OHSU

Oregon Office of Rural Health Newsletter, October 2010 Share This OHSU Content

ORH Newsletter

The 27th Annual Rural Health Conference – Thanks for making it another successful conference!

You can download presentations and vendor information at our website and see pictures on Facebook.

Apple A Day Campaign sets record!

Thanks to all you joined us for the Apple A Day Dinner and Auction. Thanks to your support, we raised over $20,000 to help support rural, volunteer EMTs and First Responders in Oregon. Thanks to you, they will be there when we call!

Check out the great pictures on Facebook!

Don’t forget to mark your calendars for next year! September 21-23, 2011 at the Riverhouse, Bend Oregon.

HRSA/Office of Rural Health Policy Update Information on ORHP/Rural HIT Network Program

The Office of Rural Health Policy (ORHP) plans to develop a new one-time funding opportunity around rural HIT. As language in the Network Development guidance states, you can only apply to one of these programs in the same fiscal year. With that caveat, ORHP knows that people have been waiting anxiously to hear more about this new rural HIT Network program so that you can determine if the Network Development program is a better fit for your needs or the rural HIT Network program. While ORHP is still working on the specific details of the HIT program, they wanted to share some updated information.

Rural HIT Program
  • Guidance Availability: ORHP expects the guidance to be released in January/February, 2011
  • Number of anticipated awards: ORHP plans to make 40 new rural HIT Network awards (based on availability of funds)
  • Funding Amount: Applicants will have an opportunity to request up to $300K per year (3-year grant program)
  • Eligibility Requirements: The eligibility requirement is the same as it is for the Rural Network Development program and Rural Outreach program. The network must be composed of at least three health care providers that are separate, existing organizations. In addition, the applicant must meet one of the 3 criteria mentioned below.
    • The applicant organization must be a public or private non-profit entity located in a rural area. To ascertain rural eligibility, please refer to the HRSA Datawarehouse site and enter the applicant organization’s state and county. A network serving rural communities but whose applicant organization is not a designated rural area will not be considered for funding under this announcement.
    • If the applicant is not located in a rural area but are a Federally-Recognized Tribal Organization, they are eligible
    • If the applicant is not located in a rural area but exists exclusively to provide services to migrant and seasonal farm workers in rural areas and is supported under Section 330G of the Public Health Service Act, they are eligible.
  • Purpose: The purpose of the program is to assist network organizations in rural communities who would not qualify for Stage 1 or 2 of Meaningful Use if it were not for this grant.
    • It is strongly encouraged that a network of more than 3 partners is formed and includes a broad range of providers to form a full continuum of care (physicians practices, critical access hospitals, tertiary referral, acute facilities, pharmacies are just some examples)
    • The emphasis of this grant is to use the funds to begin offsetting the costs of HIT acquisition.
    • Applicant organizations must have completed a readiness assessment and include the tool in the application. (A specific tool may be identified by ORHP as a requirement.)
    • One of the specific indicators of need will be actual EHR availability. There are a couple of ways in which a network may be eligible for this program. 1) If the lead applicant and their network partners do not have an EHR at all and are looking to purchase one, they would be eligible to apply for this program; or 2) if majority (2/3rds) of the network providers have not yet purchased or implemented an EHR, the network would be eligible for this program.

Information on EHR Incentive Program

Many questions have been asked about the Meaningful Use regulations. The Office of Health Information Technology and Quality (OHITQ) identified a key policy development related to the Meaningful Use Regulation as part of the Electronic Health Record Incentive Program administered by the Centers for Medicare & Medicaid Services that impacts the programs and populations served especially in the rural setting. For further information, please visit CMS' website.

Archived Webcast Available—Health Reform and Rural America

Getting Connected: Can the ACA Improve Access to Health Care in Rural Communities?

Residents of rural communities face unique health care challenges, including fewer health care providers, higher rates of chronic disease, and lower adoption rates of health IT. This briefing looked at many of the provisions of the Affordable Care Act that address the needs of rural America. Cosponsored by the United Health Foundation.

The archived webcast, podcast, individual speaker videos and downloadable resource materials are available online.

Healing Rural Patients With A Dose Of Broadband

Millions of Americans who live in rural areas travel long distances to get health care. Or they may go without it. But high-speed Internet connections now make it possible to bring a doctor's expertise to patients in far-off places, if those places are connected.

As part of its National Broadband Plan, the Federal Communications Commission has pledged $400 million a year to connect nearly 12,000 rural health care providers.

NPR

The National Advisory Committee on Rural Health and Human Services Announces Release of Report to Health and Human Services Secretary

The National Advisory Committee on Rural Health and Human Services has released its report to HHS Secretary Kathleen Sebelius. The Report is a culmination of a year-long effort to examine key health and human service issues affecting rural communities. The report focuses on home and community based care for rural seniors, the rural primary care workforce and the rural health care provider integration. Key findings and recommendations are:

  • The Committee believes that option for home-based care need to be expanded in rural areas. Studies have shown that seniors are happier remaining in the home as long as possible, but in practice too often seniors are placed into retirement homes without being offered an alternative. Allowing seniors to age-in-place is more difficult because the existing infrastructure and available resources are often concentrated on supporting nursing home care. Barriers such as geographic accessibility, ineligibility, workforce shortages and limited awareness of options all affect seniors’ decisions when choosing care. The Committee’s recommendations to the Secretary include evaluating current laws prohibiting payment to family members for care and coordination with the Secretary of Transportation to ensure seniors are able to access care.
  • The Committee recognizes the importance of not only attracting Primary Care Physicians to rural American, but in utilizing Physician Assistants and Advanced Practice Nurses who can act as the sole primary care provider in a community. Declining interest in primary care has most notably affected rural communities. An aging rural population and a retiring medical workforce exacerbate the shortages rural America already faces. An expansion of health care insurance would intensify the unmet demand for primary care in rural America. The Committee recommends that the primary care system be strengthened through local leadership, an emphasis on preventative measures and by attracting and training a workforce dedicated to care in rural areas.
  • The majority of patient care in the United States is uncoordinated due in large part of an incomplete transfer of important patient information between providers. This fragmentation of care is acutely problematic in rural areas, which face higher rates of chronic diseases that require greater care coordination. The Committee believes that the quality of care and efficiency of delivering care will both increase if integration, or the seamless patient and information flow among providers, is achieved. In this report, the Committee recommends specific ways to achieve integrated care in rural areas. These recommendations include fixes to Start regulation and a call to include rural providers in future demonstrations of Accountable Care Organizations (ACO), bundling and patient center Medical Homes.

The National Advisory Committee on Rural Health and Human Services (NACRHHS) is a 21-member citizens' panel of nationally recognized rural health experts-public and private- that provides recommendations on rural issues to the Secretary of the Department of Health and Human Services. The Committee was chartered in 1987 to advise the Secretary of Health and Human Services on ways to address health care problems in rural America. It was expanded to 21 members in 2002 and charged with focusing on both health and human service issues in rural areas.

Each year, the Committee selects one or more topics upon which to focus during the year. Background documents are then prepared for the Committee by both staff and contractors to help inform members on the issue. The Committee then produces a report with recommendations on that issue for the Secretary by the end of the year. In addition to the report, the Committee may also produce white papers on select policy issues. The Committee also sends letters to the Secretary after each meeting. The letters serve as a vehicle for the Committee to raise other issues with the Secretary separate and apart from the report process.

For more information on the Committee and to read the full report, go to The Committee's website.

EMS Newsletters

Check out the latest from the State EMS Office.

EMS for children

Good Shepherd Hospital in Hermiston, Oregon, the Hermiston Fire Dept., Umatilla Fire Department and the Pendleton Fire Dept. conducted a pediatric MVC (motor vehicle crash) simulation training. The event was the third of four EMSC rural simulation training projects in partnership with Lifeflight, ODOT, OHSU and the ORH.

You can see photos at the State EMSC Advisory Committee's website.

Oregon EMS/Trauma Webinar Learning Series

The Oregon Office of Rural Health and the State EMS and Trauma Systems Office have partnered to bring web-based education to EMTs and emergency providers throughout Oregon.

Webinars will be held on the 2nd Tuesday of each month at noon PT. Presentations will last approximately one hour and will be recorded for those who cannot attend the live presentation. CE credits will be available for those who are able to attend the live presentation. You must respond to an online survey after the presentation in order to receive a CE certificate.

Questions?

Ask Shellye Dant at  or (503) 494-4450.

EMS Staff changes

  • Joanna Faunce has resigned her MES compliance specialist position.
  • Donna Wilson has been promoted to the EMS pre-hospital standards position

Rural Volunteer EMS: Reports from the Field

Prehospital emergency care services (EMS) are an essential component of a comprehensive health care system. Reports that rural volunteer EMS is threatened appear frequently in local newspapers and online news sources. This report explores the current state of rural EMS by interviewing 49 local directors from all volunteer rural services in 23 states.

Proposed OAR Change

The Department of Human Services, Public Health Division is proposing to amend Oregon Administrative Rules chapter 333, division 265, to streamline and clarify rules, address requirements for training, and correct errors that were unintentionally made in the last permanent rule change. The Department of Human Services, Public Health Division is also proposing to amend Oregon Administrative Rules chapter 333, division 255 to clarify the minimum staffing requirements that must be met to operate an ambulance.

More on this is available at the DHS EMS website.

Are Rural Health Clinics Part of the Rural Safety Net?

The Rural Health Clinic (RHC) is a federally designated primary care provider type that addresses access to primary care in underserved rural areas. RHCs are an important part of the rural health care infrastructure as they provide a wide range of primary care services to the rural residents of 45 states. Read what a recent study on the role of RHCs play in the Rural Safety Net.

Fewer Rural Stocks, People Losing Ground

The recession has been horrible. But, relatively speaking, rural people and businesses seem to have fared better than have those in the cities.

In Rural Calif., A Debate On How To Save A Hospital

Rural hospitals across the nation have struggled to stay afloat. There are, of course, fewer patients in rural areas, and many of them are on public health insurance programs that pay far less than private insurers.

Residents in Modoc County, in the remote northeastern corner of California, will soon vote on whether to tax themselves to save their local hospital.

The county has gone broke trying to keep the hospital open, and a fractious debate has erupted in this proudly conservative frontier community over the best way forward.

Oregon’s Poverty Rate Rises, Median Income Drops

Sobering data arrives as cuts threaten protections for very poor families

(Silverton) — Providing a clearer picture of the recession’s toll on Oregon families, the U.S. Census bureau today reported that the share of Oregonians living in poverty and the share without health insurance increased significantly from 2007 to 2009.

And over the same two-year period, the income of a typical Oregon household dropped by about $1,900, according to the Census Bureau’s American Community Survey (ACS).

“The survey results confirm the damage wrought by the recession and underscore the need for Oregon and the nation to maintain a strong safety net that protects people when the economy fails them,” said Steve Robinson, policy analyst with the Oregon Center for Public Policy.

The Census Bureau estimated that 14.3 percent of Oregonians lived in poverty in 2009, significantly higher than the 12.9 percent rate in 2007. Oregon’s poverty rate in 2009 matched the national poverty rate.

According to the survey, more than 530,000 Oregonians — including 160,000 children — lived in poverty in 2009.

Oregon’s child poverty rate also grew significantly from 16.3 percent in 2007 to 18.7 percent in 2009, Robinson said. He noted that Oregon’s 2009 child poverty rate was below the national rate of 19.7 percent.

The poverty data was not the only bad news in today’s ACS data. When adjusted for inflation, Oregon's median household income fell significantly in 2009 to $48,457, down from $49,714 in 2008 and $50,393 in 2007.

The recession began in December 2007 and ended in June 2009, according to the National Bureau of Economic Research.

Troubling data also appeared with respect to health insurance coverage in the state. According to the survey, the share of Oregonians lacking insurance increased from 15.8 percent in 2008 to 17.0 percent in 2009, a statistically significant change.

The total number of Oregonians without health insurance rose to 643,000 in 2009, up 50,000 from the prior year. The number of uninsured children, however, fell by 15,000.

The news that the poverty rate rose comes as developments in Washington, D.C., and Oregon threaten the joint federal-state program that protects very poor families with dependent children. The Temporary Assistance for Needy Families (TANF) program provides small amounts of cash assistance, paired with work activity requirements, mostly to single-parent families with children. It also offers job training and childcare assistance to help parents of dependent children obtain work and remain employed.

Because of the most severe economic downturn since the Great Depression, Oregon and the nation have seen the demand for TANF rise sharply. To help cash-strapped states address that elevated need, the federal Recovery Act provided additional TANF emergency funds.

But that emergency funding expires on September 30. To date, Congress has been unable to muster the votes to extend it.

Proposed changes at the state level also threaten TANF, Robinson said. In the current budget cycle, Oregon is considering slashing funds that help parents find jobs and reducing the already very small amount families receive to meet their basic needs.

Despite the sobering data reported today by the Census Bureau, the poverty numbers would be even worse without the Recovery Act enacted by Congress, according to Robinson. He noted that a recent study found that the unemployment insurance provisions alone in the Recovery Act kept 3.3 million Americans out of poverty in 2009.

Earlier this month, the Census Bureau reported the results of a different measure of poverty, the Current Population Survey (CPS), which showed no statistically significant change in Oregon’s poverty rate when comparing 2008-09 against 2006-07. Robinson noted, however, that the results of the CPS and today’s ACS cannot be compared directly because of differences in the questions and survey designs.

The Census Bureau and others believe the ACS, which the bureau began using relatively recently, provides a better estimate of state poverty levels. The Oregon Center for Public Policy is a non-partisan research institute that does in-depth research and analysis on budget, tax and economic issues. The Center’s goal is to improve decision making and generate more opportunities for all Oregonians.

OCPP

Events

Technology Assessment 101: Selecting the Right Equipment for Your Program

A free webinar from the Telehealth Technology Assessment Center in cooperation with the Northwest Regional Telehealth Resource Center

October 29, 2010 | 12:00 - 1:00 PM PST
Presentations by Chris Patricoski, MD and Stewart Ferguson, PhD
Moderated by Garret Spargo, Director of the TTAC
This webinar is for:

  • Organizations getting into telehealth, yet don’t know how to select devices to meet their needs
  • Established telehealth programs that want to expand services but need to get the right technology
  • Telehealth program administrators

Learn About:

  • Recommended practices for performing market evaluations, device assessments, and selections
  • Tools for performing technology assessments
  • Lessons taken from over a decade of technology assessment with AFHCAN
  • Free toolkits provided by the Telehealth Technology Assessment Center that have been released, and what is planned through the next year

Register:

2010 TAO Annual Meeting and Summit

~Creating Possibilities~
The Convergence of Health Care
And Telecommunications
November 3, 2010
University Place Conference Center, 310 SW Lincoln in Portland

Keynote speaker- Dr Dale Anderson, MD, President, American Telehealth Association, University of New Mexico. For further information, visit the TAO website .

Swing Bed Management for CAHs

Thursday, 11/11, 8:30am – Friday, 11/12/2010, 12pm
7900 NE 82nd Avenue Portland, Oregon 97220
To register
For questions, contact Shellye Dant at

A swing-bed program requires more than simply saying “we offer swing-bed care.” It requires being comfortable with admission criteria, understanding the importance of documentation to support medical and physical rehabilitation, appropriately incorporating nurses and therapists into the interdisciplinary team, and knowing how to bill for the services. Staff also must be knowledgeable about the Centers for Medicare & Medicaid Services conditions of participation and finally it’s important to know how to grow “the business” to make it a financially viable program.

Join this seminar to examine all aspects of swing-bed methodology, utilization and program improvement. Participants will learn valuable lessons about documenting outcomes and promoting this service. Included as part of the program is a Stroudwater website specific to participants of this training. This website includes many sample documentation forms ready to be tailored to your hospital, as well as multiple resources related to swing bed.

CMS National Medicare Training Program Workshop

This workshop is designed to give partners a strong working knowledge of the Medicare program. Partners who attend this workshop will receive a thorough overview of the Medicare program, including:

  • Medicare updates regarding the Affordable Care Act
  • Medicare basics
  • Medicare Advantage plans
  • Medicare prescription drug coverage
  • Preventive services
  • Medicaid