News for CAHs and RHCs
The Kansas City Star | By Scott Canon
APRIL 03, 2017 1:36 PM
Sen. Claire McCaskill of Missouri calls for GAO report on closings of rural hospitals
Sen. Claire McCaskill, a Democrat, has called on two federal agencies for more details about support of hospitals and schools in sparsely populated areas.
The Missouri senator wrote to the Government Accountability Office seeking answers to several questions about the rate at which rural hospitals are closing, what’s driving those trends and what it means for the quality of health care in those areas. The GAO is the investigative arm of Congress.
She also called on the U.S. Department of Education for a report on how various federal policies affect rural schools.
In a letter to the GAO dated March 31 and shared with The Star on Monday, McCaskill warned that financial pressures on rural hospitals, driven partly by federal policy, pose a particular threat to health care in some parts of the country.
“In recent years,” she wrote, “the number of rural hospital closures has increased significantly and if this trend continues, such closures could have a devastating impact on my constituents and countless other Americans.”
McCaskill also noted that the Centers for Disease Control and Prevention has said people in rural areas face a heightened risk of death from heart disease, cancer, accidents, some respiratory disease and stroke — suggesting that rural hospitals fill a special need.
The senator noted that health care plays a significant economic role in many small towns.
She also cited a Kaiser Family Foundation report issued in January that warned repeal of the Affordable Care Act would signal a “death knell” for some rural hospitals.
Healthline News | Written by Shawn Radcliffe | Published on February 15, 2017
In recent years, many policies have chipped away at the rural health safety net that ensures that people living in remote areas still have access to healthcare.
When Terry Fulmer’s 90-year-old aunt fell and tore her shoulder ligaments, she had surgery in Albany, a two-hour drive from her home in rural upstate New York.
“Maybe she could have gotten care in a closer town. But her daughter lives in Albany so she had to go there because that’s where she recovered. She couldn’t feed herself, she couldn’t dress herself,” said Fulmer, Ph.D., R.N., F.A.A.N., president of the John A. Hartford Foundation in New York, a foundation dedicated to improving the care of older adults.
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Feb 7, 2017 -- Details the panel discussion of several rural health leaders at the annual Rural Health Care Leadership Conference. Discussion included, among other things, innovative ways rural hospitals have kept themselves afloat, the findings of the American Hospital Association Task Force on Ensuring Access in Vulnerable Communities report, and the challenges as well as the potential of telemedicine for rural areas.
At least 85 percent of patients at Banner Page Hospital responded on their surveys that nurses always communicated well. In Arizona, the average is 77 percent, slightly lower than the national average of 80 percent.
The figures are from CMS' Hospital Compare website and represent HCAHPS scores collected from January 2015 through December 2015, the most recent data available.
Page Hospital — 85 percent (I made a change from below, because our reports from the Federal Office say 85%)
Note: Hospitals with fewer than 100 completed surveys were excluded from consideration for this list. (which is most of the Critical Access Hospitals)
Presentation of the award to the Holy Cross Hospital team on Wednesday, Jan. 18, 2017. From left to right – Dina Rojas-Sanchez, Director of Support Services, Holy Cross Hospital; Mark Valenzuela, Board Chair, Holy Cross Hospital; Debra Knapheide, Chief Executive Officer/CNO/COO, Holy Cross Hospital; Joyce Hospodar, Senior Advisor, Rural Programs, Center for Rural Health, The University of Arizona Mel and Enid Zuckerman College of Public Health; Les Caid, Fire Chief, Rio Rico Fire; Matt Eckhoff, Program Director, Rio Rico Fire Community Integrated Paramedicine Program.
Nogales, AZ – January 18, 2017 – Carondelet Holy Cross Hospital has received national recognition for demonstrating innovation in emergency medical services (EMS) that benefit patients and members of rural communities. The hospital – one of only four in the nation to be honored in this round of nominations – received the Critical Access Hospital Recognition certificate from the National Rural Health Resource Center for its work with the Community Healthcare Integrated Paramedicine Program (CHIPP).
The certificate was established by the Center and the Federal Office of Rural Health Policy (FORHP) to recognize the excellent work performed by critical access hospitals (CAHs) and other rural safety net providers throughout the country. The recognition promotes excellence and innovation and honors the achievements and results of rural safety net providers while publicizing successful strategies.
The CHIPP program, which was developed to help address the needs of individuals who frequently use the 911 system and hospital Emergency Department, is intended to ensure these indivuals are treated in a more proactive and cost-effective manner. Holy Cross Hospital is a key stakeholder in the success of this program, acting as an advisor and promoter and as a key contact for providers in the medical community, and providing referrals to the program upon discharge from the hospital.
“Holy Cross Hospital is a proud partner in the Community Healthcare Integrated Paramedicine Program and continues to find innovative models of care to provide quality healthcare for all Santa Cruz County communities,” said Debra Knapheide, CEO/COO/CNO at Holy Cross Hospital, “We are proud to be recognized for our work in this collaborative effort to deliver healthcare that is affordable, high-quality and necessary for the good of our community. Holy Cross Hospital is committed to keeping pace with healthcare transformation, which is key to sustaining access to health services for rural communities.”
Matt Eckhoff, Director of Rio Rico Medical and Fire District’s Community Integrated Paramedicine Program, added: “Today’s healthcare system is working hard to connect the dots between all the different folks who provide healthcare. From the ambulance to the emergency room to the primary care provider, the more we all talk to each other, the better we can provide excellent care to those we serve. Carondelet Holy Cross Hospital’s engaged leadership team has been instrumental in connecting those dots to better serve the Santa Cruz County community.”
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
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."
TUCSON, AZ (Tucson News Now) - By Craig Reck
The potential closure of a nursing home in Willcox is the latest example of ongoing struggles for health care providers to remain open and above the red in rural areas of southern Arizona.
Administrators at Northern Cochise Community Hospital met with the community Thursday morning to hear concerns and address any questions.
The event had a good turnout, according to Dan Douglas of Charles William Leighton Jr. Hospice. He said he is worried that closing the hospital’s nursing home would hurt his business and negatively impact families in the area.
Jared Wilhelm, Director of Community Relations for the hospital, said the hospital has always operated on a very thin budget. He said the administration learned about severe losses after a line-by-line breakdown of the services offered at the hospital.
Preliminary numbers were complete by late September and the hospital’s board learned in early October that NCCH was losing close to $2 million a year, according to Wilhelm.
He said closing the nursing home would save almost $750,000 annually, so departments would have to cut their budgets in order to make up the remaining $1.25 million.
Part of the problem, according to Wilhelm, is the drop in collections. The hospital used to collect 51 percent of its money owed, but he said that number has dropped to 37 percent, causing the administration to miss out on approximately $6 million.
The hospital’s district board will make a decision Wednesday, Oct. 28 on the nursing home’s future. It could be part of the solution to keep NCCH from closing like other critical access hospitals before it in southern Arizona.
“We don’t want to be the next one,” Wilhelm said.
Tubac Regional Health Center closed its doors earlier this year, but a new facility opened up farther away in Sierra Vista. Cochise Regional Hospital shut down less than three months ago, but there is now an urgent care in operation with plans to open an emergency room as well. All of these closures are on the radar of the Arizona Center for Rural Health, according to Executive Director Dr. Daniel Derksen.
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."
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.
(November 20, 2014—Parker, Arizona) Today, on National Rural Health Day, Agriculture Secretary Tom Vilsack announced that LaPaz Regional Hospital has received a Telemedicine Grant for $316,800 through the USDA Rural Development’s Distance Learning and Telemedicine Program.
La Paz Regional Hospital plans to use the funding to serve their main hospital in Parker, Arizona and four clinical outreach sites in Quartzsite, Salome, Bouse and Parker. The hospital is the only public access hospital in the county—a county with over 4,000 square miles…and yet only 25,000 residents. The grant funds will be used to expand videoconferencing connections to this large, sparsely populated area to provide more direct contact with physicians in the participating communities.
The project is located in the Colorado River Indian Tribe’s jurisdictional area and will benefit this underserved tribal area.
The Secretary also highlighted initiatives created by the Affordable Care Act that specifically address critical health needs in rural communities.
“Delivering these programs to rural communities that often do not have access to quality, affordable medical services has tremendous economic and social benefits,” Vilsack said. “They also mean that people who live and work in rural areas will not have to travel long distances for specialized health care services.”
In addition to today’s announcements, Secretary Vilsack encouraged rural Americans to take advantage of the Health Insurance Marketplace created by the Affordable Care Act and discussed the health care reform law’s specific benefits for rural communities.
“Rural residents have higher rates of chronic conditions. This can be exacerbated by a lack of doctors or clinics in rural communities,” Secretary Vilsack continued. “The Affordable Care Act is improving the health of rural communities and giving all families the security they deserve. No one should go without healthcare because of where they live, or be forced to leave the communities they love to get the coverage they need.”
Rural Americans suffer from higher rates of chronic conditions like diabetes, heart disease and high blood pressure. The Affordable Care Act has taken steps to address the unique challenges rural communities face when it comes to getting the health care they need.
One in five uninsured Americans lives in a rural area, and yet on average only 10 percent of the nation’s physicians practice in these communities. The Affordable Care Act has significantly increased the size of the National Health Service Corps, which offers scholarships and loan repayment to health practitioners in return for practicing in rural communities and other underserved areas. More than 3,500 Corps members now serve in rural areas, and an average of 86 percent of them will remain in their communities even after completing their service.
The Affordable Care Act also invests significantly in expanding services at community health centers, where 7.5 million rural Americans get access to primary and preventive care. That comes on top of the more than $3 billion USDA has invested since 2009 to strengthen health infrastructure in rural areas, building rural hospitals and health clinics and expanding access to health care in remote rural areas through telemedicine.
Not only can a lack of health insurance coverage help lead to high rates of chronic conditions, it threatens rural families’ economic health as well. Before the Affordable Care Act passed, the average rural family paid nearly 50% of all health costs out of pocket. One in five farmers is in debt because of medical bills. Uninsured individuals living in rural areas are able to use the Marketplaces to compare qualified health plan insurance options based on price, benefits, quality, and other factors with a clear picture of premiums and cost-sharing amounts to help them choose the qualified health insurance plan that best fits their needs.
Open Enrollment for the Health Insurance Marketplace began Nov. 15, 2014, and runs through Feb. 15, 2015. Those who have plans can continue them without re-enrolling. However, consumers are encouraged to visit HealthCare.gov to review and compare health plan options and find out if they are eligible for financial assistance, which can help pay monthly premiums and reduce out-of-pocket costs when receiving services. In order to have coverage effective on Jan. 1, 2015, consumers must enroll or update their coverage by December 15.
Consumers can find local help at: Localhelp.healthcare.gov or call the Federally-facilitated Marketplace Call Center at 1-800-318-2596. TTY users should call 1-855-889-4325. Translation services are available. The call is free.
To preview plans in your area, visit: www.healthcare.gov/see-plans/
For more information about Health Insurance Marketplaces, visit: www.healthcare.gov/marketplace
(http://www.douglasdispatch.com/) People’s Choice Hospital held a luncheon at Southeast Arizona Medical Center to introduce themselves to the staff and community of Douglas on December 11.
Vice President of Finance Christopher Alise began by thanking everyone for taking the time out of their busy schedules and attending the luncheon.
“We are really excited to for the opportunity to work with everyone, to rebuilding this hospital back to a position of strength in the community,” Alise said. “We understand that it is really important for each of you in terms of your livelihood, your families, obviously your healthcare and we want to work with everyone to build back up the services.”
Alise also said that he would like to be able to keep all of the expert medical care here in the community.
“So that all of you can come here for what you need were you don’t have to drive the distance to other areas to get the care we are confident we can provide for you here,” he added.