TUBA CITY, Ariz. - The American College of Surgeons (ACS) in March designated Tuba City Regional Health Care Corporation as a level III trauma center enabling the hospital to see and take care of more critically injured patients.
ACS has only verified one other Native American Level III trauma center. That one is located in Anchorage, Alaska.. The designation moves TCRHCC up a ranking.
Four and a half years ago when Dr. Ralph Zane Kelley, a trauma surgeon and also the chief of surgery and trauma medical director at TCRHCC, arrived he said the hospital was designated by the state of Arizona as a level IV trauma center. The designation by ACS is a national ranking.
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for surgical patients. ACS is dedicated to the ethical and competent practice of surgery, according to its website.
In a recent statement, ACS emphasized that the allocation of trauma centers should be based on the needs of the population, rather than the needs of individual health care organizations or hospital groups. And, at their core, trauma systems are developed to achieve care that is optimal for injured patients.
In the state of Arizona there were only 11 verified Level III ACS trauma centers. Tuba City is now number 12 on that list. By comparison, Flagstaff Medical Center is a Level I.
"The others are ... big names that you don't normally see Tuba City on that list with," Kelley said.
He said the designation is a big deal across Indian country because of the amount of trauma on reservations, which has been verified by studies.
"I'm Native American and I was trained in Las Vegas in trauma on the agreement that I would come out here because they have such a need for trauma surgeons on the reservation," Kelley said, adding that four of the five trauma surgeons in Tuba City are Native American. The hospital employs a Native American hand surgeon and an ER doctor as well.
In trauma terms, Tuba City sees everything from car crashes, ATV accidents, assault, gunshot and knife stab wounds, patients who were bucked off a horse, gored by a bull and elderly patients falling.
"We even see a number of trauma's that are from international tourists at Monument Valley or Grand Canyon," Kelley said. "The majority are native traumas."
Shannon Johnson, RN director of trauma program services, and Kelley worked the last few years for the current Level III designation with an initial visit by ACS in 2013 and the final visit coming a year and a half later. ACS specifically looks at the trauma patients an emergency department cares for - whether they are cared for or operated on at the hospital or whether they are shipped somewhere else. The organization also looks at how the ER department tracks care of patients, how they do peer reviews of all trauma patients, how the surgeons receive trauma credentials, and the equipment and infrastructure each hospital has.
Even with the new designation, TCRHCC still has limitations on head and spine injuries - those patients are still treated in Flagstaff or Phoenix.
In addition to providing a higher quality of care, trauma surgeons and orthopedic surgeons are on call 24-7, the trauma process is tracked so it is up to the standard that ACS sets for trauma centers.
"It definitely increases the quality and competency of care that trauma patients receive here," Kelley said. "Tuba City is probably the only place on the rez that has ER residency trained board certified ER physicians. Also we have general surgeons who are advanced trauma trained."
Johnson said, in addition, the hospital has trauma nurse core curriculum certified nurses and emergency pediatric certified nurses as well.
One of the biggest things that Johnson and Kelley want people in the region to know is that the designation means something because it is one of a limited number in the state and only the second Native American hospital to be designated.
"We're accredited by a national organization and we do care for a high level of patients and definitely care for and have a higher acuity of care than the majority of other reservation facilities," Kelly said. "Tuba is constantly adding new services and new specialties to keep patients on the reservation rather than having to ship them to Flagstaff or Phoenix where it is an inconvenience for themselves but also their families."
Governor Doug Ducey signed Senate Bill 1194 on February 24, 2015 which enhances the Arizona State Loan Repayment Program by expanding the types of providers who can receive loan repayment assistance, increasing the award amounts for the initial and succeeding commitment years, and removing the 4-year service cap. This bill will become effective on July 2, 2015.
The Arizona State Loan Repayment Program qualifies primary care providers working in underserved areas of the State. Through this new legislation, mental health providers, pharmacists and geriatrics will be added to the list of eligible providers joining the currently eligible primary care physicians, dentists, and advanced practice providers like nurse practitioners, physician assistants, and nurse midwives. The new law provides up to $65,000 of loan repayment assistance to physicians and dentists for a 2-year service commitment (a $25,000 increase from $40,000 previously). Advanced practice providers can qualify for up to $50,000 for a 2-year service commitment (up from $15,000). The incentives even get better as providers stay longer in the program. For each year of continued service in the underserved area after the first two years, physicians and dentists can receive up to $35,000 from $25,000 and for advanced practice providers, up to $25,000 from $10,500. Please check our website for any future announcements about the implementation of the new legislation that includes the application cycle opening for the added disciplines. Any questions or comments, please email Ana Roscetti.
By Mary Linker Arizona Sonora News Service
Doctors are becoming a scarce commodity in rural Arizona, and despite recent legislation, it seems like money isn’t the real answer.
In February, Governor Doug Ducey signed a bill which enhances the Arizona State Loan Repayment Program. The program is set in place to entice healthcare professionals, including physicians, general dentists, nurse practitioners, physician assistants and certified nurse midwives, to underserved areas by paying back their student loans.
The bill gets rid of the 4-year service cap on the program, as well as increasing the reward for physicians and dentists to $65,000 for a 2-year commitment and a continued award of $35,000 past those two years in a qualifying health professional shortage area. The bill will become effective 91 days after the legislative session ends.
According to Arizona Health Services, there are an estimated 400 designated health professional shortage areas in Arizona. Out of those, 153 are primary care HPSAs. A primary care shortage area meets qualification by having 3,500 or more people to every one primary care provider or a high need population of about 3,000. This means that Arizona has a primary care shortage that requires 442 new primary care providers to fill.
Ana Roscetti, a workforce section manger and overseer of the loan repayment program for Arizona Health Services, thinks the money will definitely help reduce those numbers.
“Salary is extremely important when you’re looking at a job, that’s just basic,” said Roscetti.
According to the Arizona Academy of Family Physicians, graduating physicians have an average debt of $170,000.
“That means if they commit for four years to this program, they can have most, if not all, of their student loans paid off. That’s a huge relief,” said Roscetti.
“We’ve already seen an increase in participants, just this year,” she said. “We had only 17 participants last year, and we have 34 this year. That’s a 100 percent increase, even before this legislation.”
Click on the link for the full article »
Story by Zac Baker; Part one of a two part series
Arizonans are feeling the effects of a doctor shortage that health care experts expect to worsen nationally in the next ten years.
According to a report by the Association of American Medical Colleges, the nation will face a shortage of at least 46,000 physicians by 2025, and Arizona is currently 500 to 750 doctors short, said Dan Derksen, director of the Center for Rural Health at the University of Arizona.
General access to medical care in rural areas and access to specialty care throughout the state are most affected by the shortage said Chic Older, executive vice president of the Arizona Medical Association.
Getting into a specialist’s office can be determined by several factors, “particularly if you’re in certain places or have certain needs or are of a certain age or a certain insurer,” Older said.
The aging population is also causing higher demands for specialty care. Chief Health Care Officer of the Association of American Medical Colleges Janis Orlowski said the percentage of the national population that is older than 65 is increasing, and aging people need more specialty care to stay healthy.
An increasing number of Arizonans that are now insured is also adding stress to the health care system, Derksen said.
About 500,000 people got health insurance in Arizona through the Affordable Care Act and Medicaid last year that previously went without it. The influx of people now covered is creating problems in rural areas, where doctor shortages have already been an issue, he said.
“A lot of the smaller communities around the state really have trouble recruiting and retaining nurses, dentists, physicians, allied health professionals,” Derksen said.
Many doctors choose to stay in large cities because that is where they completed their residency programs, he said. They are settled and comfortable in an urban center, and do not want to give that up.
To expose medical students to life and work in smaller communities, Derksen said new residency programs are being created in rural areas where shortages are most acute.
“The data is very strong that when you train people in underserved and rural areas they end up more often practicing in those areas where they’re most needed,” he said.
Derksen also said existing student loan repayment and scholarship programs are luring medical students to shortage areas. Doctors commit to working in rural or underserved communities in to receive significant financial aid.
Efforts to recruit health care professionals from rural areas are also important, Older said. A doctor from a small town is more likely to return and practice there.
A combination of these efforts and programs influenced James Duncan, a dentist, to practice at the Mariposa Community Health Center, which has facilities in Rio Rico and Nogales. Click on the link to read more »
Physicians (including a former CMS administrator) talk about their experiences with Medicare.
by Richard Peck
Contributing Writer, MedPage Today
This is the last in a four-part series, Medicare at 50, on the history and possible future of Medicare.
Focusing on the historic relationship of Medicare with practicing physicians, this series would not be complete without direct comments from physicians and policy experts familiar with physicians' issues. MedPage Today contacted practicing physicians and policy experts for their opinions on the program's achievements and problems. Some have already been cited elsewhere in these articles, some appear here for the first time:
Brobson Lutz, MD, Internal Medicine and Infectious Disease, New Orleans: "I've been in a partnership in practice since 1978, and we took a real hit with the fee freezes under President Reagan. I understand why they happened -- some specialists were increasing their fees to the stratosphere. Also, for something like back pain, a patient can't leave an orthopedic surgeon's office without studies of all kinds for something we treat all the time, and much less expensively. Physicians who do unnecessary tests have their consciences to live with -- I just won't send patients to them."
- continued at MedPage Today:
Wednesday, April 1, 2015
By NIHAL KRISHAN
WASHINGTON – The number of people with health insurance in Arizona rose even as the state economy was falling from 2007 to 2010, when both trends reversed direction, according to a recent report by the Census Bureau.
The report said the number of people with health insurance in the state improved slightly in the period from 2006 to 2013, going from 21.8 percent uninsured to 20 percent without insurance. That moved Arizona from fifth-worst in the nation to eighth-worst, the Census numbers showed.
Rural areas have higher mortality rates
BISBEE — So that emergency crews, nurses, doctors can provide the best treatment possible as quickly as possible, Copper Queen Community Hospital hosted a special training event in January.
Claudia Romo, RN and Emergency Department Infection Prevention Department with CQCH, arranged the special Rural Trauma Team Development Course (RTTDC) in connection with Banner Health and the AZFlex Program. The course was focused on developing a “trauma team” that would work together for the best possible outcome for injured rural residents.
Videoconferencing is Being Used to Broaden Services and Cut Costs
DOUGLAS — In its convalescence, the county-owned, long-struggling hospital in Douglas is expected to bring new services and value to hospitals, clinics, and institutions throughout Cochise County.
In the past year under new management, coming out of its most recent federal bankruptcy process, the facility has seen an overhaul among its administration and vendors. An array of new medical equipment has been installed, a groundbreaking telemedicine communications program is afoot, and the new managers are meeting the hospital’s payroll obligations.
Hospital's investments in equipment, staff widens range of available services
KINGMAN - When Melanie Reynoso temporarily moved here three years ago to work at the Kingman Regional Medical Center Cardiovascular Center, it didn't take her long to realize her traveling days were over.
Reynoso, a traveling nurse who spent 13 weeks each at various hospitals across the country before settling here, has been a full-time staffer now for three years. And the nurse educator and clinical leader for the cardiovascular center plans to stay right here in Kingman and continue her employment with the hospital.
By Stephanie Innes, The Arizona Daily Star, Tucson | March 16, 2015
March 16--A case under consideration by the U.S. Supreme Court could have a significant impact on health insurance coverage in Arizona.
Health policy expert Dr. Daniel Derksen of the University of Arizona’s Mel & Enid Zuckerman College of Public Health says if the individual and employer mandates (tax penalties for not having coverage) are found to be illegal in the 34 affected states, insurance rates could go up.
“Many economists argue that this would precipitate the dreaded ‘death spiral’ whereby insurers are required to cover everyone, are prohibited from excluding or charging more for those with chronic (pre-existing) conditions,” Derksen said.
“Without individual and employer mandates, the fiscal risk can’t be pooled, fewer get insurance, those that keep insurance are increasingly those with chronic illnesses, and the insurance companies can’t make the margins work and charge higher premiums, which makes insurance less affordable.’
And while the subsidies of 150,000 Arizonans would be directly affected, Derksen said the entire federal health exchange could fall apart with a ruling against the government, and “it would be prudent for states to prepare for their decision when it is announced before or in June.”
Access to primary care providers in rural AZ is a problem. Our National Health Service Corps Loan Repayment Program and the State Loan Repayment Program are part of the solution- recruiting primary care workforce resources in those areas. Still, there’s not enough providers in rural Arizona- and 150 rural communities in Arizona need access to primary care providers.
To help alleviate this problem and support recruitment of providers in rural areas, our Bureau of Health Systems Development recently developed a partnership with the Center for Rural Health and the Arizona Alliance of Community Health Centers to support the National Rural Recruitment and Retention Network (3RNet) Program. It’s kinda like a Match.com for linking health care professionals and jobs in rural and underserved areas.
The 3RNet Program is made up of members from state agencies and non-profit organizations that work together to help many health care professionals find jobs in rural and underserved areas. They also work collaboratively to provide technical assistance to clinics about this free recruitment tool. This provides clinics with no cost marketing including tools allowing them to post online photos, detailed descriptions, maps, and other materials to attract health care professionals.
For questions about the 3RNet Program, please email the representatives from each individual agency: Ana Roscetti at Ana.lyn.Roscetti@azdhs.gov, Joyce Hospodar at firstname.lastname@example.org, or Lourdes Paez at email@example.com. If you’re an employer or clinic, register to become a 3Rnet user here.
The Telemedicine & Telehealth Service Provider Directory is a service of the Arizona Telemedicine Program. The directory is a resource for hospital and healthcare administrators and other decision-makers who want to expand or improve their healthcare services to their patients, employees, clients, etc.
Jan 5, 2015 -- Describes efforts to increase Native American and Alaskan Native enrollment in the Affordable Care Act health insurance marketplace, including creating culturally appropriate brochures, using bi-lingual outreach workers, and having mobile technologies available in the field to process sign-ups instantly.
The Rural Assistance Center has published a new topic guide on Community Health Workers in Rural Settings. Resources include a Community Health Workers (CHWs) toolkit to assist in developing a CHW program, FAQs about CHWs, and links to relevant publications, organizations and funding opportunities. Access the guide here: http://bit.ly/1zOnNBO