In this day and age of being continually challenged to do more with less and have a lean organization, do you advocate your worth to your partners? Your communities? Yourselves? If not, there is no time like the present. On June 15, 2012, the rural report on serving Medicare Beneficiaries for Congress was released by the Medicare Payment Advisory Commission (MedPAC). This document was mandated to evaluate Medicare payments to rural providers, access to care, and the quality of care in rural areas. The report states rural health care provider challenges are minimal around the issues related to poor access to care and financial status. We of course know this simply is not true!

Access to Care

Rural communities continue to face workforce challenges. If current trends continue there will be a statewide shortage of nearly 2,220 primary providers by the year 2025. There are more than 13,000 physicians in Colorado, BUT 16 counties, all rural, have three or fewer practicing physicians and two counties have no practicing physicians. Additionally, there are 14 rural counties in Colorado with NO hospital or Emergency Room. Difficulty for recruiting providers to our communities will continue. Therefore, we must show off our best assets like fresh food, fresh air, friendship and community partnerships. These all play into what you do every day!

Financial

Many rural communities face financial issues. With the hospitals being one of the largest employers, we can’t afford to have these hospitals close. Data from the Sano Capital Group shows that “due to the weak economy and lack of necessary capital investment, an ever-increasing number of rural hospitals operate at a loss. This figure escalated to over 33% in 2009 and continues to grow. These facilities operating in the red employ approximately 139,000 jobs.” Working together to preserve our community’s current access to healthcare benefits both physical and financial health. Join CRHC as we attend the National Rural Health Association, March for Rural Hospitals on July 30-31 in Washington DC.

Quality

Currently 27 of the 29 critical access hospitals (CAHs) are signed up to voluntarily submit data to the Centers for Medicare and Medicaid Services (CMS) system Hospital Compare. Data from CAHs submitted to Hospital Compare and reported by iVantage shows that CAHs are holding their own compared to urban counter parts in heart failure and pneumonia. Aggregate CAH data from Q3 2010 shows the average for all heart failure measures is 70% and Q4 2011 has increased to an average of 74%. The Q3 2010 average for all pneumonia measures is 82% and has shown an increased to an average of 86% in Q4 2011. This increase shows commitment on the part of Colorado CAHs to report quality improvement data, despite the limitations of Hospital Compare in reporting this data.

According to data reported from iVantage, “Rural Hospitals saw a 37% surge in ED utilization in the three-year period between 2007-2009 compared with all US Hospitals, which have seen ED volumes increase 24% in the decade between 1998-2008.” In Colorado, we are seeing similar trends, which is why CRHC started the Improving Communication and Readmissions (iCARE) program two years ago. Of our 29 CAHs, 14 are currently participating. In its first year, iCARE participating CAHs reduced readmissions from 4.9% to 1.3%. Year three is set to kick-off in September 2012 and will focus on inclusion of clinics within the community to enhance communication between hospital and clinic staff. Clinics will track their diabetic population through disease registries and focus on system and process improvement. All communities will be offered technical assistance as well as the opportunity to receive patient advocacy training with a focus on improving provider-to-provider and patient-to-provider communications. Be on the lookout for further information.

Promote your great qualities on your terms and be an active participant. Rural Communities lead the efforts in care coordination from innovative ideas like Community Paramedics to working in true collaboration with hospitals, rural health clinics, public health, community funded safety net clinics, federally qualified health centers, mental health, oral health, businesses, schools, and most importantly the people in your community.

The economic viability of our communities is critical to our nation’s food supply and the very essence that America was built upon. I challenge you to tell your story and ask yourself, “How can I promote my community and the great work we do each day?” Although these are daunting times, remember you are not alone. CRHC staff are some of the most highly committed and dedicated people in the industry. We are here to assist you in your efforts to face these challenges, overcome the barriers, and celebrate your successes.

I leave you with a great You Tube Video by a few Kansas State University Students, “I’m Farming and I Grow It”.