The precursor to today’s Rural Health Clinics Committee began as a task force in 2009 as the NOSORH funded and organized RHC TA Team (Rural Health Clinics Technical Assistance Team). The group began by assessing what SORH across the nation were doing to support RHC. As they evolved; the team realized that SORHs needed resources and TA as well “so they could become a more valuable partner and resource person for the RHCs in their state,
“NOSORH is fortunate to have SORHS that are well-versed on RHCs. Several take an active role in TA, and some deliver services to the RHCs.” Gloria Vermie, IA SORH Director, credits those SORHs along , consultant Rita Salain (former SORH Director) and the NARHC with shaping the NOSORH effort. The group developed the first RHC Toolkit with distinct modules. As RHCs grew in number nationally, their value and potential became evident.
Citing “the growing interest in RHC nationally”, Vermie proposed the NOSORH Board approve the RHC TA task force, become a committee. Since September 2013, group has been meeting as a NOSORH committee. Some of the committee actions are to continue SORH education, develop RHC resources, and support efforts to obtain funding that will better assist SORHs in their efforts and involvement with the RHCs. The RHC committee will host a pre-conference at NOSORH’s annual meeting in October to educate state offices about RHCs. “Everyone is invited and our goal is to have as many people as possible come out to learn about RHCs.” Vermie said.
“Not all SORHS have RHCs in their state and the level of involvement with RHCs varies from state to state,” Vermie said. “However, SORHs are a resource and a partner to any rural clinic not just RHCs”. “There is opportunity to enhance access to quality health care through supporting RHCs as they travel the health care transformation highway,” she added, “the potential for RHC to collect valuable date and to help integrated and expand health primary care are just the beginning. Without duplicating efforts SORHs can take a role that assist capacity building for RHCs, similar to how the FLEX program assists CAHs.
Back to July Branch
As part of NOSORH’s continuing work to build the technical assistance capacity of SORHs to serve rural health clinics (RHCs), the NOSORH Rural Health Clinic Committee is updating the NOSORH-SORH RHC Work Survey. The survey looks at the wide range of technical assistance (TA) that SORHs provide to RHCs. The goal of the project is to help SORHs conduct some level of TA for RHCs, and to understand the opportunities to expand the capacity of SORHs and their partners. The RHC Committee requests that SORHs complete the Survey by May 9th. Completion should take less than 15 minutes. Survey results will be shared in June. The survey is available at: https://www.surveymonkey.com/s/SORH_RHC_TA_2014.
Back to May Branch
Peer-to-peer sharing is one of the benefits of the Michigan Rural Health Clinic Quality Network (MI RHC QN), sponsored by the Michigan Center for Rural Health (MCRH). What started as a small, informal quality network with only 15 active members in June 2011 has continued to grow and gain enthusiastic members. Today, representatives from over 50 of Michigan’s 170 clinics participate in the network and attend its quarterly meetings held in Mt. Pleasant, Mich.
“When members want to talk about quality improvement initiatives in their clinics, we make sure they’re on the agenda,” said Crystal Barter, MCRH Health Systems Development Coordinator, who coordinates the network. “It doesn’t matter what initiative they choose, as long as it has made an impact in their clinic and they feel their peers would benefit from listening to it.”
The quality network is part of the MCRH’s recent effort to ramp up their work with RHCs, which also includes a focus on ICD-10 and practice management, according to John Barnas, director of the MCRH. In the past year, MCRH has been going through a process of getting clinics to collect a cohesive set of data, Barnas said. This has become increasingly important because insurance companies are giving RHCs incentive payments based on data and because of the implementation of meaningful use standards for Medicaid patients.
MCRH looked at a core group of RHCs in the quality network and compared what they were doing with various initiatives, and came up with a set of Quality Assessment Performance Improvement Measures. The measures include three core measures that network members must collect at minimum—for high blood pressure, tobacco use, and BMI (body mass index). (An Excel file of the measures is available on the RHC section of the MCRH web site).
Participation in the MI RHC QN and its quality collection is voluntary. “There’s no monetary incentive right now,” Barnas said. “These people are driven to do the right thing. We pay for their travel and buy them lunch. They like having the chance to get together. But we think eventually CMS is going to require this type of thing—to prove you’ve had some kind of impact.”
If other SORHs are interested in sponsoring a RHC quality network, Barnas suggests that they use their annual rural health conferences to convene a meeting for it. There’s a tool already out there for them to dump and track their data in real time, he said, called Quality Health Indicators (QHi).
The Georgia and Alabama State Offices of Rural Health (SORHs) have been working together to help provide training and technical assistance to the 165 Rural Health Clinics (RHCs) in their states, which lack RHC associations. The SORHs are also engaging with their state rural health associations (RHAs) in the effort.
Over the last three years, RHCs in Georgia identified three issues they were struggling with: HIT implementation, technical assistance and ICD-10 conversion, according to Charles Owens, director of the GA SORH. There is no RHC association (RHCA) in the state, and Owens describes the RHCs there as “low-hanging fruit—under-represented, and begging for resources and technical assistance.
“So, in Georgia, we started hosting RHC meetings,” Owens said. “We then realized we could work with Alabama—I’m not sure who called who first. We frequently talk with the AL SORH about different issues since our states are similar and we have borders that cross over the state line.” The multi-state NOSORH networking funding was instrumental in moving them to the next level of collaboration, Owens said.
The first AL-GA RHC Conference was held in Opelika, Ala., last summer. The conference has been followed by a series of webinars that focus on RHC technical assistance. The first was on RHC compliance and regulation, the second was on RHC billing, and the last webinar, which will be held on December 10th, will be on RHC Medicare bad debt.
“Alabama would like to partner with Georgia to have another joint conference,” said Rob Boyles, Rural Programs Coordinator and Recruiter at the AL SORH. “However, funding is the main barrier. The joint conference in June would not have happened without the grant funding provided by NOSORH.”
Another barrier with multi-state collaboration, Owens said, is geography, particularly in larger states. “Georgia and Alabama border each other, but our RHCs in the extreme north points and the east coast of Georgia were reluctant to travel all the way across the state.” But, he added, the benefit of multi-state collaboration is “learning from nontraditional sources—it’s not the people you hear from everyday. So that’s why a lot of people, including the federal government, are encouraging us to do this.”
As a result of conference participant feedback, Boyles said, it was apparent that Alabama RHCs also desire training opportunities, particularly on ICD-10. The GA and AL RHAs, in coordination with the Association of Rural Health Professional Coders, have provided two, one-day training sessions. The AL RHA will also provide two, multi-day ICD-10 “bootcamp” sessions after the first of the year. (The AL SORH has had a special training tract for RHCs in its annual rural health conference for the past two years, co-sponsored by the AL RHA.)
Owens thinks that other SORHs should consider reaching out and supporting their RHCs when there is no state RHCA or when those associations are struggling. “This is something that SORHs can do and NOSORH can help with.” Owens said. “In the Southeast, the RHC organizations are small and struggle with finances, so it’s very reasonable that SORHs could serve those RHCAs, especially since they are never going to be very large administratively.”
The Colorado Rural Health Center (CRHC) is helping rural health clinics (RHCs) in the state improve business operations and move into quality improvement activities with their Healthy Clinic Assessment (HCA) program.”
With HCA, we go in and do a basic assessment of operations of the clinic,” said Michelle Mills, CRHC CEO. “Then we put together an action plan on where they need to make improvements, and what they are doing well. This strengthens the foundation of the clinic and allows them to focus on bigger, greater things like quality improvement, collecting data in disease registries, or focus on gaining patient-centered medical home (PCMH) status and other care transitions. We’re trying to create synergy for all the things we do for folks. It’s exciting.”
Three CRHC staffers are assigned to work specifically with the clinics. The HCA is a four-to-six hour process that is done on-site. CRHC staffers interview all clinic staff and providers, and then present a de-briefing at the end of the workday about what they have heard and seen. Mills said that CRHC staffers later return to the clinic, going over their findings and helping them put together an action plan.
“So far we’ve done 80 HCAs over the last four years,” Mills said. “We have a little over 50 federally-certified RHCs and over 50 rural clinics in Colorado—so we still have a ways to go. It’s a voluntary process—clinics don’t have to take part. And they don’t have to do anything with the data we provide them. It’s a free service, an initial touch to help them move forward. But our hope is that they will want to move forward—for the betterment of the clinic and the community itself.” Mills said that the HCA supports the goals of the Affordable Care Act because it focuses on making sure that rural communities there are prepared to move toward the Triple Aim (increased access, improved quality and reduction in cost).
Clinics that want to can go on to the next step, CRHC’s iCare (Improving Communications and Readmissions) project, which has the goal of reducing readmissions. Right now, Colorado hospitals and clinics enrolled in iCare are concentrating on collecting data and putting systems and processes in place to improve quality.
“Of those we’ve helped make improvements with HCA, 15 are participating in iCare,” Mills said. “And two in our state have achieved PCMH status. We hope that all clinics sometime in the future will move toward PCMH, but it’s a long road and takes a huge amount of commitment. But while they’re doing this, we’re also helping all the clinics and hospitals achieve Meaningful Use Stage 1 status.”
John Gardner, CEO of Yuma District Hospital and Clinics, said that the HCA helped his organization make big improvements in the last four years. “CRHC approached me asking if we would be interested in participating in the Safety Net PCMH project funded by the Commonwealth Foundation,” Gardner said. “Honestly, I really did not have much knowledge of the PCMH movement and determined that it was worth exploring. After much work, and significant changes in our organizational culture, we were certified as an NCQA Level 2 Medical Home. This has been a great opportunity for our two clinics. I am thankful that CRHC invited us to participate in the project.”
Mills will be presenting information on the HCA program at an Institute for Healthcare Improvement conference on improving patient care in March.