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NC Performance Measures

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PPMD MATRIX FY2020 (19-20) Version 1.1

RHIhub Spotlight

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RHIhub has published two new Rural Monitor stories highlighting the great things that are happening in rural communities across the nation:

  • Making Informed Decisions about Rural EMS – Discusses the EMS Informed Self-Determination Process developed by Kevin McGinnis and highlights the success of St. George, Maine, had in implementing the process. RHIhub learned about this process at a Joint Committee on Rural Emergency Care (JCREC) meeting.
  • Rising from the Ashes: How Trauma-Informed Care Nurtures Healing in Rural America – Features rural communities and healthcare organizations that are a using trauma-informed care approach to help people who have experienced adverse childhood experiences (ACES), sexual assault, and other traumatic experiences.

RHIhub has published several new Models & Innovations:

Three topic guides have been updated:

Save the date for an upcoming webinar on the soon to be released Rural Telehealth Toolkit! Wednesday June 5, 2019 at 12pm Central

Did you know? If you’re hosting a rural health event, you can request promotional materials from RHIhub!

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Committee Clips

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NOSORH committees are great focal points for engaging in many NOSORH initiatives.  Descriptions of all committees and contact information can be found on the NOSORH website.

Aging in Rural- The Aging in Rural Group would like to take this opportunity to thank Scott Ekblad for his vision, passion and facilitation of this Learning Community. His organic facilitation vision provided fertile ground for topics of group interest to grow and relationships to develop. As you may know, Scott retired from the Oregon State Office at the end of April with plans to move to Southern California! We wish Scott well in his next adventure! During the April meeting, the group learned about the Washington SORH Palliative Care work. Pat Justis shared history, details and resources related to this work. The group also briefly discussed the 2019 Prevention Week Planning Guide & Resource Calendar, the Get Connected Linking Older Adults with Resources on Medication, Alcohol, and Mental Health 2017 EDITION, Promoting Older Adult Health – Aging Network Partnerships to Address Medication, Alcohol and Mental Health Problems, and A Day In the Life of Older Adults – Substance Use Facts all from SAMHSA. The next Aging Group meeting is scheduled for July 16 at 3 PM ET.

Communications-The Communications Committee met to provide input on the new theme of the 2019 Partnership Invitation and the Power of Rural – “Plug into the Power of Rural”, the Community Stars book and possible presentation ideas for the NOSORH Annual Meeting. The May meeting has been moved to May 14 at 1:00 pm ET.

Executive Committee – The NOSORH officers met last month to discuss the policy for the Chief Executive Officer performance review, provide direction for future meetings of the Board, moving forward the efforts on the strategic plan and the Power of Rural campaign.

Educational ExchangeThe EE Committee met to review two documents, the SORH Proficiencies Benchmarking Report and the Mentoring program outline, and discuss how the work of the committee may shift to support the new NOSORH strategic plan. Members were asked to provide feedback to NOSORH staff which will be compiled into the final draft. The next meeting of the EE committee will be May 20th at 3:00 pm ET to further discuss future updates to the committee and review the first draft of the workforce proficiency and SORH impact rubrics.

PPMT- The PPMT committee met in April to begin discussing data points to add to the SORH Profiles. Updates were provided on Medicaid work requirements, Association health plans, AHA’s comments on the Hospital Star Rating system and ACA Insurer notice of benefits and payment final ruling. The next meeting will be May 22nd at 3:00 pm ET.

RHC Committee –The RHC Committee is reviewing questions for the RHC Technical Assistance Survey which will be distributed to all SORH mid-summer. The information gathered through this survey helps frame the work of the committee. Another resource that is coming soon is the revised RHC Education Module #1 – An Introduction to the Rural Health Clinic Program. All SORH will receive the revised module link via email, in Roots and another shout out in the Branch. The Committee heard from our NARHC Partner, Nathan Baugh, about the RHC Modernization Act legislation introduced a few weeks ago. Nathan is working toward having a strong advocate champion for this legislation in every state. If you have a contact (Hospital CEO, RHC individual, etc.) that might represent the work of RHCs in your state, please reach out to Nathan directly via email (baughn@capitolassociates.com).

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TruServe Update

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NOSORH and TruServe will be hosting a TruServe Roundtable on May 15th at 3pm Eastern. This will be a unique opportunity for TruServe users to provide input and suggestions to make TruServe a more user friendly experience. Questions for consideration will be sent out prior to the session. Click here to register.

The next TruServe training will be held on Wednesday, May 22nd at 2:00pm Eastern.
Webinar link: https://undmed.webex.com/join/mark.barclay
Dial into: 1-415-655-0002, passcode 921 776 408#

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Policy Update

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The following update was provided by Hall Render, NOSORH Policy Liaison:

FY 20 Spending Bills Introduced in Congress
On April 29, the House Labor-HHS Appropriations Subcommittee introduced their fiscal year (FY) 2020 spending bill. The bill provides $12,500,000 for the State Offices of Rural Health, a $2.5 million increase over FY 2019 funding. Also included in the spending bill is $59 million for Medicare Rural Hospital Flexibility Grants and $19,942,000 for the Small Rural Hospital Implementation Grant Program. The House subcommittee meets on April 30 to advance the spending bill to the full House Appropriations Committee.  The Senate Labor-HHS subcommittee is expected to introduce their spending bill in May. Funding for FY 2020 begins on October 1, 2019.

CMS Proposes Changes to How Rural Hospitals Are Paid
On April 23, CMS issued its proposed hospital inpatient payment update for fiscal year 2020. In particular, CMS proposed changing the formula to reimburse rural hospitals. The proposal changes how it calculates the Medicare wage index to limit the disparity between what high-and-low-wage index hospitals get paid. If implemented, the rule would increase the wage index for hospitals below the 25th percentile, and decrease the wage index for hospitals above the 75th percentile. The proposal would be in effect for at least four years starting this October. Decreases in a hospital’s wage index would be capped at five percent for FY 2020.  The Medicare wage index has long been a source of frustration for Congress. The deadline for submitting comments on the proposed rule is June 24, 2019.

House Committee Advances Legislation to Bolster ACA
During the first week of April, the House Energy and Commerce Committee advanced six measures intended to bolster the ACA. The measures include more funding for state-based ACA marketplaces, federal navigator programs and a reinsurance bill intending to lower ACA premiums (H.R. 1385, H.R. 1386, H.R. 1425).

The three other measures passed are focused on Trump administration policies aimed at changing the ACA: H.R. 1010 reverses the administration’s expansion of short-term health plans; H.R. 986 requires the administration to rescind guidance that made it easier for plans to soften protections for pre-existing conditions; and H.R. 987 that would restore ACA outreach and enrollment funding.

This legislation was advanced hours after the House passed a resolution condemning the Trump administration’s decision to support a federal court case in Texas that repeals the ACA. In a 240 to 186 vote, the House passed a resolution calling on the Justice Department to “halt its new advocacy for abolishing the Affordable Care Act,” which the measure calls ‘an unacceptable assault’ on Americans’ health care. The resolution is largely symbolic, as the Republican-led Senate will not advance the measure.

Rural Health Bills Introduced this Month
Sen. Shelley Moore Capito (R-WV) introduced S. 1190 to amend Title XVIII of the Social Security Act to provide for payments for certain rural health clinic and federally qualified health center services furnished to hospice patients under the Medicare program. The bill would remove a statutory barrier in current law that inhibits seniors’ access to hospice in rural communities, allowing them to receive hospice from their local primary care practitioner. The bill seeks to allow RHCs and FQHCs to receive payment for practitioners’ services while caring for their patients in hospice care.

Sen. Todd Young (R-IN) introduced S. 1045 to amend the Public Health Service Act to expand the authority of the HHS Secretary to permit nurses to practice in health care facilities with critical shortages of nurses through programs for loan repayment and scholarships for nurses.

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Promising Practice: Innovative Program Teaches Colorado Providers to Be Rural Leaders

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By Beth Blevins

Teaching rural providers to be better advocates for their patients and their communities was the goal of an innovative program conducted recently by the Colorado Rural Health Center (CRHC) in partnership with the Center for Creative Leadership (CCL).

“Through the Rural Colorado Primary Care Leaders (RCPCL) program, we worked to educate 48 rural primary care providers on how to create grassroots advocacy efforts in their community,” said Michelle Mills, CEO of CRHC. “The ultimate goal of the program was to create a peer network of rural providers in the state.”

“CCL approached us after they received a grant from the Colorado Health Foundation (CHF),” said Sara Leahy, CRHC Director of Business Development. “Some of CCL’s staff members had worked with another State Office of Rural Health, and one of CCL’s headquarters is in Colorado Springs,” Leahy explained. “With this program, their goal was to work with primary care providers—MDs, DOs, advanced practice nurses, physician assistants, dentists, and dental hygienists—who practice in rural areas of Colorado.”

The CHF grant covered the $10,000 tuition for each participant, as well as travel expenses, lodging, and meals, Leahy said.

CRHC helped find the program participants. “We started off with targeted marketing to clinics and practices that were engaged with CRHC, then expanded our marketing to a broader outreach to all our membership,” Leahy said.

The participants met in three different learning sessions over the course of a year, Leahy said. “Each session was divided into two cohorts, so that two providers from the same practice could participate.”

The first session, held July 2018, focused on participants’ communication styles, teaching them practice tools like giving and receiving feedback, Leahy said. The second session, held November 2018, worked to improve their ability to lead others and to work collaboratively, she said. The third session, which took place over two days in March, helped the providers develop policies to lead their community, she said.

At that last session, Kelly Erb, CRHC Policy Analyst, spoke about public policy in Colorado. “We discussed the budget and the big bills that are currently moving through the legislature,” Erb said. “Then we discussed how providers can actually participate—whether through developing grassroots activities, writing letters to the editor, hosting community meetings, or testifying at the capital. We explored all the opportunities they have to interact with the political system both locally and on a state level.”

By the third session, participants also had completed a Capstone project, Leahy said. “The aim of the Capstone project was for them to make an impact on policy that affected their own local town and community—something that would affect not just themselves, not just their practice, but everyone that they touched base with.” Each participant had a coach who worked with him or her a few times a month on those projects, Leahy said.

Colorado providers who participated in the RCPCL program gather at the state capital in March to meet with their legislators.

On the second day of the third session, participants were able to put their Capstone projects—and all they had learned in the RCPCL program—into action. “We brought all the providers to the state capital, where we set up meetings with their local representatives and with the state health committee,” Mills said. “It really gave them an opportunity to use those leadership skills they had learned in the program.”

In addition, Leahy said, the group was split into house districts, and within those small groups they brought forward three to five talking points to discuss with their policymakers. “They did a great job of planning who would talk, and making sure they went in there with ideas and objectives,” Leahy said. The topics they discussed that day included increasing access to quality broadband in rural areas, support of more equitable and adequate payment to rural facilities from Medicaid, and integrated care barriers with telehealth, Leahy said.

“Ultimately we prepped them to say, ‘this is the beginning of a relationship, and we’re going to be resources for one another,’” Leahy said. One provider was so comfortable with the visit that he ended up taking his state senator out to lunch, Leahy added.

Though the RCPCL sessions are over, Leahy said the effects of the program will continue. “That last day, even though the program had wrapped up, folks talked about how they can continue to work collaboratively with one another,” she said. “They want to stay engaged.”

“The providers have created a relationship with their local policymakers and are now empowered to use that relationship in advocating for issues important to them,” Leahy continued. They also can use those skills locally, with their own colleagues, she said, “in activities like building short-term and long-term strategic plans for their clinics.”

“This program was super helpful in engaging the providers, and I think that it will trickle down to the community level, giving them more of a presence within their communities,” Mills concluded.


Does your SORH have a “Promising Practice”? We’re interested in the innovative, effective and valuable work that SORHs are doing. Contact Ashley Muninger to set up a short email or phone interview in which you can tell your story.

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Regional Meeting Sessions to be Recorded

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The Regional Meeting season starts next month! The 2019 meetings will feature more diverse topics and structured one-on-one time with the SORHs, creating a great environment to share ideas, seek help, promote success, and most importantly, learn from each other. All five regions will hold either a pre or post meeting on various topics, and one session at each regional meeting will be recorded. The recordings will then be made available for listening as part of the meeting resources. Sharing these sessions is just one more way to provide value to SORH by communicating ideas and information across the regions. As final agendas are being prepared, please click here for up to date information about each meeting.

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CMS Moves Forward with New Arrangements for Medicare Providers

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Last week, CMS released information on a set of five new voluntary Accountable Care arrangements for Medicare PPS providers. Fact sheets and descriptions of each of the programs are provided on the CMS website. In a conference speech, CMS Administrator Seema Verma outlined the new program and noted thatLooking forward, you can expect that some of the models we have under development will be mandatory. One reason for mandatory models is that selection effects can be significant in voluntary models.  Selection effects happen when only the providers who would benefit financially from a model choose to participate, thereby reducing the amount of savings that the model can generate. Requiring participation also helps us understand the impact of our models on a variety of provider types, so the data resulting from the model will be more broadly representative.”

The arrangements are broken into two categories termed Primary Care First and Direct Contracting. The Primary Care First models can be implemented with as few as 125 Medicare patients. Note that the models may be limited to selected regions of the country. The Direct Contracting models are more varied, but may also have applicability in rural health systems. Both sets of arrangements are planned for the future, with many of the details still to come. Participants will be selected for a development year – 2020 – with implementation of the model in 2021.

Harvey Licht of Varela Consulting shared some insight with NOSORH leaders stating that “The primary care focus of this arrangement makes it particularly applicable to rural health systems. The two alternative Primary Care First arrangements may have wide applicability. Basically, the approach is to make a global primary care payment per patient and then to provide additional bonuses based upon specific cost and health quality outcomes. There is also a risk-bearing component, placing providers at some level of financial risk for failure to achieve outcomes. The financial risks appear to be more limited than the current risk-bearing ACO arrangements.”

The NOSORH staff, committees and partners are planning resources and education for State Offices of Rural Health and their stakeholders. The NOSORH Policy and Program Monitoring Team meeting on May 22nd at 3 PM eastern will provide a discussion forum for SORH.

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RHIhub Spotlight

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The RHIhub recently published a new program model in our Models and Innovations. The School-based Drug Misuse Prevention Program was implemented in an Appalachian Ohio school system, grades K-12. Following implementation, the community experienced no new school-aged overdose deaths.

We’ve also recently updated several of our Topic Guides:

Speaking of grants, we’ve also updated the section of our website where we provide assistance in using our funding resources and services. This includes guidance on finding opportunities, determining a location’s rural eligibility, and finding data, research, and resources to support program development and grant applications.

We also have two new articles in the Rural Monitor:

In case you missed it, we have archived versions of recent webinars and a recent Twitter chat:

Did you know?

In addition to RHIhub Models and Innovations, we also feature a wide range of case studies from other organizations. Check them out!  

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Committee Clips

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NOSORH committees are great focal points for engaging in many NOSORH initiatives.  Descriptions of all committees and contact information can be found on the NOSORH website. 

Executive Committee –The committee met in March to plan for the follow up on the NOSORH strategy for 2019-2022, governance and committee structure and planning for the May, 2019 Board meeting.

Development- The Development Committee is actively working on the annual Sponsor Prospectus with a target distribution of mid-April. The Scope of Work and Compensation Survey Results can be found on the NOSORH website in the Members Only – Reports page. If you have interest in joining the Development Committee, please reach out to one of the committee co-chairs, Kylie Nissen or Graham Adams.

Policy Program Monitoring Team- The PPMT committee met on March 20th with a full agenda including a review of comments to CMS on the Hospital Star Rating system and a discussion on the new Medicare Emergency Triage, Treat, and Transport (ET3) model. More information on the ET3 model can also be found in the CMS Ambulance Open Door Forum. The next regular meeting of the PPMT committee will be Wednesday, April 24th at 3:00 pm ET. The comments submitted to CMS regarding the Hospital Star Rating can be found on NOSORH’s website, here.

JCREC- the members of the Joint Committee on Rural Emergency Care met last month to share organizational updates, discussed CMS/CMMI reimbursement changes relating to the ET3 and how to leverage National Rural Health Day to bring attention to rural EMS innovation and collaboration.

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