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NCHN eNews
October 18, 2011 29 days until National Rural Health Day
Dear NCHN Members and Friends,

Welcome to the latest issue of the NCHN Weekly Digest. The biggest buzz in rural health in the last week has surrounded the potential rural hospital cuts. Tim Size (Executive Director, RWHC) submitted a guest editorial (see under National News below) and NRHA has been blogging about the topic for the last week.

In the funding realm, there are 2 new announcements. Unfortunately, there's no Member News this week. Or, rather, we have not received any news from you. We know you have news. You just haven't submiited it. Share it!

Let us know what's going on with your network
If you have information you would like to share, or have any feedback, please email us.







NRHD November 17, 2011

Upcoming NCHN Calls & Events

Executive Committee Call
[Rescheduled for] Monday, October 24 @ 2:00 PM ET

Program Development Committee Call
Tuesday, October 18 @ 1:00 PM ET
Tuesday, November 15 @ 1:00 PM ET

Coffee/Tea Chats with Dr. Mary Kay Chess
Wednesday, October 19 @ 11:00 AM ET
Wednesday, November 16 @ 11:00 AM

Board of Directors Meeting
Monday, November 14 @ 2:00 PM ET

National Rural Health Day
Thursday, November 17, 2011


Coffee/Tea Chat with Mary Kay Chess

Good morning from Mary Kay Chess!  

An opportunity to connect with your colleagues is quickly approaching.  The next NCHN Coffee/Tea Chat with Dr. Chess is:

Wednesday, October 19, 2011
11:00 AM – 12:00 PM (ET)
The call-in number is posted on the on-line forum.

Grab your curiosity and your favorite beverage and join other network leaders for the monthly conversation.  All topics are welcomed as we consider the vitality of supporting healthy networks


You will need to pre-register to access the forum. If you need assistance, email Christy.


From the Forum

What will you be doing to celebrate National Rural Health Day?


Someone offers you the following deal:

There is a deck of 100 initially blank cards. The dealer is allowed to write ANY positive integer, one per card, leaving none blank. You are then asked to turn over as many cards as you wish. If the last card you turn over is the highest in the deck, you win; otherwise, you lose.

Winning grants you $50, and losing costs you only the $10 you paid to play.

Would you accept this challenge?




There is no new member news this week.




National Rural Health Day: Update from NOSORH

With November 17 just 29 days away, we want to remind you about the resources NOSORH has developed to help you plan your events/activities and share what some of our partners are planning to do to help us – and you – spread the word about National Rural Health Day.

  • NOSORH would like to welcome two of its newest National Rural Health Day partners – the AgriSafe Network and the National Conference of State Legislatures (NCSL) – and thank them for  helping us spread the word about National Rural Health Day.  AgriSafe, for example, has already been sharing National Rural Health Day information and resources with its members, partners and various media outlets; NCSL, meanwhile is planning to spotlight the National Rural Health Day celebration on its website on November 17.  Thank you so much to AgriSafe, NCSL and all of our partners for helping us promote National Rural Health Day and raise awareness of rural health-related issues!
  • Looking to publicize your National Rural Health Day event?  Another one of our partners – the Rural Assistance Center (RAC) – is happy to add your event to its calendar!   Simply click here to submit your information – it’s that easy!  Our thanks to RAC for their support and for being such an outstanding source of information!
  • Facebook, Twitter and other social media outlets are another way to keep fans, friends and followers abreast of your National Rural Health Day activities and raise awareness of rural health-related issues.  Looking for soundbites to post on Facebook and Twitter?  This helpful list of Social Media Posts from our friends at the North Dakota Center for Rural Health is a wonderful resource to have at your disposal.  In fact, just work your way down the list starting with suggestion #1 on Monday morning (October 17), and you’ll have a new post to share every day until National Rural Health Day!
  • We also want to remind you of the wealth of resources in the Tools section of the National Rural Health Day website that are available to you:
  • We certainly appreciate the SORHs who have taken time to Share Their Celebration Plans by either adding their information to the Google Doc or sending it to us to add for you – we already know that at least 38 SORHs have planned some National Rural Health Day event or activity.  Please remember to continue adding or updating your information so we know what you’re doing and how your plans are progressing.  If you access to Google Docs is restricted, send your info to me and I’ll make sure to post it for you!
  • Speaking of plans, we want to let you know that NOSORH is in the midst of planning a Webinar-based program, press conference and/or celebration of some sort on November 17.  We will be sure to share more details in the next week or two as they become available.

For more information, contact Bill Hessert at or 814-231-1213.



UPCOMING EVENTS Affordable Care Act 101

October 18, 2011 @ 8:00 PM ET
Conference Call

November 1, 2011 @ 12:30 PM
Conference Call

There are millions of people who lack access to health care, essential for healthy children, families and communities, throughout the United States.  Many families don’t know what their options are to access better care.

NOW YOU CAN LEARN MORE about many provisions that are currently in place that could help you and those in your congregation or community.

The Affordable Care Act expands access to care, ends abuses of insurers, and makes health care more affordable.  The law helps those with pre-existing health conditions, people who are under age 26 and without health insurance, the most vulnerable in our society and those who are currently insured.  To learn more about the health care law and how to access health care benefits in your community, RSVP to attend our Affordable Care Act 101 Conference Call from the dates listed above.


CMS Rural Health Open Door Forum

October 18, 2011 @ 1:00 PM EST

Conference Leaders: Carol Blackford, John Hammarlund, Matthew Brown

Please dial in at least 15 minutes prior to call start time.

To participate by phone:
Dial: 1-800-837-1935 & Reference Conference ID: 83522688
Persons participating by phone are not required to RSVP.
TTY Communications Relay Services are available for the Hearing Impaired.  For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.

Encore: 1-855-859-2056 Conference ID# 83522688
Encore is an audio recording of this call that can be accessed by dialing 1-855-859-2056 and entering the Conference ID, beginning 4 hours after the call has ended. The recording expires after 3 business days.


ICAHN's 11th Annual CAH Workshop

October 20, 2011
Springfield, IL

As the healthcare system continues its reform journey, awareness and positioning become paramount to not just surviving, but doing so in a manner to provide your rural communities the quality care and services they need and deserve. Organizational and physician alignment, affiliation, accountable care, debt refinancing/restructuring, and quality initiatives will all play a role in how you approach the future of your facility.


SNHPA Webinar: Addressing Declining Third Party Reimbursement for 340B Drugs

November 3, 2011
1:00 - 2:30 PM EST

Who Should Attend: Pharmacy directors, CFOs, supply chain staff, contracting staff, government relations staff, and in-house counsel.

Registration Deadline: Nov. 1, 2011

A number of 340B hospitals and health centers are reporting to Safety Net Hospitals for Pharmaceutical Access (SNHPA) that several third party payors and their pharmacy benefit managers (PBMs) are offering 340B-specific reimbursement rates at levels that are well below those which they offer non-340B pharmacies. At least one PBM contract requires providers to pass along their entire 340B savings, which would essentially rob 340B providers of the entire 340B discount to which they are entitled under federal law. The purpose of giving safety net providers access to 340B discounts is to enable them to stretch their scarce resources to provide much-needed care to indigent and low income patients. Without adequate reimbursement – which SNHPA views as a direct attack on the 340B program itself and its statutory purpose – 340B hospitals face millions of dollars in lost revenue and an eroded capacity to provide this care.

SNHPA continues to monitor these troubling developments and is taking action on a variety of fronts to address the problem.


Emergency Alert System (EAS) Nationwide Test - November 9

On November 9, 2011, at 2:00 p.m. Eastern Time the Federal Communications Commission and FEMA will conduct the first-ever nationwide test of the Emergency Alert System (EAS). An announcement will come on every TV and radio channel indicating that there is an emergency. This will only be a test and you do not need to take any action. The purpose of this test is to find out how well the EAS can alert the public about dangers to life and property in the event of an actual emergency.




This Is Not a Drill: Speak Up for Rural Hospitals
Guest Editorial by Tim Size, Executive Director, Rural Wisconsin Health Cooperative (Sauk City, WI)

October 7, 2011 - This is not a monthly test of your outdoor warning siren. I have worked in rural health for over thirty years. We have never faced a situation as threatening as the federal cuts that may hit rural hospitals.

Senator Tom Coburn (an Oklahoma Republican) speaks for many when he said he understands the need to be careful when scaling back government spending. As he told Fox News, “to continue to waste $350 billion a year in the federal government, that’s pure waste or fraud or duplication.”

Waste is often in the eye of the beholder. From my point of view, a strong rural health system is not “waste or fraud or duplication.” America’s rural hospitals are the foundation of health care being local, not just urban. America’s rural hospitals are often at the center of a rural community’s economy. Weakening or eliminating rural hospitals weakens or eliminates local access to health care and local jobs.

I am hopeful that Senator Coburn and other Members of Congress from both parties remain solidly behind rural hospitals. But it is clear that the debt crisis is fertile ground for the surfacing of longstanding anti-rural bias and or plain misunderstandings. In particular, rural hospitals seem to be in the crosshairs from a variety of directions.

After decades of trying unsuccessfully to impose an urban-based model of Medicare funding on rural hospitals, Congress created the Critical Access Hospital program to create a stable network of rural hospitals throughout rural America. That success is now being threatened by a variety of proposals, ranging from eliminating some hospitals, across the board cuts or eliminating the entire program.

There is a risk of rural communities being divided from one another, seeing less threat in one proposal versus another. I can only say that when your house is threatened by fire, it’s not the time for talking about which parts to protect and which to let go.

We know that most rural hospitals are financially just holding their heads above water. Under-payment by government programs has left them vulnerable. A sluggish economy and an increasingly competitive health care marketplace are taking their toll. Medicare and Medicaid are rural hospitals’ largest payers. Additional cuts are likely to tip many rural hospitals into the red and eventual closure.

No one knows what is going to happen in Washington over the next few months. As the Serenity prayer teaches us: we need to have the courage to act, the patience to endure and the wisdom to know the difference. I hope for most of you, you will find this a time to act.

Go to where you can easily find the phone, email and fax information for your Senator and Representative. Let them know of your deep concern for the future of rural hospitals and that you are asking them to stand with you and fight to protect that future for rural America.

RWHC is a Network Member and Member Partner of NCHN. Tim Size is a long-time member of NCHN and a strong advocate for rural health. In 2010, he was nominated for Modern Healthcare's 100 Most Influential People in Healthcare.

If you need assistance, NRHA's website has tools to help you save time:

  • Find a template for letters to the editors of your local and regional papers about super committee developments.
  • Access critical information specific to your state.
  • Learn how to invite your member of Congress to visit your facility.
  • Develop talking points for their visits.
  • Learn when they will hold open door forums and town hall meetings.
  • Find information about who to contact in your representatives’ offices to ensure your voice is heard.

» Click here to access NRHA’s congressional action kit to support rural communities.

NRHA Applauds the Introduction of HR 3212, the CAH Designation Waiver Authority Act of 2011 (Rural Health Voices, October 17, 2011)
Craig Thomas Rural Hospital and Provider Equity Act Introduced in United States Senate (Rural Health Voices, October 12, 2011)

5 ways telemedicine can boost care in rural communities

October 13, 2011 (HealthcareIT News) - It’s no secret telemedicine has had a profound impact on the industry, both nationally and globally. Organizations in big and small cities are seeing the benefits of employing such technology, and the biggest impression could arguably be on those living in rural communities.

“Some of our most important citizens live in rural, small cities, the countryside, or remote areas, and these areas have smaller populations and less-direct access to vital healthcare resources,” said Shahid Shah, software analyst and author of the blog Healthcare IT Guy. “In the past 15 years or so, we’ve made some great strides in remotely accessible healthcare; these offerings, called telemedical tools, provide important clinical care at a distance.”


ATA gathers signatures for petition demanding nationwide portable telemedicine licensure

October 11, 2011 (Telemedicine and e-Health News Alert) - The American Telemedicine Association (ATA; Washington, DC) launched, a new initiative intended to build public support and lobby legislators for reforms that eliminate hurdles to healthcare providers obtaining medical licensing for their telemedicine practices across the US. ATA said the reforms would increase consumer choice, improve safety and cut costs for patients nationwide. began gathering signatures for an electronic petition supporting a nationwide licensure portability system. Signatories of the petition will be shared, according to ATA, with Congressional leaders, state medical licensure boards and federal healthcare agencies. “It is wrong to deny a patient healthcare because of state boundaries and overly cumbersome state licensing rules,” ATA CEO Jonathan D. Linkous declared in a statement.


University of Wisconsin program tries to provide rural doctors
Number of new physicians hasn't keep pace with retiring doctors

October 16, 2011 (Green Bay Press Gazette) - Rural doctors are disappearing at alarming rates, but a University of Wisconsin-Madison program is trying to make a dent.

"There is an enormous shortage of primary care and, even more specifically, specialty physicians willing to locate in rural areas," said Dr. Paul Summerside, chief medical officer at BayCare Clinic in Green Bay and a director of the Wisconsin Academy of Rural Medicine at the UW School of Medicine and Public Health.


Fourteen Critical Access Hospitals Join The Nebraska Statewide Health Information Exchange

October 14, 2011 (Healthcare Technology Online) - The Nebraska Health Information Initiative (NeHII), Nebraska's statewide Health Information Exchange (HIE) announced recently that within the past month, fourteen Critical Access Hospitals (CAHs) have joined NeHII in an effort to access and share health information across the state. Powered by the Axolotl HIE platform from OptumInsight, NeHII electronically delivers clinical information at the point of care, integrating a wide variety of patient clinical data including laboratory results, ER reports, discharge summaries, radiology reports, progress notes, transcription, medications and other medical information.


3 Strategies of Financially Successful CAHs
by Alexandra Wilson Pecci

October 12, 2011 (HealthLeaders Media) - By definition critical access hospitals are isolated. But just because they're isolated geographically, doesn't mean they must be isolated from each other. When the going gets tough, CAHs can band together and teach each other a lot. And according to most forecasts, the going is getting tougher all the time.

"The stakes are going to be higher over the next three years than they ever have been before," George Pink, senior research fellow at the North Carolina Rural Health Research and Policy Analysis Center, tells HealthLeaders. "2011's going to have record merger and acquisition activity; a lot of small hospitals may disappear, or they may be absorbed into larger systems."

With such high stakes, financial viability is more important than ever, and when it comes to success factors for CAHs, who better to turn to than each other?


Emergency Alert System (EAS) Nationwide Test - November 9

On November 9, 2011, at 2:00 p.m. Eastern Time the Federal Communications Commission and FEMA will conduct the first-ever nationwide test of the Emergency Alert System (EAS). An announcement will come on every TV and radio channel indicating that there is an emergency. This will only be a test and you do not need to take any action. The purpose of this test is to find out how well the EAS can alert the public about dangers to life and property in the event of an actual emergency.



ORHP Funding Announcement: Rural Health Care Services Outreach Program

The Office of Rural Health Policy (ORHP) is pleased to announce the release of the FY 2012 Rural Health Care Services Outreach Grant Program (announcement number: HRSA-12-083). ORHP’s Outreach Program supports projects that demonstrate effective models of outreach and service delivery through collaboration, adoption of an evidence-based or promising practice model, demonstration of health outcomes, replicability and sustainability. Proposed projects will have an outcomes-oriented approach that will enhance and sustain the delivery of effective health care in rural communities by tracking specific health indicators that will demonstrate the impact of their project at the end of their grant period. They will be based on evidence-based or promising practice models in order to avoid “reinventing the wheel” and demonstrate health status improvement in rural communities. Proposed Outreach projects can take the framework of an evidence-based or promising practice model and tailor it to their community’s need and organization.

Applicants may propose funding for up to three (3) years from May 1, 2012 to April 30, 2015. The maximum award is up to $150,000 per year. We expect to fund approximately 80 grantees.

Closing Date: November 22, 2011

TA Call
A technical assistance call was held on September 29, 2011 (Thursday). The call was recorded and available for playback. To access the playback, please call: 1-800-229-6331. It will be available until November 22, 2011.

For further questions on this funding opportunity, please contact the program coordinator, Kathryn Umali, 301-443-7444,

Need help writing your Outreach Program application?
Contact your State Of-fice of Rural Health (SORH) for grant-writing resources. Please visit: to find your SORH contact information. A webinar about evidence-based/promising practice mod-els and evaluation will be posted on starting October 7, 2011.


Public Education Efforts To Increase Solid Organ Donation Program

Deadline: November 16, 2011

Description: The purpose of this program is to support the implementation of public education and outreach programs that show promise of increasing organ donation.  Specifically, this program supports the replication of strategies that have been identified through the research grant program of the Division of Transplantation as effective in increasing donation or strategies identified in the public health literature as being effective in modifying health behavior.  The program also supports the implementation of public education and outreach efforts that are based on an established framework for successful public health outreach programs.  This grant program is supportive of the Division's mission to educate the public about deceased donation and to encourage individuals to document their decision to be a donor in their statewide donor registry or by some other mechanism where a registry is unavailable. Projects may also increase knowledge of opportunities to donate specific organs or organ sections while living and the process, risks, and benefits of living donation. 

Eligibility: This funding opportunity is open to nonprofit providers, including faith-based and community organizations.

Funding: Up to four awards, with funding from $250,000 to $1,000,000.


Social and Behavioral Interventions To Increase Solid Organ Donation

Deadline: November 30, 2011

Description: This grant program is to increase solid organ donation and to improve understanding of how to increase solid organ donation.  The goal of the grant program is to assist eligible entities in the evaluation of, or the implementation and evaluation of, highly promising strategies and approaches that can serve as model interventions for increasing solid organ donation. Projects may focus on community education and outreach initiatives or hospital based efforts focused on family consent for donation when a death has occurred. Projects may also increase knowledge of opportunities to donate specific organs or organ sections while living and the process, risks, and benefits of living donation.

Eligibility: This funding opportunity is open to nonprofit providers, including faith-based and community organizations.

Funding: Up to four awards, with funding from $300,000 to $1,250,000.




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