Update from the CEO: Unprecedented Future in Healthcare

The rain here in Colorado over the past several days has surpassed our annual totals and our thoughts are with those individuals and communities that are experiencing the destructive aspects of this weather.

2013 is passing quickly and fall is nearly upon us and the implementation of the Affordable Care Act (ACA) is just around the corner.  As we venture into this new territory we are filled with a sense of uncertainty as well as the complexity of the ACA.   Recently, the Office of the Inspector General (OIG) released recommendations to reduce Medicare reimbursements that would jeopardize two thirds of the nation’s critical access hospitals.  The Colorado marketplace, Connect for Health Colorado, will open October 1^st and will bring private health insurance into a public market.  Healthcare providers have increasing pressures to improve population health resulting in reduced hospital readmissions through the CMS Readmission Program.  Further, the ACA calls for improved mechanisms for the recruitment and retention of the healthcare workforce.  And the triple aim is the foundation of all these efforts – to improve quality and outcomes, while reducing costs.

As your Colorado State Office of Rural Health (SORH), it is our responsibility to provide the education, linkages, tools, and energy necessary for our members during this time of profound healthcare evolution.  In 1991, the SORH was developed as a Federal-State program.  Today, Colorado is still unique in that we are one of three states that operate their SORH as an independent 501(c)(3).  Our organizational structure allows us to broaden our response to current healthcare trends through vital technical assistance programs.

In August, Colorado’s U.S. senators and representatives were home in their districts while Congress was in recess.  Recess provided an opportunity for CRHC to connect with the federal electeds, as well as members of their staff.  CRHC engaged members of Congress regarding a recent report from the Office of the Inspector General.  If the recommendations in the report were adopted, the necessary provider status and related funding would disappear from 35 percent of Colorado’s Critical Access Hospitals (CAHs).  In addition, CRHC partnered with ClinicNET to celebrate the fourth annual Safety Net Clinic Week.  Elected officials at all levels of government participated throughout the week by touring Rural Health Clinics or community safety net clinics in their district.  Also, two CRHC board members were among a small group of stakeholders who met with Senator Bennet regarding the SGR (Sustainable Growth Rate).  The Senator was collecting feedback as members are in support of a full repeal and replacement of the SGR this fall.

To read more about the OIG report, Safety Net Clinic Week activities, the SGR conversation, or to find out how you can participate in the conversation, read the full article here. 

CRHC is taking a holistic approach to working on readmissions and the triple aim.  In 2010, CRHC started a program called iCARE (Improving Communications and Readmissions) as an opportunity to engage crucial access hospitals in a statewide improvement project aligning with national trends and funding priorities.  This program is funded through the Health Resources and Services Administration (HRSA) FLEX dollars.  In 2012, we expanded the program to include provider based rural health clinics and 2013 we are partnering with local public health departments and patient navigators/care coordinators.    As the hub of healthcare in their rural communities, critical access hospitals and rural health clinics are well-positioned to be leaders and have a significant impact on the communities they serve.

The initiative focuses on three primary goals:

(1)   improve communication in transitions of care,

(2)   maintain low readmission rates, and

(3)   improve clinical processes contributing to readmissions, particularly for heart failure, pneumonia and diabetic patients

Read more about the program here.

Achieving the triple aim is certainly a huge undertaking and one that has a great deal of moving parts.  While some of our rural health clinics are poised to actively engage in our iCARE program others are working towards the triple aim through our Healthy Clinic Assessment work, which involves making improvements in basic business operations.

In addition to the activities listed above our rural hospitals and clinics have been actively engaged in implementation of Stage 1 Meaningful Use, which is certainly another step towards quality improvement, care coordination and connection among patients and providers.

As you know, rural providers are among the most difficult to recruit and retain to healthcare positions.  CRHC is the only Colorado organization with a department solely devoted to addressing this problem through direct recruitment.  Studies show that one rural physician annually generates approximately $1.5 million in community revenue, nearly $1 million in payroll, and 23 additional jobs.  In August, Colorado Provider Recruitment (CPR), the CRHC recruitment department, placed three providers to rural communities.  Read more about these placements here.

We exist because of the healthcare professionals dedicated to serving our rural communities.  Because of the incredible efforts of our members, we strive to be the voice of Colorado rural health.  Our programs are quantitatively validated by a high level of participation.  In fact, out of the 109 healthcare provider and facility members, 80 percent are actively engaged in our services.  Mia Hamm, the famous American soccer player, said “I am a member of a team, and I rely on the team, I defer to it and sacrifice for it, because the team, not the individual, is the ultimate champion.”  Together, we are the champions for rural health in Colorado. 

We end this year by planning for an unprecedented future in healthcare.  We hope our current members will continue to support one another and take advantage of our invaluable services.  We also hope future members will join our network to further strengthen our united voice.  You can find out how to get more involved here.

CRHC Seizes Advocacy Opportunities

CRHC Seizes Advocacy Opportunities

September 2013

 In August, Colorado’s U.S. senators and representatives were home in their districts while Congress was in recess. Recess provided an opportunity for CRHC to connect with the federal delegation, as well as members of their staff, through various advocacy activities. 

On August 15th, the Office of the Inspector General released a report with recommendations that if implemented, would mean loss of designation and funds for as many as 35 percent of Critical Access Hospitals (CAHs) in Colorado. CRHC sent letters (click here to review copy of letter) to our US senators and representatives reminding them of the vital role these small, rural hospitals play in their communities. In Colorado, 15 percent of the population lives in rural areas, and those rural Coloradans depend on CAHs for access to inpatient and outpatient services, as well as 24-hour emergency care. Without access to these services, the health of the population in these communities will decline. If a hospital closes in a rural community, the entire economy irreversibly erodes. Nationally, the average CAH creates 107 jobs and generates $4.8 million in payroll annually. In Colorado, the proposed changes could mean a loss of as many as 1,100 jobs in CAHs across the state!   

August 19th through the 23rd was dedicated to celebrating the fourth annual Safety Net Clinic Week (SNCW). CRHC launched SNCW in 2010 in an effort to raise public officials’ awareness and understanding of federally certified Rural Health Clinics (RHCs) and community safety net clinics. The week is dedicated to celebrating and understanding the critical role of these clinics in providing healthcare services to low-income uninsured and underinsured Coloradans. 

The week was kicked off during an open house at Doctors Care, a community safety net clinic in Littleton. More than 25 community members, as well as policymakers, attended the event, and Governor Hickenlooper’s Senior Health Policy Advisor, Katherine Blair, read the Governor’s proclamation declaring Safety Net Clinic Week. Over the course of the week, 11 state senators and representatives, Congressman Polis, and two staffers from the offices of Senator Bennet and Congressman Coffman, toured clinics. Additionally, seven clinics celebrated by holding open houses. 

On August 30th, CRHC board members John Ayoub (CEO, Melissa Memorial Hospital in Holyoke) and John Gardner (CEO, Yuma District Hospital in Yuma) met with Senator Bennet and a small group of stakeholders to discuss the Sustainable Growth Rate (SGR). The SGR is an equation for determining the level of Medicare physician reimbursement. It was created by Congress in 1997 to control the growth in aggregate Medicare expenditures. As of January 1st of 2014, physicians face a 25 percent cut under the formula.

The cost to fix the SGR this year is considerably lower than projected in the past. Therefore, there is a bipartisan commitment to a full repeal and replacement of the formula this fall. CRHC will stay in communication with our elected officials as they debate options to replace the SGR, while also engaging in discussions to make sure the money to pay for the fix doesn’t come from cuts to already underfunded rural health programs.

Congress returned to Washington this month after a long recess. Members of the house and senate want to hear from you about how policy changes will impact your practice or facility. You can find out who represents you and how to contact them by clicking here. Additionally, CRHC is here to be a resource. Don’t hesitate to contact us with your questions or stories about how these proposed changes impact your facility. We will continue to collaborate with elected officials as policy options are considered and inform them about the impacts of proposed changes on access and delivery of care in rural Colorado.

To get more involved with policy and advocacy devoted to rural health, contact Alicia Haywood, Policy and Advocacy Manager.

Member of the Month: Ryon Medical and Associates

Ryon Medical and Associates is an integrated healthcare clinic providing medical and mental healthcare to residents in Southeastern Colorado.  The clinic is located in La Junta and specializes in family practice, psychiatry, counseling and mental health for all ages.

Martin Masar is the Chief Executive Officer at Ryon Medical and Associates and holds a Masters in Social Work from Creighton University.  Prior to his current position as CEO at Ryon Medical, Masar worked at the Colorado Boy’s Ranch in La Junta.  It was during his time at the Boy’s Ranch that he met his current business partner, Kevin Harsh.  Harsh was the Director of Nursing at the time, and when the Boy’s Ranch closed, Masar and Harsh developed a business plan to renovate the old Boy’s Ranch building into a full service family clinic – now Ryon Medical and Associates.

The clinic provides a variety of services to its clients, including outpatient family medical services, outpatient mental health services, assessments and evaluations, referrals to medical centers, after hours services available by appointment, same day appointments, private and confidential treatment, psychological testing, educational testing, eldercare evaluations and nursing care center evaluations. 

Focusing not only on the physical wellbeing of its patients, Ryon Medical and Associates provides an array of mental health services.  In fact, Ryon Medical and Associates has collaborated with the Region Six Alcohol and Drug Abuse Treatment Center (RESADA) to expand its services.  Through this partnership, outpatient substance abuse treatment is available for individuals who suffer from substance abuse. 

Ryon Medical and Associates is also the recipient of a Department of Justice grant to fund the Sexual Assault Response Project.  A project coordinator has been hired and will provided education and training opportunities throughout the valley.  The program trains professionals in the care, treatment, trauma and forensic examination of assault victims. 

Ryon Medical and Associates recently joined the Colorado Rural Health Center (CRHC) membership.  “We are excited to have a rural clinic providing integrated care join our membership,” said Melissa Bosworth, Director of Workforce and Outreach at CRHC, “Not only are we happy to provide technical assistance and resources to the clinic, but we are able to share their success and challenges with other rural clinics that are moving towards integrated care.”

 The CRHC’s Quality Improvement Specialist, Kathryn Steele, recently visited the clinic to conduct a Healthy Clinic Assessment.  “This is an amazing clinic;” said Steele, “Martin and his staff at Ryon Medical are committed to treating the whole patient.”

For more information about Ryon Medical and Associates, check them out on Facebook.

Colorado Provider Recruitment Placement Update

In the past three weeks Colorado Provider Recruitment (CPR) has placed four providers in rural Colorado!

• A Physician Assistant will be going to Spanish Peaks Regional Health Center in September
• A Family Physician will be working at Delta Family Physicians starting in October
• A Physician Assistant will be starting at Yuma District Hospital and Clinics in October
• A Family Physician will be providing care at Kinder Family Clinic starting in September

Congratulations to all of the facilities and their new providers! We are so pleased that our recruitment team was able to help foster these connections. It is our hope that the providers will deliver excellent healthcare in their new communities for many years to come.

If you are interested in recruiting a healthcare provider for your vacancy, please contact CPR at cpr@coruralhealth.org

Recap from Safety Net Clinic Week

Colorado Rural Health Center's CEO Michelle Mills, said people often think all parts of the critical healthcare safety net are supported by federal funds, but the realities are startlingly different.

"Rural Health Clinics and Community Safety Net Clinics often receive very little if any federal funding; instead they rely on complex and vulnerable funding streams. Mobilizing efforts to ensure all safety net providers are recognized and adequately funded is essential to ensuring our ability to continue delivering care to some of the state's most at-risk residents," Mills explained. Click here to read the full article published on Market Watch on August 16, 2013.

4th Annual Health Care Career Event, Colorado Hospital Association

The Colorado Hospital Association will be hosting their 4th Health Career Event Monday, October 14th at Sports Authority Field from 1pm-6pm. This event will be kicked off by Art Gonzalez, Dr. P.H., FACHE, Chief Executive Officer, Denver Health, who will say a few words to experienced job seekers about adapting to health care changes as a mid-career professional. Free career coaching workshops for experienced health care professionals led by Phyllis Quinlan, RN-Bc, PhD will take place at 1:30 and 3:30pm.

The early bird discounted booth cost for exhibitors is $749 through Sept 15st and includes a free job posting to the National Healthcare Career Network.

For more information click here.

To reserve a booth click here.

Brian Depew named the new Executive Director of the Center for Rural Affairs

Center Friends,
It is an exciting and exhilarating time for rural America. That is why I am proud, honored and excited to be named the new Executive Director of the Center for Rural Affairs. I look forward to working with all of you to create a vibrant future in small towns across the country.

I owe much to a great staff, a great board, important allies and many of you. We will do this work together, and I invite you to be in touch. You can reach me by clicking here. I hope you enjoy these news articles about what we’ve been up to this month!

Best, Brian

AHA: Medicare RAC Requests Up 47% Over the Past 6 Months

Since the fourth quarter of 2012, medical record requests from Medicare Recovery Auditors, or RACs, to hospitals have increased 47 percent, according to the American Hospital Association's RACTrac Survey for the second quarter of 2013.

Over the same six-month timeframe, Medicare RACs have boosted their complex audit denials to hospitals by 58 percent. Of complex denials, two-thirds of hospitals said medical necessity denials are the costliest types of RAC requests.

More than 1,200 hospitals participated in the AHA's second-quarter RACTrac Survey. Click here to view other key findings published by Becker's Hospital Review on August 29, 2013.

Clout, not costs, drives higher charges from hospitals, study says

Bargaining leverage, not the cost of providing complex care, is the main reason why some hospitals can demand prices twice as high as their competitors' and still get contracts to treat privately insured patients, according to a new study.

The analysis by the Center for Studying Health System Change of actual payments to hospitals and physicians by private insurers in 13 U.S. cities found that the most expensive hospitals got rates as much as 60% more than the lowest-priced competitor for inpatient care, and prices that were double the competition for outpatient care.

Read the full article published by ModernHealthcare.com on September 5, 2013 here.

ACO Manifesto: 50 Things to Know About Accountable Care Organizations

Only a couple of years ago, it wasn't uncommon for healthcare experts to call accountable care organizations "unicorns." Despite the excitement and discussion around the model, few people had seen one.

ACOs have grown to become much more visible within the past three years, as more than half of Americans now live in primary care service areas served by ACOs. To better understand the model and its role in healthcare reform, Becker's Hospital Review collected the following facts about ACOs. Topics include ACO goals, terminology, geographic spread, payment structures, and the specifics of Medicare and commercial ACOs.

To learn more about individual ACOs, read the 2013 list of "100 Accountable Care Organizations to Know."

ACO basics:

1. The term "accountable care organization" was coined in 2006 by Elliott Fisher, MD, director of the Dartmouth Institute for Health Policy and Clinical Practice in Hanover, N.H.

2. An accountable care organization is a group of payers, physicians, hospitals and other healthcare providers that voluntarily collaborate to provide efficient, high-quality and coordinated care to an assigned population of patients. If providers reduce costs and/or improve specified quality metrics in a certain timeframe, they are able to receive financial rewards from or share in the savings with Medicare or a commercial payer. ACO arrangements can also involve risk, in which the provider would have to pay back a portion or all of the costs that exceeded the payer's established benchmark. Read more of ACO's Basics published by Becker's Hospital Review.

6 Tips on Rebranding a Community Hospital Under a Health System

When smaller hospitals are rebranded under a large health system, there may be concerns that the hospitals will lose their personal touch and become more corporate or distant. For Flint, Mich.-based McLaren Health Care and its 10 Michigan hospitals, however, that was not the case. In 2012, it changed the hospitals' names, rebranding the entire organization under the McLaren name and logo. For example, Bay Regional Medical Center in Bay City became McLaren Bay Region, Central Michigan Community Hospital in Mount Pleasant became McLaren Central Michigan and McLaren Regional Medical Center in Flint became McLaren Flint. Although their names changed, their commitment to patients remained.

Here are six tips for ensuring community hospitals retain their connection to the community when undergoing a brand change under a large health system.

1. Do market research. McLaren conducted focus groups and other market research to determine community members' reactions to a possible name change. The result was overwhelmingly positive, which was a major factor in McLaren's decision to move ahead with the rebranding. "The McLaren brand had been growing for some time, so we had good brand equity built into that name," says Kevin Tompkins, vice president of marketing at McLaren. "However, in many cases, people weren't aware their local hospital was part of the McLaren system." Read 2-5 by clicking here.

Wielding the Carrot and the Stick: How to Move the U.S. Health Care System Away from Fee-for-Service Payment

The U.S. health system is plagued by fragmented care, variable quality, and high and rapidly growing costs. Underlying these problems is the prevalence of fee-for-service payment, in which health care providers are paid per visit, test, or procedure. Not only does fee-for-service payment fail to provide incentives for efficiency, quality, or outcomes, it encourages the provision of unnecessary care and often discourages coordination of care and management of patients across providers and settings.

A broad range of policy experts have called for the adoption of alternative approaches to paying for health care. But how do we move our $2.9 trillion health system from fee-for-service payment to other approaches?

Three elements are key to successfully moving toward alternative payment approaches:

• The carrot—Implement policies that reward high performance and encourage changes in the organization and delivery of health care.
• The stick—Reduce and eventually eliminate the option of remaining in the fee-for-service payment system. 
• The muscle—Coordinate policies across public programs and private payers so they are applied consistently and their impact is maximized.

Read more by clicking here.

Life as an Independent Rural Hospital: Q&A With Duncan Regional Hospital CFO Doug Volinski

Three and a half years ago, Doug Volinski, CFO of Duncan (Okla.) Regional Hospital, arrived at the small independent hospital with a growing plate of experience.

He previously was the compliance officer at Valley Baptist Medical Center in Harlingen, Texas eventually becoming Valley Baptist's interim CFO and ultimately its vice president of finance. He then moved to Fort Oglethorpe, Ga., just south of Chattanooga, Tenn., as the CFO of Hutcheson Medical Center before heading west to Duncan Regional.

"I've had a lot of different experiences, and in this industry, the more and variety of experiences you have gives perspective," Mr. Volinski says.

Here, Mr. Volinski explains the major issues at Duncan Regional, the strength of the hospital's balance sheet and what other CFOs of small rural hospitals should be focused on right now.

• Q: Duncan Regional Hospital is a small, independent, 145-bed community hospital. As CFO, what are the biggest issues you're working on right now?
• Q: What is the hospital's balance sheet like today, and how does it compare to five years ago?
• Q: How would you describe the competition in the area? I understand the area is fairly spread out.
• Q: How is Duncan Regional being innovative with commercial payer contracts? Are there certain things you're doing with the Uniteds and Aetnas to make sure your reimbursement stays strong? And what is your payer mix?

Find out what Mr. Volinski's answer were by clicking here.

Care coordination may lead to less competition, higher prices, article says

Better medical care may arise from new public policies to promote more coordination from hospitals, doctors and others in healthcare, but there may be a high price to pay, two economists cautioned in a new article.

More coordination may lead to less competition and greater leverage for hospitals and doctors to raise prices, wrote Katherine Baicker of Harvard University and Helen Levy of the University of Michigan, in a New England Journal of Medicine essay that outlines the tension and risks associated with growth of new healthcare payment models.

“Well-integrated provider networks may promote coordinated care that improves the allocation of healthcare resources, but they are likely to undermine competitive pressures to keep prices down while maintaining lower quality,” the authors wrote. “Coordinated systems may thus deliver the right care to the right patient at the right time, but at the wrong price.” Read more here.

Moody's: 132 Statistics on Nonprofit Hospital Medians

Last week, Moody's Investors Service issued its annual medians report for nonprofit hospitals, finding that providers had a strong balance sheet in fiscal year 2012 but profitability metrics were down compared with FY 2011.

For the first time since FY 2008, Moody's found expenses outpaced revenue in nonprofit hospitals and health systems. Overall, median operating revenue growth dropped from 5.4 percent in 2011 to 5.2 percent in 2012. Net patient revenue growth dropped to 4.7 percent, more than a half-percent lower from 2011.

Balance sheets remained strong due to better returns from investments and more prudent capital spending — and Moody's analysts said strong cash reserves are "an important credit factor while operating in a period of unpredictability."

Several other trends bubbled to the surface after analyzing Moody's most recent hospital metrics, including the following: click here to read the list.

Criminal allegations in NM behavioral health system no surprise to one advocate

“I haven’t read the audit” of the providers in question, “but I do have concerns about the … allegations because it wouldn’t surprise me,” said Carol Miller, a longtime critic of the way behavioral health is carried out in New Mexico. “Patients and beneficiaries are often the low priorities.” Earlier this summer, the state’s Human Services Department suspended payments to more than a dozen providers after an independent auditing firm from Boston confirmed what the department said was warning signs of potential misuse of dollars. Click here to read the full article by Rob Nikolewski of the New Mexico Watchdog.

Colorado’s Data Tangle Shows Strain for Obamacare Targets

With 33 days and counting until online health insurance exchanges must open for business, states are racing to fine-tune computer systems, educate consumers and manage expectations. Marketplaces in California and Oregon said this month that technical hurdles may force consumers to apply with a broker or counselor instead of online when the exchanges start Oct. 1. In Colorado, managers are literally working around the clock to ensure computer systems share accurate Medicaid data. Click here to read the full article by Jennifer Oldham and Annie Linskey, published August 28th, 2013.

How the ACA will impact veterans and their families

The U.S. Department of Veterans Affairs (VA) recently gave a presentation to HRSA and other HHS representatives here in Denver on the topic of how the Affordable Care Act (ACA) will impact veterans and their families. They provided some resources to help veterans and their families understand what the ACA means for them, and where their decisions and choice points are. The links below can serve as resources for veterans who may be among your clients and have questions about their options when choosing between Health Insurance Marketplace participation and receipt of VA benefits. Check out: http://www.va.gov/health/aca/ or http://www.va.gov/health/aca/FAQ.asp

Exclusive: Technical snafus confuse charges for Obamacare plans

Technical glitches still plague the display of new healthcare plans to be offered to millions of uninsured Americans starting in 26 days, including how medical charges and deductibles are listed, industry officials say.

Health insurers planning to sell policies to people who are currently uninsured, under PresidentBarack Obama's healthcare reform, say they expect the problems will be remedied by October 1, when consumers will be able to buy health insurance from state exchanges. On Wednesday, the Centers for Medicare & Medicaid Services (CMS), the lead Obamacare agency, said it was on schedule to sign final agreements with insurers between September 9 and September 11, allowing them to sell specific policies on the exchanges.

"Our timeline remains the same," said CMS in a statement, "and we are working to ensure that any issues are resolved before open enrollment." Click here to read more.

How the Health Care Law is making a difference for the people of Colorado

Because of the Affordable Care Act, the 85% of Coloradans who have insurance have more choices and stronger coverage than ever before. And for the 15% of Coloradans who don’t have insurance, or Colorado families and small businesses who buy their coverage but aren’t happy with it, a new day is just around the corner.

Soon, the new online Health Insurance Marketplace will provide families and small businesses who currently don’t have insurance, or are looking for a better deal, a new way to find health coverage that fits their needs and their budgets.

Open enrollment in the Marketplace starts Oct 1, with coverage starting as soon as Jan 1, 2014. But Colorado families and small business can visit HealthCare.gov right now to find the information they need prepare for open enrollment.

The health care law is already providing better options, better value, better health and a stronger Medicare program to the people of Colorado by: read what better options are available be clicking here.

Study: PPACA Won't Cause Premium Increases for U.S. Overall

The Patient Protection and Affordable Care Act won't cause widespread increases in premiums on the individual insurance market, according to a RAND Corp. report.

Analysts found the U.S. overall and five of the 10 states they examined — Texas, Florida, Kansas, South Carolina and Pennsylvania — will see no change in individual health insurance premiums under the law. However, Minnesota, North Dakota and Ohio could see premium increases of up to 43 percent, according to the report.

In Louisiana and New Mexico, premiums standardized for age, actuarial value and tobacco use could decline under the reform law. In states where premiums go up, people could still pay less out-of-pocket for insurance coverage if they qualify for federal tax credits to cover part of their premiums, according to the report.

The PPACA won't produce significant overall changes in small group or small business premiums either, analysts found. Small group premiums standardized for age, actuarial value and tobacco use will remain unchanged for the U.S. overall and nine states — Texas, South Carolina, Ohio, Pennsylvania, North Dakota, Louisiana, Minnesota, Kansas and Florida, according to the report. Read more here

The Commonwealth Fund Connection Survey: Millions of young adults gaining health coverage under Affordable Care Act, but awareness of new marketplaces still low

An estimated 7.8 million of the 15 million young adults who were enrolled in a parent’s health insurance plan last year likely would not have been eligible for this coverage without the health reform law’s dependent coverage provision, according to a new Commonwealth Fund survey. But as of March 2013, just 27 percent were aware of the new state health insurance marketplaces that are launching October 1.

Meanwhile, millions of low-income young adults are at risk of remaining uninsured if the states they live in choose not to expand Medicaid eligibility.

Visit commonwealthfund.org to read more about the survey findings and to check out our new infographic, "Young Adults Want Health Insurance." Read the full article here.

HHS extends equal coverage to same-sex Advantage beneficiaries in skilled-nursing facilities

All beneficiaries in Medicare Advantage plans will now receive access to equal coverage when it comes to care in a skilled-nursing facility where their spouse lives, regardless of sexual orientation, HHS announced Thursday.

The guidance specifies that certified married same-sex couples would be eligible for this equal coverage and care even if they reside in a state that does not legally recognized their marriage.

This is the first HHS guidance responding to the recent U.S. Supreme Court ruling striking down the 1996 Defense of Marriage Act, which barred the federal government from recognizing same-sex marriages. But it's not likely to have wide application because Medicare coverage of skilled-nursing care is limited and the odds of both spouses being in the facility for short stays at the same time is small. Read the full article here.

Reform Update: N.Y. joins controversial care-coordination pilot for dual-eligibles

Despite controversy surrounding a national pilot to coordinate coverage and care for people dually enrolled in Medicaid and Medicare, New York announced Monday it would join six other states in the demonstration headed by the CMS.

The program, called the Financial Alignment Initiative and authorized by the Patient Protection and Affordable Care Act, has seen more than half of the 26 states that originally signed up either drop out or delay their start dates.

New York's demonstration, known as Fully Integrated Duals Advantage, is slated to begin after July 1, 2014, and run through the end of 2017. The program is intended to integrate and coordinate services in order to better address the long-term care and social needs for the 170,000 residents identified as dual-eligibles. Read the full article here.

EHR Contracts: Key contract terms for users to understand

Who is this for? Health care providers who plan to acquire electronic health record (EHR) systems should benefit from learning about the contract terms discussed in this document. When this document uses the term “you” it means purchasers and users of EHR systems who are or may become legally bound by EHR technology developer contracts.

Why should you read this? This document explains a few key EHR contract terms and what you need to know about them. Understanding these terms may help you select an appropriate EHR system and protect your practice or organization from business and patient safety risks that may arise when you rely upon EHRs for critical aspects of your operations. It should help you make sure that your EHR system does what you expect and that you have ways to manage issues as they arise. If you misunderstand these terms you may not be able to rely on your contract to help prevent disruptions to your practice.

What else do I need to know? Read the full document here.

The Great EHR Migration: Why Two Organizations Made the Switch

More than one in six providers currently using an electronic health record system has plans to change vendors within the next year.

Many of these providers are physician practices upgrading to meet meaningful use requirements or replacing a poorly-functioning system, but hospitals have increasingly been switching to new vendors as well. The financial and labor outlay required to change EHR systems is no small matter — meaning the hospitals contemplating a switch have very good reason to do so.

"There were a lot of outside forces that affected our decision," says Lisa Moffett, health information manager of UHS Delaware Valley Hospital in Walton, N.Y., of her hospital's decision to change EHRs in its physician practice. For example, Medinotes, the initial EHR system at UHS Delaware, didn't meet meaningful use criteria. "Like every other hospital, we have those incentives on our minds," she says, as well as the looming threat of noncompliance penalties. Click here to read the full article.

Report: Cerner, Epic acquired 75% of new EHR hospital business last year

Cerner and Epic combined acquired slightly more than 75 percent of new electronic health record contracts at large (more than 200 beds) acute-care hospitals last year, according to a report by KLAS.

According to the report, more than 400 large hospitals do not currently have an EHR system, providing an opportunity for the market to keep evolving.

"This mass migration [to EHRs] is clearly not over," said Colin Buckley, one of the report's authors, according to a Healthcare Global report. "The question is which way [hospitals without EHRs] will go and which factors will guide that decision." Read more here.

Data Breaches: Discovery and Prevention Techniques

"Most hospitals don't know all the data breaches they have," says Mac McMillan, current chair of the privacy and security task force at the Healthcare Information and Management Systems Society. He had very recently worked with a large hospital system that inadvertently provided a patient online access to another patient's record as the result of an administrative error. The hospital wouldn't have known about the error had the patient not called to let them know, he says.

"That's still where we are today — a lot of hospitals don't find out they've had a breach until someone tells them," says Mr. McMillan. Therefore, "from a strategic perspective, data protection has to be a combination of user awareness and reaction to incidents, and how we handle information management going forward."

Brett Short, chief compliance officer at the University of Kentucky's Chandler Medical Center in Lexington, has made a point of urging all medical center employees to report any potential breach. This year's employee training has emphasized teaching employees to identify circumstances that could result in compromised data, and report all such instances to his office for further investigation. Learn more here.

CHA Selects Alteryx Analytics Software to Improve Health Care Quality Statewide

Alteryx, Inc., the leading provider of Strategic Analytics software, and the Colorado Hospital Association (CHA), the leading voice of the Colorado hospital and health system community, today announced that CHA has chosen Alteryx Strategic Analytics to enable the Association to more efficiently and accurately evaluate the impact of legislative and policy proposals at federal and state levels. CHA will use Alteryx to rapidly blend clinical and financial data from a variety of sources and apply predictive analytics to help the Association understand the impact of policies on its members. Click here to read the full article, released on PRNewswire on August 29th, 2013.

Southern Colorado agencies seek mental health grant to expand EMS

A seven-bed behavioral health ward and expanded respite and residential services are at the center of a plan to beef up mental health care in the Pikes Peak region - all with the goal of keeping many of those patients out of hospital emergency rooms. A consortium involving the Colorado Springs-based AspenPointe outlined its plan Wednesday in a grant application to the Colorado Department of Human Services, which expects to award nearly $20 million in September to transform emergency mental health care across the state. Up to $3.8 million of that total could come to the department's southeast Colorado region, an area including Colorado Springs and about 20 counties. Much less would likely flow to the Pikes Peak region. Click here to read the full article by Jakob Rodgers, published August 28th, 2013.

Improving health and reducing premature mortality in people with severe Mental illness

Click here to read the Department of Health and Human Services's grant application requirements.

National Standards for Culturally and Linguistically Appropriate Services in Health and Health are: A Blueprint for Advancing and Sustaining CLAS Policy and Practice

Health equity is the attainment of the highest level of health for all people (U.S. Department of Health and Human Services [HHS] Office of Minority Health [OMH], 2011). Currently, individuals across the United States from various cultural backgrounds are unable to attain their highest level of health for several reasons, including the social determinants of health, or those conditions in which individuals are born, grow, live, work, and age (World Health Organization [WHO], 2012), such as socioeconomic status, education level, and the availability of health services (HHS Office of Disease Prevention and Health Promotion [ODPHP], 2010a). Though health inequities are directly related to the existence of historical and current discrimination and social injustice, one of the most modifiable factors is the lack of culturally and linguistically appropriate services, broadly defined as care and services that are respectful of and responsive to the cultural and linguistic needs of all individuals. Read the full document by the Office of Minority Health and U.S. Department of Health and Human Services by clicking here.

Medicaid Handbook: Interface with Behavioral Health Services

Price: FREE
Reviews Medicaid and its role in financing services and treatment for mental health disorders and substance use disorders. Discusses services included in state Medicaid plans, the role of the provider, reimbursement, and other factors related to Medicaid. Click here to find out more.

Can health IT reduce health disparities? New ONC report explores opportunities

Inequality related to race, ethnicity, and socioeconomic status is one of our nation’s most vexing problems, and it affects health status, access to health care, and health care quality.

Unfortunately, health disparities in access to quality care are common. The Agency for Healthcare Research and Quality’s (AHRQ) 2011 National Healthcare Disparities Report indicates that:

• Blacks received worse care than Whites for 41% of quality measures and Hispanics received worse care than non-Hispanic Whites for 39% of measures
• Uninsured individuals aged 64 and under were far less likely to have a usual source of primary care than individuals with insurance 
• Low-income individuals received worse care than high-income people for almost half of the quality measures

New ONC Report: Understanding the Impact of Health IT in Underserved Communities and those with Health Disparities. 

What our research at ONC has found, however, is that health information technology has the potential to alleviate these inequalities.

ONC recently issued a report that looks at how communities and providers are using health IT to address the specific needs of populations experiencing disparities in access, quality of care, and health outcomes. The report was based on previous work: click here to read more.

Health & Wellness Resource Library

Click here to review resources such as: A Healthy Heart, Breathe Deep, Eat Wise Move Often, and many more on The Centers for Family and Children's website.

Hispanic teens more likely to use drugs, study says

Hispanic teens are more likely to use illicit drugs such as marijuana, ecstasy and cocaine, compared with their African-American and Caucasian counterparts, according to a new study.

The study was released this month by the Partnership at Drug Freeorganization.

It says that 54% of Hispanic teens reported having used an illicit drug, followed by African-American teens at 45%. Caucasians came third at 43%.

Why? There is no definitive answer, but there are contributing factors involved, according to William Raikes, assistant director of consumer research at The Partnership at Drugfree.org.

A larger percentage -- 62% of Hispanic teens -- have been offered drugs such as ecstasy, crack/cocaine, heroin and methamphetamine at least once, compared with 53% of Caucasian teens and 46% of African-Americans. Read the full article here.

Geographic variation in access to care — The relationship with quality

Three decades of research focused predominantly on costs and the use of services among Medicare beneficiaries has repeatedly found wide regional variations in health care experiences and health system performance.1Much less attention has been paid to variations in access to care and their associated implications for quality of care and health outcomes. Our recent Commonwealth Fund report, “Rising to the Challenge: Results from a Scorecard on Local Health System Performance,”2 shows that when we look beyond state averages, there are staggeringly wide gaps in people's ability to gain access to care in different communities around the country. We also find a strong and persistent association between access and health care quality, including the receipt of preventive care.

Simply put, where a person lives matters — it influences the ability to obtain health care, as well as the probable quality of care that will be received — though it should not matter in an equitable health care system. This and other Scorecard findings have important implications that are relevant to national policy reforms and to newly available resources for improving access and quality of care. Learn more here.

Substantial disparities in health and health care persist among populations across the United States

The Issue:

At a time when health care providers and policy-makers are exploring new models to promote better health and improve health care, different populations experience persistent and increasing disparities in health status. In the United States, life expectancy and other health status measures vary dramatically depending on factors, such as race, sex, educational attainment, and zip code, that should not make a difference. This brief reviews recent research on health disparities.

Find out "What’s Next?" by clicking here.

RAC program more accurate than lobbyists

Medicare's much-criticized recovery audit program is far more accurate than hospital lobbyists say it is, though it's far from perfect and detects too little fraud rather than too much, according to a new report from HHS' Office of the Inspector General.

Of the 1.1 million cases in 2010 and 2011 in which a recovery auditor recommended denying Medicare payments, only 6% of those were ever appealed, according to figures drawn from Medicare's database of recovery-audit claims. Healthcare providers won only 44% of those appeals, the OIG's report said. Read more here.

Reform Update: Michigan Legislature approves Medicaid expansion, but will the CMS?

In the wake of the Michigan Legislature's approval of a plan to expand its Medicaid program to include an estimated 470,000 low-income residents, some observers are questioning whether the Obama administration will OK the state's request to require enrollees to pay up to 5% of their income for cost-sharing.

The Republican-controlled Michigan Senate narrowly approved a measure last week to expand the state's Medicaid program to include all childless adults with incomes up to 138% of the poverty line, or $15,500 for an individual; the state House of Representatives approved the Senate version today. Five percent of a $15,500 income is nearly $800, which experts say is a lot of money for someone at that income level. Read more here.

Federal Policy Implementation under the Affordable Care Act: Six issues whose final resolution awaits, as implementation moves forward

Full implementation of the Affordable Care Act (ACA) begins in less than 2 months, when open enrollment in the new Health Insurance Marketplace commences. All of the essential policy decisions on which implementation turns are in place and the new Health Insurance Marketplace – the heart of the law – will begin enrolling individuals and small groups when open enrollment begins on October 1.

Since the Act was signed into law on March 23, 2010, the Obama Administration has published more than 70 final rules implementing its provisions (See Appendix A). These final rules, which range from health insurance market reforms to pending regulation of the nutritional information available on food packaging, breathe life into the Act’s broad policies.

Find out what he Administration has supplemented by reading the full article here.

In Colorado’s emergency response, a rural-urban divide between life and death

A new report by the National Highway Traffic Safety Administration found that 55 percent of those who died in road crashes in 2011 lost their lives in rural areas, while only 19 percent of the population lived in rural areas. In Colorado, 51 percent of those who died in 2011 crashes perished on rural roads, according to the same report. Part of this disparity is the result of geography. Part is the result of philosophy — emergency care is concentrated where the most people live. And part is an outgrowth of Colorado’s long history of “local control” — where local officials figure out how best to care for those who suffer life-threatening traumatic injuries. Also, many rural areas are served by volunteers whose dedication is not in question but whose training and experience may pale compared to their urban counterparts.

“If you live in urban Colorado, the response is quick,” said Randy Kuykendall, interim director of the state’s emergency medical system. “If you live in rural Colorado, it’s longer, and it’s a day-to-day struggle.” And Kuykendall acknowledged that no one from the state has tried to determine exactly which areas fall into an emergency ambulance no-man’s-land - places where there is no contracted ambulance service. As it stands now, neighboring agencies respond into those areas. Click here to read the full article published September 4th, Summit Daily.

Causes and Consequences of Rural Pharmacy Closures: A Multi-Case Study

The RUPRI Center for Rural Health Policy Analysis completed case studies in six rural communities that lost their only remaining retail pharmacy since 2007. In five of the six communities, residents now either drive to the nearest pharmacy or use mail- order to receive their prescriptions and, in some instances, receive their prescriptions through a courier service from a pharmacy in a nearby town. Access to pharmacy services in these communities is of most concern for individuals with limited mobility and those who lack a support system that can pick up and deliver their prescriptions (e.g., the elderly and people with acute conditions). Rural communities will need to continue exploring options for delivering pharmacy services given the financial difficulties inherent in the traditional model of the local independent pharmacy. Click here to read the full report written by RUPRI Center for Rural Health Policy Analysis.

Additional Resource of Interest:

Rural Pharmacy Closures: Implications for Rural Communities
Independently Owned Pharmacy Closures in Rural America
More information about the RUPRI Center for Rural Health Policy Analysis

Project ECHO Brings Pain Expertise to Rural Docs

Rural areas typically are underserved by pain specialists, so primary care doctors may be on their own when caring for patients with chronic pain or may have to refer patients long distances for a pain consultation. To address this problem in New Mexico, doctors at the University of New Mexico in Albuquerque created a telementoring program in 2009 called Project ECHO (Extension for Community Healthcare Outcomes) Chronic Pain. Project ECHO Chronic Pain Program is co-directed by Joanna G. Katzman, MD, a neurologist, and George D. Comerci, Jr., MD. Dr. Katzman, Director of the UNM Pain Center, spearheaded creation of the program “as a way to leverage scarce pain resources for primary care providers working in rural and underserved areas” where their patients had to wait many months for a specialty pain consultation. Click here to read the full article by Jody Charnow, published September 5th.

House bid to undo dialysis cuts shows lobbyists’ muscle

Eight months ago, Congress ordered the Obama administration to eliminate a stark example of federal government waste: more than $500 million a year in excessive drug payments being sent to dialysis clinics nationwide.

But in a demonstration of just how hard it is to curb spending in Washington, more than 100 of the same members of Congress who voted in January to impose the cut are now trying to push the Obama administration to reverse it or water it down. Read the full New York Times article here.

Trends in cancer care near the end of life

Even though most patients with advanced cancer prefer care that minimizes symptoms, many still receive intense treatment and are not admitted into hospice care until their last three days of life, according to research from the Dartmouth Atlas Project. Although hospice care for Medicare patients with advanced cancer is increasing, so are the rates of treatment in intensive care units.

Since the last Dartmouth Atlas report, the trends in end-of-life cancer care across the country have been mixed. While patients are spending fewer days hospitalized in the last month of life, the number of days in ICUs has increased. Hospice days have also increased, but a growing proportion of patients begin receiving hospice services in the last three days of life, a time period often too short to provide patients the full benefit of hospice care. Find out what the key finds where here.

Transdisciplinary collaboration and endorsement of pharmacological and psychosocial evidence-based practices by medical and psychosocial substance abuse treatment providers in the United States

Transdisciplinary collaboration refers to the work of diverse service providers – physicians, nurses, social workers, psychologists and paraprofessionals – with distinct training and specializations (McCallin, 2001). Transdisciplinary collaboration has been shown to improve both the management and quality of care (Orchard, Curran, & Kabene, 2005; Pinto, Wall, Yu, Penido, & Schmidt, 2012), and is particularly relevant in substance abuse treatment which often requires the concurrent use of psychosocial and pharmacological interventions (Anton et al., 2006; Volkow, Fowler, Wangand, & Swanson, 2004). Regrettably, research is lacking about how substance abuse service providers compare in terms of their endorsement of pharmacotherapy and psychosocial interventions. Read the full length article here.

Financial Factors and the Implementation of Medications for Treating Opioid Use Disorders

Opportunities to effectively treat opioid use disorders (OUDs) are enhanced by the availability of pharmacological treatments. Unlike substance use disorders (SUDs) associated with stimulants or cannabis where such treatments are not yet available, there are effective pharmacological treatments for OUDs, namely methadone, buprenorphine, tablet naltrexone, and, most recently, a depot formulation of naltrexone. The diffusion of buprenorphine and naltrexone has been remarkably slow, in part because of the financial resources required to implement pharmacotherapies.

For the past 40 years, specialized opioid treatment programs (OTPs) offering methadone have been the primary setting for treating opioid-dependent patients. Historically, the nation’s OTPs have been inadequate in number to meet the demand for treatment. In 2000, before the Food and Drug Administration’s (FDA’s) approval of buprenorphine, OTPs constituted just 9% of US treatment facilities for SUDs, and methadone was included in the treatment plans of just 40% of all opioid treatment admissions (Substance Abuse and Mental Health Services Administration, 2002). The combination of the FDA’s approval of newer medications (Ling and Smith, 2002; Saxon and McCarty, 2005) and regulatory changes allowing for the prescription of buprenorphine in non-OTP settings (Jaffe and O’Keeffe, 2003) has increased the potential of expanding medications for addiction treatment (MAT) throughout the treatment system (Roman et al., 2011). Read the full article here.

Randomized treatments may be more effective at stopping disease outbreaks

Herding cats is a cakewalk compared with getting people to take flu vaccine shots in the last weeks of summer—work, school, limited pharmacy hours, beach days and countless other factors conspire to interfere. As a result, vaccinations tend to trickle in over many months. Rather than resisting this tendency, some mathematicians now think that public health officials may one day embrace it. A bit of randomness in treatment schedules may actually help manage a disease outbreak. Read more here.

Undergoing transformation to the patient centered medical home in safety net health centers: Perspectives from the front lines

The community health center movement, initiated in 1965, provided a system of federally qualified health centers (FQHC), which were designed to reduce health disparities among racial/ethnic minority groups, the poor, and uninsured by providing affordable, accessible, and high quality primary care services.1 The FQHC system has grown to provide primary care service to over 20 million patients at over 8,000 sites.2 These organizations are collectively referred to as safety net health centers (SNHCs), and include rural and migrant clinics, free clinics, and county health clinics. To enhance capacity to provide affordable, accessible, and quality service, many FQHCs and other SNHCs are embracing the patient centered medical home (PCMH) model. Click here to read more.

Patient experiences: Rural, safety net, and teaching hospitals

Click here to view the group report.

How ideas become innovations: Roundtable with healthcare innovation leaders from UCLA, Ohio State

Innovation is increasingly becoming an important discipline for many of the country's hospitals and health systems. Leaders are dually tasked to build a culture that promotes the sharing of ideas and a willingness to learn, but they must also ensure the creative process is formalized and methodical. Here, four leaders from two of the top academic medical centers in the country share their approach to innovation.

Los Angeles-based UCLA Health System has and continues to deliver a range of innovations, from how employees answer the phone to the integration of military veterans as primary care coordinators. Molly Coye, MD, MPH, is chief innovation officer for the system and oversees the UCLA Institute for Innovation in Health. David Feinberg, MD, MBA, is president of UCLA Health System and CEO of UCLA Hospital System. Both participated in the roundtable. Click here to read more.

Innovations in addiction treatment Providers working with Integrated Primary Care Services

On April 16, 2012, the SAMHSA-HRSA center for integrated health solutions convened a meeting of substance abuse providers that have integrated primary care services. the meeting aimed to gain insights and perspectives from addiction treatment programs, and their primary care partners, experienced in integrating primary care services. this document is structured around the aspects of the organizations’ integrated services, including events that precipitated their integration efforts, common and significant challenges, and lessons learned, with additional information to help other substance abuse providers integrate service delivery with primary care. it also aims to inform other specialty substance abuse treatment providers interested in integrating primary care. Click here to read the full article.

Quality matters in focus: Learning health care systems

Government agencies, health care systems, and private companies are using data drawn from electronic medical records and administrative claims to advance medical knowledge. The tools they're developing are helping to monitor the safety and effectiveness of drugs already on the market, predict an individual's risk of developing different diseases, and identify those patients most likely to benefit from a given intervention. Click here to read the full length article.

Quality matters Q&A: Using machine learning to sort through treatment options

Quality Matters: You've said what Google is to search Watson is to discovery. What do you mean by that and why is it important as Watson delves into medicine?

Gold: If you think about your own experience doing searches on the Internet, you get millions of results that you have to sort through to find the ones that are contextually relevant. Watson is a little more thoughtful. It's looking to understand the context of the question and bring back not an answer, but a set of responses that are aligned to the questions, supported by evidence, and weighted by confidence. The reason that's so important, especially in health care, is that there is often more than one possibility of what's wrong when you describe your symptoms to a doctor. The cause could be viral or bacterial and even if you know it's bacterial, you have to consider a host of other things: which bacteria, what comorbidity issues are present, what medications you're taking, your family history, and what's happening in the general populace at any given time. For instance, if you knew there was an early outbreak of pollen that year because everyone was blogging and tweeting about it, you may draw a different conclusion if your throat is scratchy.

Quality Matters: How is Watson able to make sense of such disparate information? Click here to read more.

Chicago Public Health: Q&A with Bechara Choucair

Last week the Public Health Accreditation Board (PHAB) awarded five-year national accreditation status to five public health departments, bringing the number of health departments now accredited to 19 since the credential was launched two years ago. Hundreds more health departments are currently preparing to apply for accreditation, which includes a peer-reviewed assessment process to ensure it meets or exceeds a set of public health quality standards and measures. Among the newly accredited is the Chicago Department of Public Health.

"This is an important achievement and recognition that highlights the city of Chicago’s ongoing commitment to health and wellness on the part of all of our residents,” said Chicago Mayor Rahm Emanuel in a statement issued by PHAB. Click here to read the full article.

To promote wellness, Public Health Departments are launching apps. Will they work?

The Alabama Department of Public Health is venturing into the mobile universe as the first state with a health app for residents.

“Normally Alabama comes in last when it comes to health indicators, but we were one of the first states to be on Facebook and Twitter and YouTube. This is just another goal for us,” says Jennifer Pratt Sumner, the director of the digital media branch of the department.

The app, which is free to download from Google Play or iTunes, brings all of the social media feeds put out by the various public health divisions into one place. It also provides health news alerts and information about wellness events, such as the annual Alabama Youth Rally. Some recent tips included educational conferences open to the public, and tips on safely consuming shellfish in the state. Click here to read more.

4 Technology strategies required for population health management success

As healthcare moves toward value-based care and ultimately an at-risk payment environment, population health management is emerging as the delivery model required for success. Born before health reform, population health management is fundamental to the new system's "triple aim" — to improve health outcomes, lower costs and enhance the patient's care experience.

Population health management strives to achieve the triple aim "one patient at a time" by ensuring that people receive appropriate and timely preventive and chronic care, assistance navigating the system and resources to help them become more informed and engaged in caring for themselves. Click here to read more.

The value of pediatric symptom-checkers

A common pediatric injury is a tear in the tissue connecting the upper lip to the gum, usually the result of a fall. It's also a minor injury and will heal on its own without stitches.

It can seem anything but minor to parents, however, as the injured site will bleed every time the lip is pulled out to examine it.

"That's why in the symptom-checker, if you go to 'mouth trauma' it's all spelled out for them," says Barton Schmitt, MD, the creator of one of the world's first online symptom-checker platforms currently used on more than 200 hospitals' and physicians' websites. "It tells parents, just stop looking at it, it always heals." Click here to read more.

New Report: Enumeration and Characterization of the Public Health Nurse Workforce

Report finds high job satisfaction among public health nurses, but many state health departments struggle to fill vacancies.

Key Findings:

• There is significant need to strengthen the education and training of public health nurses.
• Providing clinical services is part of the work done by RNs in state and local health departments, but these nurses assume a wide variety of roles.
• The national public health nurse workforce in state and local health departments is not as racially and ethnically diverse as the country’s population. Further, few minority public health nurses serve in leadership positions.
• The public health nurse workforce is aging; however, most RNs do not intend to retire within the next five years.
• Public health nurses report high levels of job satisfaction, despite reporting high levels of dissatisfaction with salary compensation.

64% of public health RNs indicate they would like more training and professional development opportunities. Read the full report.

Top 20 most-recruited physician specialties

Family medicine and general internal medicine are the top two most-recruited medical specialties, according Merritt Hawkins' 2013 Review of Physician and Advanced Practitioner Recruiting Incentives.

This trend is not new — primary care physicians have topped Merritt Hawkins' list for the past seven years. The demand for primary care physicians is driven in part by the growth of healthcare sites across the country. "The new mantra in healthcare is to be 'everywhere, all the time.' This means reaching into communities with a growing number of free-standing facilities or other sites that are convenient and accessible," Mark Smith, president of Merritt Hawkins, said in a news release. "These facilities have one thing in common — they all need primary care physicians." Click here for more information.

Salaries offered to the top 20 recruited physician specialties: 42 statistics

Of the 20 most-recruited physician and advanced practitioner specialties, 13 had higher average base salary offers in 2012-13 compared with the year before, according to a report from physician staffing firm Merritt Hawkins.

Merritt Hawkins based its data on nearly 3,100 physician and advanced practitioner search assignments from April 2012 through March 2013.

Hospitals, health systems, accountable care organizations and other healthcare organizations heavily recruited primary care physicians — like those in family medicine or internal medicine — the most in the past year. However, their salary offers only increased marginally, and for some, such as family physicians and pediatricians, their starting salary offers were actually down year-over-year.

Orthopedic surgeons continue to command the highest salary offers, though their average salary offer dropped 7 percent in 2012-13 to $483,000 compared with the year prior.

Here are 42 statistics on average base salary offers to the 20 most heavily recruited physician specialties and advanced practitioners over the past year. Note: Figures only represent base salaries or guaranteed income. They do not include production bonuses or benefits. Data is sorted by highest average salary offer from last year. Click here to see which specialties are in high demand.

3 Tips for Hospitals to Improve Employee Recruitment

Although many hospitals and healthcare systems have recently instituted layoffs to stay afloat, some healthcare organizations are still having trouble filling their open positions. According to a recent CareerBuilder survey, 48 percent of nursing jobs and 39 percent of allied health jobs go unfilled on average for six weeks or longer.

Vacant positions in healthcare organizations can lead to a myriad of issues, including lower employee moral and higher voluntary turnover. So why are so many positions remaining vacant? According CareerBuilder, the most common reason is that organizations are getting applicants who do not have relevant or enough experience for the position.

Fortunately, there are several things hospitals and health systems can do to either build up or bring in candidates with more experience and improve their employee recruitment efforts as a whole. Jason Lovelace, president of CareerBuilder Healthcare, shares three tips here.

1. Develop pathways to build employee experience.
2. Attract more experienced candidates.

Click here to read the third tip.