News for CAHs and RHCs

Tucson News Now | Wednesday, May 24, 2017, 8:45 pm

The National Rural Health Association (NRHA) honored Copper Queen Community Hospital (CQCH) CEO, James Dickson earlier this month with the 2017 Louis Gorin Award for Outstanding Lifetime Achievement in Rural Health Care.   

Award recipients are selected based on their creativity, unselfishness, compassion and cooperative attitude in seeking ways to make lasting contributions to rural health care.

“It is a rare opportunity for someone to be able to serve and help the community like I have for over 18 years, ” said James Dickson, “I would like to thank my staff, Board of Directors, and Physicians for believing in the vision and being able to provide access to primary healthcare in  medically underserved communities.”

Jim Dickson, has an unwavering commitment to providing rural southern Arizonans with accessible, affordable, high-quality health care. His efforts brought state-of-the-art care to southern Arizona through renovation and expansion of the hospital and RHC diagnostic and treatment services.

Dickson has achieved this through innovative and unparalleled collaborations with major health care systems in Arizona using telemedicine for sophisticated diagnostic and specialty care in Cochise County, saving residents the expense and travel to Tucson or Phoenix for services.

In addition to his work in health care, Dickson identifies and addresses unmet community needs, creating the first library for middle school students in Bisbee and offering scholarships to Cochise County high school graduates for training to land well-paying local jobs.

“Jim Dickson’s work at the CQCH critical access hospital and affiliated RHCs, and most recently, to create one of the state’s first rural freestanding emergency departments (ED) at the Douglas Medical Complex, underscores his unwavering commitment to providing rural southern Arizonans with accessible, affordable, high quality health care.” stated Daniel Derksen, MD from the Arizona Center for Rural Health at The University of Arizona.  

“For 20 years, Jim has led health care improvements in Cochise County that spans over 6,200 sq. miles, has a pop. density of 20 persons/sq.mi., and 17 percent poverty rate. For comparison, Connecticut is smaller at 5,500 sq.mi., has a pop. density of 650 persons/sq.mi. and 10.7 percent poverty rate.

His efforts brought state-of-the-art care to southern Arizona through renovation and expansion of the hospital and RHC diagnostic and treatment services.

He does this through innovative and unparalleled collaborations with major health care systems in Arizona using telemedicine for sophisticated diagnostic and specialty care in Cochise County, saving residents the expense and travel to Tucson or Phoenix for services.”

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.

» Continues at link:

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)

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  

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."

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."

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.