Serve as a Host Site for Clinicians Reentering the Workforce

In order to safely return to clinical practice after an extended absence, physicians and other health professionals are often required to be supervised or monitored for a period of time before practicing on their own. CPEP (the Center for Personalized Education for Physicians) is seeking rural and urban clinics and hospitals willing to serve as host sites for clinicians participating in the Clinical Practice Reentry Program. CPEP reentry clinicians are licensed, trained, experienced, and in good standing, and have not been subject to disciplinary intervention action by a hospital, licensing board, or other entity. These clinicians left practice voluntarily for a variety of reasons, such as family obligations, personal health reasons, alternate careers, or retirement, and wish to return to the workforce to practice in the same specialty. Serving as a host site can provide your facility with:

• The opportunity to work with health professionals on a trial basis, which may lead to successful permanent recruitment. Reentry clinicians are looking for long term placement opportunities.  
• Increased patient volume as the level of required supervision gradually decreases and the reentry clinician sees patients independently. 
• A rewarding teaching experience for your staff in assisting a peer with returning to clinical practice. 
• The ability to help address Colorado’s increasing healthcare workforce shortage.

For more information, contact Mannat Singh at 480-313-2305 or msingh@cpepdoc.org.

CEO Update: It’s Your Time to Shine

As our nation’s athletes are coming together over the next two weeks during the Olympics, their journeys are not without hard work and obstacles. Yet, the difficult journey is what has made them who they are and equipped them with the skills needed to succeed. Rural healthcare is similar and it’s time for our athletes to shine by putting the needs of rural residents in the spotlight. The journey to the next payment and delivery system will be filled with hard work and perseverance that will pay off in increased access to high quality healthcare for rural Colorado.

We are innovators and risk takers and now is our time to shine. The designation of the Medicare Certified Rural Health Clinic was put into law in 1977 by the U.S. Congress. It was created to support and encourage access to primary healthcare services for rural residents. Congress saw that the rural population’s demographics were changing in age and socioeconomic level. Today this still holds true; nearly 12 percent of Coloradans are 65 years or older. On average, 17 percent in rural Colorado counties are 65 years or older, compared to less and 12 percent in urban counties. Further, 40 percent of the population over 80 resides in a rural or frontier counties. By 2018, the over 65 population will grow by 19 percent, leaving these communities with unique access needs. Rural Health Clinics (RHCs) are poised to meet this need.

Congress believed that physicians retiring were not being replaced by younger doctors at an equitable rate. Nurse practitioners and physician assistants are important new providers who can help deliver more services to patients, especially in rural areas, and can help fill the provider gap. Since 1977, RHCs have been changing and adjusting their staffing structures to meet the needs of their population and continue to do so. Innovation, as our RHCs know, has to hurdle many obstacles to receive the benefits of a healthy community. For example, the rural and frontier retention rate of primary care providers in Colorado is only 39.7 percent over five years. Yet, one physician contributes nearly $889,000 to their community through economic impact factors, with such activities as new nursing jobs. The Colorado Health Institute released their primary care workforce report, and rural is specifically highlighted through this Denver Post follow-up article.

Congress also believed that the provision of healthcare to the rural poor, minority and elderly people was more costly than to those populations in urban areas. While this may have been true back in 1977, we have made huge strides in the area of cost. According to data from iVantage, our rural communities cost per Medicare beneficiary is $7,365, compared to $7,552 in urban. It costs $187 less per person per year, to treat a Medicare beneficiary in rural Colorado. With 98,177 people over the age of 65 living in rural Colorado, that equates to a savings of nearly $18.4 million annually.

In Colorado we have 52 Medicare Certified Rural Health Clinics. (See our updated map here.) Not only are our RHCs allowing access in parts of our state that would not otherwise have sustainable healthcare, but they are engaging in the national trends such as care coordination, electronic medical records, patient centered medical home and quality improvement. RHCs are working toward these efforts without supplementary funding and lower payment rates. Both federal and local funding would help strengthen the RHC infrastructure and allow for continued innovation.

Rural healthcare was built on the premise of providing access to our communities – the communities where residents know each other by name and everyone cares for their neighbor. The “County Doctor” in Life Magazine’s 1948 photo essay chronicled the day-to-day challenges and joys experienced by a rural physician named Dr. Ernest Ceriani, from Kremmling, Colorado. RHCs and their providers are still caring for folks from birth to death and everything in between. What is also shown through this essay is the beauty that exists in our rural communities not only in scenery, but in the quality and context of life. Remembering the beauty in our rural communities must remain a reminder of why we’re competing to meet the needs of such an important and diverse group of Coloradans. You can view the entire photo essay here.

CRHC at IHI’s 15th Annual International Summit on Improving Patient Care

At the Institute for Healthcare Improvement’s (IHI) International Summit on Improving Patient Care this March, CRHC will have the opportunity to present some of the work it and clinics throughout the state have been doing in the areas of improving operations and quality improvement. CEO, Michelle Mills will present about CRHC’s Improving Communication and Readmissions (iCARE) program and the work clinics throughout the state have been doing through this initiative to work with Critical Access Hospitals to improve communication in transitions of care, improve clinical processes, and reduce readmission rates.  At the Storyboard exhibit, CRHC will also have the opportunity to showcase some of the work being done across the state though Healthy Clinic Assessments, which work with clinics to improve efficiencies and workflow in their basic business operations.  For a sneak peak at the Storyboard, click here.

Rural Access to Emergency Devices (RAED) Training Fund

Colorado Rural Health Center has limited funding available through the Health Resources and Services Administration’s federal Office of Rural Health Policy RAED grant, to train first responders, as well as community members in CPR/AED courses.  Entities eligible for this funding must be located in rural Colorado counties (contact Ron Seedorf for questions on eligibility) and courses must have been completed between 6/01/13 and 3/1/14.  For more information, please follow this link, AED Training Funds.

For all questions regarding this funding contact: Ron Seedorf at 970-302-9021 or  rs@coruralhealth.org

CRHC's Alicia Haywood Recognized at 2013 Rural Health Fellows Graduation

In 2013, Rural Health Fellows were selected to participate in the National Rural Health Association’s yearlong, intensive program aimed at developing leaders who can articulate a clear and compelling vision for rural America.  The class represents various levels of rural health care expertise.  The 2013 Fellows were recognized last week at NRHA's Rural Health Policy Institute. Alicia Haywood, CRHC's Policy and Advocacy Manager, was one of thirteen fellows participating in 2013. 

Estes Park Medical Center Recognized as Colorado Rural Health Center’s Featured Member of the Month

Located 90 miles northwest of Denver and just a few minutes east of the entrance to Rocky Mountain National Park is the community of Estes Park, Colorado. Estes Park has a long rich history spanning from Joel Estes’s discovery of the Estes Valley in 1859, to the opening of the Stanley hotel in 1909, and the dedication of the Rocky Mountain National Park in 1915.

As a popular resort destination, Estes Park is home to nearly 12,000 residents and welcomes over three million visitors a year. With an abundance of birds and wildlife, rugged mountain grandeur, quaint shops and a bustling main street – Estes Park is a year-round attraction destination.

Serving the community and large tourist population, the Estes Park Medical Center (EPMC) is a 25-bed Critical Access Hospital and Level IV Trauma Center. Promoting wellness and providing the highest quality of healthcare, EPMC also includes a 60-bed skilled nursing facility and specialty clinic. In addition, EPMC partners closely Timberline Clinic and Salud Family Health Center located in Estes Park.

In September last year, heavy rains washed out two of the three roads into Estes Park, leaving EPMC isolated and without an easy route to transport some patients needing advanced care, down the mountain to an urban hospital. For more on this story, check out the article by Eric Whitney, After the Floods, Colorado Hospital Braces for Winter.

As a member of the Colorado Rural Health Center (CRHC), EPMC engages in a variety of programs and services. Most notable is the hospital’s involvement in the Improving Communications and Readmissions (iCARE) program. The goal of iCARE is to help Colorado's Critical Access Hospitals reduce avoidable readmission rates and improve communications in transitions of care.

EPMC also participates in the Small Rural Hospital Improvement (SHIP) program, which supports quality improvement and meaningful use of health information technology. In addition, the clinic has been involved with Healthy Clinic Assessments (HCAs). HCAs are an evaluation process on the day-to-day operations of the clinic – a snapshot of the clinic’s internal processes and staff interaction. The goal of Healthy Clinic Assessments is to streamline the operational workflow and the policies and procedures of a clinic, in order to maximize efficiency and create a seamless and positive patient experience.

The Colorado Rural Health Center also offers a wide variety of educational workshops and webinars, which EPMC has utilized, in addition to many resources to assist them with their implementation of Health Information Technology (HIT) solutions.

The Colorado Rural Health Center is proud to recognize Estes Park Medical Center as this month’s featured member of the month. To learn more about EPMC visit their website or connect with them on Facebook.

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.