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Rural Health Briefing October 10 2005
National News
1. West Virginia Critical Access Hospital In the Lead With EHR
2. HHS Supports E-Prescribing and Electronic Health Records
3. Solutions to Race-Based Health Disparities
4. Pursuing Health Information Technology
5. Telehomecare Pilot Project Legislation Introduced
6. Internet Improves Stroke Care at Rural Hospitals
7. Why Providers Are Adopting Electronic Health Records
8. Medicare Part D Rolls Out: A Brief Chronology
9. AHRQ Announces HIT Implementation Grants
Across Arizona
1. Forum to Discuss Information Technology for Rural Arizona
2. Creating Arizona Roadmap for Electronic Health Records
3. Rural Health Clinic Technical Assistance Teleconference
4. Rural Health Forum in Flagstaff
5. Remain Vigilant Against West Nile Virus
6. Hopi Tribe Wins Smoke-free Worksite Award
7. Public Health Award to Mobile Health Program
8. Quality Network Resumes Conference Calls
9. Attracting Health Care Professionals to Rural Arizona
Grants and Opportunities
1. Robert Wood Johnson Health Policy Fellowships
2. Community-Based Care for Prevention and Treatment of Drug Abuse and Mental Disorders
3. Overseas Fellowships in Global Health and Clinical Research
Calendar
- October 10-16, 2005 Border Binational Health Week, Nogales, Yuma and Cochise, Arizona
- October 11, Rural Health Clinic Technical Assistance Teleconference, to participate contact Leila Barraza at 520-626-7946 x 246 or semino@email.arizona.edu
- October 12-14, Points of View: Perspectives on Health Research in Arizona Indian Communities, Intertribal Council of Arizona, Scottsdale
- October 13-15, National Association of Rural Health Clinics Annual Conference, Washington, D.C.
- October 14, 5th Annual Northern Rural Health Forum, Flagstaff
- October 14, Hospital Medicine: A New Way to Deliver Healthcare, Phoenix
- October 16-19, National Indian Health Board 22nd Annual Consumer Conference, Phoenix
- October 18-19, Collaborative Leadership for Public Health Professionals Train the Trainer, Phoenix
- October 24-25, Innovations in Community Prevention, Washington, D.C.
- October 26, Arizona Rural Quality Network Conference Call, 11:00 a.m.-12:30 p.m.
- October 27-28, Border Health: Information for Action VI, Tucson
- October 28, The New Medicare Prescription Program, Phoenix
- November 3-4, 2005 Annual Leadership Conference, Arizona Hospital and Healthcare Association, Scottsdale
- November 5-9, National Rural Education Association Conference, Tucson
- November 14, Information Technology in Rural Arizona: A Tool to Improve Healthcare Workforce Recruitment and Retention, Quality and Education, Phoenix.
- November 14-16, Stopping the Diabetes Epidemic in Indian Country, 2nd Annual Arizona American Indian Health Conference, Mesa
- November 16, Health in a New Key: A Conference on Community Resilience, Tempe
- November 17-18, Government Health IT Conference, Washington, D.C.
- December 7-9, 21st Annual Indian Child and Family Conference, Fort McDowell Yavapai Nation, Fountain Hills, Arizona
MARK YOUR CALENDARS
National News
1. West Virginia Critical Access Hospital In the Lead With EHR
Boone Memorial Hospital in Madison, West Virginia has implemented an integrated electronic health record (EHR) system throughout the hospital, as well as in its rural health clinic and a local physician practice office. Tommy Mullins, CEO of this 25-bed critical access hospital recognized in early 2004 that this was the wave of the future and the timing was right for him to move an EHR system forward.
They worked 16 months to bring it into operation. This included researching potential vendors, attracting champions on the medical staff, administrative staff and at each department level. All were brought to the table to be part of the planning, vendor selection, training, and utilization. “The end users must be part of the planning in order to ensure buy in,” says Mullins. At the beginning he realized he had no expertise in EHR, so he found a consultant to help his team negotiate the maze of vendors and also help with the planning process.
Mullins notes that his staff is extremely satisfied and that the new system is cost effective and is reducing medical errors. They have reduced medication errors by 82 percent and reduced their account receivable from 130 to 69 days which helped cut accounts receivable from $2.2 million to $900,000.
Mullins has been invited to describe his hospital’s journey during the Forum on Information Technology on November 14 in Phoenix. (Details provided in the Across Arizona section of this newsletter.)
2. HHS Supports E-Prescribing and Electronic Health Records
HHS has proposed new regulations in support of adoption of e-prescribing and electronic health records. E-prescribing allows transmission of a prescription electronically from a physician to a patient’s pharmacy. In addition, these new regulations would allow hospitals and certain health care organizations to furnish hardware, software and training to physicians for more efficient, secure information exchange without triggering the Federal anti-kickback statute. However, a cap may be imposed on the value of technology given by a single donor to reduce the potential for abusive arrangements designed to pay physicians for referrals.
The proposed rules were published in the October 5 edition of the Federal Register. Public comments will be accepted for 60 days.
3. Solutions to Race-Based Health Disparities
A persistent racial divide in access to comprehensive, quality health services continues and a new report, Closing the Gap: Solutions to Race-Based Health Disparities highlights successes at the critical intersection of racial justice and health policy.
The report, prepared by Applied Research Center and Northwest Federation of Community Organizations, asserts that the health care system as a whole provides vastly unequal access and treatment based on race, language, and ethnicity. The report's case studies articulate real solutions to the difficult problem of race-based health inequality. The examples from across the nation range in scope from a achieving system-wide increases in health care coverage to describing how Tohono O'odham Community Action in Sells is returning to traditional agricultural practices and thereby revitalizing cultural heritage while increasing exercise and reducing rates of diabetes. Over half the adults of the Tohono O'odham Tribe have adult-onset diabetes.
Click here for access to the 64-page report.
4. Pursuing Health Information Technology
Electronic medical records (EMR) could improve patient care and possibly save billions of dollars, yet adoption faces barriers while outcomes remain manifestly unclear.
Health Affairs devoted most of its September/October 2005 issue to exploring various dimensions of this topic. A RAND Corporation study estimates annual savings of $81 billion if 90% of US hospitals and doctors full adopted EMR within the next 15 years based on an investment of $115 billion to establish such a records network. This includes $77 billion from improved efficiency and $4 billion from reduced medical errors. These savings could double if, with the help of automated reminders, all checkups and preventive measures were done. The same study cautions that more of the predicted savings would go to insurers and less would go to providers.
Commenting on the RAND study, Harvard Medical School policy experts warn that launching a national program when such a system has yet to be done completely in any hospital “risks failure on a colossal scale.”
Related articles discuss how Medicare should commit resources to facilitating this change, overcoming regulatory barriers to effective exchange of clinical data, and how telemedicine-enabled patient-provider collaboration could transform health care.
Case studies in Tennessee and Indiana outline the steps taken by states to approach EMR issues.
With Medicaid in Tennessee consuming one third of the total state budget, cost savings brought about by such efficiencies were needed. Starting with three urban and rural counties in 2004, they studied other systems, made their own plans, and set out developing partnerships. With their regional approach, they struggled with reconciling an overall, interoperable system with existing limited but effective data-sharing efforts. Also, the technology demands placed on people and institutions were not always matched with sufficient resources.
The Indiana Network for Patient Care (INPC) is a local health information infrastructure (LHII) that has been evolving since 1994. The network includes the five major Indianapolis hospital systems, public health departments and Indiana Medicaid. It delivers laboratory, radiology, dictation and other documents to most local practices. Adherence to all HIPAA requirements allows the use of data for treatment and research. In evaluating their progress, they report that smaller communities should look to larger hospitals to be the core of the LHII.
5. Telehomecare Pilot Project Legislation Introduced
South Dakota Senator John Thune introduced a bill, S 1733 on September 20 that would create telehealth pilot projects to bring medical care to people who live in medically underserved areas or are too frail to leave their homes. The Fostering Independence Through Technology (FITT) Act of 2005 would test through demonstration projects whether home health agencies can use remote monitoring technology for enhancing treatment of Medicare beneficiaries while also reducing costs of care. Agencies chosen to participate would receive incentive payments based on the percentage of Medicare savings realized as a result of the project.
Thune called for this effort to “work towards breaking down the legal, financial and regulatory barriers that are preventing the implementation of telehealth and technology into the delivery of healthcare.”
The bill can be read here. It has been forwarded to the Committee on Finance.
6. Internet Improves Stroke Care at Rural Hospitals
The Medical College of Georgia (MCG) has developed an Internet-based examination system that enables stroke patients to be treated as rapidly in rural communities as they are in bigger hospitals with stroke teams. REACH – Remote Evalution for Acute Ischemic Stroke – connects a portable station at the remote site with a stroke specialist at a larger hospital. Speed of diagnosis is vital. When appropriate, a clot buster, tissue plasminogen activator, must be given within three hours of symptoms. A study of 194 stroke patients seen via REACH showed most patients were given the treatment within two hours.
The Georgia Research Alliance is helping MCG develop a business plan that could make REACH available to other states by detailing the installation, training and relationship building required for a successful program. Click here for further details.
7. Why Providers Are Adopting Electronic Health Records
Improving clinical processes, workflow efficiency and quality of care are the leading factors driving adoption of Electronic Health Records (EHR) according to a survey of 280 healthcare providers by the Medical Records Institute. Sharing patient information and reducing medical errors were the next top factors. Containing or reducing costs ranked much lower. The survey has been made annually since 1999.
The applications most often already implemented including billing, claims processing and scheduling. In the planning stage, charge capture and/or coding, and patient eligibility were most often indicated.
The number one barrier continues to be lack of funding, followed by difficulty in finding EHR solutions not fragmented among vendors or platforms, difficulty in migrating from paper records, and lack of support by medical staff.
The survey also has sections on IT platforms in use, methods of data capture and mobile/wireless applications.
Click here for the complete survey.
8. Medicare Part D Rolls Out: A Brief Chronology
Policy holders are already receiving notification about the Medicare Part D program. Marketing plans for approved Part D plans started on October 1, and on October 13 CMS will begin to disseminate information about the program through the Medicare and You 2006 Handbook, and also the 1-800-MEDICARE, A Drug Plan Comparison Web Tool, and a Medicare Personal Plan Finder on www.Medicare.gov.
Dual-eligibles will start receiving CMS mailing on auto-enrollment information by October 27.
The enrollment period begins on November 15, the same date that states and entities offering drug coverage will provide written disclosure to Part D eligible individuals regarding actuarial equivalence.
By December 31 the Medicaid drug coverage ends for full benefit dual-eligibles. Part D coverage starts on January 1 for all beneficiaries enrolled in a plan.
CMS will be identifying beneficiaries not enrolled in a Medicare prescription drug plan in March 2006, and the spring rollout will start in April. There is also a late enrollment penalty that will start on May 16, 2006.
(Adapted from the August issue of “Rural Policy Brief” published by the RUPRI Center for Rural Health Policy Analysis.)
9. AHRQ Announces HIT Implementation Grants
$22.3 million has been awarded to 16 grantees to carry out plans for health information technology (HIT). Eleven of the 16 grants from HHS’ Agency for Healthcare Research and Quality (AHRQ) were awarded to small and rural communities.
Among them were the following:
- Critical Access Hospital Partnership Health IT Implementation, to Upper Peninsula Health Care Network in L’Anse, Michigan;
- Implementing an Ambulatory Electronic Medical Record and Improving Shared Access, to the Sarah Bush Lincoln Health Center in Mattoon, Illinois;
- Collaborative EHR Implementation to Bridge the Continuum of Care in Rural Iowa, to Hancock County Health Services in Britt, Iowa;
- Health Information Exchange: A Frontier Model, to Chadron Community Hospital in Lincoln, Nebraska; and,
- Creating Online Networks to Educate, Consult and Team for High-Risk Infants, to University of Southern Mississippi, Hattiesburg, Mississippi.
Click here for a complete list of grants.
Across Arizona
1. Forum to Discuss Information Technology for Rural Arizona
Arizona’s rural healthcare system is gaining more knowledge and seeking more leverage in the many uses of information technology. On Monday, November 14 a forum, Information Technology in Rural Arizona: A Tool to Improve Healthcare Workforce Recruitment and Retention, Quality & Education will address the current conditions and recommend future directions in these related areas: information infrastructure, electronic health records, distance education, workforce and quality improvement.
Among confirmed speakers are Anthony Rodgers, Director of AHCCCS and Galen Updike, Governor’s Information Technology Agency. Tommy Mullins of Boone Memorial Hospital has been invited (see related story, West Virginia Critical Access Hospital In the Lead With EHR, in the National News section above).
The meeting will run from 8:00 a.m.-4:00 p.m. in the Arizona State Capitol, 1700 W. Washington in Phoenix. Refreshment breaks and a sandwich lunch are included for the registration cost of $20.00. It is sponsored by the Arizona Rural Health Association in collaboration with the Rural Health Office of the UA Zuckerman College of Public Health.
Click here now for registration details or contact Rebecca Ruiz, Rural Health Office, 520-626-7946, ext. 254 or email aruiz@rho.arizona.edu.
2. Creating Arizona Roadmap for Electronic Health Records
With objectives of improving care and reducing costs, Governor Napolitano has created the Health-e Connection Steering Committee and charged it with developing an Arizona roadmap for electronic health data exchange between healthcare insurance companies, providers and consumers. A Call to Action Summit was held in Phoenix on October 5. The Steering Committee of 39 people representing business, government, healthcare and education is charged with submitting the roadmap to the Governor by April 2006 including recommended actions and milestones to be achieved within the next five years.
On April 12, 2004, President Bush called for adoption of interoperable electronic health records within 10 years.
Chris Cummiskey and Beth Schermer are co-chairs of the committee. Cummiskey is director of the state’s Government Information Technology Agency; Schermer is an attorney and temporary vice dean for administration at the University of Arizona’s College of Medicine Phoenix campus.
3. Rural Health Clinic Technical Assistance Teleconference
9:00 – 10:00 a.m., Tuesday, October 11, 2005
Billing, reimbursement, and networking will be discussed during this teleconference for certified Rural Health Clinics and facilities that wish to become designated as Rural Health Clinics. Representatives from Blue Cross Blue Shield, Riverbend, Mutual of Omaha and AHCCCS will participate.
For more information, please contact Leila Barraza at 520-626-7946 x 246 or mailto:semino@email.arizona.edu.
4. Rural Health Forum in Flagstaff
The Arizona Rural Health Association will host the 5th Annual Northern Rural Health Forum on Friday, October 14 at the Radisson Woodlands Hotel in Flagstaff. The morning event will feature presentations on changes in Medicare, the methamphetamine crisis in northern Arizona and a legislative update.
For more information, contact mailto:info@arzha.org.
5. Remain Vigilant Against West Nile Virus
Arizona state health officials reported 13 new West Nile virus cases in September, bringing the 2005 total to 63 known cases in humans. The age range of those afflicted is eight months to 87 years. Two deaths have been reported in Maricopa County.
Late summer and early fall is the time of year when mosquito-borne disease risk is usually at its highest level, especially in the warmer counties. To date, 329 mosquito specimens have tested positive this year for West Nile across Arizona.
For further information, Arizona has established a web site, www.westnileaz.com, and a toll-free number, 1-800-314-9243, to provide information about West Nile Virus.
6. Hopi Tribe Wins Smoke-free Worksite Award
The Coalition for Tobacco-Free Arizona (CTFA) has awarded its 2005 Worksite of the Year Award to the Hopi Tribe of Arizona in recognition of its hospital's smoke-free worksite policy, which has been in place since 1983 and officially in writing since 1987. The Hopi Tribe has also been recognized by the US Public Health Service, Secretary of Health & Human Services and the World Health Organization for its smoke-free efforts. CTFA's Worksite of the Year Award is given to an organization that chooses to become or remain smoke-free.
7. Public Health Award to Mobile Health Program
The Mobile Health Program (MHP) of the Mel and Enid Zuckerman Arizona College of Public Health’s Rural Health Office has been received the Commitment to Underserved People (CUP) Award from the Arizona Public Health Association. MHP works in the communities of Amado, Benson Highway, Casa San Juan, Picture Rocks, Three Points, South Tucson, Nogales, Yuma County, South Park, Naco, Casa Grande and Vail.
In addition to providing healthcare and disease prevention, community health advisors also serve as advocates to help residents create long-term solutions. When a community builds enough capacity for healthcare, MHP is able to move on and assist other communities.
The nomination lauds MHP as “a model for sustained effort in assuring the delivery of health care services to underserved communities.”
8. Rural Quality Network Resumes Conference Calls
The Arizona Rural Quality Network Group (ARQNG) will host its next quarterly conference call from 11:00 a.m.-12:30 p.m. on Wednesday, October 26. ARQNG was formed to share information on clinical topics, care processes, and quality improvement projects as well as collaborate in the development of staff training materials, tools and educational activities focused on quality of care.
Quality managers, directors of nursing and related staff are invited to participate. For details, please contact Joyce Hospodar, Rural Health Office, 520-626-7946, ext. 229 or hospodar@u.arizona.edu. There is no registration fee for participating.
9. Attracting Health Care Professionals to Rural Arizona
With use of a free website, healthcare professionals can connect with Arizona rural hospitals, clinics, health centers and private practices. The service, supported by the Rural Health Office, is known as 3RNet, the National Rural Recruitment and Retention Network. Facilities can post their needs and professionals can both search these and also post their qualifications. The most sought after providers are physicians, nurse practitioners, registered nurses, physician assistants, certified nurse midwives and dentists.
Click here to go to the Arizona 3RNet or contact Leila Barraza, 520-626-7946, ext. 246 or semino@email.arizona.edu for assistance.
Grants and Opportunities
Note: Technical assistance is readily available for the development of grant proposals and other funding applications from the experienced staff of the Rural Health Office and the State Office of Rural Health Program. Please contact Jennifer Peashock.
1. Robert Wood Johnson Health Policy Fellowships
Application deadline: November 18, 2005
This program is designed to develop the capacity of outstanding midcareer health professionals in academic and community-based settings to assume leadership roles in health policy and management, to gain an understanding of the health policy process, and to contribute to the formulation of new policies and programs.
Candidates from academic faculties and nonprofit health care organizations are encouraged to apply. Applicants may have backgrounds in the following disciplines: allied health professions; biomedical sciences; dentistry; economics or other social sciences; health services organization and administration; medicine; nursing; public health; or social and behavioral health.
Up to 10 grants of $155,000 each will be made in 2006.
This program accepts paper applications only. To request an application contact: Robert Wood Johnson Health Policy Fellowships Program. Phone: 202-334-1506, E-mail: mmichnich@nas.edu. The announcement is available online at http://www.iom.edu/rwj
2. Community-Based Care for Prevention and Treatment of Drug Abuse or Co-occurring Drug Abuse and Mental Disorders
RFA-DA-06-001
Application deadline: December 19, 2005
This HHS request for applications intends to enhance the capacity of community-based providers of drug abuse prevention/treatment services, including services for individuals with co-occurring mental disorders, to conduct practice improvement research. Such research may entail the examination of therapeutic and/or business practices currently in use but lacking scientific evidence of effectiveness. Or it may entail examination of the adoption, implementation, and sustained use of science-based therapeutic and/or business innovations.
Individuals from underrepresented racial and ethnic groups as well as individuals with disabilities are encouraged to apply.
Any community-based direct provider of treatment with the skills, knowledge, and resources necessary to carry out the proposed research is invited to work with their institution to develop an application for support. Community-based providers without adequate research capacity are required to partner with researchers from organizations having adequate capacity, such as universities and research institutes. Agencies that distribute funds for the provision of treatment are not eligible to apply, unless they are also direct providers of treatment.
An applicant may request a project period of up to 3 years. Direct costs may not exceed $150,000 per year. Preliminary studies are not required.
Click here for application details.
3. Overseas Fellowships in Global Health and Clinical Research
Application deadline: December 30, 2005
The Fogarty International Center at the National Institutes of Health, in partnership with the Ellison Medical Foundation and other agencies, is offering a one-year clinical research training experience for graduate-level students in the health professions. This is an opportunity to experience mentored research training at top-ranked NIH-funded research centers in developing countries.
The program is for students with advanced standing in a U.S. medical or osteopathic school, or who are enrolled in a doctoral-level program at a U.S. school of public health, nursing, or dentistry. Applicants must be U.S. citizens or permanent U.S. residents.
Accepted trainees will be provided a stipend of roughly $18,000 to $20,000 per year, with an additional $6,000 per year for travel, insurance, and educational materials. Click here for the RFP.
Contact Your Representatives
- 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
- 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 astute comments, precious suggestions, and inspired questions are always welcome. Please send them as well as address changes to Jim Laukes, Editor, Rural Health Briefing.
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