by Tim Size on August 3, 2009
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.
by Tim Size on June 26, 2009
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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by Tim Size on June 7, 2009
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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by Tim Size on May 8, 2009
“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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by Tim Size on April 14, 2009
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…]
by Tim Size on April 14, 2009
Readers not comfortable leaving a comment below may send feedback to: timsize@rwhc.com.
Even with or maybe because of the economic downturn, healthcare “reform” is back on the front burner. The fall election results were a lot about seeking economic stability and security. Healthcare reform is part of that search. The severity of Federal and State government deficits make reform harder but not impossible.
I have never liked the word reform. It implies good people fixing bad people. “Bad” kids used to be sent to reform school. Or we need to reform how we finance elections to limit bad things from happening. We won’t improve American healthcare by reforming millions of dedicated clinicians and healthcare workers. We won’t improve healthcare by reforming away care that most of us like. Most of us can afford our out of pocket healthcare costs, if we keep our jobs. [click to continue…]
by Tim Size on April 14, 2009
Readers not comfortable leaving a comment below may send feedback to: timsize@rwhc.com.
This is the best of times and the worst of times. I’ve always wanted to start with this line taken from the beginning of Charles Dickens’s “A Tale of Two Cities.” It certainly fits well today. Some may quibble with the “best of times” but as an aging optimist, each new day above ground is always welcomed.
President Obama has now signed into law the largest economic stimulus bill we have ever seen in the U.S. There are without a doubt some good things and some not so good things in it. Strong feelings for and against the wisdom of many of the provisions exist. [click to continue…]
