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April 2010 ORH Newsletter Share This OHSU Content

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It’s Never Too Early to Nominate Your Hero!

Nominations Sought for 2010 Oregon Rural Health Hero Award

The nomination process for the 2010 Oregon Rural Health Hero of the Year Award is now open until June 25, 2010.

Learn more about this award.

Mark Your Calendar

Oregon Rural Health Conference

September 23-25th, 2010
Salem Conference Center, Salem Oregon

Learn more about this conference.

Health Care Reform: What does it mean for Oregon?

After months of political theater, the US Congress passed sweeping health care reform—The Patient Protection and Affordable Care Act. But despite all that we have heard about it in the media, what does it really mean for Oregon? And more specifically, what does it mean for rural Oregon?

“There is a lot in this bill”, says Scott Ekblad, Director, Oregon Office of Rural Health. “But I do believe that it will help rural Oregon. Like all big pieces of legislation, it will take time to implement. This office will be taking a very close look at how it impacts rural Oregon and getting that information to you.”

Passage of health care reform was a two part process. The first was the Patient Protection and Affordable Care Act as it was passed by the Senate. It looked different from the earlier version passed by the House. The House agreed to pass the Senate version of the bill but only if the Senate agreed to changes that would be made in follow-up legislation, called the Reconciliation Act of 2010. This reconciliation package allowed additional measures that would support rural communities. These two pieces of legislation will extend health coverage to 32 million people, 95 percent of legal residents and 92 percent of all U.S. residents.

During the final negotiations, supporters were able to get specific commitments to help address the health care needs in rural communities. Specifically,

  • $800 million for doctors and hospitals:
    • $400 million in FY2010 and FY2011 for doctor payments under the practice expense GPCI
    • $400 million secured to address geographic disparities for PPS hospitals in the lowest quartile of reimbursement.
      • FY2011 – $200 million for hospitals
      • FY2012 – $200 million for hospitals
  • A White House Commitment to Quality Care Coalition.
    The Secretary of Health and Human Services sent a letter to the Members of the House Quality Care Coalition with a commitment and plan to address the current geographic variation in Medicare reimbursement and advance health care quality and value. This will be critical for Oregon, which has been penalized for its ability to keep costs down.
  • Geographic Study and Implementation Plan
    The Institute of Medicine (IOM) will evaluate and make recommendations to improve the geographic adjustment factors in the Medicare physician payment and hospital wage index reimbursement formulas. The Secretary of HHS will implement the findings and make changes in the rates by December 31, 2012.
  • National Summit on Geographic Variation and Value
    The Secretary of HHS will convene a National Summit on Geographic Variation, Cost, Access, and Value in Health Care in 2010.
  • High Value Study and Implementation Plan
    The IOM will do a second study and provide recommendations on changing the Medicare payment system to reward value and quality. IPAB will be urged to consider the recommendations of both studies in making additional payment adjustments to incentivize value and quality by 2014.
  • 340B Drug Program
    The expansion of outpatient drugs to rural facilities and CAHs.
  • Graduate Medical Education
    Redistributes 65 percent of unused residency training positions as a way to encourage increased training of primary care physicians and general surgeons. Qualified hospitals would be able to request up to 75 new slots.
  • Rural Hospital Provisions:
    Sustains and improves access to care in rural areas through various improvements:
    • Extends the outpatient hold-harmless payments for certain hospitals in rural areas
    • Improves payments for low-volume hospitals
    • Ensures that CAHs are paid 101 percent of costs for all outpatient services regardless of the billing methods elected
    • Extends and expands the Rural Community Hospital Demonstration Program
    • Extends the Medicare Dependent Hospital program for one year
    • Extends the Medicare Rural Hospital Flexibility Program through 2012
    • Extends reasonable cost reimbursement for laboratory services in small rural hospitals
  • Medicare Extenders:
    Includes one-year extensions of certain Medicare provisions, including Section 508 wage index reclassifications; increasing the work geographic index to 1.0; grandfathering direct billing for anatomic pathology technical component services; add-on payments for ground ambulance; outpatient therapy caps; and a 5 percent increase in physician payment for certain psychiatric therapeutic procedures.
  • Liability:
    Provides $50 million in appropriated funds for medical liability demonstrations.

Because of the complexity of the legislation, the implementation timeline will take several years. Kaiser Foundation has developed a timeline for implementing the health care reform.

Understanding the new health care reform legislation and how it will benefit rural Oregon is key to successful implementation. The Oregon ORH will continue to provide information on both the implementation timelines and the details of the reform and how it affects rural hospitals, clinics, workforce, providers and patients. If you have questions, please contact Robert Duehmig, and check the Policy Updates section of our website.

An Introduction to John Day

Rachel Seltzer, OHSU MS3
Oregon Rural Scholars Program

As the only academic health center in the state, Oregon Health & Science University (OHSU) tends to train and/or hire many of Oregon's physicians. Most trainees are familiar with academic medicine. What about community hospitals? Do they really practice cowboy medicine? How is community medicine different than academic medicine? Is it?

As one of nine third year medical students that are the first to enjoy the opportunities of the Oregon Rural Scholars Program. We combine the family medicine, rural medicine, and elective rotations to spend three months in rural Oregon. I am at Blue Mountain Hospital (BMH) and the associated Strawberry Wilderness Community Clinic (SWCC) in John Day, OR, serving Grant County with 6,916 people. We are midway between Bend and Ontario, and between Pendleton and Burns. So how up-to-date is medicine here? Well, I still use Up-to-date, OVID, the AMA Member Communications emails, Pharmacopoeia, and other resources just as often as I do at OHSU. BMH has regular training sessions for the staff: just before the holidays they ran a session on fetal heart monitor strips. BMH uses an electronic health record (EHR), and the SWCC has been utilizing an EHR since 2003.

The biggest lesson I have learned so far in John Day took two weeks. It is true that OHSU, and other hospitals in the Portland area, tend to see patients with more complicated conditions from across the state; that is the nature of having lots of specialists. But rural folk are made of the same stuff as city folk: they have the same medical problems. I have already seen a child who has had two kidney transplants, a gentleman with Wegener's granulomatosis, and two women who likely have CREST syndrome. I would argue, then, that community medicine is not less informed, and more simple, but is instead quite elegant, allowing family medicine physicians the responsibility of managing these patients with the help of specialists through phone consults and referrals.

Although the people of Grant County have similar medical issues to the general population, the socioeconomic situation is different here than in Portland. John Day used to be a middle class town, with a lot of residents who worked for the timber industry and the national forestry service. As lawsuits between conservationists and the timber industry tie up the courts, even local, sustainable timber companies are out of work on temporary suspension. And as the national government has scaled back spending, forest services have contracted, and many of the ranger families in the area have moved or been laid off. Two of the three mills have shut down. In the past ten years the principal of Grant Union High School has noticed an increase in the prevalence of distractibility, misbehavior, teenage depression, and even teenage suicidality. Even so, my classmate, my attending and I were permitted the opportunity to speak to the majority of Grant Union's senior class about options after high school, which included living with Mom and Dad, getting a job, going to trade school, community college, or a four-year university, getting pregnant, or getting someone pregnant. Nevertheless, last year's senior class boasted a particularly scholarly group, sending 80% to some sort of post-secondary training or education. Bear in mind this is a county where (according to the U.S. Census Bureau) there are more people with a disability (19%) than there are with a bachelor's degree (16%), and the per capita income was $17,000 per year in 2007. Before the economy tanked, Grant High School in Northeast Portland may not be happy with a statistic like this, but here at Grant Union, in light of the economic situation, and the accessibility of post-secondary education, I am quite impressed.

Now, to address the assumption that small town people are extremely friendly: they ARE! All the physician's I have worked with have invited me for dinner, at least on standing invitation. One of my patients invited me to dinner. Some ladies I met in line at a holiday Christmas tree benefit auction invited me to join their table for dinner. And then another invited me to their White Elephant gift exchange. There is something to be said for living in a town like this—it fosters a sense of community, so that few neighbors fall between the cracks. Also, while the majority of people here are from Eastern Oregon, and most of them from Grant County, I work with people from Illinois, New Jersey, Florida, California, New York, and Ohio. Additionally, a significant proportion of the healthcare professionals here trained elsewhere, many of them in Portland. So there is a breadth of perspective that I had not anticipated, and they are as inclusive and open-hearted as the locals.

A sense of community tends to be missing in a larger, more anonymous city like Portland. That Christmas tree auction? That was to benefit three different local agencies. Local businesses decorate Christmas trees to be auctioned off. Some people purchase a tree for their home, some will tell you the tree was purchased by the generosity of their business, and some will donate the tree they purchased to a needy family in Grant County. And the child who required two kidney transplants? His first donor match (the one his body ultimately rejected) came from a hospital employee. As you can see, the people in Grant County take care of each other. The sense of community is overwhelming, inclusive, and encouraging. The physicians here attend at the nursing home. They sit on the school board. They do, on occasion, make house calls. And even when they can no longer take new patients, they share the new obstetrical patient load. They keep up with CMEs, they teach medical students and family medicine residents. They speak to students about options after high school, and to teachers about recognizing teenage depression. And a group of nurses goes to Ecuador for several weeks every year to provide healthcare services.

Does community medicine equate to cowboy medicine? My experiences suggest it does not. What it does equate to is medical and social services to the community—it defines the relationships these healthcare professionals have with their patients, while they still practice good evidence-based medicine.

Rachel is a 3rd year medical student in OHSU’s Rural Scholar Program. The Oregon Rural Scholars Program is intended for students who are serious about pursuing a career in rural practice in a primary care discipline (Family medicine, Pediatrics, or General Internal Medicine), General Surgery or Psychiatry. Students in the program complete their Family Medicine, Rural and Community Health clerkships and one elective in a single community in rural Oregon in a continuous 14-week rotation. The 2009-2010 scholars have been placed in Madras, Coquille, John Day, burns and Enterprise. If you have questions, about the program, please contact the Oregon AHEC Program Office at OHSU.

Polk County Mock Crash—Working to Improve Emergency Response

Polk Crash

Two cars crash on a rural road. A family with two kids. A car full of teenagers. It is not the scene that any emergency response team or hospital ER wants to see, but it is one for which they must be prepared.

Emergency response teams from various Polk County agencies responded to just such a mock crash on March 31, 2010. The exercise was designed to push the trauma system to the limit and provide opportunities for self-evaluation and process improvement. Participants practiced on-scene stabilization, rapid transport and emergency treatment for multiple pediatric and adult trauma victims. The exercise was part of a two-day training on pediatric trauma care for Polk County first-responders and trauma clinicians.

Participants in the event included the Polk County Fire & EMS, Dallas Fire & EMS, Polk County Sheriff, West Valley Hospital, Salem Hospital, Life Flight Network, Oregon EMS-C, Oregon Office of Emergency Medical Systems and Trauma Systems, Oregon Department of Transportation Safety, Oregon Office of Rural Health and OHSU Emergency Medicine.

“It is key that all parts of the emergency response team—EMS, fire, police, Critical Access Hospitals and transfer hospitals—know just what to do in such a situation”, says Robert Duehmig, Communications Director, Oregon Office of Rural Health. “These mock exercises allow participants to test the emergency system and learn where improvements need to be made before an actually emergency.”

Trauma remains the leading cause of death and serious injury among children living in Oregon and nationally. In 2008, the Oregon trauma registry reports that of the ten leading causes of injury to children from birth to 18 years old, 28 percent were occupants in a motor vehicle crash. “Testing low frequency, high impact situations, improves all skills —particularly better communication throughout departments and across organizations,” says Kassie Clarke, Grants Coordinator, ORH. “What is learned about the trauma system in these exercises can be put to use in other situations as well.”

The West Valley Hospital simulation is part of a series of trainings that are taking place in rural Oregon communities. Cottage Grove, Hermiston, and Baker City are planned for later this year. The Oregon Flex Program has contributed funding to provide these trainings for Critical Access Hospitals and their local EMS agencies to help improve their response to trauma incidents. The Oregon EMS for Children Program developed this program along with the Oregon Department of Transportation and OHSU. The Oregon Office of Rural Health and Life Flight joined these partner organizations this year to continue the great work that was piloted in previous years. Using high-tech, high-fidelity computerized mannequins, these simulations are bringing a new level of training to rural EMS and emergency rooms.

The Oregon Flex Program wants to thank everyone involved with the training conducted last month. In particular, we want to thank Philip Engle from EMS-C, Garth Meckler, MD, from OHSU and Holly Love from Life Flight for their efforts that went above and beyond the call of duty. Other significant contributors were Joyce Wilder, Sharon McVey, and Dr. Rebecca Lucas from West Valley Hospital, Todd Brumfield from Dallas Fire & EMS, Mike Mayfield from Polk County Fire & EMS, Ted Raschkes and Raven Layton from Salem Hospital, George Olsen and Dr. Rob Cloutier from OHSU, and Dr. Jim Bryan, Lindsay Steele and Paul Pharr from Life Flight. Without this collaboration and hard work from these very dedicated individuals, we would not have had such a successful simulated mass casualty event. Everyone including the educators learned from this experience. We applaud these hospitals and EMS agencies for ensuring that they are delivering the best patient care possible for their community.


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The goal of In-A-Box curricula is to encourage Explorations in Science and Health by rural students of Oregon. Oregon Health and Science University (OHSU), Area Health Education Centers (AHEC), and the Howard Hughes Medical Institute (HHMI) have teamed up to create this program and offer it without cost to users.

In-A-Box brings science, health and career curricula into the classroom and gives students in grades 4-8 the opportunity to connect with local health and science professionals. Teachers or group leaders choose from: Ear In-A-Box, Eye In-A-Box, Guts In-A-Box, Bones and Muscles In-A-Box, Brain In-A-Box, and Expedition Northwest In-A-Box. Each box contains an assortment of films about science and health topics and careers, small group activities for students, hands-on, topic specific artifacts, literature, and many lesson extensions.

In A Box Set

Is this only for teachers? No! Our boxes can be used for health fairs, after school clubs, topic specific presentations and audience specific events. The program is no cost for users. The box is delivered or shipped to and from loan users.

Three of our boxes include a film with local middle school students interviewing professionals from OHSU about their careers. Our hope is to inspire rural students to consider the myriad of health and science careers as they progress through school.

Another goal of the box program is to link technology to science for students. Our station activities involve use of some technology as well as games that prompt their investigation of how technology is used to solve problems related to health and science.

Our recent development of Expedition Northwest In-A-Box is in partnership with OMSI’s lessons involving the ecology of the Northwest (salmon, watersheds, and evolution of species).

Another feature to our program is the desire to bring guest speakers into the venues where a box is requested. We are looking for science and health professionals (currently employed or retired) who would be willing to go into classrooms to talk to 4th-8th grade students about their jobs, what they like, who they work with, how they decided to pursue that career, etc. If you or someone you know is interested, please contact us! Students love to learn from real professionals how science translates into real work.

If you know of a teacher or group leader who might be interested in the In-A-Box Program, they can preview each box at our web site www.inaboxcurriculum.net . There are short videos and the teacher guides to explain the many resources each box offers.

or 503-494-4896.


April—Earthquake Awareness Month

Is your community prepared?

There is no shortage of new about earthquakes these days. Haiti and Chile are reminders that a big earthquake can happen. The Pacific NW is one of the most seismically active regions in the world! Earlier this year, Oregon took a step in the right direction of getting prepared by distributing $7.5 million in Seismic Rehabilitation Grants to a number of education and emergency services buildings.

So make sure you are prepared. If you have questions or concerns, now is the time to get answers.

Handbook for Rural Health Care Ethics—A Practical Guide for Professionals

The Handbook For Rural Health Care Ethics uses a case-based approach to analyzing, solving and anticipating health care ethics dilemmas. The Handbook is authored by physicians, nurses, health-care ethicists, and hospital administrators who all had scholarship or expertise in rural ethics, and was funded by a grant from the National Institutes of Health (NIH) National Library of Medicine.

TeamSTEPPS—Master Trainer Workshop

TeamSTEPPS Training March 2010: Curry General & Mountain View Teams

The first Oregon TeamSTEPPS Master Trainer course was held on the Oregon Coast in March. It was sponsored by the Oregon Office of Rural Health and the Oregon Rural Healthcare Quality Network. This intense two-and-a-half day workshop provided individuals with a comprehensive review of all TeamSTEPPS concepts and practical skills which enable them to train individuals on TeamSTEPPS fundamentals including implementation of organizational change.

“The workshop was very well-received. I enjoyed the group's enthusiasm in embracing the TeamSTEPPS principles. The focus on patient safety through an effective team is a powerful vehicle to transform organizations. It has worked in our hospital. Our network is eager to share the TeamSTEPPS experience throughout Oregon”, say Julia Fontanilla, RN, MN, West Valley Hospital.

or Suzi Bean at .

In the photo above is staff from Curry General and Mountain View hospitals.


Poisoning Second Only to Car Crashes in Causing Unintended Injury, Death

Oregon Poison Center at Oregon Health & Science University fields more than 65,000 calls a year

Unintentional poisoning is second only to motor vehicle crashes in causing unintentional injuries and deaths in the United States each year, according to the Centers for Disease Control and Prevention. The Oregon Poison Center at OHSU alone received more than 65,000 calls about potential poisonings in 2009, and more than 48 percent of those calls involved children age 5 and younger.

“Many poisonings happen when adults are distracted for just a few minutes, either by a phone call, doorbell, or something else,” warns Tonya Drayden, R.N., public education coordinator for the Oregon Poison Center at OHSU. “It only takes a moment for a child to grab and swallow something that could be harmful.”

In 2009, the top 10 types of calls to the Oregon Poison Center at OHSU concerning children age 5 and younger involved cosmetics and personal care products, pain relievers, household cleaners, foreign bodies, topical medications, plants, vitamins, antihistamines, cough and cold preparations, and pesticides.

To prevent accidental poisoning, the Oregon Poison Center at OHSU recommends families:

  • Buy products with child-resistant caps. Child-resistant caps are not CHILD-PROOF. Once your child learns how to open them, this safety tool will no longer keep your child safe.
  • Keep medicine and cleaners locked up and out of reach. Install child-resistant latches on cabinets whenever possible.
  • Clean up after house, car and garden work. Properly dispose of all left over cleaners, sprays, and pesticides. Contact your local Department of Environmental Quality (DEQ) for help.

The poisoning death rate has been rising in the U.S. in recent years, the CDC reports. There were more than 23,000 unintentional poisoning deaths in the United States in 2005; almost all of them were due to medications. An estimated 703,702 patients were treated in U.S. hospital emergency departments in 2006 for unintentional poisonings, according to the CDC, and nearly 25 percent required hospitalization or transfer for a higher level of care.

For more information about poison prevention and the Oregon Poison Center at Oregon Health & Science University visit them online or call 800 222-1222.

EMS

The Mobile Training Unit—Coming to You!

The MTU will conduct a 48–hour paramedic refresher course over three weekends in La Grande this year. The dates of the course will be April 23-25, June 11-13 and Sept. 10–12.

The MTU will be teaching the following classes through mid–April:

  • 4/8: Triage at Mist–Birkenfield
  • 4/8: Blood-borne pathogens in Milo
  • 4/10: PEPP in Molalla (full)
  • 4/19: Geriatric trauma in Lincoln City
  • 4/20: 12-lead review in Sherman County
  • 4/21: Patient packaging/extrication drill in Boardman

Learn more about the above courses.

Don’t Forget—EMS Week: May 17-21 is EMS week this year. Make sure you do something for the EMT in your life!

Read more Oregon EMS news.

Nursing Scholarship Program – Now Accepting Applications!

Applications accepted April 1, 2010 through May 6, 2010

The Nursing Scholarship Program pays for tuition and education related expenses including books, clinical supplies and laboratory fees. In exchange, scholarship winners agree to at least two years of service at a health facility with a critical shortage of nurses.

Preference is given to qualified applicants with the greatest financial need who are enrolled full-time in an undergraduate nursing program. Applicants must begin classes for the Fall term on or after July 1, 2010 and no later than September 30, 2010. It is expected that 500 awards will be made for the 2010-2011 school year.

Questions about the application? Call the HRSA Call Center at 1-800-221-9393 or visit them online.

Upcoming Events

10th Annual Emergency Medical Services Pediatric Conference

Oregon’s largest pediatric pre-hospital and hospital emergency care conference.
When: May 21 and 22, 2010
Location: Lane Community College
Continuing Education Credits Available
Additional Information & Registration

Oregon Health Policy Board

April 13, 2010
St. Charles Medical Center, Bend
Conference Room A&B
8:00 am to 12:30 pm
This meeting will be web-streamed.

Questions can be submitted to the Board during the meeting at .

Next meeting:
May 11, 2010
1 pm to 5 pm
Market Square Building
1515 SW 5th Avenue (Between Market and Clay), 9th floor

Let’s Get Healthy! Health Fair—Madras Oregon

Saturday, April 24, 2010.
Fair for general public: 9 a.m. to 3 p.m.
Madras High School (small gym), 390 S.E. 10th St. Madras, 97741

2010 Small Rural Hospital Summit, May 5-7, 2010

Salem Conference Center, Salem Oregon

NRHA: 33rd Annual Rural Health Conference

May 18-21, 2010
Savannah, GA.
http://www.ruralhealthweb.org/annual

Your Learning Center!

Don’t forget to check the ORH website for the latest in our webinar education series.

All the latest events can be found at the ORH Website