Update from the CEO: Change and Transition

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

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

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

Heart Failure Measures Set Average Data Score: 72%

Pneumonia Measures Set Average Data Score: 86%

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

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

Update from the CEO: Engagement in 2012

As the year starts to come to a close and I think of the accomplishments of the Colorado Rural Health Center team, I know these accomplishments would not have been possible without the engagement of our members, sponsors and partners. This year CRHC tracked over fifteen bills and was successful in the passage of our first piece of major legislation, House Bill 1052 concerning the collection of health care workforce data from healthcare professionals. Thank you to our Policy and Legislative Committee for lending us your time and expertise. We are looking forward to the 2013 session and encourage you to continue to share your voice. As you think about sharing your voice, many communities engaged in Community Health Needs Assessments through our STRIDES Program. These communities took engagement and collaboration to a new level with Critical Access Hospitals, Rural Health Clinics, Federally Qualified Health Centers, and public health participation. As new partnerships are formed CRHC encourages you to continue to reach out to your community members and together you can continue to innovate and accomplish great things. As Dan Heath says, “Identify the bright spots and grow them!” One bright spot that should be pointed out is CRHC staff placed thirteen providers in safety net communities in Colorado. With the workforce shortages that Colorado is facing we are proud of these placements and the ability to contribute to the healthcare of the community. Rural communities have always had a strong sense of connection and collaboration. This collaboration can be seen through the participation of fourteen Critical Access Hospitals and six Rural Health Clinics in CRHC’s Improving Communications and Readmissions (iCARE) Program. In 2012, the participating hospitals readmission rate was only 2.8%. Some of the innovative interventions that were put into place are standing orders for pneumonia vaccinations, collaboration with social workers to follow-up with patients discharged to ensure understanding of medications and instructions, scheduling of appointments with the Primary Care Office, and home visits conducted by the Director of Nursing for patients that do not have an identified primary care physician. Finally, rural hospitals and clinics have been heavily engaged in implementing electronic medical records and remain committed. To date, 18 rural hospitals and 18 rural clinics have attested to stage 1 meaningful use. Congrats to all! I wish everyone Happy Holidays and CRHC staff look forward to working with each of you in the new year to identify your Bright Spots!

Meaningful Use 'Boot Camp' Presented by CORHIO

CORHIO is hosting a free half-day "boot camp" seminar for health care professionals who are in one of the following stages of EHR adoption:

• Considering the purchase of an electronic health record (EHR) system
• Need assistance understanding or achieving Meaningful Use objectives (have already purchased an EHR system)

At the conclusion of this boot camp you will be able to:

• Select the right certified EHR technology for your practice
• Complete your HIPAA Security Risk analysis as part of the 15 core measures of Meaningful Use
• Incorporate Meaningful Use in your practice's workflow

When:
September 27, 2012
1:00 PM - 7:00 PM

Where:
Doubletree by Hilton Hotel Denver - Thornton
83 E. 120th Avenue
Thornton, CO , 80233

Agenda:

• 1:00pm to 2:45pm - "Meaningful Use 101"
• 3:00pm - Concurrent sessions (please choose one):
  • "Completing Your HIPAA Security Risk Analysis" presented by David Ginsberg, Colorado state's leading authority on HIPAA Privacy & Security Compliance
  • "Selecting an EHR Vendor" presented by Tracy Rue, Health IT Transformation Consultant
• 4:30pm to 7:00pm - EHR vendor showcase & demos

Registration is required to attend this event. Click here to register. Click here for more information.

PCMH: An Overview and Colorado's Landscape

A Patient-Centered Medical Home (PCMH) is not a place but a concept. PCMH facilitates partnerships between individual patients, their personal physicians or care providers, and the patient’s family. It is a way of coordinating all health services in a quality, cost-effective and accessible manner through use of a team approach to health care that is centered on patient and family needs. Team-centered care is especially important given significant workforce constraints in most rural communities where physician-led care may not be available.

The Patient-Centered Medical Home encompasses five functions and attributes:

• Patient-centered
• Comprehensive care
• Coordinated care
• Continuous access
• A systems-based approach to quality and safety

Quality care delivered in a PCMH model is enabled by health information technology, health information exchange and the use of registries and other tools to assure that patients get culturally and linguistically appropriate care when and where they need it.

Read the full joint Colorado Rural Health Center and ClinicNet paper here

ICD 10 Online Training - Rural Health Organizations

ICD-10 Online Training for Coders, Billers, Auditors, & All Healthcare Professionals

• Too busy to go to ICD-10 training?
• Perhaps, you’ve attended ICD-10 Workshops, but would love additional training?
• Is your budget stretched thin already -- and you wish you could find an unbelievable bargain for your staff to learn ICD-10 and how to become proficient with the rules and regulations of the future?
• If you answered yes to any of the above questions, CRHC can help now!!

Take advantage of this opportunity to enroll in the following online courses that will prepare you and your organization for the successful transition to ICD 10. These courses will provide you with history, structure, functions, guidelines and the terminology needed to ensure accurate and efficient billing processes. Whether you are a new coder, an advanced coder with years of experience, or a health care provider -- you will find value in this timely information. For more information on a specific course, please click here. If you are employed by a Colorado Critical Access Hospital (CAH) or a rural PPS hospital with less than 49 beds, you are currently participating in the FY2011 SHIP Grant Program – and -- your online classes are FREE to all hospital staff! Click here to get started now! If you are a Rural Health Center (RHC) or other rural health care facility in Colorado, please click here for a class listing and the opportunities available to you! CEU’s are available for all classes. Don’t wait. . .get started today! For more information or questions, please contact Danette Swanson, HIT Program Coordinator, at ds@coruralhealth.org

Free tool: Outpatient surgery and observation

 This pocket card available from HCPro provides “points to remember” when it comes to outpatient surgery as well as information on the appropriate use of observation services. Click here to download the pocket card.

Rural Relevance Under Healthcare Reform

iVantage Health Analytics released a quarterly update to their ongoing tracking study monitoring the rerformance of rural healthcare under the Affordable Care Act. Summary findings from research conducted by iVantage shed new, multi-dimensional light on the rural healthcare delivery system using: the latest Medicare Shared Savings data files; the first nationwide hospital rating system to evaluate community and rural hospitals including all 1,326 Critical Access Hospitals; and the industry’s largest proprietary rural Emergency Department database.

The misunderstanding that rural hospitals are more costly, inefficient and have lower quality and satisfaction is empirically challenged. More importantly as providers and developers seek to address the New Healthcare using innovative delivery models, the rural setting must be better understood and included in any strategy for patient-centered care. Read more and download the full study here.

HPSA scores: What does it mean to me and my clinic?

Living and working in rural Colorado, you have most likely encountered the acronym, H-P-S-A. For many clinic administrators and providers, you are proficient in the world of HPSA scores and know exactly what a Health Professional Shortage Area score means and why it is important to you and your clinic. For those of you who probably have heard this word and know that it is significant to you and the work that your particular clinic does, but are not positive why, we hope the explanation below can shed some light and give you a reason to pay a little more attention to the benefits of having one.

What exactly is a HPSA score? This score is a federal designation assigned to a geographic area, population group (such as low-income), correctional facility, state or county mental health hospital, or public or nonprofit facility that can demonstrate a shortage of health professionals in the service area. HPSAs can be created for primary medical care, dental health, or mental health. They reflect the level of provider shortage for a service area and are on a scale of 0 to 26, higher scores indicating higher relative need than lower scores.

What is the benefit of having a HPSA score? Your clinic may benefit from having a HPSA score in three ways. The first one is recruitment and retention. Your primary care physicians, Nurse Practitioners, Physician Assistants and Mental Health workers may be eligible to apply for loan repayment dollars through the Colorado Health Service Corps and National Health Service Corps loan repayment programs. Also by having a HPSA, you may be eligible to participate in the J-1 Visa waiver program. Secondly, your providers caring for patients on Medicare are eligible for the Medicare Incentive Program. This will provide them with a 10% monetary bonus on Medicare services billed. Lastly, if your clinic is located in a HPSA, you may be eligible to become a Certified Rural Health Clinic and receive cost-based reimbursement.

In the last few months we have seen several rural and frontier counties lose their HPSA scores. Every three years, Colorado’s State Primary Care Office (PCO) evaluates the HPSA designations in Colorado and re-assigns scores based on specific criteria. Part of the criteria that is often misinterpreted by clinics and their providers are the reporting of numbers of hours spent by providers providing direct patient care in the medical setting. It is important when submitting patient numbers to the PCO that your providers are submitting only hours spent directly caring for patients and the time spent charting and following up with those patients. Practice management, personnel management and administrative duties should not be counted. Incorrect reporting could indicate there is less need than there is in reality.

On a positive note, Gunnison County has recently been given a HPSA score! Congratulations to Dr. John Tarr at Gunnison Health Department for working tirelessly with the assistance of Colorado Rural Health Center’s Quality Improvement Specialist, Kathryn Steele, and the Primary Care Office to obtain a score for Gunnison County!

For more information on HPSA score designation, contact Kitty Stevens at the PCO at kitty.stevens@state.co.us, 303.692.2298.

For more information on the benefits of having a HPSA score, contact the Colorado Rural Health Center at info@coruralhealth.org, 303.832.7493.

CEO Update - The Forum 2012

The Forum 2012 is a two and a half day conference beginning on April 11 that will bring together participants from all over the region. It serves as an essential educational, training, and networking event for all safety net clinics, members of the clinic team, and other interested parties. The Colorado Rural Health Center and ClinicNET have partnered to present The Forum.

The agenda is packed with dozens of speakers on topics from Health Policy to Accountable Care Organizations. Since we advocate on your behalf both at the State and Federal levels, we welcome your attendance at the Health Policy session so that we may exchange information.

If you represent a rural health clinic and attend both Emergency Preparedness sessions, then your clinic may be eligible for additional reimbursement! We look forward to your participation at The Forum 2012!

Event Info:

• Date: April 11-13, 2012
• Registration: click here to register online now!
  *early bird discount has been extended through March 21st!
• Hotel and Location:
• Sheraton Denver West Hotel
  360 Union Blvd. Lakewood, CO 80228
• Booking a Room: make your hotel reservations online or call 888.627.7027 and use group code RHD11A to get the discount - extended through March 26!
• Sponsors and Exhibitors: Download the form online and email the completed form to cr@coruralhealth.org to reserve your space.

Grant Opportunity for Rural Areas

You could be eligible for a grant up to $500,000 to support distance learning and telemedicine services at your organization. The Distance Learning and Telemedicine (DLT) Grant is funded by the U.S. Department of Agriculture and is a competitive grant with around 100 awards each year. This grant targets rural areas in our country and funds programs that are interested in implementing distance learning and/ or telemedicine in rural areas to increase access to clinical and/or educational services. The focus is on using the unique capabilities of telecommunications to connect rural areas to each other and to the world, thus overcoming the effects of remoteness and low population density.

Some Distance Learning applications include:

• Real-time educational courses
• Virtual field trips
• Interactions with outside experts
• Mentoring and tutoring of distant students
• Collaborative projects
• Access to remote resources
• Staff development programs

Some Telemedicine applications include:

• Telehomecare
• Telestroke
• Telepsychiatry
• Virtual ICU
• Telepharmacy
• Teledentistry

TECHFunds Resource Center and Solutionz Conferencing Grant Program Services have partnered together to assist organizations like yours with applying for and securing grant funding to support your distance learning and telemedicine needs, providing as much or as little assistance as needed, including grantwriting services.

To obtain additional information about the DLT grant program you can visit their website or contact Irene Alvarez directly at Irene@techfundsresourcecenter.com.

Rural Medicine Speakers Needed for Practice Essentials Program

Do you have a family, internal medicine, pediatric or OB/GYN physician in your rural practice that enjoys public speaking, advocating for rural health and LOVES what they do? If so, please let them know we would be honored to host them at this year’s Practice Essentials program put on by COPIC and have them speak about their rural medicine experience.

Practice Essentials is a daylong workshop for Colorado’s physician residents to prepare them for work and life after residency. This will be a wonderful opportunity for your providers to motivate residents to ‘go rural’ and give you a chance to plug your own practice’s physician openings. There will be four different dates beginning in April and ending in June. Please email us at cpr@coruralhealth.org for more information. All travel and meal costs will be reimbursed by the Colorado Rural Health Center.

Premature Twins Delivered At New Middle Park Medical Center

In a county where babies are not routinely born, a set of premature twins were delivered at the new Middle Park Medical Center in Granby on Sunday.

Babies are rarely born in Grand County due to the population, the lack of neonatal facilities and a full-time OBGYN. The last baby born in the county was in spring of 2010, when paramedics delivered a baby in the ambulance on Highway 9 at mile marker 128 en-route to Summit County. According to Grand County EMS, about one baby per-year is born here, either in a medical facility, in an ambulance, or in one instance a few years ago, on the woman's bathroom floor of the Winter Park McDonald's.

Read more about this instance of incredible teamwork between rural Middle Park Medical Center, Grand County EMS, and Children's Hospital Colorado.

Grand Opening at Middle Park Medical Center

The grand opening of Middle Park Medical Center (MPMC) was held mid-December with a ceremony very well attended by the community. The new medical facility includes 10 computer-friendly patient exam rooms on one side of the building, with special consideration given to visiting specialist’s needs. On the other side of the building is the lab, mammography, imaging, emergency room, and two in-patient beds. Central scheduling for labs, imaging, and other services creates a very efficient workflow.

MPMC is owned and operated by Kremmling Memorial Hospital District with locations in Kremmling and Granby and is committed to helping improve the quality, availability and access to health care to the residents of the region, while working to keep costs down and improve the sustainability of care to those they serve. MPMC provides hospital and health care related services to roughly 15,000 residents of Jackson, Summit and Grand Counties, and to thousands more who come to the area to recreate and work.

NPR on CAHs: An Overlooked Perspective

by Brock Slabach, National Rural Health Association

The December 8 NPR piece produced by Kaiser Health News (KHN) didn’t report that Medicare costs are lower for rural patients than their urban counterparts. Medicare spends 4.5% less per beneficiary for rural residents compared to those living in urban areas, according to a recent Stroudwater report which used 2008 Dartmouth Atlas data. The value that rural providers (including Hood Memorial Hospital in Amite, La.) bring to the Medicare program is evident, even including alternative payment methodologies applied to small, rural facilities. Closing Critical Access Hospitals (CAHs) and sending their patients to large, urban hospitals will in fact not save money, but cost more.

Rural communities struggle with disproportionate share of poverty, obesity and chronic conditions when compared to an urban environment. Independent studies have affirmed the quality of rural health care providers. For example, rural hospitals have lower risk-adjusted rates of potential safety-related events (Jollife, 2003), rural hospitals have significantly lower adverse event rates than urban counterparts (Whitener and McGranahan, 2003) and rural hospitals have significantly lower rates of post-operative hip fracture, hemorrhage and hematoma (Cromartie, 2002).

The article accurately portrays the difficulty that small, rural hospital administrators have in running a hospital located in a rural environment. NRHA congratulates Hoppie Jones, Hood Memorial CEO, for doing an outstanding job in the midst of daunting circumstances.

Fall 2011 CROP Awardees Announced!

Congratulations to these providers, who were awarded Colorado Rural Outreach Program (CROP) retention grants!

Awardee	Provider Type	Type of Award	Award Amount
Colorado West, Inc.	Psychiatrist	Loan Repayment	$10,000
Grand County EMS	EMS/Prehospital Care	Loan Repayment	$4,170
Kremmling Memorial Hospital District	Physical Therapist	Loan Repayment	$4,876
Rio Grande Hospital	Emergency Room Physician	Loan Repayment	$10,000
Valley-Wide Health Systems, Inc.	Physical Therapist	Loan Repayment	$5,000
TOTAL AWARDS		Fall 2011	$34,047.00

Panel recommends giving hospitals more time to go from paper to electronic records

Source: Denver Business Journal

A federal advisory panel is recommending that the government give hospitals and doctors offices an additional two years to get their electronic medical record systems in order. The Health Information Technology Committee, which advises the U.S. Department of Health and Human Services, voted 12-5 Wednesday June 8 to recommend that the department push its deadline for stage 2 “meaningful use” requirements from next year to 2014.

“Meaningful use” refers to a wide range of guidelines aimed at making sure health care providers are properly using electronic health records in their day-to-day operations, which supporters claim will reduce medical errors, improve overall patient care and save money. Failure to meet meaningful-use standards could lead to cuts in Medicare reimbursement, starting in 2014. Continue reading...

CROP Applications Due May 16th

Colorado Rural Outreach Program (CROP) grant money can be used to recruit new healthcare professionals or retain the ones already on your staff by repaying portions of the healthcare professional’s educational loans, or by giving a retention bonus if all educational loans are paid off. CROP currently offers two grant cycles per year as funds are available, in the spring and the fall.

Applications are currently being accepted for the spring grant cycle. Applications MUST be postmarked by May 16th, 2011 to be considered for funding.

Please download the application packet and coversheet online. Please fill out, and save, the coversheet in Microsoft Word. You may submit your application via email, or postal mail. If submitting via email, please make the narrative and all attachments ONE inclusive document. The coversheet may be separate. Please send your CROP application to:

Attn: Grants Manager
Colorado Rural Health Center
3033 S. Parker Rd., Suite 606
Aurora, CO 80014
ep@coruralhealth.org
Main: 303.832.7493 x 234
Fax: 303.832.7496

For more information on the CROP program and to see if your organization is eligible, please click here. For questions, contact Erica Petramala at ep@coruralhealth.org.

Making Integrated Care the Standard in Colorado

By Cassidy Smith, Public Policy Officer, Colorado Health Foundation

Integrated care health services engage individuals and their caregivers in the full range of physical, psychological, social, preventive and therapeutic factors needed for a healthy life. Integrated care has become "all the rage" in Colorado health circles. To illustrate the proliferation of the concept, the Colorado Behavioral Healthcare Council mapped some of the numerous efforts underway to integrate physical health and behavioral health care services.

Supporting the delivery of integrated care is a funding priority for the Colorado Health Foundation. Yet, while grantees rave about the positive impact integrated care has had on Coloradans' health, they consistently report it is difficult to maintain these kinds of services.

Read more about how the Colorado Health Foundation, Collaborative Family Healthcare Association, Colorado Psychological Association and the Colorado Association of Family Physicians are working together to make integrated care health services a sustainable option for Colorado providers.

Primary Care Fund application released!

Primary Care Funding is now available for primary care clinics. The 2011-12 application is now online, and is due Monday, June 13, 2011. The Primary Care Fund provides an allocation of moneys to health care providers that make basic health care services available in an outpatient setting to residents of Colorado who are considered medically indigent. Commonly asked and specific questions pertaining to the Primary Care Fund grant and/or completion of the application will be addressed during the Pre-Bid Conference on Wednesday, June 1, 2011.

If you would like assistance with applying for this funding, CRHC’s Grants Research Opportunities and Writing (GROW) program can help! Please contact Erica Petramala, Grants Coordinator, for more information.

New UCCS Grant Aims to Boost Rural Nursing Programs

A new $2.2 million grant from the Colorado Health Foundation will enable nursing students to take classes at their local community colleges and online through a partnership with University of Colorado at Colorado Springs. Many classes will be offered in real time using Cisco Telepresence conferencing technology to connect distance learners to UCCS via high-definition video and other interactive features.

The newly created Southern Colorado Rural Nursing Education and Practice Collaborative will help students earn a Bachelor of Science in Nursing, a degree not currently offered through the community college system. The new partnership aims to increase the number of nursing professionals serving rural Southern Colorado and will be offered at Lamar Community College, Otero Junior College, Pikes Peak Community College, Pueblo Community College and Trinidad State Junior College.

Read more