2007 Archive

NEA Foundation Learning & Leadership Grants

Rural Health Research

New Briefing Paper on Critical Access Hospital Quality Measure Results available from the Flex Monitoring Team

This briefing paper examines the second year participation and quality measure results for Critical Access Hospitals (CAHs) in the Centers for Medicare and Medicaid Services Hospital Compare public reporting database. Overall, 53% of CAHs were participating in Hospital Compare by submitting data on at least one measure for 2005 discharges as of September 2006. The paper concludes that CAHs still have room for improvement on these quality measures, especially with regard to recommended care for acute myocardial infarction (AMI) and heart failure patients. However, it is encouraging that the group of CAHs that reported Hospital Compare data for both years significantly improved their performance on almost all pneumonia, heart failure, and surgical infection measures.

The authors of this report are Michelle Casey M.S., Michele Burlew, M.S., and Ira Moscovice, Ph.D. at the University of Minnesota Rural Health Research Center.

For more information, please contact Michelle Casey at mcasey@umn.edu. To request a hard copy, please contact Jane Raasch at raasc001@umn.edu.

The full report may be viewed or downloaded from the Flex Monitoring Team website at: http://flexmonitoring.org/documents/BriefingPaper16_HospitalCompare2.pdf.

NRHA Comments on the Proposed Hospital IPPS Regulations

The NRHA submitted comments on June 12, 2007 on the CMS proposed rule on the Hospital Inpatient Prospective Payment System (IPPS). In the rule, CMS proposes to create 745 new severity-adjusted diagnosis-related groups (DRG) to replace the current 538 DRGs. Overall, payments under the inpatient prospective payment system to hospitals would increase by an average of 3.3% in fiscal 2008 for those hospitals that report quality data to the CMS, though hospitals' payments will vary depending on the patients they serve.

The NRHA commented that while CMS spent a tremendous amount of time and effort to adjust the DRG system with a severity-adjustment system, that we were concerned with the implementation of this system by the fall. This is a short time frame to allow hospitals time to figure out the new system and to report secondary diagnosis. We believe this puts rural hospitals at a disadvantage. In our comments, we supported the American Hospital Association's proposal to have a four year phase-in of the system and other supports of rural facilities.

In addition to the new severity-adjusted DRG, the NRHA also weighed in on a number of topics including urging CMS to allow Critical Access Hospitals to keep their former provider number if they become PPS hospitals so that they can apply for Medicare Dependent Hospitals or Sole Community Hospital status and that CMS should not require Rural Referral Centers to keep their status for one calendar year. Both of these would be CMS using their authority in new ways that would affect policy around rural hospitals.

To read the full comments, please go to: http://www.NRHArural.org/advocacy/pdf/CMS-IPPS.pdf.

HIT and Quality Grants in Farm Bill

The NRHA has been a leading voice in the Campaign for a Renewed Rural Development to support passage of a flexible and fully funded Rural Development Title in the next Farm Bill. In addition, we have been working with Congressional leaders to make sure the Farm Bill includes provisions that will help strengthen the rural health system. Studies have shown that strengthening health care in rural America can have a major impact on the economic viability of our communities. The NRHA is pleased to see that the House Agriculture Subcommittee, working on the next Farm Bill, has included grants for the purchase of Health Information Technology and Quality Improvement. We will be working with the full committee and the Senate to include similar provisions.

To read more about the Campaign for a Renewed Rural Development, go to http://www.ruralcampaign.org/.

Call Your Members of Congress Now to Support Rural Health

In the Senate, a major comprehensive rural health care bill has been introduced. Senators Conrad, Roberts, Harkin, Domenici and others introduced a large package of provisions for rural health. This package, the Craig Thomas Rural Hospital and Provider Equity Act, honors Senator Thomas, who passed away recently. He spent his career as a champion of rural health care and served as a co-chair of the Senate Rural Health Caucus.

The House Rural Health Care Coalition is expected to introduce the Health Care Access and Rural Equity (H-CARE) Act of 2007 soon.

Both packages have significant improvements to the rural health care landscape. Some of the provisions found in the two bills include:

• Hospital Reimbursement Improvements - removal of the DSH cap;
• Critical Access Hospital improvements, rebasing the Sole Community Hospital formula, and the creation of the Rural Community Hospital program;
• Physician Reimbursement Improvements - mental health, physician pathology services, ambulatory trips, and the work geographic adjustment to a 1.0 floor;
• Rural representation on the Medicare Payment Advisory Commission;
• Raises the Rural Health Clinic encounter rate cap;
• Prompt payment of pharmacists by Medicare Prescription Drug Plans and MA-PD plans under Medicare Part D;
• Extension of 5% Medicare adjustment payment for home health services provided in rural areas;
• Grants for Health Information Technology, Quality Improvement, and the reauthorization of the Outreach and Network grant programs
• Expansion of the 340B program to rural hospitals

In order to help generate momentum on this legislation, we need your members of Congress to be co-sponsors of this important legislation. Please call your Senators and Representative today and ask them to become cosponsors of this legislation!

Great News for Rural Health Funding

The House Appropriations Subcommittee marked up the Labor-HHS appropriations bill on Thursday, June 7. This is the bill that funds the "rural health safety net" programs. The bill has good news for many of the programs that the NRHA monitors! We're delighted to see that our efforts paid off and the subcommittee included large increases to Outreach and Network Grants, Rural Health Research, State Offices of Rural Health, the National Health Service Corps, Area Health Education Centers, and Community Health Centers!

On the other hand, we will continue to work to reinstate programs such as the Community Access Program Grants, Health Education and Training Centers, Quentin Burdick Rural Training, and Rural EMS/Trauma that are still not funded by this Congress.

We expect the full House Appropriations Committee to vote on the bill in early July, followed by the full House of Representatives. The Senate is expected to look at the Labor-HHS appropriations bill later this month. The Senate has nearly $2 billion less slated for the Labor-HHS bill than the House, but we believe that these Rural Health programs will be protected. We will continue to update you and may need your help in order to secure these funds through the Senate and any possible Presidential veto.

To view the funding chart with the Subcommittee, go to: http://capwiz.com/nrha/issues/alert/?alertid=9894381

NRHA Official Policy on Health Disparities and Rural Veterans

The Rural Health Policy Board is the policy-making body of the National Rural Health Association. It is made up of elected representatives from each of the association's nine constituency groups, its State Association Council, its State Office Council, and its Issue Groups, the Minority and Multicultural Committee and the association's officers. This gives the board grassroots representation that reflects the concerns of the NRHA's membership. The Rural Health Policy Board determines the association's positions on public policy through a series of Policy Briefs and Issue Papers. During its two most recent meetings (February and May), a number of new policies were discussed and passed. Two of those are now available on our website:

Policy Statement defining "Health Disparities" An updated Issue Paper on "Rural Veterans" that includes the most recent data from our soldiers serving in Iraq and Afghanistan. To view these and other official NRHA policies, go to: http://www.nrharural.org/advocacy/sub/PolicyBrf.html.

Study Finds 1.8 Million Veterans Are Uninsured
Figure Has Grown by 290,000 Since 2000, Professor Tells House Veterans Panel
By Christopher Lee | Washington Post Staff Writer
Thursday, June 21, 2007; Page A09

As the nation struggles to improve medical and mental health care for military personnel returning from Afghanistan and Iraq, about 1.8 million U.S. veterans under age 65 lack even basic health insurance or access to care at Veterans Affairs hospitals, a new study has found.

The ranks of uninsured veterans have increased by 290,000 since 2000, said Stephanie J. Woolhandler, the Harvard Medical School professor who presented her findings yesterday before the House Committee on Veterans Affairs. About 12.7 percent of non-elderly veterans -- or one in eight -- lacked health coverage in 2004, the most recent year for which figures are available, she said, up from 9.9 percent in 2000. Veterans 65 and older are eligible for Medicare.

About 45 million Americans, or 15 percent of the population, were uninsured in 2005, the Census Bureau reports.

"The data is showing that many veterans have no coverage and they're sick and need care and can't get it," Woolhandler said.

Woolhandler's findings are based on data from two national surveys -- the Current Population Survey administered by the Census Bureau and the National Health Interview Survey administered by the Department of Health and Human Services. Veterans who said they had neither health insurance nor veterans or military health care were counted as uninsured.

Woolhandler is a well-known advocate of guaranteeing access to health care for all Americans through a government-run national health insurance program. Republican lawmakers seized on that association to question whether she was trying to advance that goal with her study.

"The difficulty would be that because of your desire for universal health care, that could influence how you felt about veterans," Rep. Cliff Stearns (R-Fla.) said.

Woolhandler said the data are sound. She has firsthand experience with the issue as well, she said, because as a physician she has seen uninsured veterans with untreated high blood pressure, diabetes and other conditions.

"It breaks my heart," she said. "The VA should be an important safety net for my patients, and it's not."

Nearly 8 million veterans were enrolled in the VA health system in 2006. The focus of the hearing was whether to open VA hospitals' doors to so-called Priority 8 veterans, who have no service-connected disabilities and whose earnings generally are above 80 percent of the median income where they live. Doing so would add significantly to VA's caseload and costs -- estimates range from $366 million to $3.3 billion annually -- and some veterans groups and lawmakers are concerned that it would make it harder for veterans with serious service-related health problems to get timely care.

Only about half of the 1.8 million uninsured veterans are classified Priority 8, Woolhandler said. The rest may technically be eligible for some VA care but live too far from its facilities for it to be a real option, she said.

New Carsey Institute Report Finds that Over One-Third of Rural Children Rely on SCHIP and Medicaid

A higher percentage of children in rural areas depend on Medicaid or the State Children’s Health Insurance Program (SCHIP) for health insurance than children in urban areas, a new study by the Carsey Institute at the University of New Hampshire finds.

The Carsey Institute found that in 2005, 32 percent of children in rural areas relied on SCHIP or Medicaid compared to 26 percent of children in cities. The report also found more rural children living in economically vulnerable families, with 47 percent of rural children living in low-income families in 2005, compared with 38 percent of urban families.

Nationwide, approximately 28 million children receive health insurance from Medicaid, with an additional six million covered by SCHIP. Enacted in 1997, SCHIP serves children in low-income families that generally earn too much to qualify for Medicaid, but too little to afford private health care coverage. “SCHIP plays a vital role in the health of rural children,” said Mil Duncan, director of the Carsey Institute at the University of New Hampshire. “Every year, public health insurance becomes increasingly important to low-income families as employers drop private coverage or jobs are lost due to changes in the rural economy.”

From 1996 to 2005, the number of children covered by private health insurance steadily declined, while those covered by SCHIP and Medicaid steadily increased. This trend was found in both urban and rural America. In rural communities, the steady loss of manufacturing jobs has contributed to the loss of private health insurance coverage.

“Among rural children living in low-income families, we saw private-sector insurance coverage fall from 45 percent to 37 percent between 2000 and 2005,” said William O’Hare, report author and senior fellow at the Carsey Institute. “These families have little option but to seek government-funded coverage for their children. This shift away from employer-based insurance is likely to continue, resulting in increased reliance on SCHIP and Medicaid.”

The U.S. Congress is due to reauthorize the SCHIP program in 2007. Under consideration are proposals to expand coverage to more families and increase funding.

“This year Congress has a historic opportunity when it reauthorizes the SCHIP program to expand health coverage to America’s nine million uninsured children,” said Ron Pollack, executive director of Families USA. “Both the Senate and House of Representatives have passed a budget resolution setting aside $50 billion in additional funding for SCHIP over the next five years. This report demonstrates how important it is to expand coverage to uninsured children in rural communities.

"Above all, today's report reinforces the fact that SCHIP must be reauthorized and its funding must be increased,” said Bruce Lesley, president of First Focus, a bipartisan organization dedicated to advocating sound healthcare policies to protect America's children. “With trends showing a continuing decline in the number of children covered by private sector health insurance, urgent attention must be given to America's rural communities, as they have become the neediest in the country. As the study points out, more children in rural communities are relying on SCHIP and Medicaid than those in urban regions, underscoring the need to increase the number of kids eligible for SCHIP and to expand outreach and enrollment efforts in all areas across the nation."

While Medicaid and SCHIP are covering more children each year, more than eight million children under 18 still lack health insurance. In rural America, the Carsey study found that a majority of uninsured children – 54 percent – live in families where the head of the household works full-time year-round.

Studies have found that as many as 20 million children live without health insurance at some point in the year. This is especially true in families in which a parent is employed in seasonal or cyclical work, which can be more prevalent in rural areas.

“There are a number of reasons why eligible children are living without health coverage,” said Mil Duncan. “In some cases, families are unaware that their children qualify or don’t know how to apply. In rural areas, many people have to travel long distances to apply, which isn’t an option for many low-income families. It’s clear that solutions are needed in rural America, including making private insurance more affordable and expanding public health insurance programs.”

The Carsey Institute at the University of New Hampshire conducts research and analysis on the challenges facing rural families and communities in New Hampshire, New England, and the nation. The Carsey Institute sponsors independent, interdisciplinary research that documents trends and conditions affecting families and communities, providing valuable information and analysis to policymakers, practitioners, the media, and the general public. Through this work, the Carsey Institute contributes to public dialogue on policies that encourage social mobility and sustain healthy, equitable communities. The Carsey Institute was established in May 2002 with a generous gift from UNH alumna and noted television producer Marcy Carsey.

Health Care Access and Rural Equity Act of 2007 Unveiled
The National Rural Health Association Applauds House Representatives' Pomeroy and Walden

Today, the National Rural Health Association (NRHA) applauds the Honorable Earl Pomeroy (D-ND) and the Honorable Greg Walden (R-OR), and many of their colleagues from the House Rural Health Coalition, to unveil a new rural health care bill designed to increase equity and improve access to high quality care in rural America.

HR 2860 or the Health Care Access and Rural Equity Act of 2007 (H-CARE) will:

• Authorize health information technology grants for rural practitioners.
• Require prompt payment to rural pharmacies by Medicare prescription drug plans.
• Ensure adequate rural representation on the Medicare Payment Advisory Commission.
• Establish a Rural Heath Quality Advisory Commission.
• Allow flexibility in the number of beds Critical Access Hospitals (CAH) may provide.
• Raise Rural Health Clinic reimbursements to more appropriately cover costs.
• Extend several expiring Medicare adjustment payments for rural practitioners including physicians practicing in physician-scarce areas, rural ambulance providers, rural home health agencies, and specific classes of rural hospitals.
• Create the Rural Community Hospital (RCH) program, providing the option of Medicare cost-based reimbursement for inpatient and outpatient services for hospitals with 50 or fewer beds.
• Require Medicare Advantage plans pay Critical Access Hospitals at least as much as they would receive under the traditional Medicare program.
• Re-authorize Rural Outreach and Network grants. These important programs provide capital investments so that rural communities can plan and launch innovative projects that build networks across providers, increase access to care, and are specifically designed to become self-sufficient.
• Expand the 340B program discount drug program to cover rural entities.

The bill also furthers the Institute of Medicine's (IOM) recommendation to implement demonstration projects in rural communities that test innovative ways to improve health care quality.

" On behalf of millions of rural Americans, I thank Representatives Pomeroy and Walden for their support of rural health," said George Miller, president, NRHA. "The membership of the NRHA is thrilled with the introduction of the H-CARE Act of 2007 that helps the entire landscape of the rural health system strengthen the quality of its care. We will work to make sure this vital message of access to quality care for all Americans is heard in the halls of Congress".

"This bill is about ensuring that not only can hospitals in rural areas keep their doors open, but that people living in rural America have the same access to medical services that those living in urban areas enjoy. Whether you live in Miami, Florida or Jamestown, North Dakota, everyone deserves to have the same access to quality health care services," added Congressman Pomeroy.

"Rural caregivers and rural patients deserve a better partner in the federal government when it comes to the health of rural America," Congressman Walden said. "It is high time that rural America stops being treated like a second-class constituency when it comes to issues like Medicare reimbursement. The H-CARE Act delivers commonsense solutions to obstacles that can inhibit the delivery of quality health care to millions of Americans."

The NRHA is a national nonprofit organization, with more than 15,000 members that provides leadership on rural health issues. The Association's mission is to improve the health and wellbeing of rural Americans and to provide leadership on rural health issues through advocacy, communications, education and research. The NRHA membership is made up of a diverse collection of individuals and organizations, all of whom share the common bond of an interest in rural health.

NRHA Applauds Tom Dean's Appointment to MedPAC
NRHA Concerned that MedPAC Still Lacks Full Rural Representation

Thomas M. Dean, MD, from Wessington Spring, South Dakota, has been appointed to the Medicare Payment Advisory Commission (MedPAC). David Walker, Comptroller General, made the announcement Monday.

MedPAC is an independent federal body that was established in 1997 to analyze access to care, quality of care and other issues affecting Medicare. MedPAC also advises Congress on payments to health plans participating in the Medicare Advantage program and to providers in Medicare's traditional fee-for-service programs. The Comptroller General is responsible for naming new commission members.

"We are thrilled that Dr. Dean was appointed to MedPAC," Alan Morgan, CEO of the NRHA, said. "Dr. Dean has been a tireless advocate of rural health and served our association well as its tenth president in 1990. Dr. Dean has extensive health care experience and understands the importance of representing rural beneficiaries' needs. We look forward to working with him to make sure that the views of rural Medicare beneficiaries and providers are heard on the commission."

For more than thirty years, Dr. Dean has served rural Americans in a variety of clinical settings. Nationally, Dr. Dean has been a leader in the quality movement in rural America. His research has explained the necessity of rural providers making changes at their facilities to improve patient care. He has served as the President of the NRHA and been honored by the National Health Service Corps for "for improving access to those most in need."

"Dr. Dean's experiences at a variety of facilities in South Dakota have uniquely prepared him to understand primary care, Community Health Centers, and large health systems. MedPAC will be well suited with a Commissioner that understands these issues and can help strengthen the care provided through these venues," Maggie Elehwany, Vice President of Government Affairs and Policy, said.

"We remain concerned; however, that MedPAC is not balanced towards rural members. Dr. Dean will become only the second rural voice on the seventeen member commission with any significant professional experience in rural America," Ms. Elehwany cautioned. "Federal law requires that MedPAC representation include 'a balance between urban and rural representatives.' Two out of seventeen still is far short of this. We must make sure that the twenty-seven percent of Medicare beneficiaries that live in rural America are given an equal voice on the commission."

The NRHA is a national nonprofit organization, with approximately 15,000 members that provides leadership on rural health issues. The Association's mission is to improve the health and wellbeing of rural Americans and to provide leadership on rural health issues through advocacy, communications, education and research. The NRHA membership is made up of a diverse collection of individuals and organizations, all of whom share the common bond of an interest in rural health.

New Web Tool Provides Samples of Report Cards on Health Care Quality

With rising interest in information about the quality of care delivered by health care providers, HHS' Agency for Healthcare Research and Quality has developed a new Web tool demonstrating a variety of approaches for health quality report cards.

The new Health Care Report Card Compendium is a searchable directory of over 200 samples of report cards produced by a variety of organizations. The samples show formats and approaches for providing comparative information on the quality of health plans, hospitals, medical groups, individual physicians, nursing homes, and other providers of care. The Health Care Report Card Compendium can be found at http://www.talkingquality.gov/compendium/.

"Consumers and providers alike need better information if we're to get the highest quality and value from our health care system," said HHS Secretary Mike Leavitt. "We're still learning how to gather and present that information in the best ways, and we can learn from one another. The new AHRQ Web site will help with that learning."

"The demand for information about health care quality is rising rapidly, and it will be increasingly important for this information to be presented clearly and effectively," said AHRQ Director Carolyn M. Clancy, M.D. "Report card developers can use the examples from the Health Care Report Card Compendium to explore the scope and information they might want to cover, as well as various approaches to presenting their own organization's comparative data."

The purpose of the AHRQ Health Care Report Card Compendium is to inform and support the various organizations that develop health care quality reports, to provide easy access to examples of different approaches to content and presentation, and to meet the needs of health services researchers. It also provides related Web sites and sample pages where available.

AHRQ is providing this compilation of report card samples as a service to report developers, researchers, and other users. AHRQ makes no judgment concerning the effectiveness or value of reports in the compendium but offers them to users for their consideration. Inclusion of a report in the compendium does not constitute an endorsement of the report in its entirety, or of any element in the report, by AHRQ.

Public reporting regarding the performance of health care providers and plans is expanding as standards for measuring quality grow, and reports of the quality of health care providers and services are increasingly being made available to consumers. Public reporting about quality of care is also a central feature of Secretary Leavitt's Value-Driven Health Care Initiative.

Last August, President Bush committed federal health programs to make quality information available to all enrollees. Under Secretary Leavitt's initiative, other private and public employers are likewise committing to quality reporting for enrollees in their health plans, as well as to public reporting on the costs of care.

The compendium was developed as a resource for report sponsors to supplement guidance provided on AHRQ's TalkingQuality Web site at http://www.talkingquality.gov. TalkingQuality informs and supports current and potential sponsors of health care performance reports by sharing the lessons learned by researchers and experienced report developers.

This resource was developed by AHRQ's Consumer Assessment of Healthcare Providers and Systems User Network to give sponsors and researchers access to examples of quality reports and to enable them to locate and network with each other on related issues. More information about Secretary Leavitt's Initiative on Value-Driven Health Care is available at www.hhs.gov/transparency. For more information, please contact AHRQ: (301) 427-1244 or (301) 427-1862.

Telemedicine and Telemonitoring: Its Role in Care Management
By Marybeth Regan, Ph.D., for HealthLeaders News

For years, patients and physicians have sought solutions for several dilemmas in the healthcare delivery systems:

• How can patients in underserved areas, both rural and urban, access primary care and specialty physicians, as well as other healthcare professionals when no physician is in their immediate area?
• How can treatment and medication compliance be improved for reduction of disease, risk factors, and management of chronically ill patients?
• Are there ways other than a visit to the physician’s office or the emergency department for patients to receive health information, education, and decision support regarding care?
• Can homebound patients--such as the chronically ill, disabled, and hospice patients--be monitored and treated in ways that do not require as many visits to the physician’s office, thereby improving convenience and reducing costs?
• Can quality of life be enhanced for patients with chronic conditions?
• Can telemedicine supplant traditional care?

Telemedicine is part of the enabling strategy that can answer these questions. Until now, there has not been feasible and cost-effective solutions to these problems. With the advent of the Internet, Web-enabled applications, and advances in telecommunications technology, a solution now exists: Connectivity--or some phase of telemedicine--can exist in the home and almost anywhere.

With part of its roots in medical research for military and space applications, telemedicine is expected to make it possible to link medical expertise with patients, regardless of location—providing clinicians with valuable new tools for remote monitoring, diagnosis, and intervention.

It is widely claimed and often assumed that innovation in healthcare technologies can contribute to increased access, improved quality of care, and reduced costs. Although telehealth technologies currently account for a small segment of all healthcare technologies, innovation in this area is stimulating significant improvements in productivity and quality of life. Today, after more than 30 years, the potential of telehealth has still not been fully realized due to costs, effectiveness, reimbursement and resistance to change. Telemedicine continues to expand, and pressure for policy development increases in the context of Federal Budget cuts and major changes in health services financing.

Rationale for Telemedicine

Despite these obstacles, the needs to overcome distance challenges, improve care management, and tackle chronic diseases have spurred telemedicine. Overcoming the distance factor was an early driver of telemedicine. Initially, the technology was defined as the use of telecommunications technology to provide healthcare services to persons who were at some distance from the provider. This typically occurs in two ways. Real-time examinations bear the closest resemblance to the typical face-to-face provider/patient interaction--both patient and physician are present at the same time and can provide instantaneous feedback to one another through video screens and audio. The second method used to transmit information in telemedicine, “store and forward,” is less synchronized. Data such as images and vital sign readings are stored and then transmitted to the medical expert for later examination. Image-oriented areas such as radiology and dermatology are especially suited for store-and-forward transmission, as are data for home telehealth care.

Care management is another driver of remote patient monitoring. Telemedicine has been utilized as an extension of the acute care setting for patient follow-up. Brigham and Women’s Hospital in in Boston, MA, discharges their mastectomy patients home with a laptop and camera. The first call with the physician is scheduled for the next day to review the incision and answer questions. The hospital determined that this was easier for the patient and provided the follow-up visit quickly after surgery. This solution provided benefits for both the physician and the patient.

In addition to addressing issues of distance and care management, telemedicine can be a disease management tool. Telehealth technology is now known to be effective for improving patient outcomes in many disease states, particularly chronic diseases such as diabetes and congestive heart failure. For some time, the general medical populace considered it too experimental.

Disease management companies that are paid by insurers to manage chronic care have managed patients telephonically for over 10 years. In their quest to use the newest technology, many created websites where patients can manage their own diseases. For example, an enrollee can submit clinical information using tools such as glucose monitoring logs to generate dosing and physician monitoring components. In addition, there are online courses and links to other relevant sites. Unfortunately, many patients do not have access to the technology. There are even remote monitoring devices that are used for weight (important for congestive heart failure), blood pressure and even daily vital signs.

Telemedicine’s great potential

In a context of tightened budgets, and increasing costs, telemedicine is emerging rapidly. It has the potential to affect health services delivery in many ways with rapid technological change and a volatile and changing healthcare system.

People with chronic diseases at home, for example, can take their multiple readings more frequently. Either the patient or the care support team can intervene when justified.

In addition, telemedicine, also known as telehealth or e-health, presents a chance to recognize and possibly prevent chronic conditions from worsening in patients, cutting healthcare costs through a reduction in hospital stays and outpatient clinic visits and providing better quality outcomes.

“That doesn’t mean that people don’t need to go into hospital,” says Adam Darkins, MD , chief consultant for care coordination at the U.S. Department of Veterans Affairs, which has spent $20 million for a program to install telehealth monitors in the homes of more than 16,000 patients across the country. “But if you get someone in for two days, stabilize them and get them home, rather than two weeks in an intensive care unit, it’s a win on both sides, “ says Benjamin Nagy, in Managed Healthcare Executive, Sept. 1, 2006.

Telemedicine can also foster collaborative decision making with patients. When patients access health information and obtain health education, they become informed participants in their own health decisions. The supported self-service tools of telemedicine empower patients with knowledge for the decision-making process. This sharing of accountability between providers and patients is a departure from the traditional relationship, in which accountability has resided primarily with the provider. As patients become more accountable, compliance often increases and outcomes are improved, according to Parmod Baur, PhD, president and CEO of Viterion TeleHealthcare, a telemedicine provider.

For example, home telemedicine applications for heart patients include condition monitoring, nutrition education, and meal planning. In some applications, patients are monitored on a 24-hour basis from their homes. A device worn by the patient detects potential cardiac events by tracking irregular heartbeats. The patient uses the telephone to transmit these data to a physician for evaluation and recommendations. The payoffs for monitoring cardiac patients this way are obvious: More accurate and expeditious diagnoses, fewer visits to the emergency department or the intensive care unit, and decreased costs.

In addition to interacting with a physician, patients can interact with others by participating in a home-based, on-line cardiac recovery program. Having to leave home can be highly problematic for many cardiac patients in rehabilitation. Sharing experiences in an on-line support group results in reduced anxiety and increased confidence, and often promotes physical activity. The program has resulted in an added benefit: many of these patients become friends.”

The new generation of telemedicine also brings “space age” technology into the fold. At the high-tech end of telemedicine, a robot that acts as a live-in nurse. The robot collects blood pressure, electrocardiogram, pulse, and temperature information, then transmits it back over the telephone line to a home nursing station. Nurses at the nursing station there monitor the patient’s condition and intervene when the data show that the patients needs to schedule an appointment or change the medication. One question remains: How much and what do you compromise by high tech versus high touch?

Telemedicine saves money, lives

Such difficult questions aside, what if the cost to treat patients--whether your organization is a health plan, employer, hospital or clinic--could be reduced without sacrificing care or patient satisfaction? What is the volume of clinic visits, hospital admissions, and emergency department visits could be reduced while maintaining or even improving clinical and human outcomes? Each of these is possible using advanced telephonic and web-enabled technology. Here are the examples of the financial impact of the financial impact of telemedicine on healthcare costs:

• Reduces hospitals days per thousand and physician visits for chronically ill patients. Using telephones to remind patients to take their medication or using a Web-based application to monitor glucose readings are two ways telemedicine keeps chronically ill patients healthier.
• Decreases costs of managing patients with chronic diseases. Continuous monitoring and education--which can be automated with telemedicine--reduce costs. Providers of integrated healthcare, disease management and Internet services, for example, demonstrated an average savings of $7.83 per patient for every dollar spent on one asthma management program. The program--which incorporates patient self-reports, medical records, and claims data--resulted in 52 percent fewer urgent physician visits, a 67 percent decrease in visits and a 36 percent reduction in healthcare costs compared with patient data from before the as noted in a 1998 press release by disease management company Patient Infosystems.
• Expands service area for providers using telecommunications technologies. Providers can efficiently and effectively manage more patients at lower cost per unit of care. This is important in fee-for service, discounted fee-for-service, and capitated environments.

A telemedicine cyber-revolution is providing solutions to many longstanding problems. Imagine an Internet-based technology that provides both transactional and analytical functions for receiving, transmitting, and managing clinical as well as financial data for patients. Increasingly, healthcare executives and providers are realizing the need to expand information management--one of the core competencies for success in the emerging healthcare delivery system. The transition to managing disease and promoting wellness using a new philosophy is clearly the wave of the future. Marybeth Regan, PhD, is an expert in disease and care management. She has written numerous articles on strategies for care and disease management. She may be reached at Drmarybethregan@aol.com.

340B Drug Pricing Program Findings
NORC Walsh Center for Rural Health Analysis & NC Rural Health Research & Policy Analysis Center Releases Study on 340B Drug Pricing Program

There are substantial differences between participating and non-participating rural hospitals in the 340B Drug Pricing Program in terms of revenue and services offered. The proportion of rural hospitals participating in the program is twice as high among hospitals with more than $100 million in annual revenue versus those with less than $50 million in revenue each year. Participating hospitals also provide a much higher volume of outpatient services where the ability to offer reduced-price drugs might be advantageous, according to a report by the NORC Walsh Center for Rural Health Analysis and the North Carolina Rural Health Research & Policy Analysis Center.

The 340B Drug Pricing Program enables certain types of safety-net organizations to obtain medications at prices below the "best price" typically offered to Medicaid agencies. Historically, few rural hospitals qualified for the 340B program, but the Medicare Modernization Act of 2003 revised eligibility criteria, allowing many rural hospitals to participate. The study, "340B Drug Pricing Program Results of a Survey of Participating Hospitals," surveyed pharmacy directors at participating hospitals on the program in general, the financial impact of the program, and which specific program features presented barriers to its broader implementation. Selected results were compared to those from a separate companion survey of pharmacy directors at hospitals that were eligible but not participating in the 340B program.

Key findings include:

• The average monthly savings is approximately $19,700 on total outpatient drugs for participating rural hospitals; some hospitals reported saving an average of 24 percent of the pharmacy budget.
• About 96 percent of all respondents were satisfied with the discount they received. Savings from purchasing discounted outpatient drugs have been used to offset losses from providing pharmacy services (71 percent), increase and/or improve services at the hospital (51 percent), offset losses in other departments (41 percent), reduce medication prices to the patient (27 percent), and increase the quantity and/or variety of drugs available (16 percent).
• Maintaining separate records for inpatient and outpatient drugs was the biggest challenge in administering the program, according to pharmacy directors. http://www.shepscenter.unc.edu/research_programs/rural_program/WP90.pdf

Five Tips to Help Educate Your Hospital Board on Quality
By Carrie Vaughan for HealthLeaders News
Published: May 16, 2007

Hospital board members are under increasing pressure to ensure their facilities meet--or better yet, exceed--quality and patient safety standards. Hospital comparison Web sites, quality ranking programs, and government initiatives linking performance on quality measures with pay are prompting hospital executives to make sure their board members have the tools they need to adequately monitor quality. This can be a challenging endeavor, however, since many board members are unfamiliar with medical lingo, the meaning of quality measurement data, and most importantly, what quality indicators they should be monitoring. Here are five tips to help get your board members up to speed on quality issues.

1. Define the board's role
   Board members need to know what their job is. "It is important for them to understand the distinction between making a judgment, inappropriately, about the care delivered and their understanding of where the process of care delivery failed," says Yosef D. Dlugacz, PhD, senior vice president and chief of clinical quality, education and research at the Krasnoff Quality Management Institute in Great Neck, NY. It is not the board's job to manage clinical care; their role is to understand the quality process, ask educated questions and help promote programs, he says.
2. Explain that quality is more than regulations
   Make sure the board understands that supporting quality is more than compliance with regulatory organizations. Even though maintaining government standards is a large component of quality management, board members should also understand how the quality process works. For instance, educate them on the methodologies used, how the measurement databases were developed and the communication process throughout the organization, says Dlugacz. He adds that it is also important for board members to know the driving forces behind quality, including external factors like the Institute for Healthcare Improvement and the Centers for Medicare & Medicaid Services, and internal factors like adverse events, patient complaints and malpractice suits.
3. Find quality champions
   Hospitals should consider recruiting a retired nurse or clinician to the board--someone who is an expert in patient safety and quality--says Todd C. Linden, president and CEO of 48-staffed-bed Grinnell (IA) Regional Medical Center. Hospital leaders should also encourage support for senior quality management staff. "Look for individuals who understand regulatory requirements, are good communicators, politically astute and who love to teach," says Dlugacz, adding that those individuals can help embed quality into the fabric of the organization.
4. Incorporate quality in the mission
   The board should play an active role in developing quality goals for the organization. They should have access to benchmarked data to measure the hospital's success toward these goals as well, says Linden. "Let the board take the lead in medical staff engagement," he advises. The medical staff leadership at our facility has focused all its meetings around the quality agenda, which has raised awareness and resulted in excellent physician engagement, Linden says. "The board's role in setting the vision for Grinnell to be a national leader in patient safety, quality and service excellence has driven the passion for this activity."
5. Bring theory into reality
   In the 20 years that Dlugacz has worked with board members, he has learned a lesson or two on what education strategies seem to be the most effective. "I find that highlighting incidents captures their attention. Everyone is justifiably outraged about a wrong site surgery or retained foreign body. They want to know how it could have happened, what went wrong, and most important, how to fix it," he says. In addition, hospitals should avoid presenting board members with raw data, like mortality rates. Not all deaths are comparable, says Dlugacz, "some are from technical errors, some from the progress of disease and inevitable, some unexpected and require further analysis."

Carrie Vaughan is editor of HealthLeaders Media Community and Rural Hospital Weekly. She can be reached at cvaughan@healthleadersmedia.com

ORH Conference Rural Oregon Calendar Photo Contest

Deadline: July 13, 2007
As a part of the Oregon Rural Health Conference, the Office of Rural Health (ORH) is sponsoring a Rural Oregon Calendar Photo Contest.ORH invites photographers to take their best photos of rural Oregon--people, places, things- and submit them to the ORH by July 15, 2007. Pictures chosen will be come part of a Rural Oregon Calendar that will be used as a fundraiser for the student scholarship program for future Rural Health Conferences.

If you have questions, please feel free to contact Bob Duehmig at the ORH at 503-494-4450 or ruralweb@ohsu.edu.

National Effort Promotes Prevention, Healthier Living

The U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) have launched A Healthier US Starts Here, an initiative focused on motivating seniors and others with Medicare to make the most of Medicare's preventive services.

During the spring and summer, the Medicare Prevention tour bus will visit each of the 48 continental United States to promote conversations between people with Medicare, families, caregivers, health professionals, and community organizations. Many disease prevention advocates, employers, and civic and state leaders have joined our efforts to create awareness of disease prevention and wellness.

Data show that the increased use of Medicare preventive benefits can help prevent and detect chronic diseases early in their course, when they are most treatable, and can save lives. For example:

• More than 34 million Americans have low bone mass, placing them at increased risk for osteoporosis; osteoporosis can be prevented and early diagnosis and treatment can reduce or prevent fractures from occurring.
• Decreasing total cholesterol levels by 10 percent in the U.S. population could result in a 30 percent reduction in the incidence of coronary heart disease.
• One pneumonia vaccine, which is free to Medicare beneficiaries, can be life saving-yet only about two thirds of those with Medicare report receiving the service and 46,700 U.S. adults die annually from vaccine preventable diseases.

A Healthier US Starts Here will also teach people how to make the most of the CMS web site, www.mymedicare.gov. This is a one-stop, user-friendly web site that gives registered Medicare users access to personalized information on benefits and services.

When beneficiaries log on, they can check which preventive benefits they need; check their Part B deductible status; view eligibility and enrollment information-including for the Part D prescription drug program; and take care of administrative issues such as verifying an address, ordering replacement Medicare cards, check on the status of claims, and get on-line forms and publications. People with Medicare can also get this information by calling 1-800-Medicare.

Medicare currently covers:

• One time ''Welcome to Medicare'' physical (including an abdominal aortic aneurysm screening)
• Cardiovascular screenings
• Smoking cessation counseling
• Cancer tests - mammogram screening for breast cancer, pap test and pelvic exam screenings for cervical and vaginal cancer, colorectal cancer screenings, and prostate cancer screening
• Shots and vaccines - flu, Pneumococcal, Hepatitis B
• Bone mass measurement
• Diabetes screening, glucose monitoring supplies, and self-management training
• Medical nutrition therapy for people with diabetes or kidney disease
• Glaucoma test

In addition to community partners, an array of HHS agencies are participating in the A Healthier US Starts Here initiative, including the Office of Minority Health, the President's Council on Physical Fitness and Sports, the Office on Women's Health, the Office of Disease Prevention and Health Promotion, the Office on Disability, the Centers for Disease Control and Prevention, the National Institutes of Health, the Health Resources and Services Administration, and the Agency on Healthcare Research and Quality.

Deschutes Rim Health Clinic

Good News! The Deschutes Rim Health Clinic, serving the South Wasco County community, is here! After six long years, the board of directors is finally celebrating an actual clinic building on property just east of Canyon Rim Manor, in Maupin.

In November, 2000, south Wasco county voters approved a $.25/thousand tax base to establish the White River Health District. Originally part of a planned assisted living facility, White River Health and Living, the health district branched off and became a tax-based Oregon Special District, White River Health District, with its own board of directors and tax district regulations. The first board of directors, consisting of Bob Ashley, Tom Rinearson, Jerri Parman, and Doug Jones, began work on all the background needed to build and staff a health clinic. It soon became apparent that the main concern would be funding.

Generating approximately $40,000 per year in tax revenue, the board realized that it would be quite a few years before enough accumulated taxes would build and staff a clinic. So Doug Jones, the present chairperson, wrote and applied for a low-interest loan. The White River Health District received a loan of $260,000 from the Special Districts Association of Oregon. And then came a real stroke of luck when Wasco County deeded over property it owned to White River Health District! The property is on the rim rock overlooking the Deschutes River – hence the name: Deschutes Rim Health Clinic. Then began the job of contracting for a modular clinic building, with all the attendant financial considerations and regulations. A company and design were approved. It didn’t happen quickly. Design changes, communication problems among the contractor, sub contractors and the board delayed the construction again and again. But forging ahead, the board of directors contracted with Michelle Davis to provide much needed “set-up” services for the clinic, which Michelle did with great dedication.

Last year, the board hired its new Office Manager/Medical Assistant, Diana Gerber. She is a local resident, who knows the area. Diana has been busy continuing all the background work in setting up a clinic and staff. Soon to join Diana will be our Physician’s Assistant, Sharon DeHart, and our over-seeing physician, Dr. Stephen McLennon. Dr. Lee Balentine will also have his new dental office in the clinic building. Current board members include Doug Jones, Dennis Beechler, Karletta Carrithers, Mark Peterson and Jerri Parman. Budget Committee members are Marge Gustafson, Cathy Cameron, Sherry Holliday, Virginia Fuller and Pam Ashley.

Services provided by the clinic will include routine physical and sports exams, diagnosing and treating acute and chronic illness, treating minor injuries, administering vaccinations, alcohol and drug prevention and treatment, health education, counseling and wellness promotion. Dental services will be provided by Dr. Balentine.

The Deschutes Rim Health Clinic will be a functioning clinic by June, 2007. The many years of hard work, dedication and hope for a facility to serve South Wasco County residents will have paid off. The goals of the clinic are to provide quality primary health care services and to provide health education that is oriented toward health maintenance and prevention for all members of our community.

Please see our website at www.deschutesrimhc.com or e-mail us at info@deschutesrimhc.com

East Linn Doctor Goes to Extremes to Fight Diabetes

East Linn physician Tim Hindmarsh, MD, of Samaritan Health Services, has jumped from airplanes, water-skied barefoot and pushed his physical limits in the last two years, all to raise money for and awareness of diabetes. In what he has dubbed the “Act Alive Decathlon,” Hindmarsh races around Oregon as he attempts to complete 10 action sports in 24 hours or less. The decathlon is designed to highlight the best way to avoid Type II diabetes: exercise. It has also raised more than $10,000 for diabetes education.

Skydiving, windsurfing, slalom waterskiing, barefoot waterskiing, wakeboarding, snowboarding, downhill skiing, running, cycling and motocross make up the full slate of Act Alive events.

Hindmarsh recently announced plans for the 2007 Act Alive decathlon - scheduled for July 13 - and they include dramatic changes.

The second half of the decathlon will take place in east Linn County, and Hindmarsh wants as many people as possible to participate in the cycling and running segments with him.

“I’m going to complete the motocross event in Sweet Home, cycle from Sweet Home Family Medicine to the Lebanon Airport, hop in an airplane, skydive over Lebanon, land at Pioneer Elementary school and finish off the day with a five-mile run across town,” Hindmarsh said. “And I want people to come out and join me. The goal is simply to get out in the beautiful summer weather and make a statement about exercise and diabetes.”

The Santiam Spokes cycling club and the Build Lebanon Trails group have endorsed Act Alive, with the Spokes committing to join Hindmarsh for the cycling portion and Build Lebanon Trails committing to participate in the running and walking event.

Act Alive participants will be able to do anything from cycling and running the full distance with Hindmarsh to simply walking one mile during the final leg of the decathlon. Participants may raise money by obtaining pledges, with all proceeds going to the Diabetes Education fund at the Lebanon Community Hospital Foundation, which provides diabetes education scholarships to low-income east Linn residents.

“Every penny that we raise through Act Alive will go to the Diabetes Education fund,” Hindmarsh said. “We have a huge percentage of people in our community who need to take diabetes classes and I’m very serious about helping them.”

The Oregon Office of Rural Health honored Hindmarsh with the “2006 Outstanding Contribution to Rural Health Award” for his efforts with Act Alive.

Specific event times and more information will be posted to www.samhealth.org. Simply click on the link to “ Samaritan Lebanon Community Hospital.” The site also features a video of last year’s Act Alive decathlon.

To sign up for Act Alive, or for more information, contact Brad Canfield, public relations manager at Samaritan Lebanon Community Hospital, at 451-7161 or bcanfield@samhealth.org.

Oregon Rural Healthcare Quality Network
Staying Ahead of the Curve

Since its inception in 2005, the Oregon Rural Healthcare Quality Network (ORHQN) has worked to help rural and critical access hospitals stay ahead of the curve on transparency and quality reporting issues. Healthcare regulators, payers, providers and consumers are seeking to understand healthcare data and the relationship between cost and quality. Now, regardless of the metrics and methodology of the measures, both public and private sector payer organizations are moving to pay-for-performance as a strategy to improve healthcare.

Quality outcome reporting initiatives, which have been developed using urban research, may place rural providers at a disadvantage due to their small populations and sample sizes. The urban to rural comparison of healthcare outcomes is often distorted by the inability of rural providers to spread variances over a larger volume of patients. In a small sample, one patient can have a devastating effect on a hospital’s performance ranking. Additionally, though many of the quality measures are valid, some are not applicable and do not reflect the type of services typically provided by rural facilities, such as stabilization and transfer of patients.

ORHQN hospitals are currently working together to understand the impact of reimbursement of clinical performance using urban standards for small and rural hospitals.

One of the most significant impacts is the amount of resources required to collect and report data. Pay-for-performance methodologies increase the amount of data collection and reporting a hospital must do. Rural providers are looking for solutions to address these additional requirements for performance measurement and data collection without further taxing an under-resourced and overworked staff. Pay-for-performance requirements are still voluntary for critical access hospitals, but are currently in place for rural prospective payment hospitals.

ORHQN provides a forum for rural providers and stakeholders to achieve consensus on the most relevant measures to determine rural healthcare quality. By working together, rural providers are able to problem solve, share best practices, and work toward standardizing and simplifying data collection. Currently nineteen Oregon hospitals are participating in a performance measurement initiative.

The ORHQN performance measurement initiative will allow participating hospitals to aggregate data and benchmark key performance indicators. For the initiative, ORHQN selected the Rural Performance Management (RPM) developed by Stroudwater Associates, of Portland, Maine, as a standard data collection and reporting platform. RPM provides a secure web- based service that allows hospitals to enter data into a framework; linking strategy to actions that will achieve improved performance.

RPM offers a core set of metrics in the domains of finance, customer, learning and growth, and quality and business processes. In addition, RPM provides customizable options for hospital-specific metrics. Using RPM reports, hospitals are able to analyze performance and then to identify underlying causes and gaps, which, once addressed, will lead to lasting improvement.

ORHQN is dedicated to helping rural hospitals improve quality by offering tools and services to improve performance. The performance measurement initiative and the peer review network are some of the examples of how ORHQN is keeping rural providers ahead of the curve.

For more information about ORHQN contact Linda Lang at 541-942-6555 llang@peacehealth.org.

When Workers Few, Grow Your Own
By Don Bourland
Published: Monday, April 16, 2007

Early in 2000, we faced a serious problem: It was increasingly difficult to recruit nurses and other health care workers to the central Oregon Coast.

Given that the national nursing shortage was forecast to worsen, we had to give serious thought to how Florence, a small rural community, could find nurses for our hospital.

Our challenge was compounded by the fact that the average age of nurses at Peace Harbor Hospital was 50, meaning that many of them would be retiring soon. Additionally, Florence has the highest ratio of adults to youths in the state, at five adults for each younger person. Many of those older people would need our hospital's services.

We realized that it was critical to create more health care job opportunities to keep our younger citizens in the Florence area, so they could help care for the aging residents in the PeaceHealth-Siuslaw Region.

The challenge was to develop a program using a "grow our own" approach to both reach out to the community for new workers and to tap the potential of our existing entry-level and mid-level work force. This program came to be known as the Career Pathways Initiative.

To help interest potential employees, we developed a High School Health Occupations Program in collaboration with Siuslaw High School. Several graduates of that program are now continuing in postsecondary education for health care careers, and three of the first year's graduates currently work at Peace Harbor Hospital.

One of the graduates, Megan, received a scholarship to pay for certified nursing assistant training during her senior year of high school. After graduation, she spent more than a year working in a veterinary clinic, and she recently was hired as a medical office assistant for one of our family practice physicians.

In order to strengthen our internal pipeline, we identified entry and mid-level workers who had an interest in further training. Those employees receive on-site career advising and support from our staff as well as from career advisers at the Lane Workforce Partnership.

Kim is another promising recruit. She has been a CNA at Peace Harbor Hospital since 2002. She dreamed of being a nurse, but until she moved to Florence she was not able to pursue that dream.

Kim has a small child and is now working on her prerequisites for the nursing program. She recently received a $3,000 scholarship from the Lane Workforce Partnership, as well as additional support for child care.

Kim also makes use of an employee tuition reimbursement benefit, and will apply for a scholarship from Peace Harbor to help pay for the nursing program once she is accepted.

Kim is one beneficiary of our "grow your own" strategy, and we look forward to seeing her fulfill her own dream; as well become a part of our RN team.

Through our experience, we have found that there are three critical elements of a successful "grow your own" program:

1. Partnerships with education, work force development and related advocacy groups.
2. On-site and ongoing support of employees who are interested in retraining for higher level positions.
3. Scholarship, tuition reimbursement and loan repayment programs.

We have invested large sums of dollars to recruit, interview and relocate health care workers from other parts of the country. Our vision is to reallocate many of those dollars into educational funding for those already in our community and in our work force.

We feel this is a much wiser investment, because we are increasing the supply of health care workers versus competing with other health care organizations for the limited number of available health care workers throughout the country.

This "grow your own" strategy is one of many work force solutions that will help to address the coming skilled work force shortage. The model is replicable across many industries that also face problems created by work force shortages.

Don Bourland, regional vice president for human resources for PeaceHealth-Siuslaw Region in Florence, led the Career Pathways Initiative along with Cathleen Coontz, a registered nurse who is now the work force development coordinator for PeaceHealth's Oregon Region. The initiative received a Lane Workforce Partnership and Lane Metro Partnership award for work force development in 2004. This is the fourth in a series of biweekly columns about developing Lane County's work force.

The Oregon Office of Rural Health is offering travel scholarships to the 5th Annual Western Region Flex Conference in Jackson Hole June 7-8, 2007

If you are interested in attending, please email Kassie Clarke at clarkek@ohsu.edu by May 11th.

The 5th Annual Western Region Flex Conference will be held at Snow King Resort in Jackson Hole, WY. The purpose of the 2007 Western Region Flex Conference is to provide a venue for CAHs and Flex programs in the western region of the United States to share information, ideas and experiences. This Conference will provide opportunities for networking among CAH and CAH eligible hospital administrators and financial officers, Flex program staff, state policy makers, and rural health care stakeholders in the western states. The conference will also provide an opportunity for participants to learn more about Flex programs and Critical Access Hospital success stories in the region. Online registration is available at www.unr.edu/flex/flexconf07.htm. The registration deadline is May 25, 2007. For additional information call 775-784-4841 or visit the conference Web Site.

2007 Physician Quality Reporting Initiative (PQRI) - National Provider Conference Call with Question & Answer Session

The Centers for Medicare & Medicaid Services (CMS) will host the second in a series of national provider conference calls on the 2007 Physician Quality Reporting Initiative (PQRI). This toll-free call will take place from 1:00 p.m. – 3:00 p.m., EDT, on Thursday, April 19, 2007.

This call will build on the broad overview of the 2007 PQRI program provided on the March 27, 2007 national provider conference call by providing more detailed information on provider selection of quality measures, the recently posted measure specifications, incorporating PQRI into the care delivery process, and successful reporting. A PowerPoint slide presentation will be posted to the PQRI webpage at www.cms.hhs.gov/PQRI prior to the call, so that you can follow along with the presenters, Dr. Thomas Valuck and Dr. Susan Nedza.

In addition, MLN Matters article MM5558, which provides a program overview of the 2007 PQRI, is available on the PQRI web page.

Following the presentation, callers will have an opportunity to ask questions of CMS subject matter experts.

Conference call details:

Date: April 19, 2007
Conference Title: 2007 Physician Quality Reporting Initiative – Reporting Quality Data Codes
Time: 1:00 - 3:00 p.m. EDT

To receive the call-in information, you must register for the call. Note that due to a high level of interest, CMS is significantly increasing capacity for this call. If you are planning to participate as a group, CMS asks that only one person register to receive the call-in information. This registration is solely to reserve a phone line, NOT to restrict participation.

Registration will close at 1:00 p.m. EDT on April 18, 2007. No exceptions can be made, so please be sure to register prior to this time.

1. To register for the call, participants need to go to: https://ww4.premconf.com/webrsvp/register?conf_id=6197949
2. Click "Continue" to be taken to the registration screen.
3. Fill in all required data.
4. Click "Submit."
5. You will be taken to the confirmation screen where the call-in number will be given.
6. To view the time that the call will start, you will need to select your time zone in the drop down box under "Time" on the confirmation screen.
7. Click "Confirm Registration" to receive a confirmation email.

For those who will be unable to attend, a replay option will be available shortly following the end of the call. This replay will be accessible for 7 days following the call and will end on April 25, 2007. The toll-free number for the replay is 1-888-348-4629; the passcode is 364849.

Online Evaluation Form

CMS has developed an online evaluation form that can be quickly completed and submitted. Participants are asked to complete this online evaluation form to help CMS make informed decisions on improving training activities. The online evaluation form titled “Medicare Training Evaluation Form” can be found on the registration page, http://www.cms.hhs.gov/MLNProducts/60_ContractorTraining.asp. CMS appreciates your comments.

If you have questions or require special accommodations, please contact Geanelle E. Griffith at geanelle.griffith@cms.hhs.gov or at (410) 786-4466.

Take Action: Healthy People, Places, and Practices in Communities Project

The Department of Health and Human Services (HHS) Office of Public Health and Science, Office of Disease Prevention and Health Promotion and the Regional Health Administrators are requesting proposals from small, community-based groups to evaluate a unique set of healthy lifestyles activities conducted in local settings in support of the President's HealthierUS initiative.

Proposal Deadline: March 30, 2007 (by 5:00pm MST, Postmarks not accepted)

Purpose: To evaluate activities in local communities across the HHS regions that support and promote healthy lifestyles including:

• Physical activity
• Nutrition and healthy eating
• Preventive screenings
• Making healthy choices/avoiding risky behaviors

Sample Activities:

• Walking programs for the neighborhood or workplace.
• School lunch programs that include locally grown and seasonal fruits and vegetables.
• Encouraging people to get checked for skin cancer.
• Smoking prevention program for teens.

Funds: $2,000 and up to $5,000

Funding Mechanism: Contracts*

Project Period: June 29, 2007 - June 30, 2008

Eligibility: Not-for-profit, community-based organizations including faith-based groups, after school programs, coalitions and others.

For questions about the project or the proposal instructions, contact: Email: answers@jsi.comTelephone: 1-866-224-3815

Download proposal instructions for full details, requirements, forms, and how to submit your proposal:

• Microsoft Word document - 168 kb
• HTML version
  • Timeline
  • Proposal Instructions and Forms

*John Snow, Inc. is the lead contractor for the administration and national evaluation of this project. Awardees will become sub-contractors of John Snow, Inc.

CMS Physician Quality Reporting Initiative

On December 20, 2006 the President signed the Tax Relief and Health Care Act of 2006 (TRHCA). Section 101 under Title I authorizes the establishment of a physician quality reporting system by CMS. CMS has titled the statutory program the Physician Quality Reporting Initiative (PQRI).

PQRI establishes a financial incentive for eligible professionals to participate in a voluntary quality reporting program. Eligible professionals who successfully report a designated set of quality measures on claims for dates of service from July 1 to December 31, 2007, may earn a bonus payment, subject to a cap, of 1.5% of total allowed charges for covered Medicare physician fee schedule services.

Note that this initiative applies to the traditional Medicare fee-for-service program only and is not applicable to the Medicare Advantage Plans, including the private fee-for-service plans.

The Women to Women Project, a support network for rural women with chronic illness, is seeking women to participate in a study group forming in the fall of 2007.

The College of Nursing at Montana State University is in its eleventh year of this program, which enhances rural women's ability to manage their chronic condition and assesses its effect on their quality of life.

To qualify for participation, women must be physically able to use a computer and have a basic knowledge of how to use a computer, but owning a computer is not necessary. Women interested in participating in the next study group need to be between the ages of 35 and 65 and living with a chronic disease such as arthritic conditions, multiple sclerosis or heart disease. Participants must reside at least 25 miles outside of a town with 12,500 or more people in the states of Montana, Idaho, Nebraska, North Dakota, South Dakota, Wyoming, and eastern Oregon or eastern Washington.

Women in the project are assigned to one of two groups. One group is provided with Internet access that allows them to participate in a self-help support group and gain information from health teaching units and group discussions with periodic input by experts. The second group does not use computers but provides important health-related data.

All groups participate in a telephone interview and complete three written mail questionnaires.

Women who are interested in the project are encouraged to call the program's toll-free number, 1-888-375-1317, at the MSU College of Nursing, Bozeman, Mont., or contact the program via e-mail at scudney@montana.edu.

This is available on the MSU web at: www.montana.edu/cweinert. A fact sheet can be found here and a flyer can be found here.

President's Budget Ignores Critical Role of Rural Health Care Programs

The National Rural Health Association (NRHA) expressed its deep dismay about the devastating cuts included in the President's Fiscal Year 2008 budget proposal released today. Despite continued support from Congress for many rural health programs, the Administration proposed to eliminate funding for several successful rural health programs and to drastically cut others for the fourth straight year in a row. Congress reversed the cuts proposed by the President in past years.

"Yet again, the President's budget is completely shortsighted on the crucial issue of health care for rural Americans," said George Miller, NRHA President. "This is not the time to cut programs to the most vulnerable Americans. The budget fails to acknowledge the importance of these rural health programs and the significant role they place in ensuring access to quality health care and the continued development of innovative rural health care delivery systems."

The budget eliminates or cuts funding for the following rural health programs:

• Rural Health Flexibility Grants - Funding eliminated.
• Small Hospital Improvement Program - Funding eliminated.
• Rural Health Network and Outreach Grants - Funding eliminated.
• Rural and Community Access to Emergency Devices - Funding eliminated.
• Community Access Program - Fails to restore funding to this important program.

Health professions programs are cut by $193 million in the President's budget, despite the continued challenge of health care workforce shortages in rural America.

The budget also proposes $78.6 billion in legislative cuts to Medicare and Medicaid over five years, $65.6 billion in Medicare and $13 billion in Medicaid. However, cuts to Medicare and Medicaid reach $102 billion over five years for both programs when the President's proposed regulatory changes are included. "The President's budget fails to restore or extend various provisions that help rural providers cover the extra costs of providing care in a rural setting," said Alan Morgan, NRHA CEO. "These additional cuts to Medicare and Medicaid only add insult to injury, and ignore the difficult financial situation of so many rural providers." NRHA

Available Now! Audio recording of sessions from HIT: A Rural Provider’s Roadmap to Quality!

Audio recording of key sessions and other materials from HRSA’s Office of Rural Health Policy-sponsored conference HIT: A Rural Provider’s Roadmap to Quality that occurred September 21-23, 2006 in Kansas City, MO are now available on the Rural Assistance Center website at http://www.raconline.org/HIT_Conf2006/. Recorded session topics include HIT 101, financing, leadership, implementation, and workforce. Other available items include conference agenda, speaker powerpoint presentations, and conference primer A Roadmap for the Adoption of HIT in Rural Communities. For additional information please contact Carrie Cochran at 301.443.4701 or ccochran@hrsa.gov.

Opening on the Rural Health Coordinating Council

There is currently an opening on the Rural Health Coordinating Council (RHCC). This is a Consumer position for what was HSA1, which covers Clatsop, Columbia, Multnomah, Clackamas, Washington and Tillamook counties. This is a Governor's Office appointment. The application can be found here. More information on the RHCC can be found