October 2011 Newsletter

ORH News

National Rural Health Day—Celebrating the Power of Rural

November 17, 2011

Rural communities are wonderful places to live and work, which is why nearly 62 million people – nearly one in five Americans – call them home. In Oregon, 38% of the population live in rural communities. These small towns, farming communities and frontier areas are places where neighbors know each other, listen to each other, respect each other, and work together to benefit the greater good. They are also some of the best places to start a business and test one's “entrepreneurial spirit.” Rural communities provide the rest of the country with a wealth of services and commodities, and they are the economic engine that has helped the United State become the world economic power it is today.

Our rural communities also have unique healthcare needs. Today more than ever, rural communities must address accessibility issues, a lack of healthcare providers, the needs of an aging population suffering from a greater number of chronic conditions, and larger percentages of un- and under-insured citizens. And rural hospitals and clinics – which are often the economic foundation of their communities in addition to being the primary providers of care – struggle daily as declining reimbursement rates and disproportionate funding levels make it challenging to serve their residents.

That is why the National Organization of State Offices of Rural sets aside the third Thursday of every November – November 17 in 2011 – to celebrate National Rural Health Day. First and foremost, National Rural Health Day is an opportunity to “Celebrate the Power of Rural” by honoring the selfless, community-minded, “can do” spirit of that prevails in rural America. But it also gives us a chance to bring to light the unique healthcare challenges that rural citizens face – and showcase the efforts of rural healthcare providers, State Offices of Rural Health and other rural stakeholders to address those challenges.

Visit the National Rural Health Day website for examples of letters to your legislators, proclamation that you can use in your communities as well as sample letters to the editors. If you have questions about how you can celebrate National Rural Health Day in your community or site, contact . We are happy to help!

Learn more about Rural America.

Budget Battles- Essential Rural Programs on the chopping block

Joint Select Committee on Deficit Reduction—The “Super Committee”

There is endless discussion in Washington DC about budgets and most of the focus is on the Joint Select Committee on Deficit Reduction, also known as the “Super Committee”.

Created as a part of the Budget Control Act (BCA), the 12-person "Super Committee" was established and tasked with finding an additional $1.5 trillion in cuts to the deficit by Thanksgiving. President Obama has asked the Committee to go even further and find additional savings as well as make changes to the tax system. If Congress deadlocks and fails to pass the plan or enacts less than $1.2 trillion in cuts by Dec. 23, across-the-board spending cuts (sequestration) would be triggered to make up the difference between the committee number and the $1.2 trillion savings goal, largely affecting Medicare and defense. Rural hospitals have been targeted in various proposals to the Super-Committee and to Congress as a whole. Proposals include:

  • The Congressional Budget Office (CBO): Eliminate alternative hospital designations Critical Access Hospital (CAH), Sole Community Hospital (SCH), and Medicare Dependent Hospital (MDH). This plan would reduce hospital payments by $3.8 billion in fiscal year (FY) 2012 increasing to $9.5 billion in reduced payments in FY 2021. Total cut to rural facilities over 10 years: $62.2 billion.
  • President Obama: Starting in FY 2013, the President’s plan would end add-on payments for physicians and hospitals in frontier states, reduce CAH reimbursement to 100 percent of reasonable cost, and end CAH reimbursement for facilities located 10 miles or less from another hospital. Total cut to rural facilities over ten years: $6 billion.
  • House Republican Leadership: While specifics of the proposal were not released, House Republican Leadership sought to cut $2 billion from frontier state add-on payments and $14 billion from rural hospital reimbursement structures. Total cut to rural facilities over 10 years: $16 billion.
  • Ways and Means Democrats: The Democrats from the House Ways and Means Committee embraced the CBO recommendation. They erroneously argued that the elimination of these payment structures would be more equitable and in line with other payment reforms. Total cut to rural facilities over 10 years: $62.2 billion.
  • Sequestration: If the Super-Committee fails to produce sufficient savings, Medicare reimbursements will be “sequestered”. An automatic cut of 2% will be instituted on all providers. Total cut to rural facilities over 10 years: $5.9 Billion.

The ORH, ORHA and NRHA will continue to work with our delegation to educate them on the impacts of these cuts on our rural communities. "It will be important that local communities, hospitals, clinics and providers talk to their members,” says Scott Ekblad, Director, Office of Rural Health. “Constituents get the best response and they can show a Member of Congress and their staff just what the impact would be in their district.”

Seven Oregon CAHs Make the Top 100 List

The National Rural Health Association (NRHA) has announced the names of the Top 100 Critical Access Hospitals (CAHs) in America. Making the Top 100 were seven Oregon CAHs—Cottage Grove Community Hospital, Good Shepherd Medical Center, Grand Ronde Hospital, Peace Harbor Hospital, Providence Hood River, Tillamook County General and Wallowa Memorial Hospital. The Top 100 is the first comprehensive rating of CAHs and was done through a partnership between NRHA and iVantage Health Analytics.

“We are very excited but not surprised,” says Shellye Dant, Oregon Flex Coordinator. “We know we have great hospitals and that rural Oregon continues to lead.”

"Now is the time for us to advance the analytics and transparency of the rural health sector. We play such a critical role in providing needed care to Americans, yet our challenges are completely different in access while equally complex in delivery as urban hospitals. We celebrate this diversity and these every day challenges and will need new solutions to ensure our sustainability under the Affordable Care Act. NRHA is committed to advancing performance improvement in our hospitals," said Alan Morgan, Chief Executive Officer of the National Rural Health Association. "As we focus on quality at NRHA, we will monitor a complete dashboard of indicators to ensure that our membership has the best information to run their hospitals.”

For additional information you can contact Lindsey Corey at NRHA (816-756-3140) or .

Community Health Improvement Partnership (CHIP)

Making Morrow County a Healthier Place to Live

by Andrea Fletcher

Evolution of a CHIP

Morrow is a diverse county - geographically, culturally and economically, but the residents are unifying to find solutions to locally address the unmet health needs of the entire county.

Over the years, local health professionals have pondered the challenge of how to encourage their patients to achieve an optimum level of health, or at the very least, comply with physician recommendations to prevent or manage disease. Late in 2009, these persistent thoughts and conversations propelled them to pursue a venture with the Oregon Office of Rural Health to determine the most pressing and unmet health needs for the population they served.

With the support and guidance of the Office of Rural Health in 2010, the primary and acute care, public and behavioral health organizations that serve the county convened to develop a rural health network. Shortly thereafter the network was enthusiastically joined by representatives from over 30 health, human and public service agencies and members of the community, city/county/state government leadership and programs, law enforcement, education, recreation, agri-business, faith communities, transportation and chambers of commerce, now recognized as the Community Health Improvement Partnership (CHIP) of Morrow County.

The goal of the CHIP of Morrow County is to work collaboratively through active community participation to improve access to health care services and the health status of county residents. The first priority of the CHIP was to initiate a community-driven health needs assessment of the entire county. The needs assessment included examination of demographics, health status and health behavior, health care access, utilization and health resources data and was intersected with information collected from in person interviews conducted of individuals in the community and a public visioning session.

After examining this information, the Partnership determined three areas of focus and members formed workgroups to examine in depth: communication and coordination between health care providers and communication between health care providers and the community; healthy lifestyle promotion and disease prevention; and opportunities available for physical activity and fitness infrastructure. The group will convene in October to report on the in-depth findings from the workgroups, the proposed strategies and budget for operations to help guide long-term strategic health planning.

The CHIP has a sense of community loyalty, identifies with health system goals, projects and programs, holds a shared commitment to the future and is motivating people to live a healthful life. We are blazing trails to a healthier Morrow County.

About Morrow County

Morrow County is located in the north central part of the state and east of the Cascade Mountains. The elevation varies from 250 feet on the Columbia River to nearly one mile elevation in the Blue Mountains. The county land area encompasses 2,032 square miles. It is bound by the Columbia River on the north, Umatilla County to the east, Grant County and Wheeler County to the south, and Gilliam County to the west. According to the 2010 population data, 11,173 people call this area home. Morrow County is a frontier county supporting 5.4 persons per square mile and is surrounded by three other frontier counties, all which have population densities of fewer than 2 persons per square mile. Much of the population (41%) exists outside of the incorporated cities. “Where Rural is Real,” a local Chamber of Commerce director likes say.

A growing Hispanic or Latino population (over 30 percent) resides in the north end of the county. In contrast, the percent of persons of Hispanic or Latino origin in the state of Oregon is just over 11 percent and over 16 percent nationwide. Over 26 percent of the population report speaking a language other than English at home as compared with 14 percent of the population in Oregon.

The principal industries in the county today include agriculture, food processing, lumber, livestock, and recreation. The Port of Morrow was established in 1958 on the Columbia River near Boardman. It is now the second largest port in the state in terms of tonnage and serves as a gateway to Pacific Northwest and Pacific Rim markets, according to the Oregon Blue Book. More recently, the north part of the county along the Columbia River has experienced new developments of dairy, product distribution and tree farms.

Morrow County made its place in history in 1903. The name “Willow Creek” sounds innocent enough, and usually in June the stream is not threatening as it meanders through the town of Heppner. It is located in a semi-arid region receiving less than fifteen inches of annual precipitation. Intense thunderstorms are not uncommon.

The spring of 1903 was among the warmest and driest in memory for eastern Oregon. Sunday, June 14, was another hot day as Heppner's residents prepared for family suppers or evening church services. By mid-afternoon, dark clouds were building in the hills southwest of town. At 4:30 p.m., rain, and then hail began to fall. The storm produced such a noise people could not hear the roar of the wall of water and debris that descended on the town leaving death and destruction in its path.

As the onrushing of water struck the community, Leslie Matlock, son of a former sheriff of Morrow County, and Bruce Kelly, sensing potential disaster for communities in the path of the flood, started horse back and rode 18 miles, just ahead of the water, spreading the alarm to the communities of Lexington and Ione.

The dead and dying were buried beneath water and mud and debris, and strewn in the underbrush at the edge of a flood for two miles down Willow Creek. The destruction continued one awful hour. Two hundred and forty-seven people were killed in the flood and two-thirds of the houses were destroyed.

Cities and towns throughout the state, and the Northwest, added to the relief fund and supplies as soon as the extent of the tragedy became known. Portland swung into relief work, contributing money, clothing and supplies. A relief station was opened in the Old Bank of British Columbia building at Front and Ankeny Streets. J.P. O'Brien, superintendent of the O.R. &N. Railroad, dispatched a special relief train carrying help, empty cars for the return of injured survivors—and a supply of embalming fluid, for which Heppner authorities had made urgent appeal. A special train also was dispatched from The Dalles, and work crews hastened to replace and repair railroad bridges and track washed out and damaged between Lexington and Heppner.

If you want to learn more about Community Health Improvement Partnerships, contact , Oregon Office of Rural Health at 503-494-4450.

Rural Health Hero of the Year Award Winner Announced

2011 Oregon Rural Health Hero of the Year Award

Pat Neal, 2011 Oregon Rural Health Hero of the Year, and Scott Ekblad, Director, Oregon Office of Rural Health

Pat Neal of Depoe Bay, Ore., has been awarded the 2011 Hero of the Year Award by the Oregon Office of Rural Health. The Hero of the Year award is given annually to an individual who has had a major impact on rural health in Oregon.

“Pat Neal is a wonderful Hero,” says Scott Ekblad, director of the Oregon Office of Rural Health. “She is currently involved in 10 different health care committees in her community. She is working as hard today as she did before she retired.”

In addition to her committee work, Pat, who turned 80 during the conference, also volunteers as an instructor for the AARP Driver Safety program for seniors, class leader for the local Living Well with Chronic Conditions program, and member of the Community Emergency Response Team. She has been a leader in the Community Health Improvement Program (CHIP), a strong advocate for expanded School Based Health Centers around reproductive health, as well as a planner for the Let’s Go Lincoln County, a summertime campaign to encourage physical activity and good nutrition.

“Because of Pat’s involvement in community health over the years, lives have improved in Lincoln County,” says Julia Young-Lorion, Lincoln County CHIP Coordinator. “Her public service and dedication to her community has continued strong for over 20 years and there is no indication that she intends to stop. She is compassionate, dedicated, professional and a motivating person to be around. She is truly a Rural Health Hero.”

Accountable Care Organizations (ACO) and Community Care Organization (CCO) What’s the Difference?

At the beginning of the 2011 Oregon Legislative Session, Governor John Kitzhaber appointed a team of forty three people representing providers, stakeholders and consumers to the Health System Transformation Committee, which became known as the Transformation Team. This group was tasked with creating a framework that would integrate physical health, oral health and mental health in Oregon. The goal is to create better, more comprehensive care while creating savings in the Health Care System. The framework would use payment reform, global budgets, and consolidation of Managed Care Organizations to achieve these goals, and make the necessary changes to get the state through the extreme budget cuts faced in the 2011 session. The Governor's Balanced Budget held 19% cuts to provider reimbursements for the Oregon Health Plan, and he had hopes that his plan for Transformation would lessen the burden of this cut on Oregon's Health Care Providers.

Meetings started in February, and outlined an eight week plan to create legislation to transform Oregon's Medicaid system into a well integrated, less costly system. What eventually emerged was a bill that directs the Oregon Health Authority to put together a plan to form Coordinated Care Organizations in the state that will be responsible for integrated health care of their patient populations. The Health Authority will then report back to the legislature in February 2012 for approval of the plan. Many are skeptical about the plans ability to save the assumed $239 million this biennium, but most agree that doing nothing to change our siloed health care system is not an option.

To help better understand the conversation, the Oregonians for a Healthier Community put together a comparison of Accountable Care Organizations (ACO) and Community Care Organizations (CCO).



An organization of providers that is accountable for the care of the Medicare Beneficiaries assigned to it. ACO's will have a strong emphasis on Primary Care and reducing overall costs of medical care. Community based organizations using patient centered primary care homes, fixed global budgets and efficiency and quality improvements to reduce costs for Oregon Medicaid patients. CCOs align and integrate the care of Oregonians eligible for both Medicare and Medicaid to reduce administrative costs, waste and duplication.
Governance Governance
ACO Governing Bodies consist of:
  • Providers of Service
  • Suppliers of Service
  • Medicare Beneficiaries
CCO Governance:
  • A majority interest of persons that share financial risk
  • Major components of the health care delivery system
  • The community at large
A community advisory council:
  • Local Governments
  • Community
  • Consumers
Reporting Reporting
  • Claims
  • Financial Data
  • Quality Data
  • Quarterly and Annual Reports
  • Site Visits
  • Beneficiary Surveys
OHA will report:
  • Benchmarks and Quality Measures
  • Progress eliminating health disparities
  • Rules adopted
  • Customer satisfaction
  • Costs
  • Financial Data
Payments Payments
Shared Savings and Shared Losses
  • A benchmark is established based on the estimate of what the total Expenditures for the group of beneficiaries would have been without an ACO.
  • When the total per capita cost is below the estimated benchmark, the ACO receives their part of the shared savings.
  • If the total per capita cost is above the estimated benchmark, the ACO pays their part of the shared losses.
  • Quality criteria must be reached to be eligible for shared savings.
Two Risk models
  • One sided model: The ACO only shared in savings for the first two years. In the third year the ACO shares in savings and losses.
  • Two Sided model: The ACO shares in savings and losses in the first three years, and gets a greater percentage of the shared savings than the one sided model.
Global budgets
  • Calculation methods of global budgets to be determined by the Global Budget Work Group
  • CCOs are encouraged to use alternative payment methodologies
  • Reimbursements based on outcomes, not volume of care
Work Groups Work Groups
N/A A meaningful process to establish:
  • Qualification Criteria
  • Global Budget Process
  • Process for resolving providers refusal to contract with CCOs
  • Processes for reporting financial information
  • Plan for adding PEBB and OEBB
Beneficiaries Beneficiaries
  • Medicare Beneficiaries enrolled in traditional fee-for-service programs.
  • The ACO must serve at least 5,000 beneficiaries
  • Beneficiaries are assigned based on the use of a primary care physician within an ACO.
  • Beneficiaries are not restricted to services from providers within the ACO.
  • Medicaid Beneficiaries
  • Individuals eligible for both Medicare and Medicaid
  • Beneficiaries have choice of providers within the network
Providers Providers
  • Removed if they fail to meet quality standards.
  • Primary Care providers may only participate in one ACO, hospitals and other providers may participate in more than one.
  • May participate in more than one CCO
  • Emphasize prevention
  • Removed if they fail to meet quality standards
  • May not unreasonably refuse to contract with a CCO
  • Work together to develop best practices for culturally appropriate care

Good Shepherd chef wins state cooking contest – Rural serves up great health care and great food!

Jared Bowling

Jared Bowling, Good Shepherd Chef

We all know that Oregon’s rural hospitals serve up some of the best health care the state has to offer. But now, Good Shepherd Medical Center in Hermiston has shown how to serve up some of the best hospital food as well! Jared Bowling, head chef at Good Shepherd, was part of the winning team that won the first ever Oregon Hospitals Green Chef Challenge on September 29, 2011 at OHSU. The Chef Challenge brought together hospital food service professionals, chefs, clinician, executives, community healthcare advocates and public officials from across Oregon and SW Washington. Twelve chefs from ten hospitals competed to create healthy meals from local and sustainable ingredients – featuring amazing fresh produce purchased from farmers at the OHSU Farmers Market running concurrent to the event.

“The event was a twist on the annual meeting of the Oregon Healthy Food in Health Care Project of Oregon Physicians for Social Responsibility (Oregon PSR) and highlighted the important work being done at area hospitals to create healthier eating environments for patients, staff and visitors as well as support local and sustainable food systems that are protective of human and environmental health”, explains Emma Sirois, Program Director at Oregon PSR.

Jared joined two hospital chefs from Portland that had one hour to prepare a three course meal. His team’s mean included an autumn harvest salad with berry balsamic vinaigrette, flat iron stead with chimichurri marinade and vegan chocolate mousse. But it was not just simple cooking because each team had to meet strict nutrition standards; heart healthy-low in sodium, fat and cholesterol- and reasonable calorie standards, high in fiber and free of any harmful chemicals, antibiotics and hormones.

Jared is a graduate of Hermiston High School and the Western Culinary Institute in Portland. He was the 2010 Good Shepherd Employee of the Year.

Learn more about the Oregon Hospitals Green Chef Challenge.

2011 Rural America at a Glance

A recent report by the USDA’s Economic Research Service highlights the most recent indicators of social and economic conditions in rural areas. The 2011 edition focuses on the U.S. rural economy, including employment trends, poverty, education, and population trends.

Will Payment Bundling Work in Rural? A New Report

A new report and policy brief by the Upper Midwest Rural Health Research Center assesses the financial and quality challenges – and potential unintended consequences for rural providers and patients – of implementing bundled payments for acute and post-acute care episodes; explores the possible impact on quality of care delivered under a facility-provider bundled payment system, and suggests measurement opportunities to assess the quality of care delivered under a facility-provider bundled payment system; and describes potential modifications to current bundling proposals (plus additional steps the Centers for Medicare and Medicaid Services could take) that will help address rural-specific issues.


25th NW Regional Rural Health Conference: C’ing the Future: Celebrating the Past ~ Cohesive, Community Collaboration

NW Regional Critical Access Hospital Conference: March 13, 2012
NW Regional Rural Health Conference: March 14-15, 2012
Primary Care Update: May 3-5, 2012
Call for Presentations: Deadline Oct. 24, 2011

Please consider submitting an abstract for inclusion in the March 2012 program either as a breakout session presenter or a round table discussion leader. Now in our 25th year, the conference focus is on “C’ing” the future while celebrating the past through sharing proven tips, tools, methods or initiatives. The need for Cohesive, Community Collaboration has never been greater as we continually navigate change.

Learn more about this conference.

Announcing the New Date for the 6th Annual Telehealth Alliance Meeting and Summit!

Telesolutions for Healthcare ~ Anytime, Anywhere!
When: February 2 and 3, 2012
Where: University Place Conference Center, 31O SW Lincoln, Portland Oregon

Learn more about this meeting and summit.

Upcoming Oregon Rural Health Conference
Mark Your Calendars Now!

October 24 - 26, 2012
Salishan Spa & Golf Resort, Gleneden Beach, OR

October 23 - 25, 2013
Doubletree Hotel (Lloyd Center), Portland, OR

Learn more about these conferences.

Learn more about other upcoming rural health events