We are almost there folks, National Rural Health Day is tomorrow! National Rural Health Day (NRHD) is special because we are so busy doing the work that needs to be done that we don’t actually take a step back and look to see what has come out of that work. NRHD gives us that chance to take a breath, look around, and give ourselves, our partners, and our communities, a collective pat on the back for a job well done. It has been amazing to watch all of the different events, such as handing out awards, farmer’s markets, governor’s proclamations and signing ceremonies, photo contests, blogs, press releases, and rural health videos, being announced and distributed. That, by no means, covers everything that is being planned, but it goes to show that not only do we have a passion for the work being done, but that there is a need to shine a light on all of these accomplishments. When reading these rural health success stories, I’m sometimes taken aback by how diverse and innovative we can be when dealing with the healthcare needs of our rural communities.
We celebrate NRHD each year with the hopes that we will bring attention to the 62 million people who live, work, and play in rural communities across America. I know that even though I will be sitting here in my office working on the webinars on Thursday, I’ll be wearing my NRHD button with pride, answering my phone with, “Happy National Rural Health Day!” and tweeting and posting to Facebook with the hashtag #powerofrural. I will be looking forward to seeing all of the events pan out and all of the celebrations enjoyed by those participating.
We have a full day of webinars planned to highlight all the great work being done in the state offices and with our partners around the country. We will be joined by our partners at AgriSafe, RAC, 3RNet, and NCHN to name a few. We will also have Dr. Mary Wakefield joining us for the “ACA and You” webinar highlighting the start of open enrollment and the partnerships that ORHP is currently a part of. We will also be joined by several SORHs from around the country who will be calling in to talk about the events they have planned and about the partnerships and great work being done in their states and how they have positively impacted the lives of those in their states. That is what this day is about, and I hope you will take the time to join us and pass along the word. Again, thank you all for everything you have done to make National Rural Health Day 2014 a success.
Special Projects Coordinator, NOSORH
By Sally Buck, CEO
It is an exciting time for the Medicare Rural Hospital Flexibility (Flex) Program state grantees and partners as we recognize the program has reached its sweet 16, which is to say 16 years in existence. The Flex program was born as part of the Balanced Budget Act of 1997 to provide funding to states for the designation of critical access hospitals (CAHs) in rural communities and allows hospitals to be reimbursed on a reasonable cost basis for inpatient and outpatient services provided to Medicare patients. There are now 1,326 CAHs in the Flex program that play an essential role in sustaining rural health care.
The National Rural Health Resource Center (The Center) has the pride of a parent seeing their “child” reach this milestone of 16 years. Terry Hill, former Executive Director of The Center, was involved in the initial development of the Flex Program with the Federal Office of Rural Health Policy (FORHP) to support small rural hospitals in the conversions, development of networks, quality improvement and financial stabilization. Through a contract, The Center established an innovative technical assistance model: Technical Assistance and Services Center (TASC) in 1998 to provide information and education about Flex to the state grantees and their partners.
In the infancy, TASC supported the states with development of rural health plans and creating “any necessary provider” rules, financial feasibility tools for assessing conversions. Through the toddler years, TASC provided state Flex grantees with education on cost reports, establishing networks for care transitions and quality improvement. It’s hard to imagine, but when we started, we didn’t have webinar technology, and the webpages were often static pages without search functions.
By the 10 year mark, the Flex program had moved into CAHs with swing beds to accommodate post acute care services. The “any necessary provider” rules reached their sunset, and conversions to CAH status dramatically declined. Flex programs and TASC mobilized to support CAHs to trauma designations through emergency medical services (EMS) and CAH training and regional planning. With a decade of experience, TASC, the Flex Monitoring Team (FMT) and state Flex programs worked together to provide CAHs with more data about the financial, quality and community engagement status within their state and nationally. Hospital Compare was launched by the Centers for Medicare & Medicaid Services (CMS), and although CAHs weren’t required to report quality, hundreds of performance indicators became more important for all hospitals.
As the Flex program reached the awkward stage of the teenage years, the grantees adapted to new reporting requirements, and outcome-focused work plans. CAHs were watching the transformation of health care payment models evolve without a small volume option. A new initiative, the Medicare Beneficiary Quality Improvement Program (MBQIP) was introduced by FORHP in 2010 to increase quality reporting by CAHs with rural relevant measures and data to spur quality improvement efforts. This was a critical activity as CAHs were experiencing some bullying about their performance. With MBQIP, the Flex program has dramatically increased quality reporting by CAHs and states have implemented a number of initiatives to improve patient safety, satisfaction and patient outcomes.
Now at 16 years of age, Flex is developing a vision of what it will become in the future as a mature program and what impact Flex, with over 1,300 CAHs, will have on rural health care in the U.S. and the thousands of communities served. With the changes in health care delivery and payment, the Flex Program needs to continue to share best practices, learn from peers and experts to ensure small rural hospitals can continue to improve care and the health of rural communities and reduce costs. Happy Sweet 16 to the Flex Program, and best wishes for many more successful years to come!
On April 28-30, I had the opportunity to attend the National Oral Health Conference in Fort Worth, Texas. This meeting was an eye-opening opportunity! I learned a lot about oral health issues and many ways in which State Offices of Rural Health (SORH) and oral health providers can collaborate to improve access to oral health care in rural communities. I highly recommend this conference if you ever have the chance to attend or, better yet, give a presentation about oral health projects that you are working on.
Amy Martin, PhD and Mark Doherty, DMD, MPH, gave an inspiring presentation, “Taming the Frontier: Bringing Oral Health into Rural Health” that I’m hoping to replicate in a webinar for NOSORH members. They talked about how they’ve partnered with the South Carolina Office of Rural Health to improve access to dental care in that state. Their session had many in the
audience asking, “How do I get in touch with my State Office of Rural Health?” As a result, you may be hearing from folks who’d like to partner with you on oral health initiatives.
During the conference, I had the opportunity to address the Board of Directors of the Association of State and Territorial Dental Directors (ASTDD) and to lead a roundtable discussion about partnering with NOSORH and SORHs. I left with a number of ideas for webinars to share with you what I learned. These are some of the areas that we seemed to have common interests: partnering to achieve common goals, including facilitating collaboration with Primary Care Associations (PCAs), and supporting alternative pathways to access through innovative models, including new allied dental health provider models.
If you’re interested in learning more about the event, visit the following website: http://www.nationaloralhealthconference.com.
Education and Service Director
As all of you know, here at NOSORH we have been working on our new website, and today is the day we go live. Before I get into the details of the new website I would like to thank the University of North Dakota staff, especially Maren Niemeier and Julie Arnold, the Communications Committee and the other NOSORH staff, for all of their input and time spent making sure we captured every last detail to make this website launch a success.
We have been giving you updates about the new site throughout the past few issues of The Branch and now it’s time for you to see it yourself. Some of the pages you will notice are the same, but some have moved or been consolidated. Within the pages themselves you will see our new “key issues” feature. On the right side of the inside pages you will be able to click on any issue and see every resource that NOSORH has to offer. It works as a word gram, the larger the word, the more content. Don’t let the small words fool you, we have added content, so that even some of the smaller words have a good deal of resources.
One of the great things about our new site is how interactive it can become with your help. One of the new features of the website is the NOSORH Blog. If any members would like to volunteer to post to the new NOSORH Blog, please contact Matt Strycker, firstname.lastname@example.org . It doesn’t matter how short or long the Blog, all input is welcomed. With this Blog comes the opportunity to comment and discuss issues among ourselves. Please remember when posting comments, because we do not have unique log-in’s, you will need to place a signature on your comment. This will help us maintain a robust conversation!
NOSORH will be running the ListServs going forward. You will find those new addresses under the “Member Resources” tab, under “Using the NOSORH Website and ListServs”. Some of them have changed so please check before sending any information out on them.
Lastly, we would like all of members to please find your State Office in the Directory, and make sure that all information is up to date. We have done all we can to make sure that all of those contacts have transitioned over. We will still need your help to make it accurate and reflect the work of your SORH. For any changes, please contact Donna Pfaendtner, email@example.com .
Again, thank you to everyone who has helped make this launch a success. This is just a start we may have a few bugs to work out. Let us know what you find and send me a note about what you think about the site.