We are working to improve our website as we relaunch our organization with renewed commitment to building sustainable and equitable systems to improve health and wellbeing in rural Washington.
Welcome to the Fall 2016 issue of the Washington Rural Health Association e-Newsletter. Inside this issue you will find news and information from the new Executive Director and board of directors, members, and community partners from across the state of Washington.
If you would like to submit your own story, please click here.
The WRHA e-newsletter is a publication of Washington Rural Health Association, a not-for-profit association composed of individual and organization members who share a common interest in rural health. This e-newsletter seeks to disseminate news and information of interest to rural health professionals and stakeholders to help establish a state and national network of rural health care advocates.
WRHA Members
WRHA members include administrators, educators, students, researchers, government agencies and workers, physicians, hospitals, clinics, migrant and community clinics, public health departments, insurers, professional associations and educational institutions. If you are interested in joining or renewing your membership with WRHA click here.
Welcome WRHA’s New Executive Director! Beionka Moore has more than 15 years of rural health experience and became the Executive Director of the Washington Rural Health Association on August 8, 2016. Most recently she served many years as Manager of Member Services at The Association of Washington Public Hospital Districts. There she was responsible for assisting association leadership, program strategy, and development and delivery of programs, including Washington State Hospital Association & Association of Washington Public Hospital Districts CEO Annual Leadership Retreat, Co-lead efforts to ensure viability of critical access hospitals and access to care in rural communities, she is seen as an on-going resource and convener for rural and district issues for staff and commissioners on a variety of rural issues. Beionka joins WRHA family with a strong commitment to serving those in rural communities and are in need of the kinds of responsive support that WRHA provides. She has a proven track record in responding to policy issues impacting rural communities, program outcome development and evaluation, and collaborative partnership building—all qualities critical to advancing and strengthening the effectiveness of the work we do to help people and families across Washington State. As the Executive Director, Beionka provides leadership and creativity in developing program, organization, and financial plans on behalf of the association, and carrying out plans and policies authorized by the board of directors. Additionally, the Executive Director advocates for rural interests on various state and federal health care issues, assists in growing and developing WRHA’s membership, and serves as the association's official spokesperson. With her leadership, WRHA’s positive impact will grow.
For years Shriner's Hospital for Children, Spokane has had the best in motion technology. Our fully accredited motion analysis laboratory is one of only 10 so recognized in the nation and the only one in the region. But being the best isn't good enough. The Spokane Shriner's Hospital's goal is to be better today than we were yesterday. Recently, the Spokane Shriner's Hospital upgraded the 12 infrared cameras used in the motion tracking system. The new cameras capture in higher resolution and can track smaller reflectors. The cameras also allow our process to be more efficient, saving time for our patients and families during the study. The lab recently completed the grueling reaccreditation process and are now approved for the next three years. Another marked improvement is the addition of a kinesiologist to the motion analysis team. Meet Taylor Elizondo. Taylor received his bachelor's degree in exercise science from Idaho State University before Eastern Washington University awarded him his master of science in exercise physiology. Before joining the Shriner's Hospital team, Taylor worked as a cardiac and pulmonary rehabilitation specialist and as a clinical exercise physiologist in the area. He also coaches wheelchair basketball, track and field and helps run the strength and conditioning program for ParaSport Spokane. Taylor says "I see Shriner's as an opportunity to grow both in my education and practice. I am grateful for the opportunity to invest in the Shriner's organization and help attribute to the growth of the organization. I am hoping to establish a positive role that will help with that growth." Taylor will help to further integrate exercise science with the engineering of the motion analysis technology. The improvements in technology coupled with the addition of further expertise help ensure that the Spokane Shriner's Hospital remains at the pinnacle of pediatric orthopaedics in the region well into the future.
Approximately 300 nurses participated in the 2016 Continuing Nursing Education course, "Enhancing Medical-Surgical Nursing Practice/Improve Your Practice and Prepare for Certification", which ended April 14. Provided by Continuing Nursing Education at the University of Washington School of Nursing (UWCNE) and UW Medicine/University of Washington Medical Center, this course was established in 2004 and each year has been highly rated. In 2016, nurses working at over 20 hospitals in Alaska, Hawaii, Idaho and Washington met at their agencies for three hours each week for 15 consecutive weeks (January-April). Med-Surg lectures given by experts on evidence-based, medical-surgical nursing practice were transmitted from the UW School of Nursing to nurses in urban and rural areas. Nurse educators and med-surg nurse leaders facilitated the course at each site. Approximately 98 percent of course participants completed the course and earned 45.0 contact hours. What participants said: "I am an ICU nurse that works in a rural hospital. I have been a RN for almost 30 years. Education is very limited and it is not uncommon to float to other areas of the hospital and assist. For me this course has been a dedication to my patients and myself. I cannot tell you how many times that I went to work and excitedly shared my knowledge with my co-workers." "I liked reviewing all the topics and sharing stories in class. The experiences that the nurses shared were amazing and showed how they advocated for their patients, questioned unclear orders and improved the safety and comfort of patients. Nurses truly care and I hope all of these nurses will continue their lifelong learning, stay involved and continue to advocate for patients and the nursing profession. Thank you to all the content experts, the webinar lectures were very well done. Thanks to the coordinators and planners, for without your input and facilitation for the class, nurses would have less options to advance in their knowledge and confidence." Participants and course coordinators alike gained benefits from this course. A course coordinator from Washington said: "I find our nurses also gain confidence and many start talking about their BSN and even ask about their MSN. I believe certification is key to lifelong learning commitments by nurses. As a profession we always must grow, develop and educate ourselves. Thank you for a wonderful tool and process to implement this." Med-Surg 365: Mentored CE and Targeted CE are two online formats of the course that will be held this year with registration for both offerings open from June 6, 2016 to December 31, 2016. This unique continuing education program is a partnership between the University of Washington School of Nursing (SoN), UW Continuing Nursing Education and UW Medical Center. To learn more about the Medical-Surgical Nursing Education Program, please visit: https://www.uwcne.org/medsurgnursing Co-sponsorship applications now being accepted! Hospitals and agencies in all regions of the country are invited to co-sponsor the next Enhancing Medical-Surgical Nursing Practice Course. For more information, contact Shannon Summers at [email protected] or (206) 221-4963.
The Washington Health Care Authority (HCA) recently released proposed changes to the payment rules governing Medicaid payment to federally qualified health centers (FQHCs) and rural health clinics. The changes are intended to accommodate a new alternative payment model (APM) which HCA plans to pilot with a group of interested clinics effective January 1, 2017. Goals of the new APM are to provide greater flexibility in care delivery, incorporate value based incentives for quality, and simplify what has historically been a lengthy and extremely burdensome reconciliation process.
Over the last several months HCA has been working with a stakeholder workgroup composed of representatives from FQHCs, rural health clinics, and the Medicaid managed care plans. WSHA is participating as part of the rural health clinic stakeholder delegation, in conjunction with leadership of the Rural Health Clinic Association of Washington. While there has been some agreement on the general structure of the APM, many critical details still need to be determined before clinics can accurately assess the impact and benefit of the new payment model to their organizations. These details include: • Scope of service changes. Details need to be determined on the process to calculate and adjust payments to reflect changes to a clinic’s scope of services. • Details regarding reconciliation and calculation of payment rates. Under the current payment method, payment is reconciled to the encounter rate equivalent, with a potential for overpayments and recoupments. It is unclear how HCA proposes to determine the amount of the per member per month payments under the APM. The clinics are advocating for a process where reconciliation would ensure payments sufficient to meet the minimum level required by federal law, and would allow the payment to include care provided by phone or other means that are not face- to-face visits. • Quality measures. Work remains to determine selection, weighting, and scoring of quality measures. This is challenging since some measures may not apply to many clinics due to low numbers of patients with that condition. Comments on the proposed rule are due September 27.
Submit written comments to: Name: HCA Rules Coordinator Address: PO Box 45504, Olympia WA, 98504-5504 Delivery: 626 – 8th Avenue, Olympia WA 98504 e-mail: [email protected] fax: (360) 586-9727
The Northwest Heart Failure Collaborative: Project Echo (NWHFC)
The Northwest Heart Failure Collaborative: Project Echo (NWHFC) – Our goal is to improve standards of practice for patients with heart failure in the WWAMI region
The Northwest Heart Failure Collaborative: Project Echo (NWHFC) launched a biweekly, interactive web-based heart failure consultation and education program for community healthcare providers on May 4, 2016. The one-hour online conference began with a 15-minute presentation, “Heart Failure: Identifying the Syndrome and Burden of Disease” by Todd Dardas, MD, MS, an advanced heart failure cardiologist from UW Medical Center. Dr. Dardas reviewed the defining factors that contribute to the prevalence of heart failure, modifiable risk factors most responsible for reducing the prevalence of heart failure, and the Framingham and Cardiovascular Health Study criteria for heart failure. For the next 45 minutes, a community participant presented a patient case and received consultation from an interprofessional specialist panel from UW Medicine including Dr. Dardas, Alice Chang (MSW), and Tracy Fowler (ARNP). The panel discussion was facilitated by Brenda Zierler, principal investigator (PI) of the grant funding the NWHFC: Project ECHO. The goal of the NWHFC conference series is to provide education and consultation to community providers (e.g., family and primary care physicians, nurse practitioners, pharmacists, social workers) treating heart failure patients in the WWAMI region (Washington, Wyoming, Alaska, Montana, and Idaho). The NWHFC links an interprofessional panel of specialists consisting of UWMC Cardiologists, ARNPs, Social Workers, and Pharmacists with community providers. Community participants become part of a learning community and engage in active discussion and/or present cases for recommendations from the specialists. All registered participants can submit cases for consultation. The interprofessional panel is led by Todd Dardas (MD) and includes Kevin O’Brien (MD) Claudius Mahr (DO) Tracy Fowler (ARNP), Jennifer Beckman (ARNP), Carrie Boom (ARNP), Alice Chang (Social Work), Greg Gibson (PharmD), and Liz Brule (PharmD) from UW Medicine’s Regional Heart Center. The NWHFC sessions are held on the first and third Wednesday of each month from 12:00–1:00 PM (PT). Participation is free; continuing education credits are available for a small fee ($40 for up to 24.0 AMA PRA Category 1 Credits per year). These sessions are supported by funds from the Division of Nursing (DN), Bureau of Health Professions (BHPr), Health Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS) under grant number D09HP286700100 (Brenda Zierler, PI). The NWHFC: Project ECHO is a model for lifelong healthcare learning and collaborative practice. For more information, visit NWHFC.org, or register here to join the NWHFC.
SEATTLE—The Washington State Hospital Association (WSHA) announced that Cassie Sauer, the association’s current executive vice president, will in January, become the organization’s new Chief Executive Officer.
Sauer replaces outgoing CEO Scott Bond, who will retire at the end of the year after more than three decades in the health care field. Sauer will serve as the organization’s fourth CEO since the organization formed in 1933. She has worked for the hospital association for 16 years, leading policy, advocacy, and communications. She has particularly focused on expanding access to health care through the children’s health and Medicaid expansions, creating policy to support innovative methods of care delivery, and improving care for people living with mental illnesses.
“Cassie has a strong vision for WSHA’s future; she also has the skills and experience to guide members and staff into that future,” said WSHA board chair Gregg Davidson, of Skagit Regional Health. “For the last 20 years, she has worked to improve Washington residents’ ability to get good health care, whether they are in rural or urban areas. She keeps the patient at the moral center of the work. We are lucky to have her.”
“I am thrilled to have the opportunity to serve as the hospital association’s leader into the future. The association’s work to help our hospitals and health systems achieve their missions of serving their communities with high quality care for all is very important to me. I take seriously the responsibility to represent Washington State’s hospitals in the face of extraordinary changes in the health care environment,” said Sauer.
Changes to behavioral health measure for Medicaid Quality Incentive
The Centers for Medicare & Medicaid Services (CMS) has delayed the requirement that inpatient psychiatric facilities must report on Transition Record with Specified Elements Received by Discharged Patients until Jan. 1, 2017. The transition record measure is intended to prevent gaps in care transitions caused by the patient receiving inadequate or insufficient information that can lead to avoidable adverse events and readmissions.
As a result, the behavioral health safety measure for the Medicaid Quality Incentive (MQI) has been modified to include two essential elements of the 11 proposed required elements from the CMS measure:
A plan for follow-up care, and;
Primary physician, other health care professional or site-designated for follow-up care.
The data collection period is from Sept. 1 through Dec. 31. Click here for the updated measure guidelines.
DOH continues honor roll for hospital antimicrobial stewardship
Patients who are given unnecessary antibiotics are placed at serious risk, and according to the Centers for Disease Control and Prevention, this misuse of antibiotics contributes antibiotic resistance, which is one of the most serious threats to public health, leading to 23,000 deaths annually.
The Washington State Department of Health (DOH) is continuing to honor facilities that have an antimicrobial stewardship program and are working to improve antibiotic use through education, targeted activities and assessment. This is an opportunity for hospitals to be publicly recognized for leading efforts to reduce antibiotic resistance and improve patient outcomes. The department will list names of facilities with an antimicrobial stewardship program and details about program leadership on the DOH Antibiotic Stewardship webpage.
2016 Annual Fall CHAMPS/NWRPCA Primary Care Conference Oct 15 - 18, 2016 Denver, CO Type: Conference/Meeting Sponsoring organizations: Community Health Association of Mountain/Plains States, Northwest Regional Primary Care Association, Western Clinicians Network
Long-time St. Luke's partners and physiatrists, Keith Mackenzie, MD, PS and Mark Varga, MD of Rehabilitation Associates, recently joined St. Luke's Physiatry Practice, bringing their practice and patients under St. Luke's Rehabilitation Institute for continued care in outpatient and inpatient settings. Dr. Keith Mackenzie has been practicing rehabilitation for 37 years in Spokane. He received his medical education at the University of Washington and completed a family medicine residency before completing his physical medicine and rehabilitation (PM&R) residency at the University of Washington. Dr. Mark Varga began his medical training at George Washington University in Washington D.C. and went on to gain vast Naval Aviation medical experience in primary care, emergency medicine and sports medicine. Dr. Varga completed residency in PM&R at Frazier Rehab Institute through the University of Louisville. He has been an admitting physician at St. Luke's for 17 years. "We are excited to officially become part of the St. Luke's family of physiatrists and interdisciplinary teams" said Dr. Varga. "Rehabilitation Associates' patients have been seen at St. Luke's for years and will continue to receive the most comprehensive rehabilitation in both inpatient and outpatient settings." St. Luke's Physiatry Practice has grown to 11 physiatrists and three physician assistants, expanding patient access and bringing additional knowledge and services in physical medicine and rehabilitation. "Drs. Mackenzie and Varga's medical knowledge of the Spokane community and surrounding area is unparalleled," said Dr. Gregory Carter, St. Luke's medical director. "Combining their top-notch clinical education and passion to deliver the best in physiatry care, the St. Luke's Physiatry Practice is caring for more patients with a multitude of illnesses and injuries." With the physicians joining St. Luke's, patients of Rehabilitation Associates were transitioned to St. Luke's on May 31, 2016. For more information, please call (509) 473-6706 or visit www.st-lukes.org/Admissions-Referrals/. About St. Luke's Rehabilitation Institute The region's largest, free-standing Level I Trauma Rehabilitation hospital, St. Luke's provides comprehensive medical rehabilitation services for people of all ages who have experienced a stroke, spinal cord injury, brain injury, amputation or other injury or illness requiring rehabilitative care. St. Luke's is accredited by The Joint Commission and Commission on Accreditation of Rehabilitation Facilities International. Thousands of patients choose St. Luke's for inpatient rehabilitation services at the main campus and outpatient therapy services at nine locations throughout Spokane.
Contact HCA if Experiencing Challenges with Post-Acute Care Discharge Placement for Medicaid Patients Many hospitals face finding post-hospital placement for patients who have completed their acute care hospital stay. Active conversations with the Health Care Authority (HCA), Department of Health, and Department of Health and Human Services are looking at ways to help better address the issue. HCA has asked that hospitals contact HCA directly if they experience difficulty finding post-acute placement for Medicaid patients. Here is the contact information: Gail Kreiger, Section Manager, Medicaid Compliance Review and Analytics and Medicaid Program Operations and Integrity, HCA [email protected]
Bree Collaborative Considers Prior Authorization Standard Model The Bree Collaborative, a Governor-appointed group of public and private partners working to improve health care quality, outcomes and affordability, is considering prior authorization as one of its focal points for the upcoming year. While in the past Bree has focused on issues such as developing bundle payment models, opioids, and elective deliveries, the approach of using evidence research to drive a standard model could be applied to areas such as prior authorization. The intent would be to develop a standard program that would then be adopted across payers. Bree will be making a decision on its topics for the year in the next several months. The case for including prior authorization will be presented by Dr. Robert Mecklenburg of Virginia Mason Medical Center.
340B Hospital Recertification Open through September 7.Have You Recertified? The Health Resources and Services Administration's (HRSA) 340B hospital recertification process for 2016 continues through Sept. 7. All 340B hospitals must recertify with HRSA annually to ensure they continue to meet the 340B hospital eligibility requirements. HRSA recently conducted a webinar for hospitals about the recertification process. A replay of the webinar is available on HRSA's 340B website. For more information about the 340B program, visit http://hrsa.gov/opa/.
The Center of Occupational Health & Education (COHE) Community of Eastern Washington, a program of St. Luke's Rehabilitation Institute, has renewed its three-year contract with Washington State Department of Labor and Industries (L&I) to continue getting injured employees back to work. Additionally, COHE Community of Eastern Washington expands its services to Klickitat County to assist more employers and injured workers through the workers' compensation process. "Our services help nearly 1,300 medical providers, 22,000 injured workers, 35 hospitals and more than 400 medical clinics navigate the workers' compensation process," said Ben Doornink, program director for COHE Community of Eastern Washington. "Twenty counties in eastern Washington now share the vision of collaboration for education to help prevent work-related injuries and improved injured worker outcomes." "The COHE process is fully supported with occupational health best practices like those practiced at St. Luke's," said Dr. Gregory Carter, medical director for St. Luke's Rehabilitation Institute and COHE Community of Eastern Washington. "Their continuation to provide care coordination between health care providers, employers and, most importantly, the injured worker, results in extraordinary cost savings and reduced work time loss." With the expansion into Klickitat County, the services of COHE Community of Eastern Washington cover 20 counties in eastern and central Washington, streamlining the return-to-work process quickly and efficiently. COHE offices are located in Yakima, Tri-Cities, Spokane and Wenatchee. "COHE's effort to become part of these communities, allowing the return-to-work process to work to benefit those injured and their employers, gives our team the dedication and commitment to continue sharing best practices, resources and individualized attention," Doornink said. "Our renewed contract exemplifies the results-driven outcomes for our services for this region."
For more information about COHE Community of Eastern Washington, visit www.gocohe.com.
P.O. Box 
