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
Transcript of Wisconsin Office of Rural Healthrwhc.com/mediasite/Miller Flex Overview RHC 11 09 PowerPoint.pdf ·...
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
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
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
Critical Access Hospitals Rural Health Clinics
59 CAHs in Wisconsin1,298 CAHs Nationwide
47 Certified RHCs in Wisconsin Over 3,000 RHCs Nationwide
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
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?
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
