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Rural Health Briefing, March 5, 2003
1. Update: Rural Hospital Flexibility Program
a. Arizona Flex Program Website
b. State Action
- AzHHA Support for Critical Access Hospitals
- Western Region Flex Conference
- Collaborative Model for Quality Improvement
- Arizona EMS Conference Rural Health Track
c. National Action
- Rural Community Hospital Assistance Act
- TASC List of Quality Resources
- JCAHO's Critical Access Hospital Website
2. Arizona News
a. State Budget Woes
b. Andrew W. Nichols Initiative
c. List of Arizona Sliding Scale Fee Clinics
d. New Legislation Introduced
e. Hospital Association Online HIPAA Course
f. HIPAA Workshop for EMS Providers
g. Advanced Hazmat Life Support Training
h. HIV Update for Rural Providers
i. Cultural Competency Conference
3. National News
a. National Budget Woes
b. Venture Capital in Rural America
c. Cover the Uninsured Week
d. Public Health Grand Rounds on HIPAA
e. New Report: Rural Seniors and Long Term Care Needs
f. Agency for Healthcare Research and Quality News
- New National Quality Measures Clearinghouse
- Prevention Quality Indicators
- Cultural Competence Guides for Managed Care Plans
4. How to Contact Your Representatives
a. Arizona Congressional Delegation
b. Arizona State Legislators
5. Grant Opportunities
a. Nurse Loan Repayment Program
b. Grants for Non-Profits
6. Conferences Relevant to Rural Health
a. National Conference on HIV/STD Prevention in Rural Communities
b. 9th Annual Rural Minority Health Conference
c. 26th Annual Rural Health Conference
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1. Update: Rural Hospital Flexibility Program
a. Arizona Flex Program Website: The Rural Health Briefing E-Newsletters, both current and archived issues, are available through the Arizona Flex Program website for those who may have difficulty with the electronic transmission. Arizona Flex Program This month's issue includes links to several files that were provided to us, rather than online sites; if you have trouble opening the links, please go the newsletter link on the Flex Program website. E-Newsletter
b. State Action:
(1) AzHHA Support for Critical Access Hospitals: The Arizona Hospital and Healthcare Association recently distributed the following budget briefing regarding Medicaid funds for critical access hospitals. "The Joint Legislative Budget Committee Chairmen's Budget proposes the elimination of $591,000 in state funds for Critical Access hospitals in fiscal year 2004. These funds provide cost-based reimbursement through the Arizona Health Care Cost Containment System (AHCCCS) to hospitals with 25 beds or fewer. Because Arizona receives federal matching funds for this program, if the state funds are eliminated the Critical Access hospitals will lose a total of $1.7 million in 2004. The Critical Access program has helped to stabilize financially struggling hospitals in small rural communities. A recent study conducted by the AHCCCS Administration and the Arizona Hospital and Healthcare Association found that AHCCCS inpatient payment rates cover only 57 percent of costs for hospitals with fewer than 75 beds. In light of this situation, it is essential that the state continue its support of the Critical Access program." The '03 budget debate is still underway, but wrap-up is expected very soon. The '04 budget is another story, with debated expected to extend into the summer months.
MARK YOUR CALENDARS!
(2) Western Region Flex Conference - Mark Your Calendar: Arizona's Rural Hospital Flexibility Program will host a western states regional conference May 28-30 at the Embassy Suites Resort in Phoenix. Cosponsors of the conference include the Flex programs in Alaska, Arizona, Nevada, New Mexico, Oklahoma, and Utah. Other states in the western region have participated in early conference planning, and staff members of critical access hospitals and Flex Programs in 17 states will be invited to participate. The conference will feature a site visit with Hu Hu Kam Memorial Hospital in Sacaton, Gila River Indian Community, a tribally-owned critical access hospital. Topics to be covered at the conference will include performance improvement, strategic hospital planning, new business development, rural health planning, and western states and national policy issues. Breakout sessions will include tribal and IHS issues, emergency medical services, quality improvement, border issues (state and international). A mini-workshop on finance and reimbursement and simultaneous roundtable breakfasts for CAH staff and Flex staff are also planned. Events For further information, please contact: Joyce Hospodar.
(3) Collaborative Model for Quality Improvement - Mark Your Calendar: The Health Services Advisory Group, Inc., Arizona's Quality Improvement Organization (QIO), in collaboration with the Arizona Flex Program, will conduct a one and one-half day interactive learning session June 2-3 at the HSAG Conference Center in Phoenix for critical access hospitals and other rural hospitals. The workshop will be structured using the Plan, Do Study, Act (PDSA) rapid cycle model for development and implementation of a hospital quality improvement intervention focused on pneumonia and influenza. Hospitals are asked to send small teams to the workshop, including quality assurance managers and staff, infection control and prevention managers, emergency room nurses, case managers, and patient care nurses. The workshop will be free of charge. Arizona critical access hospitals will be eligible to receive reimbursement for travel, food, and hotel expenses. Events For further information, please contact: Joyce Hospodar
(4) Arizona EMS Conference - Rural Health Track - Mark Your Calendar: The Arizona Emergency Medical Systems, Inc. (AEMS) 3rd Annual EMS Conference is scheduled June 19-20 at the Embassy Suites Resort in Phoenix. In collaboration with the Arizona Flex Program, AEMS conference planners are developing a special Rural Health Track that will focus on issues affecting rural EMS providers (including tribal), in the service regions of the state's critical access hospitals. Evan Mayfield, Public Health Analyst for the Federal Office of Rural Health Policy, will be a keynote presenter for the Rural Health Track. Mr. Mayfield is an EMT, and has been a project manager for the Rural Access to Emergency Medical Devices grant program. EMS Conference Events For further information, please contact: Sonya Roberts
c. National Action:
(1) Rural Community Hospital Assistance Act: This legislation was introduced by Congressmen Jerry Moran (R-Kan.) and Jim Turner (D-Texas) on February 26. The bill is intended to strengthen the Critical Access Hospital program by enhancing CAH reimbursement (including cost-based reimbursement for SNF units, ambulance services, geriatric psychiatric services and home health care) and permitting some needed changes in their operations. It also creates a new hospital payment status called Rural Community Hospital (RHC) for rural hospitals with 50 or fewer acute care beds, providing enhanced Medicare reimbursement and additional funding for technology and infrastructure needs. For a summary of the bill's provisions and comparison of reimbursement systems: CAH-RCH Bill
(2) TASC List of Quality Resources: The Technical Assistance and Services Center for the National Medicare Rural Hospital Flexibility Program recently collected a list of resources for quality assurance/quality improvement that may be useful to critical access and other small rural hospitals. The list includes associations, projects, and websites. Quality Resources
(3) JCAHO's Critical Access Hospital Website: The Joint Commission on the Accreditation of Healthcare Organizations now has a separate website for critical access hospitals. The website includes a link to a new Statement of Conditions, based on the 2000 edition of the Life Safety Code, which became effective on March 1. The previous edition of the Statement of Conditions was based on the 1997 Life Safety Code. New Statement of Conditions
2. Arizona News
a. State Budget Woes: A University of Arizona economist who has conducted analyses of the economic impact of the state's rural hospitals on their communities, offered an analysis of the state's budget problems in the editorial section of the March 2 Arizona Daily Star. State Budget
b. Andrew W. Nichols Initiative: The Mel and Enid Zuckerman Arizona College of Public Health is developing an Andrew W. Nichols Initiative for Rural and Border Health to perpetuate the work of Dr. Nichols, the director of the Rural Health Office until his death in April 2001, in public health policy, rural health, and border health. On Sunday, April 6, 2003, the initiative will be launched publicly at a seminar to be held at the First Christian Church in Tucson with a public lecture by Emily Friedman on "Borderline Beliefs." In August 2002, Modern Healthcare magazine named Ms. Friedman one of the 100 most powerful people in health care. Ms. Friedman's lecture will focus on Dr. Nichols' contributions to rural and border health. Borderline Beliefs Lecture
c. List of Arizona Sliding Scale Fee Clinics: The Arizona Department of Health Services, Office of Health Systems Development, maintains a list of "Arizona Health Service Sites Offering Discounted Fees. For copies of the brochure, please contact: John Payne List 1 List 2
d. New Legislation Introduced: The following lists of legislation related to health care introduced in the current session of the Legislature were provided to the Arizona Rural Health Association Board of Directors by the Arizona Hospital and Healthcare Association. Part I
Part II To verify the current status of these bills, go to: Bills
e. Hospital Association Offers Online HIPAA Course: The Arizona Hospital and Healthcare Association is offering a new HIPAA Web-Based Course for Hospital Workforce. The course was developed by Kristen Rosati, Coppersmith Gordon Schermer Owens and Nelson, Phoenix, and covers key requirements of the HIPAA Privacy standards; workplace situations that may affect privacy and confidentiality; what will happen if the standards are not followed; areas where privacy and confidentiality may be broken. Tiered pricing for the course is available as follows: $750 Base Fee for up to 250 employees; $3 per person for 250-1,000 employees; $2 per person for 1,000 or more employees; $10 Individual User. The course is available through AzHHA's internet based learning website: Care Learning
f. HIPAA Workshop for EMS Providers: On March 13, a workshop on HIPAA privacy regulations for emergency medical services personnel will be held from 8:00 am to 4:00 pm at Kino Hospital, Balbria Room, in Tucson. For further information, please contact ADHS, Bureau of EMS Regional Manager: Chuck Kramer.
g. Advanced Hazmat Life Support Training: A multi-state and multi-national faculty is offering a series of training courses for Advanced Hazmat Life Support (AHLS) Providers and Instructors. A course is scheduled in Tucson, Arizona on March 19-21 and in Lake Havasu City on April 4-5. See the AHLS website at: AHLS For further information about the Tucson course, contact: Danielle Crounse. For further information about the Lake Havasu City course, contact:
Rod Reed.
h. HIV Update for Rural Providers: The Arizona AIDS Education and Training Center of the University of Arizona Health Sciences Center is providing an HIV Update for rural health care providers today. Although this notice is too late for this meeting, to obtain information about future workshops, please contact: Robert Castrillo
i. Cultural Competency Conference: The University of Arizona Health Sciences Center, College of Medicine and Arizona Area Health Education Centers, is offering a conference on cultural competency on April 2 from noon to 5:30 p.m. at the Westin La Paloma, 3800 E. Sunrise Drive, Tucson. There is no charge for the conference, and meal is included. Continuing medical education credit will be provided for health care professionals. Health professions students are invited to attend. The conference will address the health care needs of increasingly diverse populations, the need to deliver health care in a culturally appropriate manner, and methods for doing so. For further information, contact: Rajni Gunnala or contact: Carlos Chacon
3. National News
a. National Budget Woes: Washington Post columnist, David Broder, commented in a March 2 column on the disappearance of national budget surpluses and related woes, quoting a rural hospital administrator visiting his congressman about Medicare reimbursement payments set lower for rural hospitals than for big city hospitals. "The shortfalls in federal Medicare payments mean that costs are 'shifted onto local businesses, industries, and commercial payers and the working poor, who are mostly self insured.'" As a result, corporations "see how disproportionately high the health care costs are . . . " resulting in negative impacts that "affect whole communities, not just hospitals."
Broder Column
b. Venture Capital in Rural America: A November 2002 article in the Main Street Economist, a publication of the Center for the Study of Rural American, Federal Reserve Bank of Kansas City, describes problems of access to capital in rural areas and strategies for increasing the availability of venture capital for entrepreneurs in rural areas. Rural Venture Capital For more information about the Center for the Study of Rural America, see the website at: Rural Center
c. Cover the Uninsured Week: The National Rural Health Association is a National Supporter of Cover the Uninsured Week, a week-long series of national and local events that will take place coast to coast from March 10 through March 16. Cover the Uninsured Week is a major effort to establish the issue of the uninsured as a top national priority and to encourage the nation to seek solutions for the more than 41 million Americans who have no health insurance, including 8 million children. Former Presidents Gerald Ford and Jimmy Carter are Honorary Co-Chairs of the project. For further information, see: Uninsured
d. Public Health Grand Rounds on HIPAA: On March 28 the North Carolina Public Health Grand Rounds will air "HIPAA Privacy Rule: Enhancing or Harming the Public's Health." The program will feature the experiences and best practices of Thurston County, Washington, where public health leaders and their community partners are working together to comply with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule and protect the public's health. Continuing education credit for various health professions will be offered based on one hour of instruction (2:00-3:00 pm EST). To be eligible, you must complete an online registration and evaluation. The broadcast may be viewed at a satellite downlink near you or online. Online registration, program information, and a list of currently available sites are located at:
Public Health Grand Rounds If you don't find a site near you on the website, contact: Grand Rounds or phone (919) 843-9261.
e. New Report: Rural Seniors and Long Term Care Needs: The National PACE Association and the National Rural Health Association published a new report on February 20, "Setting the PACE for Rural Elder Care: A Framework for Action." PACE is an acronym for Programs of All-Inclusive Care for the Elderly. PACE programs serve people over age 55 who meet their state's criteria for needing nursing home care, with a goal of helping them to live in the community. PACE has been shown to provide better clinical outcomes and higher rates of consumer satisfaction, while cutting costs to federal and state governments. Today, PACE programs only serve older people living in urban areas. The new report suggests ways to develop PACE programs in rural areas. As a next step, NPA and NRHA are working together to build support in the Bush administration and Congress for a rural PACE demonstration program. For more information about the PACE program, see: PACE For a copy of the report: Rural Seniors
f. Agency for Healthcare Research and Quality News:
(1) New National Quality Measures Clearinghouse: The Agency for Healthcare Research and Quality has a new web-based National Quality Measures Clearinghouse (NQMC). According to the AHRQ, the clearinghouse contains the most current evidence-based quality measures and measure sets available to evaluate and improve the quality of health care. The site is designed to be a one stop shop for physicians, hospitals, health plans, and others interested in quality measures. Users can search the NQMC for measures that target a particular disease/
condition, treatment/intervention, age range, gender, vulnerable population, setting of care, or contributing organization. Visitors also can compare attributes of two or more quality measures side by side to determine which measures best suit their needs. Measures to be considered for inclusion in the NQMC can be submitted on an ongoing basis but must meet a set of criteria that can be accessed online. NQMC
(2) Prevention Quality Indicators: In January, the AHRQ released its revised Prevention Quality Indicators software in SAS and SPSS format. The Prevention Quality Indicators are a set of measures that can be used with hospital inpatient discharge data to identify "ambulatory care sensitive conditions." These are conditions for which food outpatient care can potentially prevent the need for hospitalization or for which early intervention can prevent complications of more serious disease. to download the software: Prevention QI
(3) Cultural Competence Guides for Managed Care Plans: To address shifting demographic trends in health care, two guides have been developed by AHRQ through a contract from CMS: "Providing Oral Linguistic Services" and "Planning Culturally and Linguistically Appropriate Services." These guides are available at: Cultural Competence
4. How to 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 Arizona Legislature
5. Grant Opportunities
a. Nurse Loan Repayment Program: Applications are due by midnight on March 31, 2003. See: Nurses
b. Grants for Non-Profits
6. Conferences Relevant to Rural Health
a. National Conference on HIV/STD Prevention in Rural Communities: "Sharing Successful Strategies II," March 28-30, Bloomington, Indiana. HIV/STD Prevention
b. 9th Annual Rural Minority Health Conference: Held in conjunction with the National Rural Health Conference (see below), May 13, 2003, Salt Lake City, Utah.
c. 26th Annual Rural Health Conference: "The Changing Rural Landscape," May 14-17, 2003, Salt Lake City, Utah. National Rural Health Conference
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