ORH Newsletter Vol. MMVII ED II

{Click here for printable PDF version}

24th Annual Oregon Rural Health Conference
Mark Your Calendars!! September 13-15, 2007

 It's hard to believe, but the Annual Oregon Rural Health Conference (ORHC) is closer than you think! This year's theme -- Set No Limits: Innovation, Creativity and Leadership -- sets the stage for a conference filled with creative ideas to meet the demands of providing health care in rural Oregon.

The ORHC is the largest gathering in Oregon dedicated to the important issues of rural health care. Bringing together providers, administrators, patients, activists, policy makers and others who are concerned about health care in rural Oregon, it is an opportunity to help set the agenda. In collaboration with the Oregon Rural Health Association (ORHA), Oregon Area Health Education Centers (AHEC) and the Oregon Rural Practice-based Research Network (ORPRN), the Oregon Office of Rural Health (ORH) strives to bring you the most innovative approaches to addressing today's needs.

You will notice two changes in the conference this year -- new date, new location. Finding a date and time that can accommodate the many people who want to attend the conference can be a challenge. A number of conference attendees have expressed concern about the late fall timing of past conferences and its conflict with a rural tradition -- hunting season. To accommodate hunting season, ORH moved the conference this year to September 13-15th.

The second big change is the location. The conference rotates among the coast, the valley and east of the mountains. This year's conference will be held at the Salem Conference Center in downtown Salem. Please check out the facility by going to their website. We think you will be as thrilled as we are about the new location.

We are also excited about the line up of topics and speakers this year! There is never a lack of important issues that confront rural health care providers. With the help of an outstanding planning committee, we think we have a great program scheduled!

This year, an honored national guest speaker will be a participant in the entire conference. Hilda Heady is Executive Director of West Virginia Rural Health Education Partnerships (WVRHEP) and Vice President for Rural Health at the Robert C. Byrd Health Sciences Center of West Virginia University. She is also a former President of the Board of Trustees of the National Rural Health Association. Ms. Heady is known as a tireless worker on behalf of rural communities across her state.

WVRHEP has been nationally recognized as a model partnership between communities, higher educational institutions and government agencies by the New York Times, the Wall Street Journal and the Journal of Rural Health.

The Partnership's outcomes are impressive: From 1999 to 2004, the number of rural physicians increased by 88 percent from 88 to 165. In 2002, WV health professional students participated in community service activities involving more than 158,000 rural residents. Health professional students have opportunities to serve and learn in 28 community health centers, 30 small rural hospitals, 25 dental offices, 37 pharmacies, 13 county health departments, 20 physical therapy agencies or rehabilitation centers in underserved areas, and 16 county boards of education. Nearly 700 rural field faculty members are involved in health professional education.

There will be a day of pre-conference meetings on Thursday centered on Critical Access Hospitals, Oregon Rural Health Quality Network, statewide AHEC meeting, FLEX Advisory, Rural Health Clinic Workshop, ORPRN steering committee meeting and the Oregon Rural Health Association Board Meeting.

Friday is packed with informative sessions. The day begins with the Oregon Rural Health Association Annual membership meeting, followed by a welcome from Dr. Joe Robertson, President, OHSU. Back by popular demand, Scott Ekblad, Director, Office of Rural Health, Dr. Lisa Dodson, Director, AHEC, Dr. Bruce Carlson, ORHA, and Dr. L. J. Fagnan, Director, ORPRN will introduce you to their organizations and the work of each.

Other sessions include: Pay for Performance -- with the federal government moving quickly to implement a pay for performance program for providers, it is essential that rural providers be prepared; Quality -- key to offering successful health care services! Quality is a buzz word that people use to judge the providers they are searching for and the care they receive; Mental Health -- always a challenge in Oregon and more so in rural areas; Dental Health -- more and more, we are learning the importance of oral health in kids and adults; Recruitment & Retention -- a challenge for clinics and hospitals. How do we attract the right providers to our communities? And Partnerships for Health -- learn how partnerships can help make communities healthier.

During this legislative session, health care reform has been high on everyone's list. Come hear from legislators what happened during the 2007 Legislative Session and what will be addressed during the February 2008 session. It is vital that rural Oregon be part of that reform process.

Oregon Rural Health Conference Awards

 A very important part of the annual conference is the opportunity to honor those in our rural communities that really make a difference. Nominees for these honors are made by those of you who know them the best - your community leaders, your coworkers, and your friends.

Please, look over the guide lines and nominate someone you believe deserves an award.

How to nominate

• Complete the appropriate nomination form and attach other relevant information such as newspaper articles or additional letters of support.
• Please provide as much detail as possible in answering questions on the nomination form by attaching additional pages.
• E-mail nominations (preferred method) to Linda Peppler at pepplerl@ohsu.edu,
  fax to 503-494-4798 or mail to:

  Linda Peppler
  OHSU Office of Rural Health – L593
  3181 SW Sam Jackson Park Road
  Portland, OR 97239-3011

Nomination materials will become the property of the Oregon Office of Rural Health and will not be returned.

Selection Process
Award determinations will be based on the merits of nominees, their relevance to established criteria in the category and a demonstrated benefit to the community they serve. Greater consideration will be given to those whose nomination is accompanied by additional supporting documentation. Awardees will be determined by the Rural Health Coordinating Council. Winners and their nominators will be notified by telephone or e-mail no later than August 10, 2007.

Awards Presentation
The 2007 awards will be presented on Friday, September 14, 2007 at 12:00noon at a lunch ceremony at the 24th Annual Oregon Rural Health Conference in Salem, Oregon. Conference registration information will be posted on the ORH website in July 2007.

Awardee Attendance
Awardees will be given two complimentary lunch tickets. Additional lunches may be purchased for $19 each. Awardees will also receive a plaque honoring them for their achievement.

Deadline for nominations
All nomination materials must be received by Thursday, July 5, 2007. Questions? Contact Linda Peppler via e-mail at pepplerl@ohsu.edu or by telephone (503) 494-4450.

Please use the following links to download the ORHCAs forms. More information on ORHCAs can be found here.

• Dutch Reinschmidt Award

• Outstanding Administrator, Manager or Staff
  
• Outstanding Achievement in Community Education
  
• Outstanding Contribution to Rural Health in Oregon
  
• Outstanding Rural Health Program
  
• Outstanding Rural Health Practice
  
• Rural Health Practitioner of the Year
  

Legislative Update

 Work at the State Capitol continues with people focused on the June adjournment date. To date, 2475 measures have been introduced this session.

SB 37
SB 37 dedicates a portion of cigarette tax revenues to support funding the rural Emergency Medical Services program eliminated in 2003. The Office of Rural Health would provide grants to rural EMS organizations for equipment and training to rural Emergency Medical Technicians. The bill would also fund the technical and financial assistance account within the Office of Rural Health to provide financial assistance to isolated rural primary care clinics. In addition, it would provide emergency funds for modernization of hospital facilities in rural areas. SB 37 was heard before the Senate Finance and Revenue Committee on March 14, 2007. Members were supportive of the legislation, but discussion continues over the actual dollars and funding source.

SB 162
SB 162 modifies the organization and duties of the Emergency Medical Services and Trauma Systems Program; establishes and specifies duties of State Critical Illness and Serious Injury Steering Committee. SB 162 would establish and specify duties of the Oregon State Board of Emergency Responders. It would also authorize the Governor to take certain actions when an emergency medical situation overwhelms local emergency medical service resources. SB 162 is awaiting its first hearing.

SB 183
SB 183 would extend the reinsurance program for medical professional liability insurance policies currently administered by State Accident Insurance Fund Corporation for an additional four years. The current program is scheduled to sunset at the end of 2007. The first hearing was held in January and is awaiting a second hearing.

SB 188
This bill, along with additional revenue included in the Oregon State Student Assistance Commission budget, would enhance the student loan repayment program for health professionals in rural areas. In addition to more money, it would require health professionals to complete a minimum practice requirement in the time period immediately following completion of their training requirements or execution of Rural Health Services agreement. This bill would include dentists in the program. First hearing was held in January. OSSAC budget was heard on Monday, March 12, 2007.

If you have questions concerning a particular piece of legislation and its impact on health care in rural Oregon, e-mail Bob at duehmigr@ohsu.edu.

What's Going On?

5th Annual Critical Access Hospital Conference
March 21, 2007
Red Lion Hotel at the Park, Spokane WA

2007 Northwest Regional Rural Health Conference
March 22 & 23, 2007
Red Lion Hotel at the Park, Spokane WA

Rural Health Works Workshop in Portland
March 27, 2007
OHSU Center for Health and Healing

4th Annual Rural Nurse Conference: "Rural Nursing: Growing Quality"
June 13-15, 2007
Richland, Washington

Rural Women's Health Conference
August 13-15, 2007
Omni Shoreham Hotel, Washington DC

The Oregon Academy of Family Physicians Foundation Golf Tournament And the Mary Lundy Scholarship Fund Supporting Future Family Physicians
TIME TO TEE UP!!
And Help Future Family Physicians!!!

When: Thursday, May 10, 2007, 1.00pm
Where: Skamania Lodge Golf Course
Who: You!!!!

Since 2000, this scholarship fund has assisted six graduating doctors from OHSU who are committed to family medicine. Help us keep this tradition alive.

For more information, contact Peggy O'Neill, OAFP Foundation, 503-528-0961 or e-mail at mail@oafp.org

National Rural Health Association (NRHA) Lobbies Congress!

The National Rural Health Association held its annual Policy Institute in Washington DC February 26-28th . The meeting bought NRHA members from all over the country to learn about the latest federal issues facing health care in rural America and to lobby their members of Congress. Lynn Ironside, board member for the Oregon Rural Health Association (ORHA ) and Bob Duehmig, Oregon Office of Rural Health (ORH), represented Oregon.

The National Rural Health Association is a member association of more than 11,000 individuals and organizations. It is considered the voice of rural health in Washington DC, promoting leadership, communication, education, research, and advocacy since it was established in1978. The Oregon Rural Health Association is the local state affiliate.

NRHA Policy Institute focused on the proposed cuts included in the President's budget that was released in February. The President has proposed cutting to zero such important programs as Rural Outreach and Network Grants, Rural Hospital Flexibility Grants (FLEX), Rural & Community Access to Emergency Devices, Rural EMS/Trauma, Community Access Program Grants, Area Health Education Centers (AHEC), Health Education and Training Centers, Quentin Burdick Rural Training and Geriatric Programs. Other programs are slated for deep cuts.

NRHA members spread out on Capitol Hill to lobby their members of Congress. In addition to full restoration of funding for the rural health safety net, Members of Congress were asked to protect rural providers from any Medicare/Medicaid changes, and to restore balance to The Medicare Payment Advisory Commission (MedPAC). MedPac is the congressional advisory committee that advises Congress on Medicare/Medicaid changes. While the law requires equal representation between rural and urban representation, only one current member has experience with rural health care.

Oregon delegates Lynn Ironside and Bob Duehmig were able to meet with staff from six of the seven members of Oregon's delegation. Rep. Greg Walden, HD 2, went out of his way to meet directly with the NRHA members. As co-chair of the House Rural Health Care Caucus, Rep. Walden understands the importance of health care on the future of his rural district.

Last year, Walden introduced H.R. 5118, the Medicare Rural Provider Payment Extension Act, which would extend critical provisions relating to Medicare reimbursement/payment methods for rural health providers.

The delegation was aware of the President's proposed cuts and stated their opposition. They voiced concern about the impact of such cuts on rural communities throughout Oregon. Rep. Earl Blumenauer, HD 3, representing East Portland even agreed to join the Rural Health Caucus. Rep. Blumenauer's staff said the Congressman knows that for Oregon to prosper, all of Oregon must prosper.

The Policy Institute updated members on a number of important issues including HIT and its role in health care in particular, rural health care. Various states, including Oregon, are applying to be a part of a pilot project with the FCC to "hook up" rural areas so health care facilities, clinics, and hospitals can access the Internet. The application is being prepared by a consortium of interested Oregon parties including the Telehealth Alliance of Oregon (TAO), various Internet vendors, health systems, OHSU and the ORH. (See article to find out more about the FCC project.)

Attendees were encouraged to pay attention to the Farm Bill, scheduled to be reauthorized before the end of the year. This year's reauthorization offers many rural communities a chance to focus on rural development. More and more communities are realizing that economic development cannot come without health care. Title VI of the Farm Bill is focused on rural development. A summary of proposals in Title VI of the Farm Bill Title VI include:

Critical Access Hospitals (CAH)

• 1,283 certified CAHs need rehabilitation/reconstruction
• $1.6 billion in guaranteed loans
• $5 million for grants
• Community Facilities program through USDA Rural Development
• Enhancing Rural Infrastructure
• Need infrastructure for sustainable economic development
• Backlog of funding applications ($2 billion)
• $500 million proposed by USDA RD
• Water/wastewater grants and loans
• Emergency/first responders
• Broadband Access Program (includes Telemedicine)
• Streamlining Rural Development Programs
• Separate categories limit opportunities
• Multi-department energy grants proposed
• Business loan/loan guarantee (energy)
• Business grants (RBOG/RBEG, Value Added, Rural Cooperatives)
• Community programs (RCDI, Emergency Water, Community Facilities, Tribal)
• Consolidation for Housing Programs

Congresswoman Hooley Creates Healthcare Advisory Council

Congresswoman Darlene Hooley, D-5, has announced the creation of her Healthcare Advisory Council and has asked Scott Ekblad, Director, Oregon Office of Rural Health, to participate. During the 110th Congress, Congresswoman Hooley will serve on the House Energy and Commerce Committee as well as its Health Subcommittee. According to Hooley's office, the subcommittee on health has already held the first hearings on the reauthorization of the State Children's Health Insurance Program and the Physician Payment Reform legislation.

Congresswoman Hooley stated, "The Subcommittee has an aggressive agenda. To ensure I have access to the most pertinent information, on issues the committee will cover, I am asking for the help and input of the group." The committee will meet with the Congresswoman's staff here and in DC.

Senator Ben Westlund (Bend) and Senator Dr. Alan Bates (Ashland/Medford) are hosting a series of state-wide Town Hall meetings to discuss Oregon health care reform. As Co-Chairs of the Senate Special Committee on Health Care Reform, they will lead discussions on the framework for reform proposed by the Senate Interim Commission on Access and Affordability, Senate Bill 329. They are looking at various health care reform proposals and wish to hear from Oregonians in 17 Town Hall meetings. The first meeting was on Thursday, March 8th in Springfield with two on Saturday in Bend and Redmond, followed by Beaverton, Salem, Portland and Lincoln City next week. Complete Town Hall information and schedule can be found here.

Flex $ Around the State
One of the Flex grant opportunities available in 2005 was for CAHs to host a meeting with ER staff and EMTs to discuss better ways to coordinate patient care. Here are a few reports from hospitals that received the grant:

St. Anthony Hospital
Two American Heart Association Advanced Cardiac Life Support (ACLS) classes were provided to local city, Tribal and hospital EMTs on November 28th and 30th. Twenty-three people completed the American Heart Association recertification training course. Training such as this should improve outcomes by increasing provider knowledge. Patients will receive better care before they reach the hospital and care will be better coordinated because of the group's work on this training together.

Southern Coos Hospital Report
This Flex grant offset meeting costs to amplify and refine the communication and coordination between Southern Coos Hospital and Bay Cities Ambulance staff in serving the community of Bandon. Our two focus targets involved health response needs during large tournament events at Bandon Dunes Golf Resort and disaster preparation.

Activities assisted by the grant have resulted in better communications, more knowledge of available resources and closer working relationships between Southern Coos Health District and Bay Cities Ambulance. As a result, our new Emergency Department director/Disaster Preparedness nurse will conduct in-service trainings for both SCHD and Bay Cities EMTs. Additionally, we identified needs for continuing communications through monthly meetings, which will begin in January, 2007.

Tillamook County Hospital
Funds were used to develop two SimMan simulation scenarios specific to rural pre-hospital setting and involved both paid EMS providers and volunteer first responders. Training session outcomes will include: 1) Increased EMS provider knowledge; 2) Improved patient outcomes; and 3) Improved working relationships between paid and volunteer EMS providers as well as the Critical Access Hospital staff when co-responding to emergency medical incidents

N2K Update
In response to the nursing workforce shortage, the Oregon Health Career Center (OHCC) has developed an innovative, employer-driven and employer-financed nursing education model allowing hospitals and colleges to work together to guarantee a steady, predictable supply of new nurses beyond the current capacities of the training institutions.

The N2K Nursing Capacity Building Model is comprised of several key components that result in a unique and creative approach:

• Identify and select high performing "incumbent workers" for nurse training;
  
• Diversify the nursing workforce with a specific focus on bilingual/bicultural employees.
  
• Ensure selected employees retain full-time pay and benefit status by providing paid release time to attend course and clinical work;
  
• Modify course schedule and training modality to better meet the work and academic needs of the participating employees;
  
• Increase the training capacity of the participating nursing school by executing a "contract education" agreement that provides reimbursement for the additional costs (faculty, etc.) associated with the program;
  
• Provide strong student support services that assist participating employees (students) in the transition from employee to student and help with other non-academic issues that they may encounter.
  

OHCC will work directly with employers serious about implementing this model to bring it to life. All hospitals and health systems in Oregon will be invited to attend introductory meetings. More information will be coming soon. We will keep you updated.

FCC Announces Pilot Program

The Federal Communications Commission (FCC) has announced a pilot program that will pay for up to 85 per cent of the costs of creating a digital broadband network of networks that would securely and privately interconnect all Oregon hospitals and clinics, including dental and optical clinics, for the provision of Telehealth services. The pilot program is currently limited to two years of funding. Funds may be used for both network design and implementation. Information about the proposed FCC pilot program is available here. The FCC's rural healthcare program of the Universal Service Fund (USF) could subsidize on-going annual costs for connecting rural locations. Information about this ongoing subsidy program is available here.

So what does this all mean? The concept is to create a digital broadband network of networks that would securely and privately interconnect all Oregon hospitals and clinics, including dental and optical clinics, for the provision of Telehealth services. In addition it would connect Oregon hospitals and clinics with all Oregon state and county public health offices and all Oregon educational institutions that provide training for health care professionals or para-professionals. The network would interconnect with both the Internet and Internet2 (or National Lambda Rail) to reach relevant sites on those networks. It would be inter-operable with Oregon public safety networks to coordinate disaster planning and response. It would also connect with health insurers for secure payment mechanisms and to Oregon pharmacies for secure electronic prescribing applications. It would be securely accessible via the Internet to permit authorized access from other locations, including for clinicians on call from their homes and for home health monitoring and communicating with patients in their homes. The network would permit reliable data, digital image, digital voice and digital video transmission with quality sufficient for real time clinical instruction and medical consultations. It would provide a network suitable for secure exchange of electronic medical records among those with appropriate authorization. It would save travel costs by permitting multi-site videoconferencing for administrative conferences, education and training courses for certification and continuing education, and clinical consultations.

The ORH E-Newsletter will keep you updated on this project.