by Tim on January 27, 2010
by Tim Size, Executive Director, Rural Wisconsin Health Cooperative, Sauk City
Not a front row seat, but I had the good fortune to be in the Visitor’s Gallery for President Obama’s first State of the Union address. Regardless of one’s politics, it is a rush to be in the House Chamber to be a part of history and political pageantry.
The President spoke to the country in the shadow of the irony of the Massachusetts election. The irony isn’t what happened to the seat long held by Ted Kennedy but that the one state that has, and to all accounts appreciates, universal health care might block the rest of the country from gaining something similar.
The President took a share of the responsibility for a process that has been too partisan and pork laden for most of us. He challenged both Democrats and Republicans to stop making every day and every issue about the next election. For my part, it is clear that America does not like watching sausage being made. This doesn’t make us all vegetarians but he spoke for most of us when he said the people want fewer sound bites and more of the job getting done.
The President strongly believes in the ethical imperative of reform as well as believing it is a fundamental building block of having a strong economy and sustained job creation. Contrary to the pundits, it didn’t sound to me like he was backing away from health reform. He is not quitting.
by Tim on January 6, 2010
The health-care reform bill pending in Congress will help rural communities by more people having health insurance, beginning to address some rural payment inequities and continue some important protections for rural providers that were expiring.
The bill needs to be seen as only a really important first step on long over due changes for our country. This is not a criticism of Congress but a statement of reality when a country goes about trying to fundamentally improve a huge part of itself, like its healthcare system. [click to continue…]
by Tim on November 3, 2009
by Tim Size, Executive Director, Rural Wisconsin Health Cooperative, Sauk City
In 40 years working in and studying health care, I have never seen a more challenging time. I’m not suggesting that you need to hug a healthcare worker, or even your hospital administrator, yet.
On a typical day, they are working to protect their patients and community from the effect of not one storm but a plague of once in a generation storms. You see or hear about these events every day but you may not know how they pile up on your local hospital or clinic. Think of the uncertainty on the ground around federal healthcare reform, of state budget shortfalls, of physician and healthcare workforce shortages, the effects of the global recession, and of course, H1N1. Each one of the five is a big challenge. All five at one time would cause any of us to do more than lose sleep.
Let me be clear, I am not whining on behalf of friends and colleagues who work in the front lines of health care; just the opposite– I stand in amazement at their calmness.
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by Tim on September 9, 2009
The President made it clear he stands on common ground for our country by “building on what works.” A new government run plan that undermines the private sector now seems less likely. A major shift of patients into a plan paying Medicaid and Medicare type rates would harm rural patients’ access to local health care. Reform affecting rural communities must and can be built on quality outcomes and efficiency while delivering care locally. As the President concluded, I “believe we can replace acrimony with civility, and gridlock with progress.”
by Tim on August 23, 2009
by Tim Size, Executive Director, Rural Wisconsin Health Cooperative, Sauk City
The shouting heads on the talk shows recently sunk to a new low in their ongoing mission to misdirect the American people. One of the national health reform bills proposed encouraging doctors to discuss end of life options with patients and families. Radicals with their own agendas twisted this into a Government plot to set up “death panels.” But it is lemonade out of lemon time. We now have the long overdue opportunity to talk about what it means to our health care when we joke “none of us gets out of here alive.”
Martians may land here tomorrow. Congress may start listening to the larger number of us who don’t shout for a living. So yes, trying to help patients and families deal with tough end of life questions can be twisted into something sinister. But when each of our time comes, most of us don’t want end of life heroics. We want to be treated with respect, to be embraced and to die free of pain. [click to continue…]
There is a lot to chew on in the new Gallop Poll: “Americans on Healthcare Reform: Top 10 Takeaways” at http://www.gallup.com/poll/ As you would think, it shows the fluid nature of public opinion at this time in the “health reform” debate. But I’d draw your attention to one of the few points where the public seems close to one mind: #3 Americans agree that healthcare costs are a major problem for the country. That makes advocacy for value based purchasing as opposed to simplistic across the board cuts more important than ever. And to be clear, from a rural point of view, access to local care must be part of the value equation.
I. Three Rural Health Priorities
Assure Local Access to Quality and Cost Effective Care
· Protecting access to local care must be a high priority. Rural health’s many successes in Wisconsin are a testament to the endurance and creativity of rural communities. State and federal laws have long required health insurers to respect the right of people to receive health care locally.
· We believe that if a Wisconsin community has available local providers, health plan enrollees should not be forced to travel beyond that community because the health plan refuses to contract with local providers, when those providers would accept a contract with financial and quality terms comparable to other providers with whom the health plan contracts.
Address Forecasted Health Workforce Crisis in Both Rural and Urban Communities
· The soon to explode retirement of baby boomers will lead to a critical shortage of workers, particularly in rural America for which we are ill prepared. Many rural communities already face staff shortages.
· Make sure promoting diversity in the health workforce addresses the unique recruitment and education needed for rural and inner-city practice.
o Programs like the University of Wisconsin School of Medicine and Public Health’s Wisconsin Academy of Rural Medicine (WARM) and TRaining In Urban Medicine and Public Health (TRIUMPH) acknowledge the uniqueness of rural and inner city practices. Investments in expanding the pipeline needs we must support programs that emphasize recruitment from and training in these target communities.
o The expansion and/or reallocation of resources that currently go into Graduate Medical Education needs to be made more flexible so as to include both new rural training tracks and rural rotations.
Make Workplace Wellness and Healthy Communities a National Priority
· Reform must help individuals and communities to become healthier, to not need as much health care. Rural patients face the most daunting of health care challenges: they are older, poorer and sicker. Rural America is less healthy due to too much smoking, drinking and eating, and too little exercise, education, jobs and income.
o Healthcare reform must address factors unique to the rural context. It should lay down a road map to make our communities healthy. Prevention and Wellness provisions must present a comprehensive policy designed to ensure that all Americans will receive the state-of-the-art in both clinical and community preventive services, undertaking a coordinated effort to make comprehensive prevention research, evaluation, and delivery a permanent part of the national landscape.
o Eliminate cost-sharing on recommended preventive services delivered by Medicare, Medicaid, and insurance available in the Health Insurance Exchange.
o Support incentive models to stimulate multi-sectoral action toward community health improvement such as the University of Wisconsin’s Mobilizing Action Toward Community Health (MATCH). As repeatedly noted by the UW’s Population Health Institute, our health status is affected by multiple determinants beyond Health Care which also need to be addressed: Health Behaviors, Socioeconomic Factors and the Physical Environment.
II. Key Threats to Rural Health in Current Congressional Reform Proposals
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Readers not comfortable leaving a comment below may send feedback to: timsize@rwhc.com.
“What is good for General Motors is good for the country.” We used to say that. But now it is more like “What is good for we Baby Boomers is good for the country.” In any event, this huge generation is aging into becoming patients. The tremors of this shift will hit our country for the next twenty years.
I am an aging “cheesehead” and proud of it. I know all too well Wisconsin’s justly famous beer, cheese and brats. But my primary care physician, workplace wellness program and a life event wacked me on the head. I am lucky. This dose of personal health reform has led to overdue lifestyle changes. Hopefully I will stay on track. Multiply my story by millions of fellow cheese heads and you see the bigger challenge.
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“Meaningful EHR Use,” “Certified EHR,” And “Open Source” Recommendations
Readers not comfortable leaving a comment below may send feedback to: timsize@rwhc.com timsize@rwhc.com
Thanks to Louis Wenzlow, RWHC Director of Health Information Technology, who is the primary drafter and to other senior staff at RWHC who provided significant input. Download pdf or read below.
The American Recovery and Reinvestment Act of 2009 (ARRA) provides for Medicare incentive payments to hospitals that can demonstrate “meaningful use” of “certified EHR technology,” including for information exchange and for the submission of clinical quality measures, with definitions of these terms to be finalized by the Secretary of Health and Human Services (HHS). This paper provides a summary of published “Meaningful EHR User” definition recommendations, as well as the Rural Wisconsin Health Cooperative’s (RWHC) perspective on the issues. We also address the question of whether open source EHRs are necessarily the right fit for small rural hospitals. RWHC is a cooperative of 35 rural hospitals (including 28 Critical Access Hospitals) that promotes regional collaboration for health and health care services on behalf of rural communities.
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Readers not comfortable leaving a comment below may send feedback to: timsize@rwhc.com.
Americans on both the political left and right have finally found something to agree about. And in my opinion, they both have it wrong. Both sides now tend to say “this” country instead of “our” country. This matters because words represent ideas and ideas lead to or away from useful action.
You’d expect a visitor from overseas to say “this country” when they visit America. I’d expect an economist to compare this country to that country. But for those of us who live here, and aren’t writing a research paper, I believe we have a responsibility to think and say “our country.” Not as in “my country, love it or leave it,” but as in the sense that all of us here are part of America, its flaws and its unique blessings alike, whether we like it or not. [click to continue…]
