Swing Bed Education Webinar

When: January 20, 2010; 12:00-1:00
Topic: CST During this free webinar, presented by Wipfli, participants will understand how to develop a system for accurate billing of swing bed services, avoid costly errors and potential intermediary scrutiny, assure proper reimbursement, identify patients who could benefit from swing bed care and thoroughly understand swing bed regulations and criteria for continued stay. For more information and to register, click here.

Health Records Assistant/Coder Position Available

Immediate full time position at Lincoln Community Hospital in Hugo, Colorado. Applicant must be experienced in hospital ICD-9/CPT coding, computer entry and record completion guidelines, be self-motivated, organized, and detail oriented. Benefits with salary based on experience. For more information contact Kathy Richie at 719.743.2421, ext 3243 or send resume to krichie@lchnh.com.

CRHC Seed Grants

CRHC Seed grants up to $1,000 are available for purposes or projects whose intent matches CRHC's mission. For eligibility and application information, click here.

USDA's "Know Your Farmer, Know Your Food" Initiative

USDA's "Know Your Farmer, Know Your Food" initiative was launched in September 2009 to emphasize the need for a fundamental and critical reconnection between producers and consumers. Rural Development has loan and grant funding available through a variety of community and economic development programs. Click here for information. Additional information on USDA Rural Development programs can be found by clicking here.

The Forum 2010: Essential Perspectives for Safety Net Providers

April 19-21, 2010 at the Red Lion Hotel in Aurora
Under new ownership, all guest rooms and all meetings rooms have been completely renovated. This year's Forum is also the first annual meeting of the Association of Rural Health Clinics of Colorado. Forum educational sessions will include a variety of topics on Rural Health Clinic compliance and American Recovery and Reinvestment Act (ARRA) requirements for clinic adoption of health information technology. In addition, the 2010 Forum's expanded focus will also contain insightful topics and sessions for both certified Rural Health Clinics and ClinicNET affiliates. Agenda and registration information will be posted on the Colorado Rural Health Center website in January.

Rural Philanthropy Days Newsletter

Click here to view the December 2009 Southeast Colorado Rural Philanthropy Days newsletter with information about the 2010 Philanthropy Days event as well as a list of upcoming grant deadlines.

Colorado Rural Health Grant Program

The Colorado Rural Health Care Grant Program is available to support the health infrastructure in Colorado's rural communities. Funds are focused on improving outpatient primary care services. For more information click here.

Practice Transformation Webinar

Webinar: The Reality of Practice Transformation: It's Coming, and You Can Do It!

When: Friday January 15, 2010 from 12:00 P.M. to 1:00 P.M.

Topic: A key component of the national healthcare reform debate is the need for healthcare facilities to "transform" from the current model of healthcare delivery to one that is more collaborative, patient-centered, and driven by best care practices and technological advancements. Learn how Dr. Scott Hammond has transformed the way he and his staff approach patient care, and have created a culture at Westminster Medical Center where the clinic's providers, staff, and patients are working together on improved patient health outcomes and clinic viability. You will also learn about the variety of resources and tools that Dr. Hammond used along this journey, and how pertinent these resources are in today's fast changing healthcare landscape. CRHC and CCGC are pleased to present this no-cost webinar through a generous grant provided by The Colorado Health Foundation.

For registration information, click here.

CCGC Seeking Providers to Develop Childhood Obesity Guideline

The Colorado Clinical Guidelines Collaborative (CCGC) invites you to participate on a committee to develop a childhood obesity guideline aimed at primary care providers in Colorado. Guidelines are developed by a committee of experts who review existing evidence and current literature to identify key points that should be emphasized. For more information, click here. The estimated time commitment is two, 2-hour meetings per month, January-June 2010. It is possible to participate by conference call. CCGC is looking for the following expertise for this committee: Family Medicine, Internal Medicine and Pediatric Physicians, Nurses and PA's, Researchers, Program Directors and other interested parties. To participate, contact Sara Schwankl at sschwankl@coloradoguidelines.org or 303.962.8979 by Friday, December 31, 2009. Include your name, specialty, organization, email, and meeting time/day preference.

Senate Health Bill Filed

The long-anticipated Senate health reform bill (a bill blended from the two bills reported from the Finance Committee and Senate HELP Committees) has been filed. The bill number is HR 3589. You will find it posted on the National Rural Health Association website. NRHA is completing an analysis of the rural provisions in the bill as quickly as possible. (Upon a very quick read, however, it looks like the proposed legislation retained most of the important rural provisions that were contained in the original Senate HELP and Finance bills.) Preliminary discussions of the bill have begun on the Senate Floor--but there will be a few procedural hurdles that must be overcome before we get to the actual debate where amendments will be offered.

The bill has been scored by the Congressional Budget Office (CBO) at $849 billion over ten years, or, within the target that the Democrats were shooting for. CBO indicates that the bill will actually reduce the deficit by $127 billion over ten years and $650 billion over the following ten years. The bill is also projected to insure 94% of the population.

Sliding Fee Scale

A sliding fee scale is not mandatory for Rural Health Clinics whether independent or provider-based. There are programs that RHCs can voluntarily participate in that do require a sliding fee scale, such as the National Health Service Corps scholarship, loan repayment programs and the Primary Care Fund. For more information, sliding fee scale guidelines and template contact Rich Marquez, RHC Program Coordinator at 303-577-0373 or by email at rm@coruralhealth.org.

Assn. of Rural Health Clinics of Colorado

On November 23, 2009 the Advisory Committee of the Association of Rural Health Clinics of Colorado (ARHCC) approved the Association's bylaws. The ARHCC bylaws will be formally approved by Association members at the 2010 Annual Rural Health Clinics Forum and ARHCC Annual Meeting. All certified Rural Health Clinics in Colorado are members of ARHCC. Clinic's joining the Colorado Rural Health Center (CRHC) automatically become voting members of ARHCC. CRHC's membership drive is currently underway. For more information contact Rich Marquez, RHC Program Coordinator and ARHCC Secretary at 303.577.0373 or by email at rm@coruralhealth.org. The ARHCC benefits package is in development and will be announced in 2010.

HITECH Incentives Webinar

Webinar: "Understanding the HITECH Incentives"
When: January 14, 2010; 12:00pm-1:15pm
Topic: The Centers for Medicare & Medicaid Services is working to finalize the incentive funding details for CAHs and RHCs prescribed by the HITECH Act. During this webinar, David Ginsberg, President of PrivaPlan Associates, Inc., will review the latest information from the expected Interim final rule on: definition of Meaningful use; how providers will demonstrate or prove meaningful use; incentive funding specifics. For more information and to register, email sg@coruralhealth.org.

Colorado Stroke Symposium

December 10, 2009
The Colorado Stroke Symposium, sponsored by the American Heart Association, will be held on Thursday, December 10, 2009. Attendees will learn about Get With The Guidelines-Stroke, the American Heart Association's premier in-hospital process for continuous quality improvement for prevention of cardiovascular events and stroke. For more information and to register click here.

Recruitment & Retention Webinar

CHAMPS Webinar: "Successful Recruitment in Challenging Times"
Date/Time: Wednesday, January 20, 2010, from 11:30 am until 1:00 pm MDT
Presenter: Cherith Flowerday, Workforce Programs Manager, Colorado Rural Health Center
Target Audience: Health center and clinic staff responsible for or involved in recruitment, providers, and interested local organizations and citizens. For more information, click here.
Continuing Medical Education (CME) Credit: 1.5 hours of CME credit will be offered for this webcast; determination of credit is pending.
Registration: This event will take place online, and advance registration is required, preferably 24 hours before the event. To register, please click here. Handouts and log-in information will be emailed to all registrants the day before the event.
Cost: Attendance is free for participants from CHAMPS Organizational Members, including CME credit. Attendance is free for participants from CRHC Organizational Members; CRHC members will be charged $15 per person for CME credit after the event. Non-member participants will be billed $75/webcast link and $15/person for CME credit after the event.

To determine if your organization is a current CHAMPS member, please click here.
To determine if your organization is a current CRHC member, please call Andrea Williams at 720.248.2743 and reference this event.

Medicaid Outpatient Hospital Reimbursement

The Department of Health Care Policy and Financing (HCPF) has submitted proposed amendments revising the Medical Assistance Rule for Outpatient Hospital Reimbursement, §8.300 which will reduce Medicaid outpatient reimbursement. Information about the rule and the upcoming rulemaking hearing can be found by clicking here. For more information, contact Judi Carey, HCPF MSB Coordinator at 303.866.4416.

IV Pumps Available

Platte Valley Medical Center has some Imed/Alaris Gemini IV pumps (1- 2- and 4-channel) that were recently taken out of service. If your hospital has a need for any of these IV pumps, please email jd@coruralhealth.org. Your facility would just need to cover shipping. Parts aren't available from Alaris any longer, but can be obtained from third-party dealers. Tubing is readily available because it is the same the new pumps use.

Recent Funding Opportunities

HUD 242 (FHA Section 242) - Helping Hospitals Get Capital Financing
Loan program through the Department of Housing and Urban Development to help hospitals finance new construction, refinancing, and modernization or to purchase major movable equipment such as hospital beds, wheeled equipment, and office machines. For more information, click here or call 202.708.0599.

2009/2010 CAH Capacity Building Grant - Applications due December 4!
CRHC has released its 2009/2010 CAH Capacity Building Grant Guidelines. The guidelines are accessible on CRHC's website by clicking here. Grant applications are due December 4, 2009. If you have questions or need additional information please email jd@coruralhealth.org.

Rural Emergency Responders Initiative
USDA Rural Development administers a direct loan and grant program to develop fire and rescue facilities and equipment in rural areas and towns with populations up to 20,000. For more information, click here.

NEW Credentialing Network

Register Now! The new CRHC Colorado Credentialing Network assists hospitals and clinics with credentialing issues specific to accreditation requirements, significant legislation, and civil litigation. For an annual membership fee of $250, CRHC’s Colorado Rural Credentialing Network provides rural hospitals and clinics with education, resources, and information facilitated by a credentialing specialist. For more information click here.

CMS Updates

CMS 2010 OPPS Final Rule - Physician Supervision Requirements
On October 30, 2009, CMS released the 2010 OPPS final rule. The final rule contains several changes to physician supervision requirements that will impact Critical Access Hospitals (CAHs). Click here for an explanation of the changes.

HHS Strengthens HIPAA Enforcement
The U.S. Department of Health and Human Services (HHS) issued an interim final rule with request for comments today to strengthen its enforcement of the rules promulgated under HIPAA. These HITECH Act revisions significantly increase the penalty amounts the Secretary may impose for violations of the HIPAA rules and encourage prompt corrective action. For more information, click here.

CMS Open Door Forum
Discussion from HHS on H1N1 will be held on Tuesday, 11/10/09 from 2pm-3pm ET. The call will discuss the Secretary of HHS invoking her waiver authority under Section 1135 of the Social Security Act. Requests by providers to operate under the flexibilities afforded by the waiver should be sent to the CMS regional office. CMS will be taking questions during this call. Call: 1-800-837-1935; Conference ID 3H1N1. For more information, click here.

Updated CMS Quarterly Provider Update (QPU)
The CMS QPU was updated on 10/22/2009 through 10/30/2009 to include recently published instruction(s) and/or regulation(s). Please view the October 2009 QPU What's New Page by clicking here.

IHI Expedition: Improving Your HCAHPS Score

The Institute for Healthcare Improvement (IHI) is offering its latest Expedition program, “Improving Your HCAHPS Score Through Patient-Centered Care”, for organizations that are committed to improving the patient experience and, along with it, their HCAHPS score. IHI offers a 50% enrollment discount for hospitals with less than 50 beds. For more information about this program, or to enroll, please click here.

Group Purchase Discounts

RAC Physician Advisor Discount
CRHC has negotiated a reduced pricing option with Executive Health Resources, Inc. (EHR),The Physician Advisor Company™, to provide RAC protective services. EHR teams are dedicated to ensuring medical necessity compliance and revenue integrity, and improving reimbursement while optimizing hospital efficiency and helping to increase quality of care. For more information about the available discounts, please contact Jen Dunn at jd@coruralhealth.org . To learn more about EHR, please visit their website by clicking here.

McKesson InterQual Care Guidelines
The discounts range from 22%-35% depending on the InterQual criteria set licensed. To be eligible for the discount you must be:

• A Colorado CAH Initiating or renewing a subscription
• Not currently subscribing through an agreement through another hospital system/group

For more information about the discount, , please contact Dana Spiel at McKesson at 480-203-2656 or danaz.spiel@mckesson.com.

Milliman Care Guidelines
A 10% discount if they license by December 15, 2009 (this discount will not be available in 2010!). The discount will be applied to the fees each year of a 5-year agreement. Please contact Rodger Hopkins, at Milliman (425-413-6584) or rodger.hopkins@milliman.com for more information or to attend a demonstration.

CAH Bed Limits & H1N1 Patients

In response to the recent H1N1 (Swine Flu) outbreak, President Obama and HHS Secretary Sebelius have officially declared a national state of emergency which will allow critical access hospitals to file a request to CMS that would temporarily waive the daily limit of twenty-five occupied beds for critical access hospitals. Though this does not indefinitely lift the limit, nor does it apply to any bed limits for which H1N1 patients are not a contributing factor, it does seek to address the current outbreak and address for surges in patient loads. The waiver is not automatic, and each CAH must submit an individual request to be reviewed by CMS in order for it to be granted. The request must be sent to their regional CMS office. Click here for your regional CMS office contact information. For more information see the links below:

• Explanation of 1135 Waivers
• CMS H1N1 Information Website
• Information Sheet from AHA

Section 1135 Waiver Requests for CAHs

November 10, 2009 from 2pm-3pm: H1N1 Discussion Call
The purpose of this third H1N1 call is to discuss the Secretary of Health and Human Services invoking her waiver authority under Section 1135 of the Social Security Act. We will be talking live questions during this call. If you would like to submit a question prior to the call, please send your question to: Pandemic@cms.hhs.gov. Put "November 10, 2009 Call" in the subject line. All callers please dial: 800.837.1935 and use Conference ID 3H1N1. Dial in at least 20 minutes prior to start of the call.

RHCs Eligible For Up To $2000 for Emergency Preparedness

All Colorado’s Rural Health Clinics are eligible to receive up to $2000 from the Colorado Department of Public Health and Environment (CDPHE) for completing emergency preparedness activities. RHC Program Manager, Toloa Pearl, will be contacting you soon to discuss your deliverable requirements.

H1N1 Vaccine and the RHC Cost Report

Like pneumococcal and influenza vaccines, clinics will capture the cost to administer the H1N1 vaccine on the cost report. Right now CMS approved cost report software can report and calculate costs to administer pneumococcal and influenza vaccine only. This means that CMS approved cost report software needs to be updated to capture cost to administer the H1N1 vaccine. Two new columns will be added to the vaccine section of the cost report:

1. H1N1 only
2. H1N1 plus influenza

The timeline for completing the updates to the software is not known however to-date CMS Regional Offices, MACs and approved CMS Cost Report Vendors have been notified. Clinics are advised to adjust their existing cost report vaccine logs as follows:

1. pnuemo
2. influenza
3. H1N1 only
4. H1N1 plus influenza

CMS Medicare Learning Network Publications

Now Available:

• The Medicare Physician Guide: A Resource for Residents, Practicing Physicians, and Other Health Care Professionals (October 2009) offers general information about the Medicare program, how to become a Medicare provider or supplier, Medicare reimbursement, Medicare payment policies, evaluation and management services, protecting the Medicare Trust Fund, inquiries, overpayments and fee-for-service appeals.
  Download The Medicare Physician Guide
• The Facilitator’s Guide: Companion to Medicare Physician Guide: A Resource for Residents, Practicing Physicians, and Other Health Care Professionals (October 2009) includes all the information and instructions necessary to prepare for and present a Medicare Resident, Practicing Physician and Other Health Care Professional Training Program, including instructions for facilitators, customization guide, a PowerPoint presentation with speaker notes, pre- and post-assessments, master assessment answer keys and a course evaluation tool.
  Download The Facilitator's Guide

November is Diabetes Month

Twenty-four million adults and children in the United States suffer from diabetes. Complications from diabetes can include increased risk of heart disease, blindness, glaucoma, nerve damage and kidney damage. However, detection and treatment of diabetes may prevent or delay many of these complications. As a health care professional who provides care to patients with Medicare, you can help protect the health of your patients by educating them about their risk factors and encouraging them to take advantage of Medicare-covered diabetes detection and treatment services. For More Information CMS has developed several educational products related to Medicare-covered diabetes-related services, including:

• The Guide to Medicare Preventive Services for Physicians, Providers, Suppliers and Other Health Care Professionals - This recently revised comprehensive resource provides coverage and coding information on the array of preventive services and screenings that Medicare covers, including diabetes and glaucoma screening tests, diabetes self-management training, medical nutritional therapy, and supplies and other services for Medicare beneficiaries with diabetes. Click here.
• Diabetes-Related Services brochure - This recently updated brochure provides health care professionals with an overview of Medicare's coverage of diabetes screening tests, diabetes self-management training, medical nutrition therapy, and supplies and other services for Medicare beneficiaries with diabetes. Click here.
• Quick Reference Information: Medicare Preventive Services - This double-sided chart provides coverage and coding information on Medicare-covered preventive services, including diabetes and glaucoma screening tests, diabetes self-management training, medical nutritional therapy, and supplies and other services for Medicare beneficiaries with diabetes. Click here.
• The MLN Preventive Services Educational Products Web Page - Provides descriptions and ordering information for MLN preventive services educational products and resources for health care professionals and their staff. Click here.
• Glaucoma Screening brochure - Click here for an updated brochure provides information on coverage for Medicare-covered glaucoma screenings, including the dilated eye examination.Information for your use and materials for consumers and health professionals developed by the National Diabetes Education Program are available by clicking here.

For more information about American Diabetes Month, please visit the American Diabetes Association Web site by clicking here.

Rural Health Care Leadership Conference

February 7-10, 2010 at the Pointe Hilton Squaw Peak Resort, Phoenix, AZ
The 23rd Annual Rural Health Care Leadership Conference, presented by Health Forum and the American Hospital Association, brings together top thinkers in the field, and offers you proven strategies for accelerating performance excellence and improving the sustainability of your rural hospital. The conference provides a unique focus on innovative ideas, thoughtful insights, and successful strategies for improving rural hospitals and developing rural health care leaders. Early Bird Tuition rolled back to 2004 rates! Reserve your spot by December 7, 2009 for the greatest savings. Click here for more information.

Colorado Flu Report

The Colorado Rural Health Center would like to thank Nancy Gilbert, Emergency Preparedness Coordinator and the Colorado Community Health Network for H1N1 news and updates updates. Current data indicate that hospitalizations peaked during two weeks in mid-October. Surveillance activities indicate that the number of hospitalizations and level of influenza-like activity are currently declining. It is important to note that while the overall influenza-associated hospitalizations are decreasing, there is still a significant influenza burden in the state.

• A cumulative total of 1553 hospitalizations from 48 counties have been reported.
• A total of 34 deaths (7 pediatric and 27 adult deaths) have been reported.
• Influenza-Like Illness Surveillance from Kaiser Permanente for the Denver-Boulder metropolitan area continued to drop for the third week in a row down to 4.4% for the week ending October 31st.
• State laboratory virologic surveillance continues to show that virtually all influenza viruses currently circulating in Colorado are 2009 H1N1 virus.
• Influenza-Associated Deaths by Age Group Colorado 2009-2010 (cumulative through 10/31/09)
• 0-18yrs: 7
• 19-24yrs: 2
• 25-49yrs: 14
• 50-64yrs: 6
• 65+yrs: 5
• TOTAL: 34
(Note: These numbers represent a minimum estimate of deaths because of under-reporting and because only lab confirmed deaths are included. For more information, please click here.)

Colorado Volunteer Mobilizer

Since January 1st of 2009, the Colorado Volunteer Mobilizer (CVM) System has grown 29 % from 1400 approved volunteers to 1802 members. Administrators for the system now exist for all 64 counties in the state of Colorado. This increase in volunteers may be attributed to the addition and training of local administrators and clarification of legal protections volunteers have in Colorado statute.

Recently the Division of Mental Health within the Human Services Department of Colorado added 27 mental health groups through the Colorado Crisis Education and Response Network (COCern). COCern is a collaborative effort of mental health, substance abuse and behavioral health responders. With a community of over 600 trained behavioral health responders our CVM census will expand rapidly.

Since the first of the year state and local administrators have sent 97 alerts to volunteers for drills, quarterly test alerts, the H1N1 outbreak in late April/May of 2009. During the week of October 12th another alert was sent to program administrators for advising volunteers on preparedness for the fall flu season. The CVM program will continue to grow by reaching our projected year-end goal of 2000 volunteers in mid-November 2009. Currently, 652 individuals registered within the CVM are members of one of the state medical reserve corps with the remaining 1150 approved volunteers in general volunteer, licensed and certified professional or the public and environmental health groups.

With the new ESAR-VHP grant for September 30, 2009 – September 29, 2010 a new and professional image will be developed for the CVM and MRC programs. Contact with a professional exhibit design group will assist the program with branding and marketing to our specific target audience with materials that appeal to their professional goals and objectives within the Colorado community.

Already in development the completion of the CVM/MRC Response Volunteer Trailer will assist the programs with continued presence in the community and provide credibility for the state upon arrival for drills, training and/or real events.

H1N1 Update

It appears that the rate of H1N1 infection may be slowing down in Colorado, especially on the Front Range. Novel influenzas tend to come in waves so it is possible that we will see another H1N1 surge before flu season is over.

LAIV Vaccine
There have been some questions recently on whether healthcare workers should take the LAIV and if they do are they still able to see patients. Please visit the CDPHE website for more information.

Certain people should not receive the nasal spray flu vaccine including:

• Children under the age of two years of age;
• Pregnant women;
• People 50 years of age and older;
• People with a medical condition that places them at a higher risk for complications from flu, (chronic heart or lung disease including asthma or reactive airways disease; diabetes or kidney failure, illnesses that weaken the immune system);
• Children under the age of five with a history of recurrent wheezing;
• Children or adolescents receiving aspirin therapy;
• People who have had “Guillain-Barre” syndrome (GBS), within six weeks of getting a flu vaccine;
• People who have a severe allergy to chicken eggs or who are allergic to any of the nasal spray components.

NRHA's Grassroots Working Group

Join NRHA's Grassroots Working Group for health reform! This is YOUR chance to have an impact on the largest health care bill in generations. Health reform legislation is progressing quickly in Congress, and NRHA has created a special tool to share information through this crucial period. Join us for weekly conference calls to hear updates on reform progress and strategize going forward. We need the help of all our members to remind Congress that rural America is a crucial part of health reform. In order for any health reform to be a success for the 25 percent of Americans who live in rural areas, it must address three issues:

• The workforce shortage crisis must be abated;
• Equity in reimbursement must occur;
• Health disparities must be eliminated and vulnerable populations must be protected.

To participate in the Grassroots Working Group, please send a blank e-mail to join-grassroots@lists.wisc.edu, and you will receive an activation e-mail in reply. For more information on rural America and health care reform, click here.

New CMS CAH Regulations for Clinical Labs

The CMS 2010 IPPS final rule includes a change to CAH-Owned Clinical Laboratories which will require these laboratories to meet provider-based requirements as of October 1, 2010. Additionally, off-campus laboratories operating as part of the CAH and created/acquired on or after January 1, 2008 must satisfy both the provider-based requirements and provisions concerning the off-campus facility's minimum distance from a hospital or another CAH. CAH-owned clinical diagnostic laboratory facilities that do not satisfy the provider-based and, if applicable, distance requirements, by October 1, 2010 may continue to participate in Medicare, but will not be considered part of the certified CAH and will be paid under the Clinical Laboratory Fee Schedule (CLFS). For more information from CMS, click here; for an advance copy of the CMS State Operations Manual revisions, click here.

Proposed Rules for Meaningful Use and EHR Incentive Payments

CMS and the Office of the National Coordinator for Health Information Technology (ONC) encourage public comment on two regulations that lay a foundation for improving quality, efficiency and safety through meaningful use of certified electronic health record (EHR) technology. The regulations will help implement the EHR incentive programs enacted under ARRA. The CMS proposed rule and fact sheets, may be viewed by clicking here. ONC's interim final rule may be viewed by clicking here. Join CRHC for the "Understanding the HITECH Incentives" webinar (listed in the events section) where we will discuss the impact these proposed regulations will have on CAHs.