Military Credentialing and Licensing, Health and Human Services (HHS) Secretary Kathleen Sebelius announced a new program to help military veterans with health care experience or training, such as medics, pursue nursing careers. The program is designed to help veterans get bachelor’s degrees in nursing by building on their unique skills and abilities.

Administered by the Health Resources and Services Administration (HRSA) at HHS, the Veterans’ Bachelor of Science in Nursing Program will fund up to nine cooperative agreements, of up to $350,000 a year. Funding of $3 million is expected to be awarded by the end of fiscal year 2013 (September 30).

“The Veterans’ Bachelor of Science in Nursing Program recognizes the skills, experience and sacrifices of our veterans, while helping to grow our nursing workforce,” Secretary Sebelius said. “It helps veterans formalize their skills to get jobs, while strengthening Americans’ access to care.” Find out where program funding will go by clicking here. 

The Aging Workforce: Challenges for the Health Care Industry Workforce

By The NTAR Leadership Center

March 2013

The aging of the U.S. population has tremendous implications for the health care industry, both as employers of an older workforce and as providers of services to a growing number of older patients. By 2050, the U.S. Census predicts that 19.6 million American workers will be 65 years or older, roughly 19 percent of the total U.S. workforce. In fact, the number of individuals in the labor force who are 65 years or older is expected to grow by 75 percent while the number of individuals in the workforce who are 25 to 54 is only expected to grow by 2 percent. By 2016, one-third of the total U.S. workforce will be 50 years or older — a group that may number 115 million by 2020 (Heidkamp, Mabe, & DeGraaf, 2012). Read the full article here.

Aging U.S. to Drive Up Heart-Related Health Costs: Study

By Reuters

April 24, 2013

The costs linked to heart failure in the United States are expected to more than double within the next two decades as the population ages and treatments help patients with the disease live longer, a study released on Wednesday found.

The American Heart Association predicted that the number of Americans with the fatal condition will grow to 8 million in 2030 from about 5 million in 2012. The costs to treat them will rise to $53 billion from $21 billion, the group said in its analysis.

If indirect costs related to heart failure are included, such as lost productivity and wages when patients become too sick to work, the total costs jump to $70 billion from $31 billion over the 18-year period, its study showed. Read the full article here to find out what the steep increase highlights.

Oregon's Medicaid Lottery: A Participant's View

By Kaiser Health News and Washington Post

May 10, 2013

A study of Oregonians who won a 2008 state lottery to get Medicaid benefits has sparked an intense debate about the value of expanding health care to the poor and about the benefits of health insurance in general. The researchers reported in the New England Journal of Medicine last week that those who gained Medicaid coverage used more health services than low-income residents who had not been accepted into the program. But the Medicaid enrollees did not show significantly better blood pressure, cholesterol and blood sugar levels than the other group, although they had lower rates of depression.

After winning the lottery, Mary Carson, 55, was accepted into the Oregon Health Plan, the state's Medicaid program, in 2011. She and her partner live with her three children. They earn about $1,000 a month by making and selling replicas of historic battle knives used in the Civil War and the two World Wars, doing odd jobs and providing respite care for people with cancer. Her comments on a popular blog about some of her own experiences on Medicaid have garnered some attention. 

Kaiser Health News interviewed Carson by phone this week. The following is an edited transcript of the interview.

Profile of Rural Health Clinics: Clinic & Medicare Patient Characteristics

By Rural Health Research and Policy Analysis Center

March 2013

Review of 2009 Medicare Outpatient Claims Data

In 1977, Public Law 95-210 created the Rural Health Clinic (RHC) Medicare and Medicaid reimbursement designation for qualified primary care practices. With over 3,900 certified sites located across the county, RHCs are an important component of the rural health care infrastructure. RHCs can be private/for-profit or non-profit. Some operate as independent medical practices, while others are part of a hospital-owned system or other health care organization (“provider based”). RHCs receive cost-based reimbursement, subject to tests of reasonableness, for primary care services provided to Medicare beneficiaries. 

This Findings Brief is the second in a series on RHCs which draws on a large, national secondary dataset that includes data on all RHCs that bill Medicare. Using data extracted from 2009 Medicare outpatient provider claims, this Findings Brief presents a summary of the geographic distribution and clinic-level characteristics of RHCs, as well as an overview of the Medicare beneficiaries they served. Click here to read the study's key findings.

Rural Areas See Increase in Immigrants

By Daily Yonder

April 5, 2013

In key parts of rural America and ag-dependent metro counties, more than 25% of the population was born in a foreign country.

The percentage of the U.S. population born in foreign countries isn’t as great in rural areas as it in metro America. But the foreign-born population has been on the increase in non-metro areas, especially since 1990.

The Economic Research Service of the U.S. Department of Agriculture has followed this trend and has published a background report on “Immigration and the Rural Workforce.” Below are some key excerpts. You may find the entire report here.

Immigration Bill Aims to Ease Doctor Shortage

By American Medical News

April 29, 2013

Sweeping reforms proposed to update U.S. immigration policy would include additional visa waivers for foreign physicians who agree to practice medicine in rural areas and other regions with underserved patient populations.

Organized medicine groups praised the Senate legislation, introduced on April 16, for aiming to improve international physicians' and medical graduates' ability to immigrate to and work in the U.S. The bill — the Border Security, Economic Opportunity, and Immigration Modernization Act — would strengthen the nation's borders, provide new processes for individuals seeking to live legally in the country, and provide a potential way for some people in the country illegally to become American citizens, proponents said. Read the full article here.

Member of the Month: Heart of the Rockies Regional Medical Center

Heart of the Rockies Regional Medical Center (HRRMC) is a 25-bed Critical Access hospital in Salida Colorado. Located in the Upper Arkansas Valley, HRRMC currently serves over 16,000 residents. The hospital was originally established in 1885 as the Denver and Rio Grande Railroad hospital serving railroad employees. HRRMC provides a full range of services from complete family care to surgery.

HRRMC has been directed under the leadership of Ken Leisher since 2006, who recently announced his retirement. Ken has been at the forefront of HRRMC’s vision to be a world-class rural healthcare organization. “We are proud to offer a host of medical services and surgical specialties; a Family Birthing Center, Level IV Trauma Center, chemotherapy, and the latest diagnostic imaging technology, including digital mammography.” CRHC appreciates Ken’s dedication and contribution to the success of HRRMC over the years. We wish him every success in his retirement.

Robert “Bob” Morasko will take over as CEO on May 28th. Morasko brings with him over 20 years of experience as a CEO in the healthcare industry and recently served as the CEO at Campbell County Memorial Hospital in Gillette, Wyoming. Morasko earned a Master of Business Administration from City University in Washington and is a fellow of the American College of Healthcare Executives. Read more about Bob in the HRRMC press release issued May 6th.

HRRMC has been a member of CRHC for several years and actively participates in a variety of CRHC services and programs, including educational workshops and webinars, annual conferences, the Small Rural Hospital Improvement Grant Program (SHIP), and currently contracts through CRHC’s Colorado Provider Recruitment program.

HRRMC constantly strives to improve the level of patient care it provides. For instance, on Wednesday, October 26th, 2011 HRRMC successfully attested for Stage 1 Meaningful Use of their Electronic Health Records making them the second Critical Access Hospital in Colorado to attest and apply for Medicare EHR Incentive Funds. A CRHC staff member reminisced of this journey stating, “They overcame many obstacles on their journey to Meaningful Use and could not have reached their goal without strong leadership and perseverance.” CRHC was delighted to have had the opportunity to work with Heart of the Rockies as its CO-REC partner to help guide and council them along the way. CRHC continues to support HRRMC and recently celebrated Dr. Loftin, Dr. Sadler and Dr. Moss’s successful attestation to Medicare Meaningful Use in February of this year.

Other notable accomplishments include being named as one of the nation's Best Hospitals for Patient Experience in Obstetrics by the 2013 Women's Choice Award from WomenCertified®. HRRMC was also named one of the HealthStrong™ Top 100 Critical Access Hospitals (CAHs) in the United States, which included only four Colorado hospitals.

Click here to learn more about Heart of the Rockies Regional Medical Center or check them out on Facebook.

Colorado News

Featured articles include...Agriculture Secretary Vilsack Announces Funding for Projects to Boost Rural Electric Grid Efficiency and Reliability... Transforming Health Research on the High Plains... Despite Outrage, Health Exchange Wants Additional $125 Million... New Colorado Medicaid Dental Benefit for Adults to Begin April 2014



Agriculture Secretary Vilsack Announces Funding for Projects to Boost Rural Electric Grid Efficiency and Reliability
By RAC Online
Apr 30, 2013

Funding Includes more than $20 Million for Smart Grid Projects
Agriculture Secretary Tom Vilsack has announced funding for four rural electric projects in eight states to provide reliable, affordable electricity for rural residents. USDA remains focused on carrying out its mission, despite a time of significant budget uncertainty. Today's announcement is one part of the Department's efforts to strengthen the rural economy. Vilsack made the announcement during the legislative conference of the National Rural Electric Cooperative Association in Washington.

One of the rural electric cooperatives that will receive funding is Colorado's Tri-State Generation and Transmission Association, Inc., which serves 44 consumer-owned distribution cooperatives. It is receiving a $73 million loan to upgrade generation and transmission facilities, improve 50 miles of transmission line and build a substation. The loan amount includes more than $18 million for smart grid projects. Click here to read the full article.

Transforming Health Research on the High Plains
By News USA
May 13, 2013

(NewsUSA) - Ned Norman is a rancher. Maret Felzien is an English professor. And conventional wisdom says neither is likely to help healthcare research become more meaningful to patients and caregivers.

But Norman and Felzien, and their rural community in eastern Colorado, are doing just that through the High Plains Research Network (HPRN), a partnership of rural hospitals, clinics and primary care practices that are improving the care they provide to patients through research and quality improvement programs.

The network is one example of the Patient-Centered Outcomes Research Institute's (PCORI) vision for research that meaningfully engages members of the community. That's why PCORI (www.pcori.org) awarded the HPRN a Pilot Project contract in April 2012 to continue its community-based effort through "Boot Camp Translation." Click here to read the full article.

Despite Outrage, Health Exchange Wants Additional $125 Million
By Solutions
May 7, 2013

Despite outrage from some lawmakers who called review of Colorado’s health exchange a “mockery,” a bid for an additional $125 million in federal dollars is likely to move forward by next week.

“I would anticipate that we will sign off on this,” said Sen. Irene Aguilar, D-Denver. This (federal) money exists. If we don’t take it, we’re going to have citizens picking up the costs for their premiums. Our goal is to have the most successful exchange in the country and this is part of that.” To read more click here.

New Colorado Medicaid Dental Benefit for Adults to Begin April 2014

By Daily Dose

May 10, 2013

Colorado’s Medicaid office announced its new adult dental benefit, not offered before in the state, will begin in April of 2014.

Gov. John Hickenlooper is expected to sign the bill authorizing the new benefit this weekend. State health finance officials and consumer health advocates consider the new benefit big progress, as dental benefits have often been an afterthought in public health spending and are not part of the federally mandated minimums. Some states whose Medicaid programs were more flush had offered dental benefits, but Colorado before now had not found the money. For more information click here.

Resources, Information and Distance-Learning Opportunities

CRHC supports events presented by other organizations.  Check out the following resources including topics on EMS, Improving Care Quality, Telemedicine, Medicare, best practices, logic models, conferences...

Collaborative Family Healthcare Association's 15th Annual Conference
October 10-12, 2013
Broomfield, CO

The CFHA Conference is for individuals and organizations interested in innovative and cost effective strategies for integrating behavioral health and medical health care delivery, improving patient outcomes, professional networking and provider training.

The audience includes medical and mental health providers and administrators who seek collaborative solutions to the complex challenges of patient care, as well as: physicians; psychologists; pharmacists; dentists; marriage and family therapists; social workers; nurses; other clinicians; teachers; researchers; consumers, patients and families.

Emergency Medical Services, Community Paramedicine Insights Forum (CPIF)
Cost: FREE
Date: Monday, May 20, 2013 Occurs 3rd Monday of each month
2:00-3:30 pm Central Time
Webinar

On a monthly basis, a 90 minute webinar-based call will be held that features an insightful presentation and a questions session based on experiences and lessons learned from efforts to establish a community paramedicine program somewhere in the U.S. There will also be a focused discussion on a particular "issue of the month", and an open discussion on issues or questions that participants wish to share.

A Community HIE: Optimizing Patient Care in a Secure Environment
Cost: FREE
Date: Wednesday, May 15, 2013
2:00-3:30 pm Central
Webinar

This webinar will feature and demonstrate a community health care provider's experience in developing a secure and effective health information exchange (HIE). Speakers will review legal, privacy and security and other issues involved with implementing HIE, as well as how patient care can be optimized through secure information exchange.

ACA's Opportunities for Improving Care Quality & Efficiency: A Three-Part Series
Cost: FREE
Wednesday, May 15, 2013
Webinar

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.

1. Administrative Simplification and Operating Rules: An Update; 10:00-10:45 am Central Time
2. Gaining ROI By Implementing Federal Operating Rule; 11:00-11:45 am Central Time
3. Consumer Access to Data and the State Insurance Exchanges: An Update; 12:00-12:45 pm Central Time

What Does it Take to Run a Successful Telemedicine Program
Tuesday, May 21, 2013
1:00 p.m. - 2:00 p.m. Central
Webinar

With the advances in technology, telemedicine is no longer rocket science, but to run a successful telemedicine program still takes dedicated staff and knowledge of telehealth principles. During this webinar we will look at some of the challenges to running a successful telemedicine program, key attributes of successful programs and the new occupational roles being developed to support telemedicine programs.

Understanding Medicare Webinar
Cost: FREE
Tuesday, May 21, 2013 - Wednesday, May 22, 2013
12:00-2:00 pm Central Time
Webinar

This webinar is for those wanting to learn or refresh their knowledge of the fundamentals of the Medicare Program. This session runs May 21 to 22, 2013 and again September 17 to 18, 2013.

TeamSTEPPS Implementation: The Good, the Bad and the Ugly
Cost: FREE
Wednesday, May 8, 2013
Noon - 1:00 pm Central Time 
Webinar

Webinar will discuss the University of Washington's approach to implementing the TeamSTEPPS tools and strategies, UW's successes and failures with TeamSTEPPS, and offer lessons learned and strategies for success in using TeamSTEPPS to improve patient safety.

AHRQ: Logic Models Webinar 
Cost: FREE
Tuesday, June 4, 2013
Noon - 1:00 p.m. Central 
Webinar

Advanced Methods Webinars: Contributions to Planning, Executing, Analyzing, and Reporting Research on Delivery System Improvement.

LEAN 6 Sigma: Eliminating Variation in Data Collection: Repeatability, Reproducibility, & Attribute Agreement Analysis
Cost: FREE
Tuesday, May 14, 2013
11:00 a.m. - 12:00 p.m. Central Time
 Webinar

Bad data leads to bad decisions, so how can we know that the data we are collecting is correct and accurate? This presentation will teach participants how to eliminate variation and improve accuracy in their own internal data collection and inspection processes and is especially useful in organizations that rely on observational data for making decisions.

EHR AND MEANINGFULUSE BOOT CAMP
June 27, 2013
11:30am-5:00pm Mountain Time
Double Tree Hotel, Westminster, CO
Bootcamp

Attend the free EHR & Meaningful Use Boot Camp and learn how to incorporate Meaningful Use objectives into your practice to increase efficiency, improve patient outcomes and make the most of the expense and time you put into your EHR adoption. Presented by CORHIO, with David Ginsberg as the featured speaker.

We need your support! Consider partnering with CRHC as a Classic Sponsor.

Help us Educate, Advocate, Collaborate, and Innovate!

Sponsorship is for vendors, for-profit organizations and corporations, and other supportive parties. The fee is $2,000 and benefits are focused on connecting your organization to facilities in need of your products and services.

CRHC Classic Sponsors enjoy numerous unique benefits, including marketing exposure to CRHC’s 3,500 rural and urban constituents across the state and nation. These benefits have been specially designed for businesses who provide essential products and services to our rural facilities and communities. By signing on as a Classic Sponsor, you are supporting rural healthcare and gaining access to a vast audience of decision makers and leaders.

"A Word from our Classic Sponsor" is our monthly feature article submitted by current sponsors.  Each month a sponsor is selected to write an article to be included in the monthly e-newsletter.  In April, Mary Groves with Peck Shaffer and Williams, LLP featured an article about how tax-exempt financing can help build Colorado's healthcare and infrastructure.  Next month will feature Unique Solutions, CRHC's approved group purchasing vendor.  CRHC recognizes that our classic sponsors bring more to the table than great products and services; they bring expertise and a wealth of information that our members can benefit from.

Classic Sponsor benefits include:
•Your organization’s name and a link to your website posted on a Partners & Sponsors page of the CRHC website
•$100 off exhibiting at any CRHC event
•Discounts to attend or sponsor any CRHC event
•Recognition in the CRHC annual report
•Participation and sole sponsorship opportunities for webinars
•Ability to place a feature article about your company in our e-newsletter
•Opportunities for direct referrals

Sponsorship is good for 12 months. Click here to see our current 2013 supporters.  Interested in becoming a sponsor? Click here to become a Classic Sponsor or contact Bridgette Olson, Program Manager, with questions. 

CRHC Sponsored Events

CRHC presents a variety of events throughout the year. Check out our calendar of events for upcoming events. This month features ARHPC Coding Certification Bootcamp in Rifle. Save the Date for other events including the Annual CAH Workshop and 22nd Annual Colorado Rural Health Conference, both held this October in Colorado Springs! Details included...

ARHPC Coding Certification Bootcamp
Coding Certification for Rural Healthcare Facilities
Presented By: John Beard, ARHPC / John Burns, ARHPC
Date: May 21, 22, 23, 2013
Time: Day 1 and 2 = 8:30am - 4:30pm / Day 3 = 8:30am - noon
Location: Grand River Hospital Conference Center / 501 Airport Rd, Rifle, CO 81650

A nationally recognized ARHPC instructor (over 15 years of experience) will provide valuable information needed to meet your coding, reimbursement and compliance goals in 2013.  Topics covered include the following coding manuals: 2013 CPT Professional; 2013 HCPCS; 2013 ICD-9. Click here to register.

Annual CAH Workshop
Save the Date for October 16, 2013!
The workshop will be held at the Crowne Plaza in Colorado Springs, CO.

Including Shift Happens! Making the Connection between Customer Service, Culture Change and Communication – Part Three Workshop of the Fail-Safe Strategies webinar/workshop series as a break out session. Details and registration to come! Please contact Caleb Siem with any questions or for more information.

22nd Annual Colorado Rural Health Conference
October 17-18, 2013
Crowne Plaza Hotel, Colorado Springs
This year's conference will provide participants with a wide range of educational topics, networking, resource opportunities and much more. Registration is open! CRHC has issued a Call for Sponsors and Exhibitors, click here for more information.