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Rural Health Briefing May 14 2004
National News
1. CMS Proposes FY 2005 Payment Increases and Policy Changes
2. Search the Health Disparities Community Solutions Database
3. New PDA Tools from AHRQ
4. SIDS Education Kit for American Indians and Alaska Natives
5. HHS Names First Health Information Technology Coordinator
6. Mobile Health Care Could Become as Compelling as Email
7. Rural Healthy People 2010 Now Available
Around Arizona
1. AHRQ Director to Speak in Phoenix on Health Disparities
2. AHCCCS Reenrollment Period Now Before Legislature
Grants and Opportunities
1. NRHA / MultiPlan Offer Rural Health Initiative Outreach Grant Program
2. Telecom and Internet Discounts for Rural Health Providers
3. Community Responsive Interventions to Reduce Cardiovascular Risk in American Indians and Alaska Natives
4. Creating Better Health Through Innovation 2004
5. 2004 Minority Fellowship Program Cancer Track
Events
- May 19-20 - Health Center Financial & Operations Management Seminars, National Association of Community Health Centers, Scottsdale
- May 20 - Getting Out of the Box and Into the Community: Creative and Effective Strategies for Grassroots Participation, Association for Community Health Improvement, audioconference, 9:00-10:00 a.m. MST
- May 20-21 - New Frontiers in Diabetes and Preventive Care, Phoenix
- May 25 - AHRQ Quality Indicators Training Session, Jackson Hole, Wyoming
- May 25-29 - National Rural Health Association Conference, San Diego
- May 26 - CAH Reimbursement, online webinar from CareLearning includes new Medicare provisions
- May 27 - Improving Governance and Accountability: A Balanced Scorecard Approach, online conference
- June 1-4 - Direct Service Tribes, First Annual Meeting, sponsored by the Indian Health Board, Phoenix
- June 2-4 - Second Annual Western Region Flex Conference, Lake Tahoe
- June 3 – Rewarding Quality Summit, Phoenix
- June 9-11 - Arizona Intertribal Circle of Caring & Sharing Training Conference: "Tribal School Readiness: Strategies for Our Future," Flagstaff
- July 8 - Congestive Heart Failure Quality Assurance Training in Rural Hospitals, videoconference seminar, Tucson and Phoenix
- July 19-21 - 31st Annual Arizona Rural Health Conference, Phoenix
National News
1. CMS Proposes FY 2005 Payment Increases and Policy Changes
The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that would increase payments to acute care hospitals for inpatient services in fiscal year 2005, offer additional financial relief to rural hospitals, and for the first time in the history of
Medicare, create a direct link between quality services to Medicare beneficiaries and payment for those services. The proposed rule would implement major payment and policy changes for acute care hospitals required by the comprehensive Medicare modernization legislation signed into law on December 8, 2003.
CMS projects that the combined impact of the inflation update and other proposed changes will yield an average 4.7 percent increase in payments for urban hospitals in fiscal year2005, while rural hospitals will see an average increase of 6.0 percent. In FY 2005, Medicare payments to approximately 3,900 acute care hospitals under the inpatient prospective payment system (IPPS) are projected to be $105 billion, up from a projected $100 billion in fiscal year 2004.
As required by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), hospitals reporting specified quality data will receive an inflation update equal to the hospital market basket percentage increase, currently estimated at 3.3 percent. Hospitals that do not report this information will receive the market basket percentage increase less 0.4 percentage points, or an estimated 2.9 percent increase. The market basket percentage increase refers to the projected rate of inflation for goods and services used by hospitals in caring for Medicare beneficiaries. This is the first time that hospital payment rate increases have been related to performance, in this case by providing incentives for giving information to patients and health professionals related to quality of care.
The proposed rule would also implement Section 406 of the MMA, which requires CMS to make an additional payment to low-volume acute care hospitals that are located more than 25 road miles from another acute care hospital: payments will be based on their additional incremental costs. CMS has determined that this adjustment will be paid to
hospitals with 500 or fewer discharges in a year that meet the distance requirement, because the available evidence shows that costs per case increase below this level of discharges. CMS is proposing to use the number of discharges from a previous fiscal year both in determining whether a hospital qualifies for the adjustment and in determining the amount of the adjustment to make it possible for hospitals to know in
advance whether they will be receiving adjustments and how much.
The MMA contained a number of provisions to help critical access hospitals (CAHs) as they serve rural beneficiaries. For example, these hospitals can now designate up to 25 beds as either acute care beds or swing beds – beds that may be used for either acute or post-acute care, and can set aside units of up to ten beds each to be used exclusively for inpatient rehabilitation and psychiatric services. These units, which would not count toward the CAH's 25-bed maximum, will be paid as if they were distinct parts of acute care hospitals, and will have to meet the same standards as units in acute care hospitals.
The proposed rule establishes a five-year demonstration project required by the MMA to test the feasibility and advisability of establishing a separate payment system for inpatient services provided by rural community hospitals. The MMA requires that the demonstration include up to 15 hospitals in rural areas of states with low population densities. Participating hospitals will be paid on a reasonable cost basis for the first year of the demonstration. Thereafter, the hospitals will be paid at the lesser of reasonable costs or a target amount. The proposed rule will be published in the May 18 Federal Register. Comments will be accepted until July 12, 2004, and a final rule will be published later in the year. The proposed rule may be viewed at: http://www.cms.hhs.gov/providers/hospital.asp
2. Search the Health Disparities Community Solutions Database
The American Public Health Association has launched a tool to help local government agencies, activists and health professionals implement programs to reduce disparities in their communities. APHA has developed a database of solutions that are working in communities across the country: the database is searchable by category, key word, state and race/ethnicity. It offers information, implementation advice and contact information for nearly 400 programs that are addressing health disparities. What's more, enter your own inventive solutions to help build the database. Complete details at: http://www.apha.org/NPHW/solutions/
3. New PDA Tools from AHRQ
AHRQ has released PDA applications for clinical preventive services and pneumonia severity. They can be downloaded at no cost.
The Interactive Preventive Services Selector application and online guide identifies clinical preventive services for screening, counseling, and preventive medication based on the patient's age, sex, and pregnancy status. It reflects current recommendations of the U.S. Preventive Services Task Force (USPSTF) and can be used as a clinical tool for delivering appropriate services. It is located at: http://198.76.191.14/ipss/ipss.htm
The Pneumonia Severity Index Calculator is an interactive tool to assist clinicians in determining the most appropriate care for newly diagnosed cases of community-acquired pneumonia (CAP) at the point of care. It will help calculate the severity index of a pneumonia patient. The output includes mortality rates and pneumonia class types.
It is located at: http://pda.ahrq.gov/clinic/psi/psi.htm
4. SIDS Education Kit for American Indians and Alaska Natives
Mortality rates for Sudden Infant Death Syndrome (SIDS) continue to decline but rates among American Indian and Alaska Native populations still remain disproportionately high. It is one of the leading causes of infant mortality.
American Indian organizations joined forces with the CJ Foundation to develop culturally appropriate educational materials; materials that teach mothers and other care givers measures they can take to reduce the risk of SIDS among their children. The CJ Foundation has developed this Face Up to Wake Up(tm) SIDS Risk Reduction Resource Kit to disseminate materials across Indian Country, free of charge. The kit is a resource for health care professionals and health educators who work with Native community members. It includes a manual designed to assist the educator in both one on one and classroom instruction and also to enhance the instructors' current level of understanding regarding SIDS. There are also two videos and a resource CD that contains posters, brochures, PSAs, radio spots and other educational materials ready to be printed.
If you would like to request this resource kit, click here.
5. HHS Names First Health Information Technology Coordinator
David J. Brailer, M.D., Ph.D., has been named National Health Information Technology Coordinator, a new position at HHS to coordinate the nation's health information technology efforts. HSS is also developing other improvements to the health information infrastructure.
HHS and other federal agencies will adopt 15 additional standards agreed to by the Consolidated Health Informatics (CHI) initiative to allow for the electronic exchange of clinical health information across the federal government.
With HHS support, the voluntary international health standards-setting organization known as Health Level 7 (HL7) is announcing a favorable vote on a functional model and standards for the electronic health record. The model is a significant step toward establishing nationwide guidelines for electronic health records. Such a system would allow a doctor or health care provider to access an always-up-to-date electronic health record of a patient who has agreed to be part of the system.
The medical vocabulary known as SNOMED CT can be downloaded for free for use in the United States through HHS' National Library of Medicine. SNOMED CT, created by the Collegeof American Pathologists, is a key clinical language standard needed for a national health information infrastructure
6. Mobile Health Care Could Become as Compelling as Email
Health care and mobile phones are usually only mentioned in the same sentence during debates about the safety of handsets and masts. This could change over the coming years according to a report just published by the Cambridge, England-based consultancy Wireless Healthcare. The report suggests mobile operators could play a key role in providing public health care services.
Wireless Healthcare believes that when subscribers gain access to mobile phones that can interact with other wireless devices, mobile operators could become key players in a fully engaged health care scenario.
The report "Mobile Operators - Fully Engaged", identifies three areas where mobile health care services are applicable within a fully engaged health care scenario. These three areasare dietary information, fitness and training, and health monitoring.
Unlike a fixed line service, a mobile phone usually has just one unique user who keeps the handset within reach throughout the day. The report identifies technologies such as wireless enabled scales and blood pressure monitors that are essential for a mobile patient monitoring services. Health monitoring services would be used to monitor compliance with diets and health care plans and gather data prior to a patient's visit to their health care provider.
Adapted from Virtual Medical Worlds
7. Rural Healthy People 2010 Now Available
Focusing on immunization and infectious disease in addition to injury and violence prevention in rural areas, Texas A&M University System Health Science Center, School of Rural Public Health has issued new sections of Rural Healthy People 2010. Featured articles include case studies of regional early childhood immunization efforts and associated models fo practice.
Coming in September 2004 will be sections on access to long-term care, education and community-based programs and public health infrastructure.
The report can be downloaded from: Southwest Rural Health Research Center
Around Arizona
1. AHRQ Director to Speak in Phoenix on Health Disparities
The National Healthcare Quality Report represents the first national comprehensive effort to measure the quality of health care in America, while the National Disparities Report is the first national effort to measure differences in access and use of health care services by various populations. Dr. Carolyn Clancy, Director, Agency for Healthcare Research and Quality, will address the important conclusions in these reports on May 26, 9:00-10:30 a.m., at the HSAG Conference Center, 1600 E. Northern Avenue, Suite 100, Phoenix. Register online at http://www.hsag.com/conferences/conf_nhqdr.asp
2. AHCCCS Reenrollment Period Now Before Legislature
Community health advocates expressed support for a legislative attempt to move the redetermination period for AHCCCS enrollment from 6 to 12 months during the budget negotiation in the current session of the Arizona legislature in bills SB 1402 and SB 1410.
They contend that interruptions in insurance result in disruptions in the timely delivery of children’s vaccinations and interfere with effective treatment of chronic diseases. Furthermore, the anticipated savings to AHCCCS due to the number of people who fail to reenroll because of the shorter redetermination period is offset by the additional administrative costs of eenrolling individuals. Higher health care costs can also result when those who are not reenrolled are compelled to use emergency room services for primary care treatment.
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 by email at mailto:peashock@email.arizona.edu.
1. NRHA / MultiPlan Offer Rural Health Initiative Outreach Grant Program
Application deadline: October 15, 2004
The National Rural Health Association (NRHA) and MultiPlan are seeking applications for a 2004 Rural Health Initiative Community Outreach Grant. The grant program allows rural hospitals to offer new services, expand existing services, or reach new populations. Eight grants will be awarded.
To receive a grant, your hospital must be a member of the National Rural Health Association and must participate in MultiPlan's healthcare network.
Please contact MultiPlan's Network Support Service Dept at (800) 677-1098 or rural@multiplan.com if you have any questions regarding the NRHA/MultiPlan Rural Health Initiative Community Outreach Grant Program. Applications available at: http://www.multiplan.com/providers/ruralhealth.cfm.
2. Telecom and Internet Discounts for Rural Health Providers
The Universal Service program, which provides telecommunication discounts to assist rural health care access, is now accepting applications for new funding. There are some changes for this funding year that are important to highlight.
* Twenty-five per cent (25%) of the monthly charge for Internet access, web addresses and/or web hosting are now supported. To apply for this support please check the appropriate box on Line 30 in your FY 2004 Form 465 and submit the new form 466-A. Please read the instructions for both forms and example (466-A EZ) provided.
* Also new for FY 2004 is a change in applicant eligibility. A revised list of eligible entities is provided.
* For telecommunication carriers and Internet service providers (collectively know as "Service Providers") there is an updated PDF entitled, "Procedures for Service Providers." Please refer to this document for helpful information.
As a result of recent Federal Communications Commission (FCC) action, health care participants may be eligible to receive a 25% discount on their monthly Internet service charges. These services are limited to the monthly Internet net access charge, monthly charges for web hosting and web addresses. Eligibility for this discount is open to all rural non profit HCP's in addition Emergency Departments of for profit rural hospitals are eligible. A complete list of eligible services for both Internet and telecommunications services is provided.
Dedicated Emergency Departments of for-profit hospitals and not-for-profit providers located in rural areas are also now eligible. Over the past six years, several thousand rural roviders have taken advantage of this program.
Call Rural Health Care Division at 1-800-229-5476 with any questions. Hours of operation are 8AM to 8PM, Eastern Time, Monday through Friday.
http://www.rhc.universalservice.org/whatsnew/032004.asp
3. Community Responsive Interventions to Reduce Cardiovascular Risk in American Indians and Alaska Natives
Letters of Intent due: September 22, 2004
Applications due: October 22, 2004
The National Heart, Lung, and Blood Institute (NHLBI) invites applications for
cooperative agreements to conduct five-year studies in American Indian/Alaskan Native (AI/AN) populations to test the effectiveness of behavioral interventions
to promote the adoption of healthy lifestyles and/or improve behaviors related
to cardiovascular (CV) risk, such as weight reduction, regular physical
activity, and smoking cessation. These behaviors and lifestyles are known to
affect biological cardiovascular risk factors, such as hypertension,
dyslipidemia, obesity, glucose intolerance, and diabetes. A central feature of
this project is to develop and test culturally appropriate interventions that
could be incorporated into clinical programs of the community health care
systems or delivered through public-health approaches in Native communities.
The NHLBI intends to commit approximately $1.0 million in direct costs in Fiscal
Year 2005 to fund four field Centers in response to this RFA. Each applicant may
request a project period of five years and a budget for direct costs of up to
$250,000 for the first year, $425,000 for the second year, $450,000 for the third
year, $475,000 for the fourth year, and $275,000 for the fifth year.
Details at: http://grants.nih.gov/grants/guide/rfa-files/RFA-HL-04-023.html
4. Creating Better Health Through Innovation 2004
Submission deadline: June 22, 2004
In support of its mission to improve individual and community health, the VHA Health Foundation strives to find, fund and disseminate new, effective models of health and health care. Programs submitted for funding consideration should be ready to implement - or further refine - and should clearly incorporate the following elements:
Innovation - A novel and/or significantly better approach to solving a problem or need related to health and/or health care;
Impact - Process and outcome measures quantified during the grant period;
Replicability - Aspects of the program that stimulate adoption/adaptation by others;
Sustainability - Evidence of strategic and operational integration, including financial viability.
Six to eight grants will be awarded in the range of $100,000 to $250,000. Activities pertaining to the grant must be concluded no later than December 31, 2005. The applicant organization must match at least 50 percent of Foundation funding (includes cash and/or in-kind services). Grants are available to U.S. health care providers, including hospitals, health care systems, clinics and medical practices. Local partnerships are encouraged to apply, with a health care provider serving as lead agency.
Download the Call for Proposals brochure (115k PDF, 8 pages) and related forms needed to submit your proposal.
5. HRSA Grants for Rural Health
(i.) Rural Health Care Services Outreach Grants (HRSA-04-001)
Application deadline: September 13, 2004
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.
Eligibility: 1) 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 (list included in application materials) and all services must be provided in a rural county or ZIP Code; or 2) 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 or 3) The applicant is a federally recognized Native American Tribal or quasi-Tribal entity that will deliver services on Reservation or Federally recognized Tribal lands (documentation of status must be included). 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.
A funding preference will be given to any qualified applicant that can demonstrate one of the following three criteria:
1) At least one of the consortium members is located in officially designated health professional shortage areas (HPSAs) OR medically underserved communities (MUCs) OR serve medically underserved populations (MUPs). To ascertain HPSA and MUP designation status, please refer to the following website: http://bhpr.hrsa.gov/shortage/index.htm.
2) Ambulatory practice sites designated by State Governors as serving medically underserved communities; OR
3) Propose to develop project with a focus on primary care and prevention and wellness.
The applicant must request and identify the particular preference they are eligible for to receive a funding preference.
The Office of Rural Health Policy seeks to expand the outreach program into geographic areas not currently served by the program. Consequently, HRSA will consider geographic location when deciding which approved applications to fund.
Contact: Lilly Smetana, 301-443-6884, lsmetana@hrsa.gov
6. 2004 Minority Fellowship Program Cancer Track
Applications due: June 4, 2004
Association of Schools of Public Health has funds available to support 5 fellowship positions for minority doctoral students in cancer-related prevention research. The selected fellows will conduct research related to the efforts of, and within, the CDC-funded Prevention Research Centers that compose the Cancer Prevention and Control Research Network (CPCRN).
Intervention strategies could include: promoting primary prevention (e.g., tobacco control, diet, UV protection); increasing utilization of cancer screening/early detection (e.g. colorectal, breast); or using informed-decision making for screening (e.g. prostate, colorectal). The support offered through this program will expand minority representation in the public health prevention research workforce and provide fellows an opportunity to gain practical "hands on" experience through participation in cancer-related projects under the direction of the CPCRN's leading experts.
Underrepresented minority students currently enrolled in doctoral level, research-based (e.g. PhD, DrPH, EdD, ScD) training programs at accredited universities or schools of public health with CDC-funded Prevention Research Centers are eligible to apply for this program. Fellowship positions are for a two-year period, usually beginning in September 2004. You may also access program and application information via the Internet at http://www.asph.org/.
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.
Your comments, editorial suggestions, and discerning questions are welcome. Send them as well as address changes to Jim Laukes, Editor, Rural Health Briefing.
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