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ORH Recruitment Services—Changing to Meet the Times!

Recruitment and Retention—two of the biggest challenges facing providers in rural Oregon. Since 1979, the ORH has been assisting communities in recruiting physicians, nurse practitioners and physician assistants to hospitals and clinics. How candidates search for jobs has changed over the years as much as the practices themselves. Today, candidates expect quick and easy access to site information and sites want to entice potential candidates by ‘marketing’ their opportunities. In addition, who we are recruiting has changed. In the past, the focus was on healthcare practitioners. Today, sites are also looking for nurses, allied health and non-clinic staff such at IT and administration.

According to Jo Johnson, Recruitment Specialist at the ORH, the expectations of providers have changed over the years. In the past, they expected to be guided through the hiring process. CVs were considered privileged information and released to practice sites only when the physician or provider felt comfortable.

Practice sites have also changed. Previously more cautious about publicizing openings, they are now struggling to get information to candidates for the ever growing list of vacancies. “With the market being so competitive, and the needs increasing beyond just physicians, practice sites are interested in getting as much information to prospective candidates as possible,” says Johnson.

“The new ORH Recruitment Service is designed to meet these changing expectations, “says Scott Ekblad, ORH Director. “We needed to change to meet the needs of rural Oregon.” The role of the Recruitment Specialist is central to meeting recruitment needs. Staff will focus on candidates who truly want to come to Oregon and practice medicine and on the sites that are utilizing our new service and posting their opportunities.

Key to successful recruiting is understanding who you are recruiting for and just who should be part of that recruiting process. “I will now be able to spend more time with sites to help assure appropriate recruiting, says Johnson. “If they are recruiting for a physician when they should be looking for an NP or PA, then that is a problem.” Candidates want to know, as best they can, what it is they are getting into when signing a contract. They want to know that they are picking the right fit, personally and professionally. It is just as important for sites to understand what they need.

Just as important as knowing who you are recruiting for is knowing who is doing the recruiting. That may seem like a simple concept, but it is often misunderstood. Specifically identifying the site’s recruitment team is key to a successful recruitment and retention plan. Assigned roles and responsibilities, as well as accountability becomes essential to successful recruitment and retention. Everyone at the practice site is a part of the process. A front-line person who is observed by the candidate being short with a patient could be a deal-breaker. Everyone in the practice needs to understand how important they are to the success of the practice and therefore, the recruitment. While the administrator may make the final decision, co-workers and board members must be part of the process. They are the site and if they demonstrate interest and excitement about the candidate and their practice, then the candidate will be much more energized about the possibility of practicing there.

The role of the community is also central to any successful recruitment strategy. It is not just the practice site looking for a candidate, but an entire community looking for a provider who fits. The candidate is not going to live at work, so it is vital for him or her to meet the community. In many cases, the provider may not be making the site visit alone—he or she will have a spouse, partner and or children. Opportunities for the rest of the family and the quality of the schools could be the most important part of any decision a candidate makes.

“I am very excited about the opportunity to spend more time working with sites as they put together their recruitment and retention processes,” stated Jo Johnson. “This is just so important and I know our rural communities have so much to offer.”

If you have questions about the ORH Recruitment Services Program or call the Office of Rural Health toll free at 866-674-4376.

NW Regional CAH & Rural Health Conferences Scheduled for March 19-21, 2008

Creating a Thriving Rural Workforce, Health System, and Community
The theme for these two consecutive conferences says it all. Come hear from your rural health colleagues about successful models, lessons learned, and how to effectively move forward.

Incorporating Washington, Oregon, Idaho, Montana and Alaska, this is the Northwest's largest gathering on rural health with more than 300 health professionals attending each conference at the Red Lion Hotel at the Park in Spokane, WA.

For full conference schedules or to register online (new this year!) go to www.ahec.spokane.wsu.edu. For added convenience, you can register for one or both conferences at the same time using just one registration form.

6th NW Regional Critical Access Hospital Conference: March 19, 2008
This one-day conference is designed specifically for CAH administrators, staff, clinicians and board members. Come learn, share, plan, and maximize the opportunities offered through the CAH designation as experts present on quality/performance improvement, billing, rural workforce, health information technology, CMS, board development, models of rural care delivery and more. Join us at the CAH Conference and the NW Regional Rural Health Conference.

Featured speakers include Marcia Brand, PhD, Federal Office of Rural Health Policy; John Gale, MS, Maine Rural Health Research Center; Peter House, MHA, WWAMI AHEC Program Office; and Ed Phippen, Health Work Force Institute.

This conference is produced by state offices of rural health for Alaska, Idaho, Oregon, and Washington.

21st NW Regional Rural Health Conference: March 20-21, 2008
The conference is designed to be of interest to a wide range of rural health advocates including providers, community leaders, administrators, board members, commissioners, policy makers, public health professionals, and others. The conference strives to stay abreast of the current policy and regulation developments at the federal, regional, state and local levels which impact healthcare delivery. While at the same time delivering content inclusive of collaborative rural models, innovative community projects, quality, healthcare information technology and other underlying themes that shape the way business is done.

Featured speakers include WA Governor Christine Gregoire; Mary Wakefield, PhD, RN, Center for Rural Health & Health Sciences School of Medicine, University of North Dakota; Clinton MacKinney, MD, Stroudwater Associates; and a panel of Northwest Health Leaders moderated by Mary Selecky, Washington's Secretary of Health.

The conference is presented by the Washington Rural Health Association and the WA statewide Office of Rural Health including the AHEC of E. WA, WSU Extension; Office of Community and Rural Health, WA State Department of Health; University of WA School of Medicine; WSU and Western WA AHEC.

Conference Schedules and Registration
Registration is required to attend the conferences and preferred by March 7. CAH Conference registration is $50 and Rural Health Conference fees range from $125-$245. For a copy of the brochure containing information for both conferences, go to www.ahec.spokane.wsu.edu. or contact the Area Health Education Center of E. WA, WSU Extension at (509) 358-7640, 800-279-0705 or .

RHC & Flex Webinar Learning Series!

Medicaid Billing for Rural Health Clinics

Thursday February 21st at 12pm, the Office of Rural Health will sponsor a one hour webinar presentation on Medicaid Billing for Rural Health Clinics (RHCs). The presentation will be conducted by Daneka Karma, the RHC Program manager for the Division of Medical Assistance Programs (DMAP). This session is the first of 4 sessions for RHCs during 2008. Following sessions will take place in April, June and August on topics such as RHC Cost Reporting and RHC Survey and Certification. Learn more about Medicaid Billing without leaving your desk!! Please contact Justin Valley for more information regarding this webinar at . Check the ORH Website for details of future RHC Webinars.

Cascading the Balanced Scorecard—How to get the most involvement and effectiveness from all employees

Tuesday, March 4 at 12pm, the ORH offers another of its one hour, monthly training session for Critical Access Hospitals and other rural providers. This month will be a presentation by Tami Lichtenbert, the Rural Health Resource Center, on the Balanced Scorecard and how to get the most out of your employees. If you want to be a part of this great series, simply e-mail Shellye Dant at . And check the ORH Webpage for information on all future webinar presentations.

Oregon Gets New Medical School

Samaritan Health Services and Western University of Health Sciences create Oregon’s First Doctor of Osteopathy Medical School.

Samaritan Health Services (SHS) plans to partner with Pomona-based Western University of Health Sciences to develop a college of osteopathic medicine as part of a health sciences campus in Lebanon. The campus will offer a variety of health professions programs in addition to a conference and events center, medical office building, hotel and restaurant complex and other support services.

In addition to osteopathic medicine, other programs under consideration for the campus include nursing, physical therapy, paramedic training and other health-related professions, SHS President/CEO Larry A. Mullins said. Although many of the programs would be developed in conjunction with Western, Mullins said Legacy Health Systems and Linn-Benton Community College have expressed interest in having a presence on the campus for their own educational, clinical, outreach and research programs. Discussions are also taking place with other potential partners.

After months of discussions and multiple site visits, the two organizations have agreed to form a task force that will complete a feasibility study and draft the resulting agreements establishing a college of osteopathic medicine as part of a 51-acre campus. The new campus will be located across from Samaritan Lebanon Community Hospital in Lebanon.

While the task force is working to finalize plans for the college of osteopathic medicine, Mr. Mullins said the Lebanon Community Hospital Foundation has agreed to take the lead in raising community funds for the conference and events center to be used by students as well as the general community. Plans for the center include an auditorium/lecture hall, flexible meeting room space, a catering kitchen and outdoor garden area. A private developer will be selected for the hotel/restaurant project and the medical office building.

The health campus project represents the next step in a growing partnership between Samaritan and Western, Mullins said. The two are currently collaborating on a program that places third- and fourth-year medical students in a series of clinical rotations with Samaritan-affiliated hospitals. SHS also plans to apply for accreditation to offer graduate medical education, such as residencies and fellowships, in a number of physician specialty areas.

“There is a strong link between where physicians do their training and where they end up practicing medicine, so we believe these steps will greatly strengthen our ability to recruit and retain outstanding physicians to the area,” Mullins said. “Most of the medical students here now are from the Pacific Northwest, and they have encouraged us to establish residency programs so they can stay in this area after medical school.”

“This is exciting news,” says ORH Director Scott Ekblad. “There is such a need for more providers in Oregon, especially rural Oregon. We see this as a great opportunity to help meet the provider needs of Oregon.”

Western University President Philip Pumerantz, Ph.D., said there is a need for additional graduate health education in the nation, and a number of factors ultimately led to pursuing the partnership with SHS. “This is an opportunity here in Oregon to put in place the elements which will, in a few short years, lead to the establishment of a multi health professions satellite campus of Western University of Health Sciences,” he said.

Benjamin Cohen, D.O., provost and chief operating officer at Western, said that SHS is “an extraordinary hospital system that is steeped in the highest quality of health care delivery with a humanitarian approach of care. This approach also underlines the curricular and clinical experience at Western University, and we are pleased to partner with an organization that practices what we teach.”

Approximately 2,300 students currently attend Western University, which offers graduate programs in pharmacy, nursing, veterinary medicine, and allied health professions in addition to osteopathic medicine. The university will open four new programs in 2009: dentistry, optometry, podiatry and graduate biomedical sciences.

Mullins said SHS will also continue to pursue medical education opportunities in partnership with Oregon Health & Sciences University, Oregon State University and other higher education institutions. SHS, OHSU and OSU signed a letter of intent last year to host OHSU medical students in Corvallis as part of their training, but that program has not yet been funded by the Legislature.

SHS currently offers educational experiences to more than 900 students annually at its various locations, including the Health Careers and Training Center at Samaritan Lebanon Community Hospital. The center provides classroom and laboratory space for a number of health occupations in conjunction with Linn-Benton Community College.

OHP Standard Opens Program to a Limited Number of People—Get on the Reservation List Now!

OHP Standard Reservation List

Do you or someone you know need free or low-cost health care coverage?

From January 28 through February 29, 2008, the Department of Human Services (DHS) will take names for a reservation list of adults who are 19 years old and older and need health care coverage. DHS is getting ready to open the OHP Standard program to a limited number of people. Unfortunately, there is not enough money to cove everyone who may qualify. So, to be fair to everyone, DHS has created an OHP Standard reservation list. If you add your name to the list, DHS will send will send you a confirmation postcard with a reservation number. After the list closes, on February 29, DHS will randomly draw a limited number of names from the list and mail OHP Standard reservation list applications to those people whose names have been drawn.

Anyone can be put on the reservation list, it is not an application. Use one of the following three options to get on the OHP Standard reservation list:

  • Submit your request online at http://www.oregon.gov/DHS/open/request-form.shtml
  • Call 800-699-9075 (phone) or 503-378-7800 (TTY), and ask to be placed on the OHP Standard reservation list. The phone bank will be open Monday through Friday, 7 a.m. through 7 p.m. The call will take from 10-12 minutes. Someone may call for you — they just need your full name, date of birth and mailing address. Be sure they have this information for every adult in your home who’s interested in getting on the list.
  • Pick up an OHP Standard reservation list request form from any DHS or Area Agency on Aging (AAA) office, or most major clinics and hospitals. The list can be mailed, faxed or dropped off at any DHS/AAA office.

For more information please visit the DHS website at http://www.oregon.gov/DHS/open/

Getting Docs on Board – Quality and Safety is a Team Commitment!

Traditionally, hospital quality and patient safety have been left in the hands of the clinical staff — board members and senior executives focused more on the strategic and financial goals of the organization. However, that dynamic is no longer the case. Hospital executives and community board members are taking an increasingly larger role in defining and monitoring the hospital's quality goals. So how can senior leaders and trustees ensure that physicians are on board with their quality agenda?

  • Ask physicians how the hospital can improve quality, says Melissa Coleman, a board member at Delnor-Community Health System in Geneva, IL. The 128-staffed-bed hospital has several physicians on the hospital board as well as the quality committee. The physicians help the quality committee set agendas based on their daily interactions and observations, she says. "They are out there on the frontlines. They know what will improve quality…If you are initiating or implementing a quality initiative, get doctors involved and let them drive it."
  • Have a sincere and intensive discussion with the medical staff at least once a year on what they are doing to improve quality, advises James A. Rice, PhD, vice chairman of The Governance Institute. For instance, physician leaders should inform the board what processes they are establishing to guard against medical errors, enforce hand washing, and handle credentialing and privileging issues.
  • Align the quality goals of the physicians and the hospital. Rather than asking, "Why can't we get doctors engaged in our quality agenda?" senior leaders and board members should ask themselves, "How can we get engaged in the physicians' quality agenda?" says James L. Reinertsen, MD, president of the Reinertsen Group and a senior fellow at the Institute for Healthcare Improvement. Physicians' focus on quality usually relates to their patients' outcomes and wasted time. So if the hospital's quality goal is to look good on the Centers for Medicare & Medicaid Services' core measures for evidence-based medicine, that probably won't engage docs. But framing the organization's goals around improving patient outcomes for specific disease states and basing the clinical indicators to monitor the organization's progress on evidence-based medicine and CMS guidelines will more than likely get physicians on board, says Reinertsen. "Now you have a plan that is exactly the same plan, but it has been framed in a way that engages physicians."
  • Establishing medical conference committees can also help align the quality agenda of the medical staff, board members and senior leadership. These committees are usually composed of three or four key physician leaders and three or four board members who come together two or three times a year to look at the quality agenda, monitor performance, and brainstorm on strategic initiatives, says Rice.
  • Include the medical staff in strategic discussions on technology trends that have the potential to improve clinical outcomes and patient safety. Board members, senior executives and medical staff leaders should look at the efficacy of the technology — both clinical and IT — as well as the capital consequences for the hospital, says Rice, adding that the discussion can take place two to three years in advance of those capital decisions. "That is another partnership or culture of respect that is important to build between the board, management and physician leaders," he says.

Carrie Vaughan, for HealthLeaders News

Survey compares rural and urban/suburban physicians

The nation's current doctor shortage is most acute in rural America, and an aging U.S. population combined with an increased interest in "quality of life" issues will likely make the situation worse before it gets better, according to representatives from locumtenens.com. The physician recruitment firm recently surveyed doctors to better understand their perceptions of practicing medicine in rural America versus practicing in areas with populations of 50,000 or more.

The survey found that there may be fewer differences, at least clinically, between practicing in rural areas and urban ones than one might think.

"Most of the physicians were pretty pleased with how rural medical practices worked for them," says Tim Skinner, executive director of the National Rural Recruitment and Retention Network (3RNet)  in La Crosse, WI. "There are a lot of plusses to the practice of rural medicine — and actually many of the rural practices have the same equipment, the same technology as suburban and urban practices do. Much of it is quite up-to-date."

Of those surveyed who have practiced in rural areas, for example, 31 percent said they think profitability among rural practices was about the same when compared with their urban counterparts, and 23 percent even said rural practices were more profitable. Only 18 percent said practicing in a rural setting was more frustrating than working in an urban facility, and 45 percent said urban and rural settings were "about the same" in regard to frustration.

There are, however, stark differences between the two — especially when it comes to connecting with patients. Of those surveyed who had practiced in rural areas, 52 percent said they think doctors have a closer relationships with patients in a rural practice, compared with 3 percent that said they think doctors have closer relationships with patients in an urban or suburban practice.

"What's different is you have a more personal connection," says Jim Stone, MD, who practices in Atlantic, IA. "Medicine has become a volume-based profession, and in an urban setting you have much less time to spend with patients."

The survey also gauged the physicians' thoughts on lifestyle comparisons between urban and rural settings. Predictably, the findings were all over the map — 31 percent said they liked rural settings more, 19 percent said they preferred urban settings, and 15 percent said life was about the same.

Doctors say where one prefers to practice is simply a matter of the type of person they are and the lifestyle they are accustomed to. "I think it really has a lot to do with the physician's personality and also the desires of the physician's family," says James C. McLoughlin, MD, a surgeon who practices in Ogdensburg, NY. "Rural settings can be more attractive to physicians who are interested in control of lifestyle: no traffic, little pollution, first-name basis for many conversations, really getting to know the people in a community. For the physician who likes the anonymity of a big city, rural life would probably not be desirable; however, for someone who enjoys solitude and space, rural life can be attractive."

Because of this, Skinner says rural facilities need to look at a potential physician's background and interests when trying to recruit. "A physician who is going to go to a small, rural community in Wisconsin is probably going to be very interested in hunting and fishing, as opposed to the physician who is going to go to a desert area in Arizona and New Mexico who might be more interested in cultural artifacts, archeology, anthropology, and desert life," Skinner says. "You have to look at those preferences."

Smaller facilities should also take steps to show potential physicians that they will not be overwhelmed by being the only, or one of few, doctors in a community. McLoughlin suggests community and rural hospitals seek partnerships with larger city or teaching hospitals by becoming part of an extended telemedicine network. That way, physicians practicing in the rural location don't feel isolated from colleagues, McLoughlin says.

"When a 'tough case' comes into the hospital, the rural practitioner would have access for input from a larger department of physicians or possibly even from those practicing at an academic center," McLoughlin says. "Avoiding the isolation of 'now I'm stuck with this patient that I can't figure out' should be a major goal of any rural hospital trying to recruit physicians."

Perhaps the most telling finding from the LocumTenens.com survey was why physicians who had not practiced in a rural setting had never done so. The three top answers were: never found the right opportunity there (26 percent), never been offered a position there (23 percent), and never considered it (19 percent). Only 4 percent answered they never practiced in a rural setting because they did not want to work there.

"As a former physician recruiter, I thought it was stunning to see that only 4 percent of responding physicians with no rural practice experience said they didn't want to practice medicine in rural America," says LocumTenens.com Senior Vice President Pamela McKemie. "What we'd like rural hospital executives to 'get' from our survey results is that physicians from all types of environments are open to practicing rural medicine, but you've got to approach them about your opportunity before they can consider it."

This is another example of why rural facilities need to be a little more cognizant of making sure the invitation to practice isn't restricted to a small group of physicians who are born in rural areas, Skinner says. "We really need to emphasize the connection between the community development piece and the medical staff development piece," Skinner says. "In a small town they have to put that together because lifestyle issues have a great deal to do with people either appreciating a smaller community or not."

Skinner says it is crucial that facilities not only promote satisfaction among staff working with patients and practices in rural facility, but also work with the community as a whole to help draw potential physicians. He suggests healthcare providers tout agencies and resources such as social and human services that can potentially support physician practices. Stipulating how close the nearest college is for potentially furthering the physician's education, developing a strong community-based Web site, and promoting available leisure activities in the area are all ways providers can work with the community to attract physicians.

"The smaller the town, the more important the community development piece is," Skinner says. "What they can do is they can really step up and say, 'This is what our schools offer, here are our recreational and cultural activities.' If the community piece is missing, they might pass on a rural practice even if they offer the physician and the physician's family everything that they need."

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RHIOs: The Keys to Sustainability

"Circuitous" is a very appropriate term to describe the regional or state health information movement over the past several years. But make no mistake, healthcare and health information sharing is a top priority for many organizations. More than 200 state and regional health information organizations — considered the foundation on which to build a national health information network — are in various stages of formation across the nation.

They have not, however, taken a cookie-cutter approach to establishing electronic ties among payers, providers and other organizations involved in delivering healthcare. While they share a common goal, they are using a variety of business and information technology strategies to get there.

The typical mission is to support the healthcare stakeholders committed to developing a centralized healthcare data repository for the purposes of quality improvement, provider performance measurement, and public reporting.

Sustainability for RHIOs

To be self-sustaining, regional or statewide health information organizations must implement a funding model which is supported by the healthcare community they serve, and which provides an adequate source of funds to cover development and operation. The best opportunities for funding come from those most likely to benefit from a tangible return on investment.

Many health information organizations have the luxury of public and private grants to provide the required capital for startup. To remain successful, however, a sound business plan and strategy should be developed to maintain long-term viability. The business plan should demonstrate a sound return on investment.

Of course, the biggest challenge in becoming self-sustaining is implementing a model where the funding is endorsed by the healthcare stakeholders being served. The model must provide enough funding to cover development and operation of the RHIO. Successful business models have used technology to connect and support patients, consumers, providers, payers, and employers with tools to improve their lives and businesses. Several business models have been designed to simplify and reduce the administrative burden. There are various revenue models that can be considered, including:

  • Employers pay a per employee/per month fee
  • Payers pay a per claim fee
  • Providers (physicians & hospitals) pay a monthly access fee
  • Other transaction fees — i.e. lab report, per EMR, per medication history, etc
  • Access fees from public safety reporting organizations (i.e. Center for Disease Control, Homeland Security)
  • Hybrid models combining some or all of the above funding opportunities.

Another aspect of a sustainable funding model is to create both product and service offerings that add value to the healthcare system by improving the affordability, quality, usability, and accessibility of healthcare. For example, web-based portals and workflow processes that support administering clinical care and improve healthcare quality, such as:

  • Clinical consults and referrals
  • Presentation of patient centric clinical data for routine and emergency care
  • Integrated practice management and office workflow systems
  • E-prescribing and prescription refill requests
  • Transactional and historical electronic and personal health records
  • Availability of diagnostic test results
  • Electronic order entry capabilities
Reduction of clinical burden

Providing physicians with quality reporting materials, and subsequent access to the details behind these reports is a great place to start funding sustainability. A monthly membership fee can be considered for participating providers.

To improve the value of the solution to providers, it is also important to add lab results to the database sooner rather than later. This data would serve two purposes, the first providing availability to the physician, and secondly the ability to improve the quality reporting measures beyond the base administrative data claims set. Offering the lab data to providers could add an increased monthly premium to the membership fees.

Implementing personal health records is also an important step in the process. According to a recent HIMSS survey, only 32 percent of hospitals had reached a full implementation of electronic medical records, and only 37 percent of the remaining hospitals were involved in EMR development. In addition, a far smaller number of individual practitioners and physician groups have actually implemented EMRs at any stage. When you have the administrative claims data, you are already 90 percent of the way to having an on-line PHR tool available for providers and consumers.

Additionally, RHIOs will continue to increase their value proposition with assisting in reducing healthcare costs. For example, TennCare reported a 17 percent decrease in costs on patients who did not have access to a PHR in 2005 but did have a PHR in 2006. By adding PHRs sooner in the cycle, providers set up for the next logical step of receiving government and private funding by providing this tool for consumers.

Public good

Evaluating the need for providing population based health reporting is a means for government funding, and for serving the public. Strengthening the public facing story can be enhanced by adding the PHR as noted in the section above.

The first step is the expansion of the vision to accommodate the "public good" in a more robust manner. Hiring a professional fund-raising staff member can be a great start. Given there are more than a million charitably supported nonprofit organizations nationwide who have sustainable business models, it is not hard to see that this model can extend to RHIOs. Data suggests that an RHIO might expect that as much as one-third of the total RHIO revenue will continue to come from government grants and philanthropy in the foreseeable future. Our recommendation is to apply dedicated focus on receiving grants and philanthropic efforts as natural expressions of community support that can be developed and maintained over time.

Reduction of the administrative burden

Many RHIOs have already outlined plans for supporting providers by reducing the administrative burden via real-time Electronic Data Interchange and Claims Clearinghouse solutions. This is a viable funding model based on transaction fees.

From a phasing perspective, it is recommended that RHIOs continue implementing solutions that reduce the clinical burden. This does not preclude a RHIO from running a parallel project to implement EDI solutions that can add even more value for providers, and assist in providing an additional funding source. It is important to phase in the functionality in a manner that will balance the needs of a successful pilot, value for the providers, and technical constraints that may exist for each option.

RHIOs in the community

The U.S. Department of Health and Human Services lists three primary roles for Health Information Organizations — whether state-wide or regional in the community:

  • Provide governance and serve as a trusted intermediary
  • Facilitate consumer interactions
  • Support the financial, organizational, legal, technical and clinical processes

Healthcare Consumers are asking for:

  • High-quality, affordable healthcare
  • Availability of accurate data in a timely manner
  • Faster HC delivery
  • Ability to view claims history
  • Improved quality and safety of care, and access to quality data to support their care decisions

These roles have been discussed at length in articles and papers. However, to be economically viable and sustainable, the organization must go beyond them. Successful Health Information Organizations must also incorporate the following roles and goals:

  • Educate the community
  • Connect the community
  • Develop a solid organizational foundation
  • Establish community standards for information exchange
  • Select the right vendor partners for information technology
  • Perform pilot projects
  • Act as a facilitator
  • Cut healthcare costs by 20 to 30 percent
  • Improve reimbursement process
  • Implement a comprehensive solution

Marybeth Regan, PhD, is an expert in disease and care management. She has written numerous articles on strategies for care and disease management. She may be reached at Marybeth.regan@reden-anders.com. Robin Randall-Lewis is an expert in Consumerism and Transparency strategy, which extends into RHIO's and the associated funding models. She may be reached at .

HRSA Seeks Comment on Small Rural Hospital Grant Program

The Health Resources and Services Administration (HRSA) is seeking comments from the public on its plan to institute a permanent deviation from a policy in HHS with regards to HRSA’s Small Rural Hospital Grant Program (SHIP). The SHIP grant program will assist eligible small rural hospitals in implementing HIPAA compliant Prospective Payments Systems (PPS) in order to reduce medical errors and improve patient quality.

, include "Small Rural Hospital Improvement Grant Program'' in the subject line of the message.

U.S. Curtailing Bids to Expand Medicaid Rolls

By Robert Pear

WASHINGTON — The Bush administration is imposing restrictions on the ability of states to expand eligibility for Medicaid, in an effort to prevent them from offering coverage to families of modest incomes who, the administration argues, may have access to private health insurance. The restrictions mirror those the administration placed on the State Children’s Health Insurance Program in August after states tried to broaden eligibility for it as well. Until now, states had generally been free to set their own Medicaid eligibility criteria, and the Bush administration had not openly declared that it would apply the August directive to Medicaid. State officials in Louisiana, Ohio and Oklahoma said they had discovered the administration’s intent in negotiations with the federal government over the last few weeks.

The federal government has leverage over states, because it pays a large share of the costs for Medicaid and the State Children’s Health Insurance Program, and states have to comply with federal standards to get federal money. The insurance program was created for children whose families have too much income to qualify for Medicaid but not enough to buy private insurance.

On Dec. 20, the Bush administration rejected a proposal by Ohio to expand its Medicaid program to cover 35,000 more children. Ohio now offers Medicaid to children with family incomes up to twice the poverty level, or about $41,000 a year for a family of four. The state had proposed increasing the limit to three times the poverty level, to about $62,000.

“Federal officials told us that they would apply the criteria set forth in the Aug. 17 letter to our proposal for expansion of Medicaid,” said Cristal A. Thomas, the Ohio Medicaid director.

Dennis G. Smith, the director of the federal Center for Medicaid and State Operations, confirmed that account.

“To be consistent and logical, you have to apply the criteria to Medicaid and CHIP,” Mr. Smith said in an interview.

The same concern, about the substitution of government health care for private insurance, is present under both programs, he said, and states will not be allowed to “sidestep the Aug. 17 policy directive” by expanding Medicaid.

Jeff Nelligan, a spokesman for the Medicaid agency, said Ohio officials “were trying to get around the Aug. 17 policy directive.” Under that policy, states had to enroll 95 percent of eligible children below 200 percent of the federal poverty level before they could expand their programs, a criterion that many state health officials said would be impossible to meet.

Tony Fratto, a spokesman for President Bush, defended the administration’s stance.

“We want states to focus on enrolling their neediest population before they consider expanding Medicaid and CHIP to middle-income families,” Mr. Fratto said. “This policy demonstrates the president’s compassion. He wants to direct scarce tax dollars to those with the greatest needs.”

Administration officials say government health programs start to “crowd out” private insurance when they cover families with incomes from 250 percent to 300 percent of the poverty level — about $51,600 to $62,000 for a family of four.

Some state officials complained about both the substance of the Medicaid policy and the way it was adopted.

“The Aug. 17 letter is a CHIP policy, not a Medicaid policy,” said Mike Fogarty, chief executive of the Oklahoma Health Care Authority. “But it’s being applied in a much broader way. We are seeing many more roadblocks.”

The Oklahoma Legislature voted in May to cover 42,000 more children under Medicaid by increasing the income limit to 300 percent of the poverty level, from 185 percent. “In recent weeks,” Mr. Fogarty said, “we got a very clear signal from federal officials that we would not be allowed to go beyond 250 percent of the poverty level.” Louisiana officials reported a similar experience. “We found that we have much less flexibility to make changes in Medicaid than we thought,” said J. Ruth Kennedy, deputy director of the state’s Medicaid program.

The new federal policy reflects a significant shift. In the first four years of the Bush administration, Tommy G. Thompson, the secretary of health and human services, often boasted that he had approved record numbers of waivers, allowing states to decide who got what benefits under Medicaid and the child health program.

“Our goal is to give governors the flexibility they need to expand insurance coverage to more Americans,” Mr. Thompson said in 2001.

The child health program complements Medicaid. Income limits vary from state to state and tend to cluster from 133 percent to 185 percent of the poverty level for Medicaid, with states allowed to go 50 percentage points higher for the child health program.

Mr. Bush has been engaged in a yearlong battle with Congress over the child health program. In his budget request last February, Mr. Bush said he wanted to return the program to its “original objective” of covering children with family incomes less than twice the poverty level. He asked Congress to cut payments to states that covered children at higher income levels.

The Democratic-controlled Congress showed no interest in Mr. Bush’s proposal. But the administration has tried to achieve a similar objective unilaterally, with the letter to state health officials.

Under the new policy, states must meet certain conditions if they want to cover children with family incomes above 250 percent of the poverty level. For example, a child who had private coverage in the past must be uninsured for at least one year before being enrolled in a state child health program.

In June, the Louisiana Legislature unanimously approved a bill to expand eligibility for the State Children’s Health Insurance Program by raising the income limit to 300 percent of the poverty level, from 200 percent.

But Ms. Kennedy, the Louisiana official, said, “After receiving the Aug. 17 letter, we had to change course.”

Louisiana is now seeking permission to increase its income limit to 250 percent of the poverty level. And it has had difficulty getting federal approval.

In correspondence with the Louisiana Department of Health and Hospitals, federal officials have suggested that the state does not have enough money to pay its share of the costs.

In addition, federal officials challenged Louisiana to explain why it did not want to enforce the one-year waiting period for children who had lost private health insurance because of a parent’s death or the failure of a business where a parent was employed. In such cases, the state replied, the loss of coverage is involuntary, and the waiting period would “penalize children and families for circumstances beyond their control.”

In Wisconsin, Gov. James E. Doyle, a Democrat, and the State Legislature also wanted to expand eligibility for the children’s health program by increasing the income limit to 300 percent of the poverty level, from 200 percent. The federal government approved the proposal after Wisconsin scaled it back to 250 percent. Coverage for children above that level is to be financed entirely with state money.

“Federal officials made clear that they would not approve our proposal if we went to 300 percent of the poverty level,” said Jason Helgerson, the Medicaid director in Wisconsin.

Looking Back

What were the top health care stories of 2007??

Looking back to 2007, health care surfaced as the leading domestic issue. With presidential campaign, and the number of uninsured rising by 2.2 million, it’s no wonder health care made the news. See what else made the top 10 health policies of 2007.

Looking Forward

Looking to 2008, see what PricewaterhouseCoopers’ Health Research Institute predicts will be the top eight health industry issues of the coming year:

  • Hospital coffers will feel the impact of a new Medicare reimbursement system that’s designed to better recognize the severity of patient illnesses. Specialty hospitals and others that see less acutely ill patients could see their revenues decline, while urban hospitals that treat sicker patients could benefit.
  • Increased oversight and authority by the U.S. Food and Drug Administration may boost the public’s trust in drug safety, but also could add to the regulatory burdens on pharmaceutical companies. The FDA now may require drug companies to conduct additional clinical trials to assess risks associated with a drug after it has been released to the public.
  • A surge in the number of retail health clinics, such as those in drug stores, will force states, payers and policymakers to think about the best ways to deliver primary care. Hospitals could benefit from retail clinics if they draw uninsured patients, while pharmaceutical companies may need to market more to the nurse practitioners who run the clinics.
  • The market for individual health insurance could get much broader if other states and the federal government follow the lead of Massachusetts, which requires that all residents have coverage. Individual coverage also could get a boost from Republican proposals for tax incentives to help consumers buy individual policies.
  • Retirees are playing a greater role in funding their health-care coverage, whether they like it or not. As the population ages and health-care costs increase, employers are shifting more responsibility for retiree coverage to the retirees. In a PricewatehouseCoopers survey of multinational company executives, 73 percent said they needed to reduce contributions to retiree health coverage and cap benefits.
  • Big pharmaceutical companies, groaning under the high price of drug development, will keep buying and collaborating with life-science companies to stock their product pipelines. But biogenerics — generic copies of biological drugs — could crimp drug company revenues.
  • New IRS rules will mandate that nonprofit hospitals uniformly disclose more details about the community benefits they provide, such as charity care. Hospitals also will have to be more forthcoming about executive salaries and benefits, because of pressure to justify their tax-exempt status.
  • Asia is poised to become the world’s largest pharmaceutical consumer and producer. American drug companies have increased their marketing and clinical trials in Asia because of the market’s size, increasing wealth and growing awareness of health-related issues. On the production side, much of Asia provides high-quality, inexpensive labor. But watch out: Several Asian drug companies aim to become worldwide pharmaceutical powerhouses, not just contract manufacturers.

CAH News Updates

Cost, mortality decline for Medicare patients in P4P project

According to a study released by Premier Inc., hospitals participating in a Medicare pay-for-performance demonstration on average reduced the cost per patient by more than $1,000 over three years and the mortality rate by 1.87%. The study of more than 1.1 million patient records from participating hospitals concludes the nation could save $4.5 billion and nearly 70,000 lives annually if all hospitals implemented the program and achieved the same results. More than 250 hospitals are participating in the demonstration, which rewards improvement in national quality measures for patients treated for pneumonia, heart bypass, heart failure, heart attack, and hip and knee replacement. Premier estimates the project improved the median composite quality score for participating hospitals by an average 17.3% from October 2003 through June 2007. The Centers for Medicare & Medicaid Services has extended the demonstration through 2009. AHA President and CEO Rich Umbdenstock called the Premier demonstration "a significant step in helping determine how to best improve patient outcomes through incentives." View the study.

(Information provided by the American Hospital Association)

CMS to allow CAHs to participate in outpatient quality reporting

The Centers for Medicare & Medicaid Services has granted the AHA's request to allow critical access hospitals to submit and publicly report outpatient quality data along with other hospitals. More information will be available from CMS later this year, including when CAHs can begin reporting data. Hospitals participating in Medicare's outpatient prospective payment system are required to submit data on seven outpatient quality measures to receive a full payment update in FY 2008. The program contractor last month announced that CAHs, which do not participate in the OPPS because they receive cost-based reimbursement, would not be allowed to submit the outpatient measures. However, AHA urged CMS to let CAHs participate in the quality reporting because of their commitment to public transparency and quality improvement.

(Information provided by the American Hospital Association)

Education's Role in the Metro/Non-Metro Divide

Average earnings are lower in nonmetro areas than in metro areas, even after accounting for differences in the individual characteristics of nonmetro earners. The nonmetro-metro earnings gap is greater for workers with more education and more experience. For nonmetro households, lower earnings may be offset by factors difficult to measure, such as lower living costs or the value of rural amenities.

Learn more.

In the News

Curry Health District

Curry Health District Welcomes William I. McMillan as the new CEO. Clinical Services Administrator, Debbie Champagne has been hired as the new Clinical Services Manager.

PeaceHealth Medical Group

Nena Harvey has been hired as the new Director of Operations, PeaceHealth Medical Group, Siuslaw Region.

Honor Given

Belinda Kruger, NP, has been named Oregon's 2008 Family Planning Clinician of the Year by her colleagues statewide.