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Rural Health Briefing August 31 2005
National News
1. Rural Health Funding Still Facing Congressional Votes
2. Final Rule on Necessary Provider CAHs
3. Changes to Medicare Coverage of Telehealth
4. Healthy People 2010 Under Review
5. National Coordinator for Health Information Technology
6. Reports on Evidence-based Practice Centers
7. The Changing Legal Environment for Health Information
8. AHRQ’s Native American and Alaska Natives Research
9. APHA Calls for Medicaid Reform Policies
Across Arizona
1. Addressing Rural Information Technology Healthcare Issues
2. Latina Public Health Scholarship Winners
3. Galloway Honored by U.S. Public Health Service
Grants and Opportunities
1. Connecting Public Health with Health Information Exchanges
2. Rural Health Network Development Planning Grants
3. End-of-Life Quality of Care Grants
4. Rural Health Care Services Outreach Grant
5. Rural Health Network Development Grants
6. Quality of Care Grants Address Depression
Calendar
- September 7-9, Arizona Public Health Association Annual Meeting, Sedona
- September 8-9, Best of the West: Educating, Training and Collaborating on Tobacco Control, Phoenix
- September 8-9, Second Annual Health Information Technology Summit, Washington, D.C.
- September 14-16, Phoenix Area Tribal, Urban IHS Diabetes Nutrition Meeting, St. George, Utah
- September 10, Arizona Statewide Conference on Immigration, Phoenix, for information contact 602-463-2509 or latejana86@hotmail.com
- September 15-16, 20th Annual Hispanic Women’s Conference, Phoenix
- September 16-21, National Association of Community Health Centers Annual Convention, Miami Beach, Florida
- September 23, JCAHO Periodic Performance Review, Scottsdale
- September 30, 3rd Annual Arizona Women’s Conference, Tucson
- October 5-7, NRHA Critical Access Hospital Conference, Kansas City
- October 2-4, Connecting Rural Health Communities Through Information Technology, Butte, Montana
- October 6-9, National Indian Education Association Annual Conference, Denver
- October 13-15, National Association of Rural Health Clinics Annual Conference, Washington, D.C.
- October 18-19, Collaborative Leadership for Public Health Professionals Train the Trainer, Phoenix
- October 24-25, Innovations in Community Prevention, Washington, D.C.
- October 27-28, Border Health: Information for Action VI, Tucson
Mark Your Calendar
- November 3-4, 2005 Annual Leadership Conference, Arizona Hospital and Healthcare Association, Scottsdale
- November 5-9, National Rural Education Association Conference, Tucson
- November 14, Information Technology in Rural Arizona: A Tool to Improve Healthcare Workforce Recruitment and Retention, Quality and Education, Phoenix
- January 9-11, 2006, National Leadership Summit on Eliminating Racial and Ethnic Disparities in Health, Washington, D.C.
- March 28-31, 2006, Fourth Annual Western Region Flex Conference, Las Vegas, Nevada
National News
1. Rural Health Funding Still Facing Congressional Votes
Recently Rural health advocates successfully petitioned the U.S. Senate to restore a considerable amount of money for rural health programs in their version of the Labor, Health and Human Services, Education, and related programs appropriations bill. This funding was, overall, much lower in the President's original budget request and in the version of the bill that was passed by the House of Representatives. The House and Senate now must reconcile their two versions of this bill.
Additional effort is now needed to make sure that the changes adopted by the Senate are included in the final bill. The most direct route is by contacting members of the House Rural Health Care Coalition by September 9. They are listed on the websites of Co-Chairs Greg Walden, and Earl Pomeroy. Then use the CapWiz site to find your Representative's contact information and place a call or email.
Key provisions affect the following valuable HRSA programs that work together to provide seed funding and support to rural health care providers, patients, and rural health services researchers.
Rural Health Research Policy
Senate proposed level of funding: $8,528,000
House proposed level of funding: $ 0
Rural Health Policy Development is the only federal program that supports health services research for rural issues. This critically important grant program supports eight rural health research centers. These centers provide research reports and data to policymakers, including the U.S. Congress and the U.S. Department of Health and Human Services (DHHS), as they make decisions regarding pressing health care issues.
This program also supports the DHHS Federal Office of Rural Health Policy; created by Congress in 1987 to ensure that rural considerations are taken into account during policy making within the DHHS. With the advent of the Medicare prescription drug benefit and the creation of the Medicare Advantage program by the Medicare Modernization Act (MMA), this office plays a critical role in ensuring that the needs of rural health care providers and patients are considered throughout each stage of MMA implementation.
Rural Health Outreach Grants
Senate proposed level of funding: $39,278,000
House proposed level of funding: $10,767,000
The Rural Health Outreach Program supports innovative health care delivery systems as well as vertically integrated health care networks in rural areas. Since 1991, 3.2 million people in 46 states have taken advantage of grants totaling $228 million through this program. The grants fund demonstration programs and usually last no more than three years. The intent is to provide initial support for innovative ideas in rural communities and then to phase out federal funding as the projects become self-sufficient.
Community Access Program (CAP) Grants
Senate proposed level of funding: $60,000,000
House proposed level of funding: $ 0
CAP grants are designed to increase access to health care service for uninsured and underinsured populations in rural areas. The program awards grants to public and private health care providers to work together to coordinate and strengthen health services for the uninsured and underinsured in their communities. Grants are used to develop integrated approaches to addressing access disparities by eliminating fragmented service delivery, improving efficiencies among safety net providers, and encouraging greater private sector involvement.
Rural Emergency Medical Services (EMS)
Senate proposed level of funding: $500,000
House proposed level of funding: $ 0
Rural EMS funding provides grants to recruit emergency medical service personnel in rural areas and to train them in the areas of emergency response, injury prevention, and safety awareness. Rural EMS funding also supports the development of technology-enhanced education methods and the acquisition of medical supplies and protective equipment for emergency medical services personnel, as well as emergency preparedness and prevention efforts in rural areas.
Rural and Community Access to Emergency Devices
Senate proposed level of funding: $8,927,000
House proposed level of funding: $1,960,000
Automated external defibrillators (AEDs) are small, easy-to-use devices that shock a heart back to normal rhythm during cardiac arrest, saving the life of the victim. Access to AEDs for police forces, fire departments, first responders, and community organizations in rural areas is critical to increasing the survival rates of cardiac arrest victims in remote locations. The Rural and Community Access to Emergency Devices program assists in purchasing emergency devices such as AEDs and in training first responders in their use.
2. Final Rule on Necessary Provider CAHs
CMS released a final rule that impacts Critical Access Hospitals (CAHs) that have been granted necessary provider status and are proposing to rebuild in a new location that does not meet the distance requirements of the “35 mile rule.” The final rule removes the proposed distinction between a replacement and relocation of a necessary provider and eliminates the proposed distance requirement.
CAHs will still have to meet the same state-specific necessary provider critieria plus serve at least 75% of the same area with 75% of the same services and at least 75% of the same staff at the new location.
Click here for the details of the rule.
3. Changes to Medicare Coverage of Telehealth
CMS has issued draft revisions of the physician payment schedule for 2006 which includes proposed changes for telehealth coverage.
In these revisions, CMS added individual medical nutrition therapy services but not group nutritional therapy or Diabetes Self-Management Training Services to the list of eligible services. Registered dieticians and Nutrition Professionals were added as two new types of eligible providers.
CMS has asked for public comment on two issues: 1) the definition of interactive telecommunication system to include a two-way audio and one-way video system for certain specialty consultants; and, 2) adding skilled nursing facilities (SNFs) to the list of eligible originating sites.
Click here to access the full draft rule, Federal Register, August 8, 2005, Volume 70, Number 151, pages 45763-45812.
4. Healthy People 2010 Under Review
Written comments are being sought on the activities of Health People 2010. The Office of Disease Prevention and Health Promotion, Office of Public Health and Science, HHS, is conducting a midcourse review of the program. It will consider changes and revisions proposed to the Healthy People 2010 objectives and sub-objectives. Comments may be submitted via Healthy People Web site by September 15. Click to access the AHRQ Web site for more information. Click to read the August 12 Federal Register notice.
5. National Coordinator for Health Information Technology
A new Office of the National Coordinator (ONC) for Health Information Technology has been created to lead the development of a nationwide, interoperable health information system. Its mission extends to developing a strategic plan for such a system in both public and private sectors and working with other relevant executive branch agencies.
Click here for further details. Announced to date is an outline of broad goals, component offices and three areas to which it is now directing its efforts: 1) regional health information organizations; 2) nationwide health information network; and 3) adoption of Electronic Health Records (EHR).
Dr. David J. Brailer was appointed National Health Information Technology Coordinator on May 6, 2004.
6. Reports on Evidence-based Practice Centers
Medicare's prescription drug benefit arrives in 2006, and health plans begin to enroll Medicare beneficiaries this fall. At the same time, AHRQ is launching its new Effective Health Care Program to help patients, clinicians, and payers choose the best treatments for their needs. It builds on years of experience in AHRQ's Evidence-based Practice Centers (EPCs) and outcomes and effectiveness programs.
Two recent publications offer background on the EPC experience and a preview of considerations that will be important for the new AHRQ program. In a commentary entitled Advancing Excellence in Health Care: Getting to Effectiveness published by the Journal of Investigative Medicine, AHRQ Director Carolyn M. Clancy, M.D., and Center for Outcomes and Evidence Director Jean Slutsky provide an overview. Key issues include the need to provide information in clear, ready-to-use formats for multiple audiences. The article points to the need to develop methods for efficiently generating new evidence through "practical clinical trials." The report calls attention to the potential role for health information technology in both gathering and disseminating effectiveness information.
In June, the Annals of Internal Medicine published a supplement reviewing the experiences and lessons learned since the AHRQ-sponsored EPCs were launched in 1997.
The commentary is Advancing Excellence in Health Care: Getting to Effectiveness. The supplement is Challenges of Summarizing Better Information for Better Health: The Evidence-Based Practice Center Experience. A limited number of copies are available by sending an e-mail to ahrqpubs@ahrq.gov.
7. The Changing Legal Environment for Health Information
Health information is important to health care quality improvement. The rapid advances in health information technology are raising significant legal questions. To shed light on this complex subject, The George Washington University School of Public Health and Health Services with support from the Robert Wood Johnson Foundation is producing a series of reports. The first of these, Charting the Legal Environment of Health Information, broadly explores the legal environment of new health information systems including the sharing of data among many users. The 67-page report ranges across topics from anti-trust to privacy considerations and certain legal implications of centralized vs. decentralized data-exchange models. It forecasts that as the health care system is transformed from “a series of isolated businesses into virtual, large-scale undertakings linking multiple actors (many of whom may be marketplace competitors) industrialization of this magnitude raises many legal questions.”
Subsequent reports will focus on medical health records, legal tools being developed in response to changes in related processes and implications for eliminating racial and ethnic disparities in health care delivery.
Click here for the full report.
8. AHRQ’s Native American and Alaska Natives Research
The Agency for Healthcare Research and Quality has released program brief describing activities in which information technology, educational programs, cooperative partnerships and analyses of care are being used to improve health outcomes in U.S. indigenous populations.
Highlights include:
- Quality Care and Error Reduction in Rural Hospitals in nine states in the Western U.S. (based at University of Montana);
- Effectiveness of Prenatal Diabetes Education Among Pima Indians (based at University of Arizona)
- IT Systems for Rural Indian Clinic Health Care (based at California Rural Indian Health Board)
- Planning for Health Information Technology Implementation (based at Tahlequah City Hospital)
- Cultural Variation in Data Privacy and Bioethical Views (based at University of New Mexico).
In 2005 AHRQ will become a partner with the Native American Research Center for Health program, presently funded by NIH and IHS. It conducts research and research training in response to American Indian and Alaska Native communities.
Click here for the six-page report.
9. APHA Calls for Medicaid Reform Policies
The American Public Health Association (APHA) is calling for Medicaid reforms that will encourage preventative care and treatment for children. It warned against focusing on “artificial, short-term financial savings” that would “disproportionately affect minority and rural beneficiaries and exacerbate health disparities.”
The white paper, Medicaid, Prevention and Public Health: Invest Today for a Healthier Tomorrow, urges federal and state lawmakers to focus on four key areas:
- ensuring access to preventative services;
- guaranteeing treatment for children with conditions detected by screenings;
- prohibiting cost sharing for receipt of covered services; and
- assuring access to affordable prescription drugs.
Click here for the 22-page report.
Across Arizona
1. Addressing Rural Information Technology Healthcare Issues
Arizona’s rural information technology needs and capacities related to healthcare will be discussed and strategies for action recommended at a forum in Phoenix on November 14. Presentations on improving rural health care with applied information technology will be followed by small work groups that will identify gaps and propose related remedies.
The day-long event, “Information Technology in Rural Arizona: A Tool to Improve Healthcare Workforce Recruitment and Retention, Quality and Education” is sponsored by the Arizona Rural Health Association and cosponsored by the Rural Health Office of the UA Zuckerman College of Public Health.
2. Latina Public Health Scholarship Winners
Five Latina students at The University of Arizona Mel and Enid Zuckerman College of Public Health have won scholarships winners for demonstrating academic ability and a commitment to serving the state's Latino population.
The recipients of this year's Latina Scholarship are undergraduate pre-health education student Sonia Aguila; master of public health students Lourdes Barrera, Olga Felix and Christine Armenta; and Melisa Celaya, who is pursuing a doctorate in epidemiology.
Aguila amassed more than 200 hours of supervised clinical activity with the Arizona Health Academy, a program designed to give hands-on experience to students interested in health careers. Barrera volunteered as a medical interpreter at Clinica Amistad and Clinica San Juan. She currently works at St. Elizabeth of Hungary Clinic, which provides a range of health services to people who lack insurance.
Felix has worked for Clinica Adelante, a non-profit organization serving migrant farm workers, as well as the Tucson Urban League and the Wesley Community Center.
Armenta, a registered nurse, is concurrently pursuing a master of public health degree from the UA Zuckerman College of Public Health and a master's in science nursing from ASU. Celaya co-founded the UA chapter of a service-based sorority, Gamma Alpha Omega, in 1993 and currently works at the Arizona Respiratory Center.
Each winner will receive $4,000, funded by Canyon Ranch Health Resort and the Hispanic Women's Corporation.
3. Galloway Honored by U.S. Public Health Service
James M Galloway has been named 2005 Clinical Physician of the Year by the U.S. Public Health Service Physicians Professional Advisory Committee. The award recognizes his work in improving cardiovascular care to American Indians including the “Make a Link” program, an educational and public health approach focusing on the connection between diabetes and heart disease.
Galloway serves as senior cardiologist for the IHS and directs the National Native American Cardiology Program in Phoenix. He also had dual appointments as associate professor of both clinical medicine and public health in the UA Zuckerman College of Public Health at the UA College of Medicine.
4. Arizona SHIP Grants
The Office of Rural Health Policy's Small Rural Hospital Improvement (SHIP) Grant Program provides funding to small rural hospitals. Fifteen Arizona rural hospitals with under 50 beds will receive their grants for the 2005-2006 program year in October.
Grants and Opportunities
Note: Technical assistance is readily available for the development of grant proposals and other funding applications from the experienced staff of the Rural Health Office and the State Office of Rural Health Program. Please contact Jennifer Peashock.
1. Connecting Public Health with Health Information Exchanges
Application Deadline: September 7, 2005
The Information Links program will provide grants to support the participation of state and local public health agencies in health information exchanges. The grants are available to public health agencies for activities in support of population-based public health services, as opposed to direct provision of health care (e.g., safety-net provider services). The program is designed as a one-time, short-term stimulus to catalyze and facilitate greater participation by public health agencies in health information exchanges.
State and local health departments and nonprofit organizations, such as public health institutes, specifically designated by a state or local health department to receive funds on their behalf, are eligible to apply.
Approximately 20 grants of between $75,000 and $100,000 each will be awarded. This is a program of the Robert Wood Johnson Foundation.
For application details and to register for applicant conference calls please visit http://www.informationlinks.org
2. Rural Health Network Development Planning Grants
Announcement number: HRSA 06-007
Application deadline: September 8, 2005
This program is intended to support organizations to plan a network among health care organizations to integrate systems of care administratively, clinically, financially and technologically. Unlike the Rural Health Outreach Grants (see later in this section) there funds are not used for direct delivery of services. The planning grants provide assistance to plan, organize and develop a health care network where there is not a significant history of collaboration.
Awards of $25,000-$100,000 will be made for periods of one year.
Click here for details.
3. End-of-Life Quality of Care Grants
Application deadline: September 15, 2005
The Aetna Foundation is seeking proposals to enhance the quality of health care with a special emphasis on reducing racial and ethnic disparities. The current cycle will address end-of-life care in the following areas: training and education (including cultural competency), support services and resources for caregivers, and initiatives that reduce barriers to use of palliative and home care services.
Requests can range from $50,000-$300,000 over one to three years. The process begins with online submission of a short abstract describing the project. Qualifiers will be requested to submit full applications.
Click here for complete details.
4. Rural Health Care Services Outreach Grant
Announcement number: HRSA 06-005
Application deadline: September 23, 2005
This program encourages the development of new and innovative health care delivery systems in rural communities that lack essential health care services. It emphasizes creative strategies in which the grantee forms a consortium with at least two partners.
Projects should be based on demonstrated community needs and may include primary care, dental care, mental health services, home health care, emergency care, health promotion and education programs, and outpatient day care.
Grants are available of up to $375,000 for three years.
Click here for details.
5. Rural Health Network Development Grants
Announcement number: HRSA 06-010
Application deadline: September 26, 2005
This program is intended to support organizations to further ongoing collaborative relationships among health care organizations to integrate systems of care administratively, clinically, financially and technologically. The ultimate goal here is to strengthen the rural health care delivery system by improving the viability of the individual providers in the network. Networks must consist of at least three separately owned health care providers. Such networks must demonstrate an understanding of key needs of the community’s health care providers and be prepared to provide solutions and benefits to providers.
Both horizontal (all member are the same type of organization) and vertical networks (members of different types of organizations) are eligible.
Grants are available of up to $540,000 for three years.
Click here for details.
6. Quality of Care Grants Address Depression
Application deadline: October 15, 2005
The Aetna Foundation is seeking proposals to enhance the quality of health care with a special emphasis on reducing racial and ethnic disparities. This program addresses care of depression in the following areas: training and education for health care professionals (including culturally sensitive care); screening and outreach efforts to enhance early identification, diagnosis and treatment of depression; and public education programs to enhance understanding and treatment of depression.
Requests can range from $50,000-$300,000 over one to three years. The process begins with online submission of a short abstract describing the project. Qualifiers will be requested to submit full applications.
Contact Your Representatives
a. Arizona Congressional Delegation: Links to Arizona members of the U.S. House of Representatives are available at: U.S. Representatives. Links to Arizona members of the U.S. Senate are available at: U.S. Senate
b. Arizona State Legislators: Available through the Arizona Legislative Information System (ALIS): Call 1-800-352-8404 or follow links at Arizona Legislature.
Important Links
Editor's Note: This online newsletter is a project of the Arizona Rural Hospital Flexibility Program, housed in the Rural Health Office at the UA Zuckerman College of Public Health, and supported through a grant from HRSA (Office of Rural Health Policy). The Rural Hospital Flexibility Program was created by Congress to improve the financial viability and stability of health care in rural areas, including creation of a new designation for rural hospitals as Critical Access Hospitals (CAHs). Designated CAHs are eligible for cost-based reimbursement for services provided to Medicare patients. In some states, including Arizona, additional reimbursement is also available for CAH services provided to Medicaid patients.
Your discerning comments, invaluable suggestions or probing questions are always welcome. Please send them as well as address changes to Jim Laukes, Editor, Rural Health Briefing.
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