Special Delivery: January 2014

Update from the CEO: Opportunities in the New Year

Happy New Year!

With the start of every year we are faced with both opportunities and challenges. The opportunities that lay ahead are highlighting the power of rural and strengthening what we do best, primary care! As you know primary care is highlighted and a central part of the Affordable Care Act and how our country intends to move forward with healthcare.

Last year the National Rural Health Association (NRHA) released a policy brief entitled, The Future of Rural Health. I have the great honor and privilege of sitting on the NRHA Policy Congress, the entity that wrote the document. The policy brief highlights why rural health is different, the current status of the rural health system, environment for change, core concepts and principles of rural health services, concerns unique to rural health, the role of electronic technologies, innovative approaches to improving access, quality and cost, incentivizing new models of care, and transforming existing models of care. As you know, with the implementation of the ACA, healthcare is changing at a rapid pace and many rural healthcare stakeholders struggle with how to meet current requirements and demands while looking towards and preparing for the future. The brief states that “the current rural safety net programs are not structured for success in this new environment.” How do we utilize this information to help inform and guide our work? We need a way to “outline a meaningful phased and non-destructive transition strategy that successfully links today’s payment and patient care delivery structures to the health care systems of the future.” Easier said than done. The following covers CRHC’s plan on helping you succeed given the challenges detailed in The Future of Rural Health.

In Colorado, despite the current volume-based payment mechanism and lack of capital, rural hospitals and clinics are moving towards new models of care such as patient-centered medical home, care coordination and quality reporting. This is a delicate balance, since many of our rural hospitals and clinics are facing increasing fiscal limitations. Did you know that CRHC has a financial workgroup that meets quarterly to discuss challenges, opportunities, and current best practices? We are utilizing financial data from iVantage to inform these conversations and will be aggregating this data to inform policy makers on the Hill in Washington D.C. next month (February 5th). CRHC is also developing reports intricately examining rural health data to inform community conversations and create evidence-based model change innovation. Be on the lookout in our Special Delivery for release date. Health Information Technology is here to stay and almost all of the rural hospitals and over half of the rural health providers that CRHC has worked with have achieved Stage 1 meaningful use. While technology is frustrating and very expensive, rural Colorado has faced this challenge just like we always do, with flexibility and perseverance – equaling success.

“The need for transitional support cannot be over emphasized, noting rural payment and delivery policies must preserve what we have until we have clarity of where we are going.” We must keep the current payment structure while the future is being planned! This is vital for access, for care, and for the economic success in our rural communities. CRHC will be the primary source to advocate on your behalf! “The goal of rural health advocates should be to improve the health of rural people.” CRHC’s mission is to enhance healthcare services in the state by providing information, education, linkages, tools, and energy toward addressing rural health issues. Since 1991, our mission has remained relevant and even more so today.

Primary care is the key – it’s what you do best and what the future holds. Capitalize on this, use it to sustain the health of your population, grow your services, and help your communities thrive. Has your clinic received a CRHC administered Healthy Clinic Assessment (HCA)? If not reach out and improve your processes and systems to build and strengthen the foundation for the future. You can then focus on patient centered medical home (PCMH), quality improvement and ultimately care coordination. Did you know that two Rural Health Clinics (RHCs) in Colorado have achieved NCQA PCMH Level 3 status? So can you! Did you know that seventeen clinics and hospitals are participating in CRHC’s iCARE program focusing on improving care coordination, improving communications, and diabetic outcomes, while decreasing incidences of heart failure, pneumonia, and hospital readmission rates? If you haven’t gotten involved reach out today! Of course none of this is possible if you don’t have providers. The Colorado Provider Recruitment (CPR) team at CRHC is here to assist you in finding the right clinician. Contact them for immediate assistance.

You have the ability and the power to capitalize on these challenges. It won’t be easy, but it’s necessary for survival, access, and care in rural Colorado. Together we can give more voice and power to rural!

Our strength is community.

Plugging holes in rural health care

TIERRA AMARILLA – More than 7,500 feet above sea level, and 75 miles from the nearest hospital emergency room, the quiet town of Tierra Amarilla isn’t just isolated.

“We’re the frontier,” says Darren DeYapp, executive director of La Clinica del Pueblo de Rio Arriba off U.S. 84.

The clinic is the hub for medical, dental and behavioral health care in this sparsely populated area and served 2,405 patients last year, according to federal data. Click here to read the full article posted in the Albuquerque Journal.

Nurse Corps Loan Repayment Program

2014 application cycle is now open! Applications must be submitted to the Nurse Corps Program Portal by 7:30 pm ET February 27.

Application technical assistance conference calls will be held January 30, 2 to 3:30 pm ET and February 13, 8 to 9:30 pm ET. Access information will be posted here as soon as it is available.

NURSE Corps Loan Repayment Program enables dedicated registered nurses committed to caring for underserved people to serve in hospitals and clinics in some of America's neediest communities, improving the lives of their patients and transforming their own.

NURSE Corps members help to build healthy communities in poor urban and rural areas as they build their own fulfilling and productive careers. Click here for more further information.

Institute of Medicine: Creative ideas to inspire kid, families and communities to make healthier choices when they eat

Victor’s Garden

Eating healthy and being active have benefits for all of us, no matter how old we are or where we live. Victor’s Garden is designed to help parents and other adults talk with children about how they can make healthier choices when they eat and how they can be more physically active. While staying fit might seem like an individual decision, it works best when families, schools, businesses, and communities come together to prevent obesity. In addition to promoting healthier eating habits and more physical activity, this book aims to inspire children to think about what they can do to make their communities healthy places to live and grow. Click here to download a copy (English/Spanish). Click here to order a FREE classroom set of 30 copies of Victor’s Garden, plus the Action Guide. Further resources and information are available at http://www.scholastic.com/inspireaction/

Accelerating Progress in Obesity Prevention: Solving the weight of the nation

Click here to read the full report

Two-thirds of adults and almost one-third of children in the United States are overweight or obese, representing young and old, urban and rural, and majority and minority populations. This epidemic of excess weight is associated with major causes of chronic disease, disability, and death. Obesityrelated illness is estimated to carry an annual cost of $190.2 billion.

These staggering human and economic costs, along with the difficulties of treating obesity and the slow progress made in reversing national obesity trends, underscore the urgent need to accelerate progress in obesity prevention. The Robert Wood Johnson Foundation asked the Institute of Medicine (IOM) to identify catalysts to speed progress in obesity prevention. The IOM committee appointed to this task presents its findings in its report, Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation.

The committee evaluated hundreds of prior strategies for their promise in accelerating obesity prevention over the next decade. It mapped how the most promising interacted with, reinforced, or slowed each other’s progress. This “systems approach” way of thinking allowed the committee to identify recommendations and understand how they would be important individually and, when implemented collectively, would further strengthen efforts to prevent obesity. The result was the series of goals that follow.

Make physical activity an integral and routine part of life
Create food and beverage environments that ensure that healthy food and beverage options are the routine, easy choice
Transform messages about physical activity and nutrition
Expand the roles of health care providers, insurers, and employers
Make schools a national focal point

In addition, the committee identified related recommendations, strategies, and potential implementation actions organized around five critical environments—physical activity, food and beverage, message, health care and work, and school— that urgently need reform in order to accelerate progress.

Mountain West Dental Institute to be new home in Denver for Kids in Need of Dentistry (KIND)

The MWDI (Mountain West Dental Institute) will be the new home in Denver for Kids in Need of Dentistry (KIND). Beginning in 2014, every Monday children in need will receive high-quality dental care at the MDDS Dental CE Clinic thanks to a grant from i-Orthodontics and the support of the MDDS Board of Directors.

MDDS and KIND would like to thank Midmark, Bien Air and Planmeca for the contributions of equipment and time training Dr. Avani Khatri and the KIND clinic staff. The KIND staff is thrilled and in total awe of the amazing high-tech equipment they now have access to. As the trainers went through the features of the Bien Air Handpieces, the Midmark chairs and lighting and the 3-D capabilities of the Planmeca, exclamations like "get out of town" and "that is unbelievable" were frequently heard from both doctor and staff. MDDS is very excited to be partnering with KIND on this new initiative and is proud to be their new home in Denver.

Michael Stanislawski of Midmark explaining the dental equipment to KIND staff members

To view more pictures, please visit the MDDS Facebook page.

4 Hospital, health dystem CEOs describe their leadership style

Hospital and health system CEOs share how they or their colleagues and employees would describe their leadership style. There is no one-size-fits-all leadership style for success as a CEO, as everyone has their own approach to management. Some may be authoritative while others are on a first-name basis with nearly every member of their staff. Humor may be emphasized, or transparency, or both. Here, four accomplished CEOs of hospitals and health systems from across the country share how they or others would describe their leadership style. Click here to read the full article by Heather Punke.

Top 5 causes of physician burnout

Nearly 40 percent of the nation's physicians — 39.8 percent — reported experiencing at least one symptom of burnout in Medscape's Physician Lifestyle Report 2013, but the causes of their burnout vary. Generally, many physicians said burnout was caused by excessive workload and the loss of control over their profession. Click here to view the top five causes as posted by Becker’s Hospital Review.

Effects of doctor shortage minimal in Panhandle

Rural areas in the United States are seeing a decrease in the number of doctors they have available. However, residents of the Nebraska Panhandle area live in a region with a well-established medical community. Regional West Medical Center (RWMC) is a regional referral center with physicians on staff who represent many different areas of medical specialization. Click here to read the full article by Irene North, www.starheral.com.

New report adds emphasis to effort to get dentists to accept Medicaid

Colorado Dental Association leaders launched an initiative last month to get members to take at least Medicaid patients each. On Tuesday, a new study showed why the effort is needed desperately. The Colorado Health Institute (CHI) found in its report “More Dental Insurance: Enough Dental Care?” that eight of the state’s 64 counties have no dentist at all who is offering care and another nine counties currently have no dentist accepting Medicaid. Click here to read the full article by Ed Sealover at the Denver Business Journal.

Effects of doctor shortage minimal in Panhandle

Telemental Health in Today's Rural Health System

Telemental health is widely promoted as a way to address access barriers to mental health care in rural areas. However, we lack a clear picture of how telemental health is being used across the country. This brief describes the organizational setting, services provided, and staff used in 53 telemental health programs. The report concludes by outlining the opportunities and challenges for telemental health in today’s rural health system. Click here to read the full report by Lambert, Gale, Hansen, Croll and Hartley.

Assessing the Impact of Rural Provider Service Mix on the Primary Care Incentive Payment Program

The Patient Protection and Affordable Care Act of 2010 created the Primary Care Incentive Payment Program. For the years 2011 through 2015, if certain evaluation and management services represent 60% or more of Medicare allowable charges, then the provider qualifies for a 10% bonus calculated on the primary care portion of allowable charges. Based on analysis of 2009 Medicare claims data, more than 70% of rural primary care physicians (PCP) and non-physician practitioners (NPP) qualify for payments. The average incentive payment for qualifying rural PCPs would result in an additional $8,000 in Medicare patient revenue per year. For qualifying NPPs, the result is an additional $3,000 in Medicare patient revenue per year. Click here to read the full report by Shane, MacKinney, Ullrich, Mueller, and Weigel.

Colo. Medicaid dental expansion may be stunted by access issues

Almost half a million Coloradans are expected to gain dental benefits under Medicaid by 2016. That doesn’t mean they’ll be able to see a dentist. Two state policy changes rolling out next year are intended to improve access to oral health care for low-income Coloradans. The Legislature earlier this year voted to expand Medicaid’s dental benefits to adults — it now only covers children for most kinds of care. Click here to read the full article by Kristin Jones, I-News at Rocky Mountain PBS.

Strategies: The silver lining behind the Affordable Care Act

If you’re an employer there are also numerous positive outcomes from the ACA roll-out. Really. We will have more paperwork, some of us will have more costs, and more meetings with our insurance brokers. However, some business owners will benefit from tax credits and other incentives to offer employee’s health insurance. Some employers will engender enhanced loyalty just by helping direct employees to the resources available through the health care exchange. Other employers will be able to retain key staff by offering health insurance that previously seemed unattainable or cost-prohibitive. Another less apparent silver lining will be the unprecedented access to new, experienced consultants, who recently found the courage to leave their jobs and start new companies. Many companies will now have the option of working with, and have access to, newly formed organizations or independents, and thereby drive down the costs typically associated in working with larger more established firms. Click here to read the full article by Stephanie Klein at the Denver Business Journal.

Colo. hospitals see additional Medicare cuts

New cuts to Medicare, enacted as a result of the new federal budget compromise approved earlier this month, could mean the loss of an additional $90 million in payments to Colorado hospitals. Click here to read the full article published by the Northern Colorado Business Report.

Indian health professions scholarship programs

Click here for recently released information on Indian Health Professions Preparatory, Indian Health Professions Pre-graduate and Indian Health Professions Scholarship Programs that you may be eligible for.

Rural hospitals feel the pinch

The rollout of the Affordable Care Act has already set off significant change and uproar around individual insurance plans. As the ACA settles into place in 2014, more change and concerns are coming to small rural hospitals. Under the ACA, small rural hospitals will see significant reductions in traditional Medicare payments, and some will see new payment requirements for patient care. Rural hospitals rely on Medicare payments - which primarily cover older people - for almost 45 percent of their annual income. The changes in how Medicare money reaches rural hospitals - and all hospitals around the country - are an attempt by federal lawmakers to improve health care and reduce costs. Click here to read the full article by Christina Janney, published on The Kansan.com.

Call for proposals - Community Assessment and Education to Promote Behavioral Health Planning and Evaluation (CAPE)

This is an opportunity for communities (from very rural to highly urban) to receive a grant to be involved in identifying current community behavioral health practices and to assist in developing new and improved methods.

We are working with the “Community Assessment and Education to Promote Behavioral Health Planning and Evaluation” (CAPE) project. This is a national project dedicated to identifying and sharing best practices for benchmarking community behavioral health. Funding is through the U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA) and facilitated by the U.S. Department of Agriculture’s National Institute of Food and Agriculture. Project members are drawn from universities across the United States. Project website is at: http://healthbench.info/home.html

The CAPE project has issued a “Call for Proposals” to fund eight pilot communities to participate in a joint exploration of what communities are now using to gauge community behavioral health and how these methods can be improved. This includes an online survey of local health decision makers (broadly defined) aimed at developing a better understanding of where local leaders draw their information about community behavioral health trends as well as a joint shaping and testing of new tools to make the process more accurate and efficient.

PROPOSALS ARE DUE JANUARY 21, 2014. Community selections are expected to be announced at the end of January. The pilot program is expected to run from March 3, 2014 to October 31, 2014.

Communities selected for this program will receive funds to buy out up to 8 months of up to 1.0 FTE (0.67 FTE total) per selected community for current staff members to join the CAPE project. Funding will come in the form of a contract with the land grant institution leading the community effort. Community teams of one, two, or three individuals will be considered. Pre-approved travel or other pre-approved out-of-pocket costs will be directly reimbursed.

ANY U.S. COMMUNITY IS ELIGIBLE. The eight communities are expected to be drawn from a range of community types from very rural to highly urban. Communities are expected to be defined using county lines (single-county units are preferred but multi-county proposals will be considered, especially in tribal areas) due to the availability of Federal county health statistics. The selection process may also take into account a desire to balance the eight communities across the four USDA regions to obtain input from a more diverse set of circumstances.

For more detailed information, please go to: http://healthbench.info/communities.html. Direct your questions to: Scott Loveridge, North Central Regional Center for Rural Development at loverid2@msu.edu.

How to enroll in the marketplace

Tuesday, February 4, 2013

1:00-2:00pm MT

Click here to register

We are in the open enrollment period for health insurance in the Health Insurance Marketplace. We will explain the health care law, show you how to shop for plans using our new window shopping tool, explain how to enroll, and answer your questions. Open enrollment ends on March 31, 2014.

Q&A webinar on the health care law

Thursday, January 30, 2014

1:00-2:00pm MT

Click here to register

Join HRSA for an interactive webinar on the health care law, the Affordable Care Act.

Elevate clinical care effectiveness and efficiency webinar

January 24, 2014

11:00-12:00pm MST

Click here to register (free)

Are you maximizing the return on your clinical data? Can key stakeholders extract critical insights for planning and delivering patient care? In the face of explosive data growth and increasingly complex data formats, clinicians often hit the limits of the traditional analytics approach which focuses on structured data and represents only a small percentage of information. A new approach to holistically integrate both structured and unstructured data, including free-text clinical notes, is key to breakthrough efficiency and intelligence for driving meaningful care improvement and cost reduction.

Use of clinical decision support to improve medication management (national conference call)

January 28, 2014

10:30am MST

Click here to register

The Agency for Healthcare Research and Quality (AHRQ) has identified a gap in health care and public health practitioners’ knowledge of health IT using multiple mechanisms, including the findings of the continuing education (CE) planning group. This series of Webinars is designed to increase practitioners’ ability to improve health care decision-making support patient-centered care, and improve the quality and safety of care through the use of health IT. This session will identify strategies for using clinical decision support (CDS) to improve appropriate prescribing, dosing, and monitoring of medications by health care providers.

New Allied Health job board with colorado provider recruitment

Colorado Provider Recruitment will be incorporating an Allied Health Specific Job Board to better serve your recruitment needs! We welcome you to post any clinical or non-clinical opening you have that CPR does not already recruit for. From there, interested candidates will contact you directly. The best part? This service is free to you, as a member of the Colorado Rural Health Center!* For a full listing of positions CPR is actively recruiting for, please click here.

To get started email your complete job description to:

Emily Berger

Allied Health Recruitment Coordinator

720.248.2744

eb@coruralhealth.org

*If a facility is not a member of the Colorado Rural Health Center and does not have an active contract with Colorado Provider Recruitment, a $100.00 fee will be applied to each job posting on the Allied Health Job Board.

School-based health care initiative 2012-13 evaluation report

This report from the Colorado Health Foundation outlines the evaluation of the School Based Health Center initiative in efforts to determine if the initiative was effective in moving its grantees toward self-sustainability. Click here to read the full report.

Helping consumers with eligibility and the application process

Click here for some answers to commonly asked questions on eligibility for the new insurance marketplaces.

EMS funding available - FY15

Approximately $6.7 million is available through grants and system improvement funding for organizations involved in providing emergency medical and trauma services in Colorado. Apply for these funds at www.coems.info under the Funding Program tab. Read the full FY15 Funding Guide for details or contact Jeanne-Marie Bakehouse and/or Michael Gerber with questions. Applications will be accepted until Feb. 14 at 5 p.m.

Community Water Fluoridation 101 Webinar

The internet has revolutionized the way people get information, and with that has come increased questioning of solid public health practices like vaccinations and water fluoridation. This webinar will cover the basics of community water fluoridation, including its history and scientific evidence supporting the practice, to help NNOHA members feel more comfortable engaging patients and community members in conversations about this public health measure. This webinar is ideal for practitioners and advocates who want a deeper understanding of how fluoride works to strengthen teeth and why water fluoridation is an efficient and effective public health intervention for the United States.

Click here to register for this webinar.

Utilization management and utilization review webinar

All hospitals must have a UM/UR plan that describes the process used to review all services provided by the institution and by the members of the medical staff. Register now for this great webinar featuring experts from the Joffit Group, as they discuss the components involved in setting up an efficient UM/UR. The webinar is FREE for CRHC members and $99 for non-members.

Are you prepared for the switch to ICD-10?

A recent survey found many organizations are largely unprepared for ICD-10 implementation. As the Oct 1 deadline approaches, CRHC has the resources to make sure your facility is ready. Register now for the ICD-10 Implementation Webinar Series Jan 16, Feb 13, and March 13! Each webinar is FREE for all CRHC members and $49 for non-members. CRHC also offers basic essential online training classes, available to rural healthcare facilities; contact Danette for further details.

Member of the Month - Pioneers Medical Center

Pioneers Medical Center Recognized for Outstanding Leadership in Rural Healthcare

Colorado’s rural health association – the Colorado Rural Health Center – recently recognized Pioneers Medical Center as 2014’s first featured Member of the Month

DENVER, CO – The Colorado Rural Health Center (CRHC), headquartered in Aurora, functions as both the State Office of Rural Health and the association for Colorado’s widespread rural health organizations. Each month, the CRHC recognizes one of its members whose work supports the CRHC’s vision that all rural Coloradans have access to comprehensive, affordable, high quality healthcare.

Pioneers Medical Center is a community-based healthcare facility operated by the Eastern Rio Blanco County Health Service District. Governed by a publicly elected Board of Directors, the hospital (a Critical Access Hospital and Level IV Trauma Center), the clinic and the long-term care residence deliver a wide variety of health services to residents in and around Meeker, Colorado. Located in Rio Blanco County – Meeker is a short drive from Craig, Rifle, Rangely, Glenwood Springs and Grand Junction and is known for their Sheepdog Championship competition and Colorado’s oldest annual rodeo.

Pioneers Medical Center opened its doors in 1950 and ten years later constructed the Walbridge Wing, which provides long-term skilled nursing services. It wasn’t until 1990 that the Meeker Family Health Center – a rural health clinic - was created.

Pioneers Medical Center and their team of over 120 professionals are passionate about helping the community stay healthy. Ken Harman, Pioneers chief executive officer says, “I truly believe the compassion and individualized care of the Pioneers’ staff exceeds the usual scope of care found in most hospitals.”

Known for always putting their patients first, Pioneers Medical Center was recognized by iVantage Health Analytics in October when they were named HealthSTrong^TMAward winner for Excellence in Patient Satisfaction. They were also named a 2013 Guardian of Excellence Award winner by Press Ganey Associates, Inc. The Guardian of Excellence Award recognizes top-performing facilities that consistently achieved the 95^th percentile of performance in Patient Satisfaction.

The Colorado Rural Health Center is proud to feature Pioneers Medical Center as this month’s featured member of the month. Not only was Pioneers the first to renew their membership for 2014, but they were the first member to contract with CRHC’s Colorado Provider Recruitment to recruit a Registered Nurse.

Pioneers Medical Center is involved in the Improving Communications and Readmissions (iCARE) program, which offers Colorado’s CAHs and their clinics the opportunity to engage in a statewide improvement project aligning with national trends and funding priorities demonstrating sustainable improvements and outcomes. They are also involved in the Small Rural Hospital Improvement Program (SHIP), which is a statewide collaborative project focusing on creating and refining quality improvement systems and processes with the goal of meeting electronic health record (EHR) Meaningful Use criteria.

Involved in many of CRHC’s education and training opportunities, Pioneers Medical Center is an engaged member of the Colorado Rural Health Center. If you would like to learn more about Pioneers Medical Center, you can find additional information on their website, Facebook, or email them directly at info@pioneershospital.org.

Do you know a CRHC member that is leading the way for rural healthcare delivery in Colorado? Click here to complete a nomination to recognize any of CRHC’s current members. Questions, contact info@coruralhealth.org.