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Rural Health Briefing, May 1, 2006
National News
1. Payment Changes Proposed for Inpatient Acute Care
2. Components for Health Information Sharing
3. National Resources for HIT
4. HIT Costs and Benefits Examined
5. RHIO Realism
6. Telepharmacy Meets Rural Needs
7. Swing Beds Gaining in CAHs
8. Snapshot: Health Care Costs 101
9. CMS Updates Rural Health Factsheets
10. Health of Rural Women
11. Community Connections Stories at AHA
Across Arizona
1. Setting Policies to Eliminate Health Disparities
2. Five Year Vision for Arizona’s Health Information
3. Electronic Health Records for Rural Arizona
4. Diabetes Education Connects with Telemedicine
5. Mobile Health Program Reaching Out
6. Awards Abound
7. Do AHCCCS and KidsCare Save Money?
EMS
1. Flex Program Offering Mini-Grants to Rural EMS Systems
2. CAH ER Nurses and First Responders Training in Sierra Vista and Flagstaff
Grants and Opportunities
1. Broadband Transmission Grants for Rural Areas
2. Rural Health Research
3. Indian Health Service Children and Youth Projects
4. Rural Funding for Distance Learning and Telemedicine
5. Matching Support to Aid Critical Health Needs
6. Grants for Early Treatment of Mental Illness
Calendar
May 1-7, Cover the Uninsured Week, nationwide
May 6-9, Second Annual Mobile Health Clinics Forum, San Diego
May 15-19, NRHA Annual Conference Week, Reno, Nevada
May 15-17, National Summit on the Methamphetamine Epidemic, Memphis, Tennessee
May 15-19, 2006, 3rd Annual Rural Nurse Conference, Coeur d'Alene, Idaho
May 18, Improving Native American Health through Telehealth and Emerging Technologies - 1st Annual Summit, Washington, D.C., contact Paul Moorehead, 202-230-5174.
May 31-June 3, 9th Annual Conference, Community-Campus Partnerships in Health, Minneapolis, Minnesota
June 4-7, AHRQs Annual Patient Safety and Health IT Conference , Washington, D.C.
June 26-28, Social Services Performance Summit , Washington, D.C.
July 10-12, AHRQ’s Translating Research into Practice and Policy , Washington, D.C.
July 10-12, 2nd Annual Rural and Community Hospital Symposium and Management Conference , Las Vegas, Nevada
July19-21, 33rd Annual Arizona Rural Health Conference , Bisbee
Mark Your Calendar
September 21-23, Health Information Technology: A Rural Provider’s Roadmap to Quality , Kansas City, Missouri
National News
Payment Changes Proposed for Inpatient Acute Care
CMS has issued a notice of proposed rulemaking that would begin the transition to the first significant revision of the Inpatient Prospective Payment System (IPPS) since its implementation in 1983. When fully implemented in FY 2008 the revised IPPS would improve the accuracy of payment rates for inpatient stays by basing the weights assigned to Diagnosis Related Groups (DRGs) on hospital costs rather than charges, and adjusting the DRGs for patient severity. Over 1000 hospitals in rural areas would see an average increase of 6.7 percent.
Click here for the press release. Comments on the proposed rule will be accepted until June 12, 2006.
Components for Health Information Sharing
Connecting for Health, a public-private collaborative, has released its Common Framework: Resources for Implementing Private and Secure Health Information Exchange. It provides the initial elements for secure, authorized, and private clinical information sharing.
The Common Framework includes 16 technical and policy components, which were developed by experts in information technology, health privacy law, and policy. This initial set of critical technical and policy components demonstrates how various health information networks can share information while protecting privacy and allowing for local autonomy and innovation. Components include technical documents and specifications, testing interfaces, and code, as well as a companion set of privacy and security policies and model contractual language to help organizations interested in information exchange move quickly towards the necessary legal agreements for private and secure health information sharing. The components have been tested since mid-2005. The Common Framework materials are available for download at no cost at www.connectingforhealth.org.
National Resources for HIT
HealthIT is the main website used by HHS to highlight federal efforts. It currently features the American Health Information Community (AHIC), an advisory body advising the Secretary of HHS on accelerating the development of Health IT. AHIC will make recommendations on consumer empowerment, chronic care, biosurvelliance and electronic health records. Click here for details.
AHRQ’s National Resource Center for Health Information Technology describes emerging lessons and collaborations. Active links are on these key topics: computerized provider order entry; electronic health/medical records; electronic prescribing; health information exchange; and, telemedicine. Descriptions of funded projects in each of these areas are included. An active database of the key literature on HIT costs and benefits allows searches on HIT elements; IOM categories; Types of Healthcare Organization Settings; Study design; Health system HIT leaders; and, Cost/benefit outcomes. Click here for details.
HIT Costs and Benefits Examined
A new AHRQ report, Costs and Benefits of Health Information Technology, is a synthesis of studies on the quality impact of health IT (HIT) as well as the costs and organizational changes needed to implement such systems. This report reviews scientific data about the implementation and does not project future health care benefits or savings, in contrast to other reports.
The report acknowledges that while health IT has been shown to improve quality of care for patients, widespread implementation has been limited by uncertainty of what types of HIT will improve care and manage costs for specific organizations.
Click here for the 154-page report.
RHIO Realism
What factors should hospitals consider when approaching or developing Regional Health Information Organizations (RHIOs)? A new report, based on case studies and interviews, from the American Hospital Association distills the issues into a handful of observations.
- Be proactive.
- Assess your internal capacity.
- Consider the risks and benefits of being a pioneer.
- Let the clinical and care improvement priorities drive the project.
- Build trust and good will.
- Create a platform for shared investment and financial sustainability.
- Build privacy and security into the business and technical infrastructures.
- Be realistic about timeframes.
One predominantly rural case study, CareSpark, serves a 17 county region of northeast Tennessee and southwest Virginia. Formed in January 2005, its business plan calls for a fully sustainable organization. It is participating in a federal contract to build a national health information network prototype architecture.
Click here for the 40 page report, Health Information Exchange Projects: What Hospitals and Health Systems Need to Know.
Telepharmacy Meets Rural Needs
North Dakota has moved into the era of telepharmacy. Here’s how it works. A licensed pharmacist at a central pharmacy site supervises a qualified registered pharmacy technician at a remote site through the use of video conferencing, a central pharmacy computer link and an audiolink. The technician prepares the prescription drug for dispensing by the pharmacist. The pharmacist communicates face-to-face in real time with the technician and also provides traditional pharmacy services such as drug utilization review, prescription verification and patient counseling.
As of September 2005, 33 remote telepharmacy sites were served by 17 central pharmacies in 55% of the state’s counties.
The enabling administrative rules were adopted with collaboration of the North Dakota Sate University College of Pharmacy, the state Board of Pharmacists and the stare Pharmacists Association.
Click here for more details.
Swing Beds Gaining in CAHs
An increasing number of CAHs use swing beds as in-hospital, skilled nursing facilities. However CAHs have little reimbursement incentive to substitute swing bed care for acute care since Medicare pays under the same cost-based rules for both but such services draw fixed overhead away from the cost-based acute care areas. Despite concerns that CAHs might withdraw these services, it does not seem to be the case according to Trends over Time in the Provision of Skilled Nursing Care in Critical Access Hospitals. Swing-bed participation in this group rose from 83% in 1996 to 95% by 2003, while it remained around 40% for all other eligible facilities.
The brief was produced by the North Carolina Rural Health Research and Policy Analysis Center and is available here.
Snapshot: Health Care Costs 101
Now in its 2006 edition, this presentation provides a concise, visual snapshot of national health care spending trends in a series of charts and graphs. Based primarily on National Health Expenditures data from the CMS, the slides show how spending is distributed by type of service and illustrate growth in spending categories such as hospital services and prescription drugs. For the first time, it also examines how contributions from households, business, and government are blended to finance both public and private health coverage.
Click here for the presentation.
CMS Updates Rural Health Factsheets
Six rural health fact sheets are available in downloadable format from the Centers for Medicare & Medicare Services’ Medicare Learning Network (MLN) web page. They range from two to four pages.
Rural Referral Center Fact Sheet (new this year)
Medicare Disproportionate Share Hospital Fact Sheet (new this year)
Rural Health Clinic Fact Sheet (revised)
Critical Access Hospital Program Fact Sheet (revised)
Federally Qualified Health Center Fact Sheet (revised)
Sole Community Hospital Fact Sheet (revised)
Click here for the MLN site, then scroll down to the 2006 rural fact sheets.
Health of Rural Women
An unintended consequence of welfare reform is a substantial increase in former welfare recipients, especially rural, low-income mothers, who have lost Medicaid coverage and become uninsured. This according to a new study by the RUPRI Center for Rural Health Policy Analysis, The Impact of Welfare Reform on Health Insurance Coverage in Rural Areas.
The report shows that while welfare reform has been hailed for decreasing dependence on welfare and for moving former welfare recipients into jobs, less attention has been paid to the quality of those jobs and whether those jobs come with health insurance, and especially whether there is a difference between urban and rural conditions.
Click here for the eight-page report.
A fact sheet from Rural Families Speak Project lends further support to maintaining physical, oral and mental health of rural mothers in order to prevent further poverty. The report, Health: Essential to Rural, Low-Income Mothers’ Economic Well Being, is available by clicking here.
Community Connections Stories at AHA
The American Hospital Association's Community Connections initiative is documenting the ways that hospitals' work extends beyond the hospital walls. From free clinics to job training to immunizations, hospitals are engaged in numerous activities that benefit community health and well being. As a resource for hospital leaders, AHA is collecting and sharing examples of how hospitals are making America healthier. Tell your story by visiting www.caringforcommunities.org
Across Arizona
Setting Policies to Eliminate Health Disparities
Creating a Statewide Policy Agenda to Eliminate Health Disparities is the title of a working meeting to be held Thursday, May 18 in Tempe. Participating community leaders and policy makers will identify the top policy areas for improving the health of minority and vulnerable populations. The meeting is sponsored by the Arizona Public Health Association (Disparities Section), Arizona Department of Health Services, UA Zuckerman College of Public Health (Center for Health Equality) and American Heart Association’s Cultural Health Initiatives.
Space is limited. Please contact Edwina Glick, eglick@azdhs.gov for a registration form by May 5. Or call the Arizona Center for Minority Health at 602-542-1219.
Five Year Vision for Arizona’s Health Information
Arizona’s Health-e Connection Roadmap is setting the course and the vision for Arizona to develop a transparent health electronic exchange system, and practical steps over five years to leverage existing efforts in positive directions.
Early stages call for a secure health information portal for demonstration purposes and seeding “trading zones” for products and services like a continuity of care record and lab results among networks of hospitals, physicians and payers.
The Roadmap pledges to accommodate the needs of rural communities and small physician practices.
Over the next transition year, a public-private nonprofit entity will be created to provide oversight and direction for implementing the Roadmap.
The rationale is clear: “The delivery and management of healthcare has extended beyond the walls of a single hospital or a single doctor’s office and has resulted in healthcare information being located in a variety of institutions. …(I)t is of paramount importance to move healthcare information with the patient so that is is available wherever and whenever they receive care.”
Download the Health-e Connection Roadmap here.
To glimpse at another state’s approach, see California’s CalRHIO’s data standards roadmap, a guide for health care organizations as they purchase new or upgrade current health information technology. It is also intended to assist health IT vendors in upgrading and developing products.
The roadmap illustrates the current data standard in use and the standard expected to be in use by 2010 and beyond. Nine areas are addressed: administration and finance, allergies, clinical documentation, imaging, immunization, laboratory, medication, services, and vocabulary.
Electronic Health Records for Rural Arizona
Ten Arizona CAHs sent representatives to the workshop, Electronic Health/Medical Records: Practical Strategies for Selection and Implementation, in Phoenix on April 10. Program topics ranged from types of records systems, doing a risk assessment and document management to return on investment, pay for performance and Medicare compliance.
In terms of their state of preparedness for HIT, the participating hospitals are all over the map. Many have mixed systems (paper and electronic) and are converting as conditions allow. Others are getting bids from vendors or doing assessments. One hospital tried and failed with an EHR system and is now back to the planning phase. The Arizona Rural Hospital Flexibility Program, funded by the HRSA’s Office of Rural Health Policy, will allocate approximately $106,000 in small grants to Arizona CAHs (not affiliated with larger health care systems) for the purpose of planning and implementing electronic health record systems. These applications are due May 19, 2006.
Diabetes Education Connects with Telemedicine
The Carondelet Diabetes Education Institute in conjunction with IHS’s Phoenix Indian Medical Center (PIMC) and the Rural Health Office recently concluded a successful pilot using the Arizona Telemedicine Network to offer a series of six diabetes education core classes simultaneously in two locations, PIMC and Carondelet St. Joseph’s Hospital in Tucson. The majority of the participants were RN’s working in varying capacities. These included senior professionals and diabetes educators.
With chart-topping evaluations, the success of the training via the videoconference method has led organizers to preparations for future trainings at rural sites throughout Arizona.
If you would like further information about taking these classes, please contact Juana Casillas, Rural Health Office, 520-626-5837 or Donna Zazworsky, Carondelet Diabetes Education Institute, 520-349-4864.
Mobile Health Program Reaching Out
The Mobile Health Program (MHP) of the Rural Health Office is employing wireless communications to facilitate group diabetes health education classes in Amado in collaboration with the Arizona Telemedicine Program and St. Elizabeth of Hungary Clinic. The MHP was also awarded a Maternal and Child Health Block Grant from Pima County to support efforts to reduce health disparities in prenatal care for underserved community residents. This will be done in collaboration with the UA Department of Family and Community Medicine Family Practice Residents and the Women's Pregnancy Centers.
Awards Abound
Maia Ingram of the Rural Health Office was acknowledged with the Outstanding Community Service and Public Health Practice Award at the University of Arizona Awards of Distinction ceremony on April 18. Dean G. Marie Swanson noted that Ingram “embodies the commitment and spirit of social justice when working along-side Arizona communities.”
Other members of the UA Zuckerman College of Public Health recognized for their achievements were Dr. Norma Gray and Darlene Lopez. Both were given Outstanding Teaching Awards.
2006 MEZCOPH Staff Awards of Excellence were made to Sonia Medina and Donna Peterson.
Do AHCCCS and KidsCare Save Money?
St. Luke’s Health Initiatives wanted to know if Arizona could save money by reducing AHCCCS enrollment. Using 2004 data in the Arizona HealthQuery database, researchers from Arizona State and Brigham Young Universities found that enrollment in AHCCCS was associated with decreased emergency department use and decreased hospitalization as enrollees received more care through routine visits. A decision to change eligibility and disenroll members produces the opposite effect: more emergency department use, more hospitalizations and less routine care.
A conservative estimate of related costs indicates that AHCCCS currently saves the system $4.3 million per year. Similarly, maintaining the KidsCare Parents Program saves the system $2.4 million. Additionally, disenrollment costs the state millions in lost matching dollars from federal sources.
Click here for the full study.
EMS
Flex Program Offering Mini-Grants to Rural EMS Systems
The Arizona Rural Hospital Flexibility Program, in collaboration with Southeast Arizona EMS Council (SAEMS), is offering two mini-grants of $5,000 each to enable two EMS systems affiliated with Arizona critical access hospitals (CAHs) to participate in the ScanHealth online data system. Seven EMS systems in Cochise County are currently participating with extremely positive results. ScanHealth makes possible data entry and retrieval of first responder patient care forms. The online system enables direct Internet connection to all data plus report summaries. It also provides an optional immediate link for billing and collections. Access to data reports can be used to improve procedures, protocols, records improvement and skill sets.
Call Taylor Payson at 520-529-0450 if you are interested. First-come, first served. EMS systems already using ScanHealth are not eligible. The two grants must be completed by August 31, 2006.
A general information meeting with ScanHealth is tentatively scheduled for May 31 (date to be confirmed). Call Taylor Payson to indicate your intent to attend the meeting and apply for the mini-grant. Also please get further technical information from the Scan Health website, http://www.scanhealth.com/HealthEMS.asp .
For further information, contact Alison Hughes, Director, Arizona Flex Program at 520-626-6253 or ahughes@u.arizona.edu .
CAH ER Nurses and First Responders Training in Sierra Vista and Flagstaff
The Arizona Rural Hospital Flexibility Program will be sponsoring EMS training in triage, pediatrics, and obstetrics. This training is for Critical Access Hospital ER Nurses and First Responders from the EMS agencies that serve Arizona's 12 CAHs. The training will be held in Sierra Vista on June 2nd and in Flagstaff on July 14th. More details will follow. For more information, please contact Leila Barraza at 520-626-6467 or semino@email.arizona.edu.
Grants and Opportunities
Note: Technical assistance is available for the development of grant proposals and other funding applications from the professional staff of the Rural Health Office and the State Office of Rural Health Program. Please contact Jennifer Peters.
Broadband Transmission Grants for Rural Areas
Application deadline: May 15, 2006
The Community Connect Grant Program provides financial assistance in the form of grants to eligible applicants that will aid currently unserved areas, on a "community-oriented connectivity" basis, with broadband transmission service that fosters economic growth and delivers enhanced educational, health care, and public safety services. USDA Rural Development will give priority to rural areas that it believes have the greatest need for broadband services. Eligible applicants are Indian tribes or tribal organizations, state and local governments and profit or non-profit corporations. $8.9 million in grants are available.
Click here for details.
Rural Health Research
Application deadline: May 19
HRSA’s Office of Rural Health Policy is seeking proposals for policy-relevant rural health research on issues of national significance in the area of rural health services. The projects should examine critical issues facing rural communities in their quest to secure adequate, affordable, high quality health services. Research findings will be of interest to national, State and local decision makers with concerns about rural communities. Up to five awards of $150,000 each will be made.
Click here for details.
Indian Health Service Children and Youth Projects
Application deadline: May 25, 2006
The purpose of the Children and Youth Projects (CYP) is to assist Federally recognized Tribes and urban Indian organizations in promoting health practices, and addressing unmet needs. This will be accomplished through (1) community designed public health approaches; (2) school-linked activities; and/or (3) clinical services.
CYP goals are to support children and youth, to promote healthy nutrition, physical activity, reduce teen pregnancy, and aid in the risk reduction of injuries, early morbidity, and premature mortality from injuries. Additional program goals are to aid in the risk reduction of alcohol, tobacco, inhalant and substance abuse, to support a healthy learning environment, and to promote staying in school, and to support community level activities directed.
Awards will range from $5,000 to $75,000.
Click here for details.
Rural Funding for Distance Learning and Telemedicine
Application deadline: June 12, 2006
USDA’s Distance Learning and Telemedicine (DLT) Program provides access to education, training and health care resources for people in rural America. It offers financial assistance to encourage and improve telemedicine services and distance learning services in rural areas through the use of telecommunications, computer networks, and related advanced technologies by students, teachers, medical professionals, and rural residents. Eligible applicants are Indian tribes or tribal organizations, state and local governments and profit or non-profit corporations. $8.9 million in grants are available. Grants are expected to range from $50,000 to $500,000 from a total FY 2006 fund of $20 million.
Click here for details.
Matching Support to Aid Critical Health Needs
Application deadline: July 6, 2006
Local Initiative Funding Partners links the Robert Wood Johnson Foundation and local grantmakers that seek to fund original projects to improve the health of vulnerable people in their communities.
Grantmakers propose a funding partnership by nominating community initiatives that offer creative solutions to critical health or healthcare problems.
These projects must be new, innovative, collaborative, and community based. Local funding partners must be willing to work with each grantee to obtain sufficient dollar-for-dollar matching funds throughout the grant period. Matching funds must represent new funding specifically designated to support the proposed project.
Up to 14 matching grants of $200,000 to $500,000 per project will be awarded in this cycle.
Click here for details.
Grants for Early Treatment of Mental Illness
Application deadline: September 1, 2006
The American Psychiatric Foundation is seeking applications for public education projects that promote the early recognition and treatment of mental illness. Grants may be for new initiatives or expansion of current programs. Requests must be for educational, informational or outreach efforts targeting the public. Efforts may focus on a specific mental disorder, mental illness in general or target a specific population.
Click here for application details.
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 questions (and answers) are always welcome. Please send them as well as address changes to Jim Laukes, Editor, Rural Health Briefing.
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