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Rural Health Briefing March 1 2004
National News
1. Rural Health Funds Would Shrink Under ‘05 Executive Budget
2. SHIPs Eligible for 340B Discount Drug Program
3. CMS Updates
4. Guidelines for Reporting Hospital Quality Data
5. Comments on Proposed Regulations via Internet
6. One More Reason to Keep Our Rural Hospitals Open
7. Distance to Nearest Hospital Critical to Heart Attack Survival
8. 12,800 Respond with Universal Service Comments
9. Public Health Week to Focus on Eliminating Health Disparities
10. Telemedicine Information Exchange
11. Rural Health Network Case Studies
12. What’s Important to Rural Health in New Medicare Bill
Across Arizona
1. Arizona Rural Health Association Awarded $9,500
2. Call for Presentations – 31st Annual Arizona Rural Health Conference
3. $7 Million for Rural Hospitals Proposed in Arizona Legislation
Grants and Opportunities
1. Project EXPORT Graduate Fellowships
2. Rural Health Outreach Grants
3. Environmental Health Education in Tribal Communities
4. AHRQ Grants for Rural Telecommunications
5. Matching Grants for Advanced Telecommunications
6. Rural Mental Health and Drug Abuse Research
Events
- March 16 - Community Health Advancement Partnership teleconference
- March 26-27 - Strategies for Today’s Clinician: Management of TB, STDs, HIV and Hepatitis C at the Border, Yuma (No charge, but fax intent to attend to Arleen Heimann at (520) 626-6134 by March 12)
- April 5 - Using Health Network Innovations to Build Capacity in Rural Arizona, Phoenix
- April 6 - Project EXPORT, Promoting Health Equity in Arizona-One Community at a Time teleconference
- April 15-16 - Celebrating Public Health in Arizona, Arizona Public Health Association Spring Conference, Tempe
- April 29-30 - Steps to a Healthier US Summit, Baltimore
- May 2-5 - Ninth Annual American Telemedicine Association meeting and exposition, Tampa
- May 20-21 - New Frontiers in Diabetes and Preventive Care, Phoenix
- May 25-29 – National Rural Health Association conference, San Diego
Mark Your Calendar!
- June 2-4, Second Annual Western Region Flex Conference, Lake Tahoe
- July 19-21, 31st Annual Arizona Rural Health Conference, Phoenix
National News
1. Rural Health Funds Would Shrink Under ’05 Executive Budget
Congress helped rural providers in the Medicare reform law, but now the Executive branch would reduce rural healthcare under the 2005 budget request. The budget blueprint recently sent to Congress would make significant reductions in rural health programs administered by the Health Resources and Services Administration of HHS and would represent "the largest reductions to rural programs in more than 10 years," according to the National Rural Health Association. Specifically, this budget proposal would reduce rural health outreach grants to $11 million in fiscal 2005 from $40 million in 2004 and eliminate the Rural Hospital Flexibility Grant Program and all HRSA funding for public health improvement projects. The federal government will spend an estimated $372 million on such projects in fiscal 2004. The proposed cuts have rural providers -- which won a number of concessions in the Medicare reform law -- preparing for another struggle.
2. SHIPs Eligible for 340B Discount Drug Program
Thanks to a change in the cap on the Medicare Disproportionate Share (DSH) for rural hospitals, SHIP grantee hospitals may now be eligible for the 340b discount drug program. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (P.L. 108-173) increased the DSH cap for small and rural hospitals to 12 percent. That change has opened the door to the 340b program for all small and rural hospitals with a Medicare DSH percentage of at least 11.75 percent. Qualifying hospitals will be eligible to take part in this program, which can provide substantial savings on outpatient drug purchases. For more information and to find out if your facility qualifies for this benefit visit HRSA's Bureau of Primary Health Care's Pharmacy Affairs Branch Website. Or direct questions to: BPHC's Pharmacy Affairs Branch, 1-800-628-6297.
3. CMS Updates
a. Guidelines for Reporting Hospital Quality Data
CMS has announced the guidelines hospitals should use in submitting their quality performance data to comply with Section 501 the Medicare Prescription Drug, Improvement and Modernization Act (MMA). Hospitals that do not submit performance data for 10 quality measures will receive 0.4 percent smaller Medicare payments in fiscal year 2005 than hospitals that do report quality data. In order to qualify for the full monetary update, they must sign up with the Quality Improvement Organizations' data warehouse by June 1, 2004 and transmit the required data there by July 1, 2004, which will reflect patient discharges during the most recent quarter available. A set of 10 quality measures has gone through years of extensive testing for validity and reliability. They have been chosen because they are related to three serious medical conditions that are common among people with Medicare and that result in hospitalization, which are heart attack (acute myocardial infarction), heart failure, and pneumonia. Fact Sheets with further detail for hospitals are available at www.cms.hhs.gov/quality/hospital.
b. Comments on Proposed Regulations via Internet
Private citizens, companies and others who want to comment on proposed Medicare and Medicaid regulations now, for the first time, can submit their opinions electronically via the Internet. The new electronic process began with the rule proposing changes to the prospective payment system for long-term care hospitals, published in the January 30th Federal Register. Those wanting to comment electronically can do so through the http://www.regulations.gov/ Web site or the link to the new CMS system provided in CMS' published rules. In addition to comments on proposed or final regulations, the new CMS system will be open for comment on other documents, including policy notices soliciting public input and notices asking for other information, such as nominations for advisory committees.
4. One More Reason to Keep Our Rural Hospitals Open!
Distance to Nearest Hospital Critical to Heart Attack Survival
Heart attack victims who make it to the hospital in time to receive medical attention are four to five times more likely to survive compared with those who don't make it to a hospital promptly, according to a new Cornell University study. The research also finds that for each five-minute increase in distance from a hospital, a person's probability of getting to the hospital in time falls by 1.25 percent.
“With prompt medical attention, a person's blockage to the heart, which causes a heart attack, can often be dissolved,” says Liam O'Neill, assistant professor in the College of Human Ecology at Cornell. O'Neill adds: "But as hospitals close and services and staff are reduced, the time that heart attack victims must travel to get to a hospital may be increasing, especially in rural areas. This puts patients at a much greater risk in the event of a cardiac or other emergency."
5. 12,800 Respond with Universal Service Comments
Recently, the FCC sought comments on ways to streamline the application process and expand outreach efforts regarding the rural health care universal service support mechanism. This was, in part, because participation in this program has not met projections and the Commission may assess whether their rules and policies have something to do with that gap. The Universal Service program provides telecommunication discounts to assist rural health care access. The six-year old program has only spent approximately $14 million in discounted telecommunications services out of $400 million per year allocated for this program. 14,400 responses were received. Results have yet been released.
6. Public Health Week to Focus on Eliminating Health Disparities
As part of the April 5-11, 2004 Public Health Week, the American Public Health Association is looking for smart, innovative projects/interventions that are currently being used around the country to help end health disparities. They are searching for health disparity projects/interventions in all shapes and sizes – not necessarily just "proven" projects/interventions, just promising ones that have the potential to make a difference. In addition, an event planners guide and toolkit are available from http://www.apha.org/NPHW/toolkit/
7. Telemedicine Information Exchange
To find a comprehensive, international, quality-filtered resource for information abouttelemedicine, telehealth, and telemedicine/telehealth related activities, click to the Telemedicine Information Exchange. Sections include news, features, bibliographies, citations, active programs, meetings, funding, vendors, journals, home health, and legal issues. Find it at http://tie.telemed.org/AboutTheTIE.asp.
8. Rural Health Network Case Studies
The Networking for Rural Health project has published a report Using Rural Health Networks to Address Local Needs. It includes five complete case studies from sitesranging in size from five non-profit FQHCs in south central and southwest Texas to a group in the Upper Peninsula of Michigan that encompasses a regional medical center, 13 community hospitals, a tribal health center and a behavioral health provider network. Each case study draws from analysis of reports, telephone interviews, and histories. They also detail implementation challenges, post-grant activities, the potential for replicability, and lessons learned. This 48-page monograph is available from
http://www.academyhealth.org/ruralhealth/casestudies.pdf.
9. What’s Important to Rural Health in New Medicare Bill
Changes in the 2003 Medicare Act will have an impact on rural health care providers. The Rural Health Policy Research Institute at the University of Nebraska Medical Center has prepared a report that highlights certain provisions of the Act particularly important to rural interests. Highlights are organized by interest and type: rural beneficiaries, regulations affecting access, provider payment, regulations affecting providers, administration improvements and contracting reform, demonstrationprojects and grant programs. A useful appendix points to areas of rural relevance and also makes a side-by-side comparison of features of the new law and the prior law. This policy paper (P2004-1) is available at http://www.rupri.org/healthpolicy/.
Across Arizona
1. Arizona Rural Health Association Awarded $9,500
The Arizona Rural Health Association received a grant from the Federal Office of Rural Health Policy, through the National Rural Health Association, to promote rural health activities in Arizona. The $9,500 grant will support the Association's Northern and Southern Arizona Forums, the rural health conference, the legislative forum, the Association website, and an electronic newsletter.
2. Call for Presentations – 31st Annual Arizona Rural Health Conference
The 31st Annual Arizona Rural Health Conference is seeking presentations for the July conference. The conference will examine challenges, opportunities, models that work, and innovative new ideas for collaborating to make Arizona voices count around issues that matter. Topics of particular interest are: health disparities, changing the rural health environment, workforce issues, rural practice, and telehealth. Submissions should be received by March 15, 2004. Submit a proposal directly online or download an application at http://rho.arizona.edu/rhc2004/conference.htm or call Rebecca Ruiz at 520-626-7946, ext. 254. The Rural Health Office of the Mel and Enid Zuckerman Arizona College of Public Health, and the Arizona Rural Health Association sponsor the conference.
3. $7 Million for Rural Hospitals Proposed in Arizona Legislation
The gap between costs and reimbursements in rural hospitals is getting attention inthis session of the Arizona Legislature. Senate Bill 1191, sponsored by Senator Marsha Arzberger and numerous other legislators, would create a rural hospital fund of $7 million for the purpose of eliminating the payment disparity.
According to the Arizona Hospital and Healthcare Association (AzHHA), unique financial challenges due to smaller patient populations than urban hospitals and competition for physicians, nurses and other medical personnel require rural hospitals to spread costs over a smaller revenue base. A joint study by AHCCCS and AzHHA reported disparities in payments to hospitals compared on the bases of location and size of hospitals. The study found that while AHCCCS payments cover 94 percent of overallhospital costs for serving AHCCCS members, coverage of costs for rural hospitals fell to 71 percent and for smaller hospitals (fewer than 75 beds) fell to 57 percent.
Sen. Arzberger said, “I know of no business that can deliver their product at half their actual cost. Yet our rural hospitals are treating AHCCCS patients and their reimbursement is around half.” The Senate Standing Committee on Health passed the bill, in amended form, unanimously on February 26. See details of the bill at ALIS Online http://www.azleg.state.az.us/DocumentsForBill.asp?Bill_Number=sb1191
Grants and Opportunities
1. Project EXPORT Graduate Fellowships
Minority students interested in conducting research and community interventions could find support for their work through the 2004-2005 Project EXPORT Graduate Fellowships. The fellowships are designed to support incoming and continuing minority graduate students who are interested in pursuing a career in minority health disparities, especially in areas of diabetes and substance abuse among Native Americans and Hispanic populations in the Southwest. The Arizona EXPORT program is currently focusing on two sites: the Southside of Tucson and the community of Hard Rock on the Navajo Reservation.
Project EXPORT Fellowships provide an annual stipend of $8,000. The fellowship is for one year with a possibility of renewal. Applications must be received by March 15, 2004.
To receive complete details, please contact Griselda Martinez, Project EXPORT Administrative Associate at 520-626-7946 Ext. 236 or at grm1@coph.arizona.edu.
2. Rural Health Outreach
The Rural Health Care Services Outreach Grant Program supports projects that demonstrate creative or effective models of outreach and service delivery in rural communities. Applicants may propose projects to address the health care needs of a wide range of population groups and to deliver many different types of health care and health care related services in rural communities.
The applicant organization must be a public or nonprofit private entity located in a rural area or in a rural ZIP Code of an urban county and all services must be provided in a rural county or ZIP Code. Or the applicant organization exists exclusively to provide services to migrant and seasonal farm workers in rural areas and is supported under Section 330g of the Public Health Service Act. The other option is that the applicant is a federally recognized Native American Tribal or quasi-Tribal entity that will deliver services on Reservation or Federally recognized Tribal lands. The entity must represent a consortium composed of members that include three or more health care providers and that may be nonprofit or for-profit entities. Details at
http://fedgrants.gov/Applicants/HHS/HRSA/GAC/HRSA-05-002/Grant.html
3. Environmental Health Education in Tribal Communities
The Program to Build Capacity to Develop, Implement, and Evaluate Environmental Health Education and Promotion Activities in Tribal Communities is available from CDC's Procurement and Grants Office. Approximately $175,000 is available to fund between three and four awards to federally-recognized Indian tribes, consortia of Indian tribes, or Indian tribal organizations. The purpose of the program is to improve tribal capacity to develop, implement, and evaluate health education and promotion activities and take collaborative action to address tribal environmental health issues. The estimated funding award date is September 1, 2004. Applications are due March 25, 2004.
Details at http://www.cdc.gov/od/pgo/funding/04025.htm
4. AHRQ Grants for Rural Telecommunications
AHRQ currently has $26 million earmarked specifically for patient safety projects in rural and small community hospitals. Three RFAs have been issued to fund projects directly related to health information technology initiatives to improve patient safety and quality of care. Health information technology includes electronic health records, personal health records, e-mail communication, clinical alerts and reminders, computerized provider order entry, computerized decision support systems, handheld computers, information resources, and electronic monitoring systems.
All applications must be received by April 22, 2004.
The three RFAs can be found at the following sites:
Transforming Healthcare Quality through Information Technology Planning Grants
http://grants.nih.gov/grants/guide/rfa-files/RFA-HS-04-010.html
Transforming Healthcare Quality through Information Technology Implementation Grants
http://grants.nih.gov/grants/guide/rfa-files/RFA-HS-04-011.html
Demonstrating the Value of Health Information Technology
http://grants.nih.gov/grants/guide/rfa-files/RFA-HS-04-012.html
5. Grants for Advanced Telecommunications
The Technology Opportunities Program (TOP) is a merit-based matching grant program that promotes the use of advanced telecommunications and information technologies in the non-profit and public sectors. TOP provides organizations with the opportunity to explore the possibilities that new interactive technologies offer to improve the provision of "educational, health care, or public information." These projects encourage the deployment of broadband infrastructure, services, and applications. In health care, TOP will support projects that use network technologies to improve the efficiency of, effectiveness of, or access to health-related services.
Rather than simply requesting funds to build capacity or upgrade existing equipment, each application must describe a project that pinpoints specific problems, proposes innovative solutions involving the application of telecommunications and information technologies, and provides realistic and measurable outcomes. Full details at http://www.ntia.doc.gov/top/grants/documents/notice2004.html.
Technical Assistance Workshops are offered to give potential applicants an opportunity to find out more about TOP, its goals and objectives, and the particulars involved in applying for this year's grant funds. The Los Angeles, CA, Workshop will be held on Friday, March 26, 2004, at the Renaissance Hotel at the Los Angeles International Airport, 9:00 a.m. to 4:00 p.m. Details at
http://www.ntia.doc.gov/top/conferenceworkshops/workshops.htm.
6. Rural Mental Health and Drug Abuse Research
The National Institute of Mental Health (NIMH) and the National Institute on
Drug Abuse (NIDA) have grants available for research that will ultimately lead to a reduction in the burden of mental illness and drug abuse in rural and frontier populations. Key purposes are to: (1) enhance understanding of structural (including community risk and resilience factors), cultural, and individual factors that may limit the provision and utilization of prevention and treatment services in these communities; and (2) generate knowledge to improve the organization, financing, delivery, effectiveness, quality, and outcomes of mental health and drug abuse services for diverse populations in rural and frontier populations.
Applications may focus exclusively on mental disorders, drug abuse disorders, or on the co-occurrence of these and related disorders. This program will use the NIH research project grant (R01), small grant (R03), and exploratory/developmental grant (R21) award mechanisms. The objective of the R01 is to support a discrete, specified project. The objective of the R21 is to encourage applications from individuals who are interested in testing innovative or conceptually creative ideas that are scientifically sound and may advance our understanding of how to more effectively deliver high quality services to underserved rural and frontier populations. Exploratory/developmental grants (R21) are limited to 2 years of support with a combined budget for direct costs of up to $275,000 for the two-year period. Details at http://grants.nih.gov/grants/guide/pa-files/PA-04-061.html
Events
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March 16 - Community Health Advancement Partnership teleconference
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March 26-27 - Strategies for Today’s Clinician: Management of TB, STDs, HIV and Hepatitis C at the Border, Yuma
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April 5 - Using Health Network Innovations to Build Capacity in Rural Arizona, Phoenix
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April 6 - Project EXPORT, Promoting Health Equity in Arizona-One Community at a Time teleconference
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April 15-16 - Celebrating Public Health in Arizona, Arizona Public Health Association Spring Conference, Tempe
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April 29-30 - Steps to a Healthier US Summit, Baltimore
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May 2-5 - Ninth Annual American Telemedicine Association meeting and exposition, Tampa
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May 20-21 - New Frontiers in Diabetes and Preventive Care, Phoenix
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 Mel and Enid Zuckerman Arizona 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.
Comments, suggestions, questions, as well as address changes and additions to distribution list or removal from distribution list should be sent to Rural Health Briefing.
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