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NCHN eNews
July 12, 2011
Dear NCHN Members and Friends,

Welcome to the latest issue of the NCHN Weekly Digest. There is a lot of relevant news this week. In national news, JAMA's July 5th report on quality of care at Critical Access Hospitals has generated quite a buzz and we have links to responses from The Daily Yonder, NRHA, and the Flex Monitoring Team below. In the NCHN realm, we welcome new member Michelle Brauns with the newly formed Giles County Health Network and also bid a fond farewell to North Country Health Consortium's Martha McLeod.

As always, if you have news to share or have feedback, please email us.







Upcoming NCHN Calls & Events

2011 Leadership Summit Committee Call
Wednesday, July 13 @ 11:00 AM ET

Coffee/Tea Chats with Dr. Mary Kay Chess
Wednesday, July 20 at 11:00 AM ET

Executive Coaching Training Calls
Wednesday, September 14 at 11:00 AM ET
Wednesday, December 14 at 11:00 AM ET

Next Quarterly Membership Call
Monday, September 12 @ 12:30 PM ET (Topic TBA)

1st NCHN Leadership Summit
Tuesday, September 27
Hyatt Regency Crown Center: Kansas City, MO
Visit for more details. Registration & other information will be available soon!


NCHN Welcomes a New Member

Please join the Board in welcoming Michelle Brauns, Project Director, and Giles County Health Network as a NCHN Network Member.

Giles County Health Network (G-NET) was formed in 2011, is comprised of 8 members, and is located in Pearisburg, Virginia. Its mission is to facilitate and expand the delivery of health care services to the people of Giles County through the development of a vertical health network that integrates existing and future health care services administratively, clinically, and financially, and expands access to essential health care services. G-NET will broaden the current target population of uninsured adults to include underserved children by: expanding access to the under-insured as well as the uininsured, by expanding the scope of available services in Giles County to include health navigation, and by facilitating the addition of critical transportation services and cultural training of medical professionals.

Michelle BraunsContact Information
Michelle Brauns, Project Director
219 Buchanan Street
Pearisburg, VA 24134
Ph: 540-921-3502


From the Forum

2011 - 2012 Committees have been updated. If you are on a Committee, please login and check to make sure you have access to the appropriate Committee forums.



A priest sent a courier from Rome to Venice to reach Venice in 7 days.The Mayor of Venice sent a courier to Rome to reach Rome in 9 days.The distance was 250 miles.In how many days will they meet?




Martha McLeod Leaving North Country Health Consortium

Dear NCHN Members and Friends,

As you may know, after 12 years I am leaving the North Country Health Consortium (NCHC) effective July 29th .  I do not have any definitive plans except to take a break and refresh.  I have two delightful grandchildren and I plan to enjoy some time with them while I take a step back and get a larger perspective of the health care and health policy world.  After 25 years in the field, and with all the changes in the health care world, I think there are many new and exciting opportunities brewing.  In the short term, I will be available if there is any unfinished business that needs attention.   

Nancy Frank, MPH, who has been our Development Director, will take over as the Interim Executive Director. NCHC couldn’t be left in better hands.  I am very pleased that the transition is going smoothly and everyone has been so supportive and welcoming to Nancy.  Nancy can be reached at or by phone at 603-259-3700 x223.

Thank you for the wonderful relationships that have made our work in the area of rural health so successful.  Together we have worked to improve the health status for everyone in our region, especially the North Country’s most vulnerable populations. Over my 12 years with NCHC, I have seen the organization grow in reputation, in budget and in our influence and impact, shaping the quality of NH’s rural health system and improving health outcomes. 

I could not have done my work without a great staff and supportive Board and members.  Thank you for allowing me to be part of your lives and share in the collaborative ventures that have developed through our work together.  We have risen to the challenges of rural health and seen many successes from our work.  As a native of the North Country, it has been particularly rewarding for me to be able to channel my own passion in a way that improved the quality of life of the people who live in this region of NH.

My best to all of you.  I know you will continue the good fight. 

Please feel free to stay in touch or let me know if I can be of any help. After July 29th, I can reached at  or on my cell at 603-491-0542. 


Martha McLeod

Notes from Cindy Siler on Her Presentation at ORHP's Grantee Meeting

On Wednesday, June 29th, Cindy Siler with Tennessee Rural Partnership participated in the Strategic Plan Panel that was part of the ORHP Workforce and Network Development Technical Assistance Workshop. The workshop was coordinated by Georgia Health Policy Center. Cindy shared her network's RURAL approach to strategic planning.

Hi everyone!

Attempting to present a methodology that took years to develop and refine for activating and energizing an agency’s real Strategic Plan in twenty minutes is quite a challenge and I was grateful for the opportunity.

As a matter of fact, I learned a lot while preparing. With my efforts to deliver the plan, two messages seemed to continue to surface:
1) get prepared by honestly thinking through where you want to go and what you want the corporation to look like in the future, and
2) figure out how that picture is best tested and proven on a very regular basis for you and the Board.

Then the objectives and activities can fluctuate through the years…Recognizing that funding changes, staff leave, Board members are human and the overabundance of circumstances that can go astray, make every effort to stand firm and stay focused on the mission…. And who better to do that than RURAL folks? Because we all know that we are Really Unusually Ready to Accept Life (not as we hoped for but in the reality that it is today!)…take care to shoot only the right quail at the right time!


Job Accouncement: Helping Ourselves Prevent Emergencies (H.O.P.E)

Position: Prevention Coordinator
Location: Criag, AK

This position will be responsible for the development of a domestic violence prevention program on Prince of Wales Island, located in Southeast Alaska. The Prevention Coordinator will coordinate efforts with the Prince of Wales Health Network, and be supported by the Network in program development.


HCC of Lafayette County

The HCC of Lafayette County's newsletter for July 2011 is available online. This issues includes a link to the 2010-2011 Annual Report and information about the Rural Missouri Health Co-op.




AgriSafe Webinar: "The Impact of Health Care Reform on Rural America"

July 20, 2011
12:00 - 1:00 PM CDT

Topic: The Impact of Health Care Reform on Rural America
Presenter:  Maggie Elehwany, Government Affairs and Policy Vice-President, National Rural Health Association


CMS Rural Health Open Door Forum

July 12, 2011
2:00 - 3:00 PM ET

Rural Health Open Door Forum Overview 

The Rural Health ODF addresses Rural Health Clinic (RHC), Critical Access Hospital (CAH) and Federally Qualified Health Center (FQHC) issues, as well as some inclusion of other questions and concerns that occur in clinical practice pertaining to other CMS payment systems that also extend into these settings. Topics that frequently arise on this forum often deal with payment & billing for services subject to Health Professional Shortage Area (HPSA) and/or Physician Shortage Area (PSA) status, cost report clarifications, classifications for & qualifications of rural provider types, and the many special provisions being implemented for improving rural health in the Medicare Modernization Act of 2003. Timely announcements and clarifications regarding important rulemaking, quality program initiatives, and other related areas are also included in the Forums.

The next Rural Health Open Door Forum is scheduled for Tuesday, July12, 2011 from 2:00pm-3:00pmET. If you wish to participate, dial 1-800-837-1935 Conference ID 59683815. This call will be Conference Call Only. Please see the Downloads section below for the full participation announcement. Thank you for your continued interest in the CMS Open Door Forums.


Agricultural Medicine: Occupational and Environmental Health for Rural Health Professionals - The Core Course

July 11 - 13, 2011
Omaha, NE

This course is offered by UNMC College of Public Health and is intended for physicians, nurse practitioners, physician assistants, nurses, veterinarians, health educators, migrant health clinicians, physical therapists, undergraduate and graduate students, and others with an interest in rural and agricultural health care.


Webinar: How to Recruit and Retain Physicians in a Rural Market

July 21, 2011
1:00 - 3:00 PM CST

This webinar will address physician recruitment and retention activities which represents the difference between just “surviving” and “thriving” of any hospital. It will also address how the new federal health care reform law has just raised the recruitment stakes for available physicians, especially primary care. Experts predict that there will not be enough physicians to treat the millions of people who are newly insured under the law. According to the Association of Medical Colleges, the physician shortage will be 150,000 physicians in the next 15 years. The greatest demand will be for primary care physicians who will have an increasing role in coordinating care for each patient. This predicted shortage will mean more limited access to health care and longer wait times for patients.

Offered by Illinois Hospital Research and Educational Foundation
Cost: $260 for Non-IHA Members


NRHA: Quality and Clinical Conference

July 20 - 22, 2011
Rapid City, SD

The Quality and Clinical Conference is an interactive conference for quality improvement coordinators, performance improvement coordinators, rural clinicians, quality improvement organizations, and nurses practicing on the front lines of rural health care.


Grant Management: Native Traditions & New Technology

August 16-17, 2011
Billings, MT

Learn how to:
Find New Funding
Write Better Proposals
Manage Federal Awards
Win More Grants

Offered by Center for Rural Outreach & Public Services, Inc. and




Speak Your Peace: Measuring Rural Healthcare
by Robert Bowman, M.D.

July 11, 2011 (The Daily Yonder) - Rural health care providers are paid less to provide treatment to a population that is more likely to be poor than those in the cities. No medical researchers are saying rural hospitals don't provide the same quality of care as those city institutions that have more money and richer patients. Well...

Which is it JAMA? Where is your consistency in articles regarding quality of care? 

One article, published in the Journal of the American Medical Association last year by Clemens Hong, notes the difficulty of separating the context of primary care of the underserved from the quality of care.

This is a landmark article, painstakingly difficult to complete, and it concluded that patients "with greater proportions of underinsured, minority, and non–English-speaking patients were associated with lower quality rankings for primary care physicians." 


NRHA also responded to the JAMA's July 5th report on quality care at CAHs
The Flex Monitoring Team, the nation's leading experts on rural health care quality, has prepared a detailed analysis of JAMA's report (pdf)

More from The Daily Yonder
» How Will the New Health Care Impact Rural?
» Wednesday Roundup: Rural Hospital Death Rates

Six European nations plan demonstration telemedicine projects through 2013

July 8, 2011 (Telemedicine and e-Health News Alert) - Institutions from six European nations—Finland, Ireland, Northern Ireland, Norway, Scotland, and Sweden—will carry out 10 projects intended to demonstrate video consultation, mobile self-management and home-based health services starting in September. The projects are part of the multi-national Implementing Transnational Telemedicine Solutions (ITTS), which is led by the Centre for Rural Health (Inverness, Scotland). The projected cost of ITTS is €2.3 million ($3.3 million), to be funded by the European Union's Northern Periphery Programme. ITTs projects will run through December 2013.


More from Telemedicine and e-Health:
Anti-smoking, stroke telehealth services eyed for Medicare reimbursement
» View the proposed rule... (pdf)

AHRQ: New Toolkit Helps Medical Practices Examine the Impact of Health IT on Workflow

A new toolkit funded by AHRQ and prepared by the University of Wisconsin-Madison’s Center for Quality and Productivity Improvement (CQPI) will assist small and medium sized practices in workflow analysis and redesign before, during, and after health IT implementation. The toolkit, Workflow Assessment for Health IT, includes tools to analyze workflow, examples of workflow analysis and redesign, and others’ experiences with health IT and workflow. 


E-Health Project Boosts Physicians' Ability To Use Patient Registries, AHRQ-Funded Study Shows

July 8, 2011 - Massachusetts physicians who took part in a 4-year, $50 million health information technology (IT) program increased their ability to generate and use registries that provide information about laboratory test results and medication use, results of a new AHRQ-funded study show. The ability to use patient registries, or lists of patients with specific conditions, medications or test results, is considered an essential tool for improving health care and is in the “meaningful use” criteria developed by the Centers for Medicare and Medicaid Services. A total of 163 physicians from 134 practices in 3 communities participated in the health IT program between 2005 through 2009. Sponsored by the Massachusetts eHealth Collaborative, the program consisted of robust electronic health records and work-flow redesign and technical support at no cost to the practices. Compared with all physicians who were surveyed in 2005, all respondents in 2009 were more likely to be able to generate significantly more laboratory and medication registries.


Medicaid: More than Just Numbers

July 8, 2011 (The White House Blog) - It’s no secret that our country is in the middle of a tough dialogue about the budget and spending. President Obama knows that the American people and ordinary families should be at the heart of these discussions. 

In recent days, White House officials have been meeting with organizations like The Arc, MomsRising, and Family Voices to discuss the important role Medicaid plays in the lives of millions of Americans. They heard from parents of children with developmental, intellectual and physical  disabilities who told us about Medicaid providing the services and supports so their children could thrive in the community when no one had given them a chance. They heard from mothers who would go without health care but for Medicaid and families where Medicaid has helped change and save lives.


HHS and states move to establish Affordable Insurance Exchanges, give Americans the same insurance choices as members of Congress
Proposed rules offer states flexibility, choices, competition and clout for consumers and small businesses

July 11, 2011 (HHS News Release) - Today, the U.S. Department of Health and Human Services (HHS) proposed a framework to assist states in building Affordable Insurance Exchanges, state-based competitive marketplaces where individuals and small businesses will be able to purchase affordable private health insurance and have the same insurance choices as members of Congress. Starting in 2014, Exchanges will make it easy for individuals and small businesses to compare health plans, get answers to questions, find out if they are eligible for tax credits for private insurance or health programs like the Children’s Health Insurance Program (CHIP), and enroll in a health plan that meets their needs.

“Exchanges offer Americans competition, choice, and clout,” said HHS Secretary Kathleen Sebelius. “Insurance companies will compete for business on a transparent, level playing field, driving down costs; and Exchanges will give individuals and small businesses the same purchasing power as big businesses and a choice of plans to fit their needs.”

Today’s announcement is designed to help support and guide states in their efforts to implement Exchanges.


More from HHS:
HHS grants boost disaster preparedness in hospitals, health care systems (July 1, 2011)

CMS Proposes 2012 Medicare Home Health Payment Changes

July 5, 2011 ( - The Centers for Medicare & Medicaid Services (CMS) today announced a number of proposed changes to Medicare home health payments for 2012 that if finalized will promote greater efficiency and payment accuracy.

A proposed rule was displayed at the Federal Register today proposing a 3.35 percent decrease in Medicare payments to home health agencies (HHAs) for calendar year (CY) 2012. This would be an estimated net decrease of $640 million compared to HHA payments in CY 2011. It would include the combined effects of market basket and wage index updates (a $310 million increase) and reductions to the home health prospective payment system (HH PPS) rates to account for increases in aggregate case-mix that are largely related to billing practices and not related to changes in the health status of patients (a $950 million decrease).




Funds for Community-Based Healthy People 2020 Innovations (DHHS)

Deadline: August 5, 2011

The Healthy People 2020 Community Innovations Project Grant Program provides support to community-level projects that use Healthy People 2020 overarching goals, topic areas, and objectives to promote improved heath at a community level. Proposed projects must address at least one of the Healthy People 2020 topics and incorporate at least one of the following priorities that are linked to the Healthy People 2020 overarching goals:

• Environmental Justice: supporting the rights of all people to live in a healthy environment;
• Health Equity: dealing with issues that cause some groups of people to have worse health than others; and
• Healthy Behaviors Across All Life Stages: activities to improve the opportunities for people of all ages to make healthy choices.





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