wisconsin office of rural healthrwhc.com/mediasite/miller flex overview rhc 11 09 powerpoint.pdf ·...
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Rural Hospital Flexibility Program &
RHC Update
Wisconsin Office of Rural Health
Kathryn Miller
Rural Hospitals & Clinics Program Manager
Wisconsin Office of Rural Health
November 2009
Wisconsin Office of Rural Health
www.worh.org
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Wisconsin Office of Rural HealthWorkforce• Full time Physician and Dentist Recruiters• (Allied) Health Careers Website• Loan Assistance Program• WI Academy of Rural Medicine (WARM)
Rural Hospitals/Clinics/EMS• Flex Program• SHIP Program
Informational Resource• Fed/State/Regional research• Daily News Feed
Wisconsin Office of Rural Health
www.worh.org
• Daily News Feed• Website of resources• Training series online
Rural Communities• Rural capacity building• Strong Rural Communities Initiative • Rural Health Development Council• Health Information Technology
Advocacy (Federal, state and regional)• Connecting independent efforts• Academic/community partnerships
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Program Basics: State Flex Programs 101
• Health Resources and Services Administration, Office of Rural
Health Policy administers the Flex Program nationally
• Program guidelines focus on:
– Quality Improvement (QI)
– EMS Integration
– Network Development– Network Development
– Supporting and Sustaining CAHs & RHCs
– Rural Health Planning
– Program Evaluation
• 45 states participate annually
Wisconsin Office of Rural Health
www.worh.org
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Critical Access Hospitals Rural Health Clinics
59 CAHs in Wisconsin1,298 CAHs Nationwide
47 Certified RHCs in Wisconsin Over 3,000 RHCs Nationwide
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Rural Health Clinics Needs Assessment
• WORH contracted with Rural Health Solutions
• Assessment conducted from Feb – July 2009
• Purpose: To better understand the operations of RHCs in WI: RHCs’ unique and shared strengths, weaknesses, issues and concerns
Wisconsin Office of Rural Health
www.worh.org
weaknesses, issues and concerns
• 21 interviews conducted with 28 staff
• 39 of 47 RHCs (83%) in WI represented
• Some of the RHC staff represented more than one clinic during the interview process
• Interview included 1-4 RHC staff
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Rural Health Clinics Needs Assessment
Questions Asked:
• Recruitment and retention needs of RHCs?
• How are RHCs being operated and staffed?
• What types of services do RHCs provide: behavioral, oral, vision?
• What are the working relations of RHCs?
Wisconsin Office of Rural Health
www.worh.org
• What are the working relations of RHCs?
• Health information technology status of RHCs?
• What quality improvement initiatives/strategies are being
implemented at RHCs
• What do they need to advance quality and patient safety?
• What are the strengths and challenges of Wisconsin’s RHCs?
• How should RHCs be supported to best meet their needs?
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RHC Needs Assessment Findings
Finances:
• Over half are experiencing a financial loss
• All RHCs interviewed stated they do NOT have a grant-writer on staff
Wisconsin Office of Rural Health
www.worh.org
grant-writer on staff
• Provider-based RHCs reported stronger financial viability
• Increase in wait times for payment from MA and Medicare
• No RHCs reported having billing or coding issues
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RHC Needs Assessment Findings
Oral/Behavioral/Vision Services:
• Only one reported provision of behavioral health services
• None reported provision of Oral Health or Vision
Wisconsin Office of Rural Health
www.worh.org
• None reported provision of Oral Health or Vision Services
• Physicians ARE providing some behavioral services such as prescribing medicine
• RHCs refer patients for oral, behavioral and vision health services on an as-needed basis
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RHC Needs Assessment Findings
Health Information Technology:
• 41% of RHCs report having purchased an EMR
• 18 RHCs are planning for their EMR
• 7 are implementing an EMR
Wisconsin Office of Rural Health
www.worh.org
• 7 are implementing an EMR
• 10 have completed implementing an EMR
• Some are reporting that they have been unable to find an EMR that meets hospital AND clinic needs
• Several commented that their HIT staff have limited to no formal IT training
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RHC Needs Assessment Findings
Workforce Recruitment/Retention:
• 38% report they are recruiting at least one physician, and have been recruiting for an avg of 18.6 mos
• No RHCs reported workforce retention as an issue
Wisconsin Office of Rural Health
www.worh.org
• No RHCs reported workforce retention as an issue
• RHCs most frequently report using their hospital affiliate or a recruitment firm to meet recruitment needs
• Medical assistants and nurses were the most commonly identified hard-to-fill positions
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RHC Needs Assessment Findings
Needs:
• All RHCs report having grant writing training needs
• RHCs that have not completed the implementation of EMR expressed a need for additional EMR support
Wisconsin Office of Rural Health
www.worh.org
EMR expressed a need for additional EMR support
• Remote training options (such as Webinars)
• Provider recruitment
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RHC Needs Assessment Findings
Greatest Challenges:
• Health care provider relations
• Health care provider recruitment
• Health care provider isolation
Wisconsin Office of Rural Health
www.worh.org
• Health care provider isolation
• Financial viability of the clinic
• Increasing unemployment & bad economy = communities that cannot afford health care services
• Increasing demand for free/discounted health care
• Delayed payment from Medicare, MA, other payers
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RHC Needs Assessment Findings
Greatest Challenges:
• Health Information Technology
• Clinic Practice Management
• Maintaining survey & licensing requirements
Wisconsin Office of Rural Health
www.worh.org
• Maintaining survey & licensing requirements
• Medicare’s lack of coverage for preventative services
• Lack of integration between hospital & Clinic
• Routine injections that are not billable when there is no reason to see a Physician
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Supporting and Sustaining CAHs & RHCs• Workshops and training
• HIT training, planning, networking
• Community Grants
• Quality Improvement Initiatives
How can WORH Help?
• Quality Improvement Initiatives
• Technical assistance: Regulations, Reimbursement
• CAH Relocation assistance & support
• Cross-Collaboration: CAHs, RHCs, EMS
• Listservs: CahCoalition, CAH Nurses, CAH Financial Managers, RHCs
Wisconsin Office of Rural Health
www.worh.org
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How can WORH Help?
Grants Writing Resources• Grant Workshop: How to Succeed in Securing
Grants: Held in August & September: http://www.worh.org/Ruralwork
• Rural Community Development Blog http://www.worh.org/CommunityBlog/, authored by
Wisconsin Office of Rural Health
www.worh.org
http://www.worh.org/CommunityBlog/, authored by Kevin Jacobson, WORH’s Rural Communities Program Manager
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Quality/Performance Improvement
• Collaboration with WHA
• 4 on-line Modules featuring: Lean, Six Sigma & The Model for Improvement
• http://www.worh.org/Ruralwork#present
How can WORH Help?
Wisconsin Office of Rural Health
www.worh.org
Other QI Projects:
• The Wisconsin Pressure Ulcer Prevention & Reduction Project
• The Rural Hospitals Stroke Improvement Project
• Reduction of HealthCare Acquired Infections
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Health Information Technology
Contracting with RWHC in 2009-2010 Grant Year
• Weekly monitoring of HIT/TeleHealth/Stimulus News
• Dispersal of information via an informational website (currently being built)
• Monthly report to all interested parties
How can WORH Help?
HIT “Certificate” Program
• Have held preliminary meetings with Technical College, examining the possibility of developing an HIT Certificate Program
• The concept of “growing your own” HIT experts
Wisconsin Office of Rural Health
www.worh.org
• Monthly report to all interested parties
• “How CAHs Can Prepare for the Stimulus” Webinar
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Workforce Recruitment
How can WORH Help?
New Physicians for Wisconsin Program• Physician Recruiter Randy Munson
Health Professions Loan Assistance Program• Kevin Jacobson [email protected]
Wisconsin Office of Rural Health
www.worh.org
Club Scrub• Collaboration with the Rural WI Health Cooperative
• Goal: “Grow your own” Healthcare providers
• Targets Middle-school students
• Provides a “sampling” of different health professions
• Available for download on the WORH website
• http://www.worh.org/ClubScrub
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Rural Health Clinics “FAQ” Manual
• Contracting with Rural Health Solutions
• Will include topics such as: rules, regulations, staffing & reimbursement
How can WORH Help?
Wisconsin Office of Rural Health
www.worh.org
staffing & reimbursement
• Will incorporate and address the questions/issues that arose from the Needs Assessment
• Designed for use by RHC providers, RHC staff, and other entities interested in starting an RHC or pursing RHC certification
• Targeted for completion July 2010
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Rural Health Summit
• Held in April 2009 in Wisconsin Dells
• 110 participants
• Representation from all rural healthcare “sectors:” CAHs, RHCs, EMS, Public Health, CHCs, Long Term Care, Mental Health
How can WORH Help?
Care, Mental Health
• Identified Strengths and Weaknesses within each Rural Healthcare Sector
• Identified ways for all healthcare sectors to collaborate together
• Be on the lookout for the 2010 Rural Health Summit!!!
Wisconsin Office of Rural Health
www.worh.org
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Contact Information
Kathryn Miller
Rural Hospitals & Clinics Program Manager
Wisconsin Office of Rural Health
310 N. Midvale Blvd., Suite 301
Madison, WI 53705Madison, WI 53705
Phone: (608) 261-1891 or 1-800-385-0005
www.worh.org
Wisconsin Office of Rural Health
www.worh.org