Published in The Atlantic | DEBORAH FALLOWS | June 13, 2016
Finding Health Care in the Desert
With the closest hospital 100 miles away, Ajo, Arizona’s Desert Senita Health Center acts as the region’s clinic.
We returned to rural Arizona for our American Futures project this spring. During our travels, we have visited a number of towns that could easily be called rural: Eastport, Maine (pop. 1,300), far down-east and a mile across the strait from Campobello Island, and Chester, Montana (pop. 850), 40 miles from Canada, vie for being the smallest.
Ajo, Arizona, one of our favorite towns, is slightly bigger. About 2,300 people live there throughout the year, and the numbers swell to almost twice that when the snowbirds arrive from the states that border Canada. Many winter residents arrive in their RVs or campers, and others settle into charming stand-alone small houses. By snowbird standards, Ajo is very affordable.
Arizona Public Media | Story by Gisela Telis
May 20, 2016 -- Sheri George, founder of the San Tan Valley Substance Abuse Coalition, fights to get her neighbors the help they need by bringing mental health care services to rural Arizona. (Video length: 8:52)
LAS VEGAS, N.M. — The notice came with only six days’ warning. Alta Vista Regional Hospital, the only primary care facility within 65 miles of this northeastern New Mexico town, was closing its obstetrics division, effective March 7. For women like Desiree Castillo, who was pregnant with her second child, that meant scrambling to find a new doctor more than an hour away in Santa Fe or Raton for prenatal care and birthing.
Later that month, Castillo and her husband, Carlos Castillo, drove the 65 miles from Las Vegas for her first ultrasound in Santa Fe. “She called me around 11 all excited, saying, ‘It’s a boy, it’s a boy!” said her mother, Julie LouAnn Valdez.
As Desiree was driving home that afternoon on Interstate 25 east of Pecos, her husband ill and asleep in the passenger seat, a powerful wind gust knocked their sport utility vehicle out of control. The vehicle rolled, killing Desiree and her unborn son, whom she had already named Ezra Augustine Castillo. Her husband survived.
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Phoenix New Times | By Chris Parker | TUESDAY, MAY 3, 2016 AT 5 A.M
Our health is our most precious resource, yet our health-care system’s more adept at mining wallets than making us healthy. We pay one-and-a-half to two times what other countries pay for health care without appreciably better outcomes.
America spends more than $9,500 per person annually, more than one-sixth of our gross national product (17.5 percent), or more than $3 trillion on health care. The government alone spends $4,197 per person, more than many countries with universal health care. The United Kingdom, by comparison, spends the equivalent of $2,800 per citizen and covers everyone.
All this spending hasn’t made us healthier.
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The guide provides information and resources concerning the concept of social determinants of health, and encourages activities to help rural healthcare providers address these issues and improve the health of the communities they serve.
The tool has been updated with a new interface and includes a map-based location verification. View the short video to learn how to use the tool's new features and then find out if your location is considered rural based on various rural definitions by using the tool.
The U.S. Department of Health and Human Services released a report showing that states can greatly
improve access to behavioral health services for residents by expanding Medicaid under the Affordable
Care Act. Substance use disorders and mental illness are prevalent and serious public health problems in
American communities. According to the report, in 2014, the most recent year for which data is
available, an estimated 1.9 million uninsured people with a mental illness or substance use disorder
lived in states that have not yet expanded Medicaid under the Affordable Care Act and had incomes that
could qualify them for coverage. The report finds that people with behavioral health needs made up a
substantial share of all low-income uninsured individuals in these states: nearly 30 percent. While some
of these individuals had access to some source of health insurance in 2014, many will gain access to
coverage only if their states expand Medicaid, and others would gain access to more affordable
SANTA CRUZ COUNTY, AZ (Tucson News Now) - By Monica Grimaldo
A community outreach program called the Community Healthcare Integrated Paramedicine Program, otherwise known as CHIPP, is helping the Rio Rico Medical & Fire District reduce emergency department visits by providing health education to residents suffering from a chronic illness.
"So far, the program seems to be working," said spokesman for RRMFD Capt. Michael Urbanski. "We're visiting these patients less."
Urbanski, who has been with the RRMFD for 10 years, said paramedic teams of two visit the resident's home and, with their permission, conduct surveys and assessments to make sure certain healthcare needs are being met.
"Our community is small," said Urbanski. "We're very invested in our community. We want to see them do their best and be at their best health."
The program’s executive director Matt Eckhoff said the program kicked off in January 2014. It hopes to improve the health and quality of life of the program’s participants, at no cost, by promoting health education, improving medical management and being able to link those participants to community resources.
They also perform home and safety scans to prevent falls or other home hazards.
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Rural Health Grants
A hospital's relationship with its community is an integral part of its ability to serve residents and improve their access to healthcare. Since 1995, MultiPlan's Rural Health Outreach Grant Program has awarded over $490,000 to help rural hospitals reach out with programs and services that address the healthcare needs of their communities.
- Applying hospitals must meet these requirements to be eligible for a Rural Health Outreach Grant:
- The applicant must be a participating provider of the MultiPlan, PHCS, HealthEOS, Beech Street or Texas True Choice networks.
- The applicant must be a hospital in a rural area with population less than 1,000 persons per square mile.
- The facility must provide acute care.
- The facility must be considered an inpatient hospital.
2015 recipient: Northern Cochise Community Hospital in Willcox, Arizona. This 24 bed inpatient Critical Access Hospital is seeking Pediatric Prepared Emergency Care Certification, making them the only hospital within a 90 mile radius to hold such credentials. They will be using the grant money to purchase equipment for their pediatric facility.
THE KATE B. REYNOLDS CHARITABLE TRUST IS EXCITED TO ANNOUNCE the 2016 New Rural: Innovations in Rural Health Award. We are seeking original, innovative solutions that have the potential to drive health improvement in rural communities.
These don't have to be finalized projects--we encourage submissions from around the country that highlight new ideas and emerging work. Individuals, for-profits, nonprofits and goverment agencies are welcome to apply. Finalists will receive a $7,500 award and one innovative and inspiring idea will win the New Rural Award and a total of $25,000.
In rural communities across the country, health care is becoming an increasingly scarce commodity. More than 50 rural hospitals have closed nationwide since 2010, and hundreds more teeter on the brink of bankruptcy. It’s a trend driven by falling revenues and decreased federal funding, and it could have dire implications for small-town America’s future. Sarah Varney of Kaiser Health News reports.
March 2, 2016 Bill Buckmaster: Dr. Daniel Derksen, director of the University of Arizona-based Center for Rural Health discusses the critical care needs facing Arizona’s rural hospitals and clinics.
KVOI AM Radio 1030. Tucson’s Voice. The Bill Buckmaster Show.
From 32:40 to 40:45 at: http://www.buckmastershow.com/shows/2016/3-2-16.mp3
Arizona Illustrated with Tom McNamara, Episode 222, Arizona Public Media, PBS, KUAT Television.
Dan Derksen, Director of the Arizona Center for Rural Health is featured, starting at 9min, 0 sec; 10:20-11:40 and 17:00-17:45 (min:sec).
Video link below.
The Center for Rural Health at the University of Arizona Mel and Enid Zuckerman College of Public Health was awarded a $1.5 million grant to provide training and information to Arizona's 14 Critical Access Hospitals, 21 Rural Health Clinics, and a statewide network of primary care, trauma and EMS workers.
The Health Resources and Services Administration (HRSA) awarded the Center for Rural Health (CRH) at the University of Arizona Mel and Enid Zuckerman College of Public Health, a three-year $1.5 million grant to support Arizona Medicare Rural Hospital Flexibility Program (AzFlex) which provides quality, operational and performance improvement in Arizona’s rural hospitals and affiliated outpatient services.
Arizona’s 14 Critical Access Hospitals and 21 Rural Health Clinics play crucial roles in assuring access to quality health care, improving population health outcomes and contributing to a community’s overall economic health and development. The AzFlex program provides technical assistance, training and information resources for Arizona’s Critical Access Hospitals, Rural Health Clinics and a statewide network of rural primary care, trauma and Emergency Medical Services providers.
The AzFlex work plan for the next three years has four program areas: Quality Improvement; Financial and Operational Improvement; Population Health Management and EMS Integration; and Critical Access Hospital Designation in Arizona.
“The Center for Rural Health is ideally suited to carry out this important work in Arizona’s rural communities,” said Daniel Derksen, M.D., director of the CRH and principal investigator for the grant.
The CRH also also houses the Navigator Consortium, the Small Rural Hospital Improvement Program and the State Office of Rural Health.
“While our Critical Access Hospitals fiscal performance improved in 2014, we face new threats,” said Jill Bullock, CRH associate director and AzFlex Program Manager. Some of the threats Bullock cites include the 5% Medicaid hospital payment cut; lower participation rates in Medicaid and Marketplace coverage in rural, Hispanic and American Indian populations served by Arizona’s Critical Access Hospitals and Rural Health Centers; new state and federal regulations; and requirements to report on quality, satisfaction and other performance measures.
“Those threats are ominous. Over the last five years, 58 rural hospitals have closed, including one in Douglas, Arizona where 70 people lost their jobs,” said Dr. Derksen who testified on the issues challenging rural hospitals and health services before the health subcommittee of the U.S. House Committee on Ways and Means in July of 2015.
Ken Alltucker, The Republic | azcentral.com
4:32 p.m. MST January 13, 2016
With her husband's life fading from a stab wound to the head, Laura Brown's only thought was how quickly she could get to his side.
She was in Scottsdale. He was at a Yuma hospital.
On the road to Yuma, she got a call. Her husband, Bruce, was being flown by medical helicopter to St. Joseph’s Hospital and Medical Center in Phoenix. His brain stem had been severed. A day later, he was pronounced dead.
In the days and weeks after the March attack, Brown mourned the loss of her husband. She also lost her son, Blake, 25, who is mentally ill and was responsible for his father's fatal injury. Blake has been placed in long-term confinement at the Arizona State Hospital.
Then, the devastated wife and mother faced a new and lingering pain: a costly and unexpected air-ambulance bill.
While Brown's case appears to be headed toward a satisfying resolution, other consumers around the nation routinely face sticker shock when confronted with air-ambulance bills.
Brown's husband’s health insurer largely covered the cost of his hospital care, and she paid the portion that the insurer did not.
But that wasn't the case with the air-ambulance company. Tristate Care Flight’s transport, which her husband could not consent to and she was not made aware of before takeoff, resulted in a $64,620 bill.
Brown’s insurance company, Ameriben, has already paid Tristate Care Flight $19,909. Ameriben told Brown that the Bullhead City-based air-ambulance company was not part of the insurer's network of providers with set, negotiated rates, but it agreed to pay about twice the rate that Medicare would have paid for a similar trip.
Tristate Care Flight wanted Brown to pay the rest of the bill: $44,711.
Though Brown's appeal to her late husband’s insurance company to pay a larger portion of the bill so far has been unsuccessful, this story appears to have a happy ending for Brown.
After The Arizona Republic contacted John Cole, chief operating officer of Tristate Care Flight, to discuss the company's billing practices, he began investigating the case. On Wednesday, Brown said, he notified her that if the company is unable to secure additional insurance payments, it would write off the balance of the bill and that she would owe nothing.
Cole would not divulge details of his conversation with Brown, but said, "I am helping her out with her situation. She is very happy."
Air-ambulance billings are complicated. According to Brown's bill, Tristate Care Flight charged a base rate of $17,325 for the one-way helicopter transport. It also charged $289 for each mile of the 163-mile trip. The base charge and per mile charge made up the bulk of the bill, which included four other minor charges.
Brown isn't the only consumer surprised by air-ambulance bills.
In 2014, the National Association of Insurance Commissioners (NAIC) issued a consumer alert about the cost of and coverage for air-ambulance bills, in part, due to consumer complaints and feedback from state insurance commissioners, an NAIC spokeswoman said.
The NAIC alert said that the average air-ambulance trip is 52 miles and costs from $12,000 to $25,000 per flight.
Other estimates suggest that these emergency medical trips may cost more. FAIR Health, a database of nationwide insurance claims that provides a search tool for consumers, estimates that a Phoenix resident can expect to be billed $25,678 for a one-way air ambulance trip, plus a charge of $283 per mile.
These bills can catch consumers off guard because health insurers may not cover all charges and may require consumers pay a significant portion. Consumers often are not in a position to refuse service or negotiate rates because these medical helicopters typically are dispatched only for medical emergencies.
Some experts say that air-ambulance bills raise an important health-policy question: Who is financially responsible when a health provider seeks to recoup full, charged rates, even beyond what an insurance company is willing to pay?
"There is a lot of discussion about balance billing," said Dr. Daniel Derksen, director of the Arizona Center for Rural Health at the University of Arizona.
Derksen said consumers need to read and understand what their insurance policies cover, but he added that it can be difficult in an emergency, when a medical helicopter is required.
"You can't say, 'Let's see if this is a covered benefit or not,' " Derksen said. "When you are making decisions that can affect someone’s health outcomes, normally you do what's in the best interest of the patient and you sort through the details of who is going to pay for it later."
Perhaps anticipating resistance from Bruce Brown's insurer, Tristate Care Flight mailed a letter to the Browns' Scottsdale home within two weeks of the emergency transport. Tristate offered to help file an appeal to compel the insurance company to pay a larger share of the bill.
Cole said billing complaints are common in the air-ambulance industry.
“This happens all the time,” Cole said. “It is something we work with each individual patient. It is not our goal to put anybody in a position where they are unable to pay. We just want to provide good care.”
Cole added that operating an aircraft with pilot and a trained crew available 24/7 is an expensive proposition. Crews and an aircraft must be available at a moment's notice to respond to car crashes and other medical emergencies across the company's four-state territory. And a medical aircraft may cost as much as $6 million, according to the NAIC bulletin.
Tristate outsources its billing to a third-party company, and Tristate often writes off bills that it is unable to collect, Cole said.
Tristate Care Flight was founded in 2002 by Bullhead City orthopedic surgeon Blake Stamper, also a pilot, who saw the need for a quick response for injured patients, according to the company's website.
Last November, Tristate Care Flight agreed to sell the business to Air Methods Corp. in a $222.5 million deal. A news release announcing the merger said that Tristate had revenue of $81.5 million in 2014.
Brown questioned why the air-ambulance company was able to charge her even though her husband could not provide consent. His brain stem had been severed and he showed little evidence that he would survive the injury. Brown was not made aware of the transport until the helicopter was on its way to Phoenix.
Cole said that such discussions rarely happen during an emergency. The top priority of the flight crew is to make sure the patient gets proper care.
"We just get going, that's the bottom line," Cole said.
After Bruce Brown was discovered stabbed at his home in Yuma, he was transported to Yuma Regional Medical Center. Yuma doctors determined he needed to be treated at a hospital that offered more-advanced care, so they called for an air-ambulance transport.
The hospital typically does not investigate whether a patient's insurer has a negotiated contract with an air-ambulance company. The hospital's priority is to find a transport company with an available aircraft, pilot and crew that can respond quickly, said a Yuma Regional spokesman.
Although Ameriben has negotiated contracts with other air-ambulance companies, the hospital called Tristate Care Flight that day. Ameriben uses Blue Cross Blue Shield's network of providers. Air Methods, the company that is purchasing Tristate Care Flight, has a contract with Blue Cross.
For Brown, the air-ambulance bill capped a heartbreaking scenario. With Wednesday's news, she hopes she can now move on.
"This could have been life-altering," Brown said of the bill. "I'm thankful."