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ORH Newsletter-September 2009 Share This OHSU Content

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Apple A Day

A benefit for the Oregon Office of Rural Health and the communities it serves.

Rural Communities are facing many challenges when it comes to providing health care services. The Apple A Day Campaign is a chance for all of us to do our part.

Rural communities rely heavily on volunteers to provide emergency medical services (EMS). They are finding it more and more difficult to recruit EMS volunteers, who must pay out of their own pockets for the required training and continuing education. Proceeds from the Apple-A-Day Campaign will help subsidize their training.

Proceeds from the Apple A Day Campaign will also be used to help rural clinics provide care to patients, regardless of their ability to pay. Rural communities typically have a disproportionate number of poor and uninsured individuals. Rural providers treat many of these people knowing they will never be reimbursed for their care. This event will raise funds to reimburse rural providers for this uncompensated care. Register today—Let’s do our part to meet the needs of rural Oregon.

You can Register online. If you are unable to attend the dinner, please make your contribution today.

26th Annual Oregon Rural Health Conference

November 5-7, 2009
Salishan Spa and Golf Resort, Gleneden Beach, Oregon

ARRA and HIT

There is no shortage of talk when it comes to The American Recovery and Reinvestment Act (ARRA). And one important component of that Act is health care and Health Information Technology (HIT). But despite what you might think from reading the newspapers, much of that money has not yet begun to flow. But just how does it help Oregonians with health care and HIT?

The ARRA funding is designed to work as a three year bridge—helping communities and states through the economic downturn. This includes providing direct assistance and benefit to local Oregonians through existing programs and tax incentives as well as helping with Medicaid payments.

The ARRA appropriates $2 billion for grants and loans as well as $34 billing for entitlement programs such as Medicare and Medicaid. It is also designed to help health care providers and facilities to begin adapting HIT as the start of health care reform.

But if there is all that money, why have we not seen it? The overall HIT funding stream is not as simple as we might want. What does that money buy?

The $2 billion is dedicated to five main programs: Health Information Exchange Grants, Electronic Health Record Adoption Loan Program, the Health IT Extension Program, Workforce Training Grants and New Technology and Research Grants. For each of these programs, there are some things we know, and things we do not yet know.

Health Information Exchange Grants (HIE): These grants will be issued through the Office of the National Coordinator for HIT (NCHIT). These grants will be given to states or to a qualified state-designated entity. They can be sued for both the planning and the implementation of HIEs. Deadline for letter of interest is September 16, 2009 and final application is dues on October 16, 2009. State of Oregon is currently considering this grant.

Electronic Health Record Adoption Loan Program: This program will also be administered through the NCHIT. Grants will be given to states and tribal entities. Money can be used for establishing a loan program for health care providers. This program will require a state match. We do not currently know the amounts of the awards or what the process for application will be.

Health IT Extension Program: This program will be administered through the NCHIT. It will go to Regional Extension Centers for the purpose of supporting the centers as research and consulting organizations that assist less advantaged providers. Funding will consist of up to 50% of capitol and annual operating budget for two years. Regional Health IT Technology Center grant preliminary application is due on September 8, 2009 and a final will be due on November 11, 2009.

Workforce Training Grants: This program will be administered through the Department of Health and Human Services (HHS) and the National Science Foundation. Recipients will be higher education centers for the purpose of promoting HIT workforce development. We are still waiting for the final application process and the total award amounts.

New Technology Research and Development Grants: This program will be administered through the Nation Institute of Standards and Technology and the National Science Foundation. Recipients will be institutions of higher education, government labs and non profit organizations for the purpose of promoting research and innovation in technology. We are still waiting for guidance on the application process.

The largest amount of money, $34 billion, is dedicated to Medicare and Medicaid as incentives for physicians and hospitals that purchase and use Electronic Health Records (EHR). While not all the details are available on how the program will work, we do know the following:

Medicare, Physicians and EHR
  • Funds will be available commencing in calendar year 2011
  • Compensation for “meaningful HER users” will be in an equal amount, or up to 75% of allowable charges for professional services furnished by physicians
  • These incentives are for five years and will have a declining schedule each year
  • There will be a phasedown for physicians adopting after CY 2013
  • Beginning in CY 2015, reductions in Medicare reimbursements by 1% to 3% annually will impact physicians that are no “meaningful EHR users”
  • Incentives will be available to physicians of qualified Medicare Advantage organizations
  • No incentives will be available after CY 2016, when disincentives will begin
  • Certain hospital-based professionals such as pathologists, anesthesiologists and emergency room physicians are specifically mentioned as being ineligible.

One key element waiting to be fully defined is the term “Meaningful Use”. We do not know at this point when we will know the definition that will be used. Medicare incentives for physicians are defined as follows:

Medicare Incentives for Physicians Table
Medicare, Hospitals and EHR
  • Will be provided to subsection D hospitals
  • Incentives start in FY 2011 (October 2010)
  • Hospitals are compensated according to a formula
  • There will be transition factors that will decrease each year
  • Phasedown of program begins in FY 2013 for hospitals that are newly adopting
  • No incentives for hospitals adopting after FY 2015
  • Adjustments, beginning in FY 2015, for those hospitals who are “not meaningful EHR users”
    • Market Basket Adjustment percentage reduced for non-critical access hospitals
    • Rate of payment for inpatient critical access hospital services reduced for CAH
  • Hospitals that are under common governance with a qualified Medicare Advantage Organization will also qualify
Medicare Incentives for Hospital Table

Medicaid Incentives, part of the $34 billion incentive program, is available for non hospital providers as well as hospitals. Under the ARRA, states may make payments to Medicaid providers to encourage adoption and use of certified EHR technology. First year of program, recipient must “engage in efforts to adopt or implement upgrade of technology”. In the second and subsequent years of the incentive, they must demonstrate “meaningful use”. Like the Medicare incentives, we are still waiting for the definition of “meaningful use”. While the legislation does not address the issue of reduction in Medicaid payments for failure to demonstrate the “meaningful use”, it does state that providers and hospitals cannot receive duplicative Medicare and Medicaid payments.

Incentives for non-hospital based providers include:

  • Up to 85% of certain cost for certified EHR technology (subject to caps)
  • 1st year of payment capped at $25K (or less, based on studies)
  • Cost of purchase and implementation or upgrade to EHR technology, support and training services
    • Engaging in efforts to adopt, implement or upgrade a certified EHR technology, or
    • Investment was made prior to beginning of funding period with demonstration of “meaningful use” of certified EHR technology
  • Subsequent years of payments, capped at $10k / yr, for cost relating to the operation, maintenance and use of a certified EHR technology.
  • First year cost must not be later than CY 2016
  • No payments made after CY 2021 or for more than five years
    • Maximum incentive will be $65K
Medicaid Incentives for Hospitals
  • Hospitals that adopt in FY 2017 or late are not eligible for any incentives
  • Incentives are limited to six years
  • Incentives equal the product of the overall Hospital EHR amount & the Medicaid share
  • Total amount, in any year, shall not exceed 50% of the Medicaid incentive and no more than 90% in a two year period
  • Qualified Medicaid providers include physicians, dentists, certified nurse midwives, nurse practitioners, and physician assistants that are practicing in rural health clinics and FQHCs. Children and acute hospitals also qualify. In addition, recipients are required to have a percentage of patient volume allocated to either individuals receiving medical assistance or to need individuals.
Medicaid Incentives Table

HIT Investment through the ARRA brings a lot of opportunity for hospitals and providers. While some money through the stimulus package has begun to flow, HIT money has proved a bit slower. The Office of Rural Health will continue to work with Oregon’s Health Information Infrastructure Advisory Committee (HIIAC) to get the most up to date information and opportunities to you. If you have questions, you can contact the Oregon Office of Rural Health at 503-494-4450.

Quality Healthcare—Using a TEAM approach to Make it Real at Rural Hospitals Across Oregon

When we go to work, we know we want to do more than assure the delivery of health care. We want to make sure we are delivering the highest quality health care possible. But how do we know we are reaching that goal? TeamSTEPPS can help!

What is TeamSTEPPS? TeamSTEPPS is a teamwork system designed for health care professionals that works as a powerful solution to improving patient safety within your organization. And it is more than just a passing fad. In fact, TeamSTEPPS is an evidence-based program rooted in more than 20 years of research and real life lessons. The Department of Defense, in collaboration with the Agency for Healthcare Research and Quality (AHRQ), developed TeamSTEPPS. Together, they have teamed with the American Institutes for Research to build a national training and support network called the National Implementation of TeamSTEPPS Project.

“We are very excited about this program,” says Kassie Clarke, Oregon FLEX Coordinator. “The FLEX Program sponsored three Oregon facilities—West Valley, Mountain View and Grand Ronde—to attend a master training session in Nebraska. This training gives Oregon a great opportunity to take a lead in implementing the program statewide.”

What does TeamSTEPPS do for your team? TeamSTEPPS helps your organization provide a higher quality, safer patient care environment by: producing highly effective medical teams that optimize the use of information, people, and resources to achieve the best clinical outcomes for patients. It will help you eliminate barriers by increasing your teams’ awareness of and clarify roles and responsibilities and resolve conflicts by improving information sharing.

It is more than just words at West Valley Hospital. They implemented a TeamSTEPPS program with huge success. Since their first TeamSTEPPS training sessions rolled out in April, 128 employees have been trained-- including clinical hospital staff as well as non clinical staff. With training completed, employees made a personal commitment to work on a patient safety and teamwork based strategies in monitoring, mutual support and communication. “This has been wonderful,” says, Sharon McVey, a West Valley RN. “We need to be efficient and we need to be high quality—this program allows us to be both.”

Communications is key. Using the TeamSTEPPS approach, West Valley has implemented a hospital-wide “Brief” where all clinical department representatives and management discuss the hospital’s “state of operations” for the day. “This is about five minutes or so,” says, McVey. “Our goal is to share important information at the start of the day, so everyone knows what’s going on.” Department specific issues are dealt with in localized department briefs or “huddles”. This allows each department to hone down on what is working well and what needs to change. June 1st, the Emergency Department was the first to implement regular huddles for problem-prone and high risk situations such as Trauma codes, AMI’s, and admissions to Med/Surg.

“We are very excited about the futures,” says Sharon McVey. “We will have our new quarterly new employee TeamSTEPPS trainings beginning in September. We will continue with our newsletters and continue to stress the briefs, huddles and communications.”

“There will be a TeamSTEPPS presentation on November 5th at the Oregon Rural Health Conference,” says Clarke. “This will be a great opportunity for hospitals to learn first-hand how they can benefit from this program.”

Want to learn more? Contact at the Office of Rural Health.

Former Senator Gordon Smith Receives NOSORH Award

Gordon Smith accepts NOSORH Award

Former Oregon Senator Gordon Smith received the Legislative of the Year Award from the National Organization of State Offices of Rural Health. Oregon Office of Rural Health Director Scott Ekblad presented the award to Senator Smith during a luncheon in Pendleton. He received the award along with Senator Edward Kennedy, D-MA. Each year, NOSORH gives the award as recognition of a legislator or policymaker who has been helpful in advancing NOSORH’s legislative agenda. During his tenure as one of Oregon’s two senators, Sen. Smith worked hard to improve health care in rural Oregon.

NOSORH was created in 1998 by the State Office of Rural Health to promote a healthy rural America through state and community leadership. NOSORH promotes the capacity of state offices of rural health to improve health care in rural America through leadership development, advocacy, education, & partnerships.

Changing to Meet Your Needs!

As you know, there are many changes happening in health care every day at the state and federal level. To help you navigate this information, we have implemented a Policy Update page on our website. We will use this page to post the most recent changes and proposed changes that may affect you and your facility.

Did you know that September is

Leukemia and Lymphoma Month

The HRSA 2009 Novel H1N1 Influenza Guidance for HRSA grantees has been updated

The preparedness and response effort to the 2009 Novel H1N1 Influenza Pandemic is ongoing and this webpage will continue to be updated as new and pertinent information is released.

The H1N1 guidance provided through this web page is voluntary. HRSA is providing this to help HRSA–funded programs plan how to best protect their workforce and serve their communities. When products and updates in support of H1N1 pandemic response efforts are released, these will be posted to www.hrsa.gov/h1n1/.

Feedback Needed on Environmental Health Competency Survey

The West Virginia Rural Health Research Center is conducting a study to develop and validate an environmental health competency guide for rural primary care providers. Working with a group of experts, we have developed a draft list of core environmental health competencies needed in order for primary care providers to provide sound health care in rural communities. The next step is to evaluate the competencies for content validity, completeness and clarity. We are seeking feedback on the draft competency list from environmental health, public health, primary care, rural health and other stakeholders. The survey will take approximately 20-25 minutes to complete and is completely anonymous. Please take a few minutes to complete the survey.

ORH Newsletter wants to feature YOU!

Does your organization have a success story they want to share?

or 503-494-4450.