Rural Hospital Leaders Unite! And plan to be in Austin this November 8 & 9. The Inaugural TORCH Leadership & Management Institute is going to be fantastic. We’ve put together a crack team of leadership coaches and management experts and they’re ready to share the wealth of their experience with you in this compact, on-site training seminar that is certain to please. Hopefully, you are getting to know our esteemed and expert faculty through our new Illuminations newsletter. They are:

• Gary Cooke, Gary Cooke Consulting – Writing & Strategic Communications;
• Krish Dhanam, Zig Ziglar, Inc. – Performance & Human Development;
• Judy White House, Capital Insights – Human Resource & Organizational Development;
• Ron Kessler, Ron Kessler Group – Executive & Leadership Coaching;
• Debbie Leverett, Entera+Partners – Organizational Development & Customer Satisfaction;
• Mary Rauch, Mary E. Rauch Communications – Business Etiquette & Public Speaking

The whole idea behind the TORCH Leadership & Management Institute is to help you as rural hospital executives and supervisors realize your true leadership potential. To that end, the faculty of the TORCH Leadership & Management Institute has helped us to design a curriculum that will help strengthen the leadership and management capabilities of hospital administrators, executive-level staff and departmental directors.
       You’ve ascended to a management position within your hospital because of the skills you possess. You’re an experienced member of the hospital staff and you’ve earned the respect of your colleagues and the medical staff. You now have the ability to improve your job performance without the big expenses of a formal academic setting. The Institute is here to help you by providing specific training which you can utilize everyday.
       Mark your calendars for November 8 & 9 to be at the Hyatt Regency Hotel on Town Lake in Austin. The conference program will be mailed out soon. We look forward to seeing you.

Following the passing of John F. Boff, Susan Reed was appointed as TORCH Interim President/CEO. In his announcement to the membership, Board Chairman Jim Buckner stated, “Susan has accepted this new role and we are confident that she will continue to ably manage the organization with the same dedication and integrity she has in the past.”
       Reed, who has been heading the management team at TORCH during the six months of John’s illness, as Vice President of Programs and Administration is responsible for managing financial and operational activities, integrating member services with administrative procedures for efficient use of resources, participating in developing and implementing member programs, oversight of conference and trade show planning and implementation, and coordinating activities of the TORCH board of directors and the appointed councils and committees. She will now provide leadership in carrying out the objectives of the governing board, overseeing policy development, and coordinating the activities of the subsidiaries and the foundation.
      Susan Reed brings years of association experience to her duties with TORCH and the other four associations which are managed in the TORCH office. Working side-by-side with John Boff during the founding of TORCH, Reed has been with the organization for over 16 years. Previous to that, she was with the Texas Hospital Association, the Texas Medical Association, and the Texas Department of Health.
       “I am proud to work with the board, members, and staff of TORCH as we continue our tradition of service to rural hospitals by implementing the new services created this year, developing additional innovative programs, collaborating with other organizations, and advancing our advocacy initiatives. We can best honor John’s memory by building on the foundation he started for us,” Reed commented on her appointment.

The highly anticipated House-version of this Session’s rural health omnibus bill has been announced. The official bill number is House Resolution 6030. While the bill includes many of the same provisions as Senate Bill 3500, it also contains additional improvements for Rural Health Clinics and specific recommendations with regards to MedPAC representation. TORCH has asked that each and every Rural Texas Congressman consider endorsing the bill as an official co-sponsor. Some, like Congressman Ron Paul, Ruben Hinojosa and Chet Edwards have already made that commitment.
      The bill, as it is written, would expand cost-based reimbursement for two more Critical Access Hospital services. It would eliminate the fee schedule for clinical lab services and eliminate the 35-mile ‘isolation test’ for CAH-based ambulance services. In addition, the bill would give Rural Community Hospitals, those hospitals with 50 or fewer beds, the option to receive cost-based reimbursement. RCH facilities would be paid 101% of their reasonable cost for providing both inpatient and outpatient services.
      Numerous extensions would be granted to several payment provisions in the Medicare Modernization Act, including the Outpatient PPS hold harmless for rural hospitals with less than 100 beds and Sole Community Hospitals. Payment bonuses for rural providers would also be extended, including 5% to home health agencies and physicians who practice in designated shortage areas. The bill would also ensure that Critical Access Hospitals and Rural Health Clinics receive cost based reimbursement under the new Medicare Advantage model.
      As was mentioned above, the bill is unique in that it would force Medicare to do a couple of other things that the Senate-version currently does not. It would raise the RHC Payment cap from $63 up to $82, which would bring the rate closer to the rate being paid to the Federally Qualified Health Centers. The bill would also require the Medicare Payment Advisory Commission to ensure that its rural representation is at least proportional to the rural Medicare population which currently stands at about 28%. This would yield at least 2-3 more rural appointees for the foreseeable future.
      Having similar and comprehensive rural health legislation being filed in both houses is a very encouraging sign that these outstanding issues are being taken seriously. A TORCH Voter Voice campaign will be launched soon in order to help facilitate a timely response from our members. Please help us ensure that this important legislation is adequately supported by your own locally elected member of Congress.

An article in the Austin Business Journal states that the Texas Medical Association says Medicaid reform will be one of the top priorities for its physicians and state leaders when the Texas Legislature reconvenes in January. Lawmakers hope to address two issues, according to the Austin-based association. They want to minimize the amount Medicaid costs the state and help more people obtain health insurance.
      To affect change, the TMA is studying Medicaid plans in other states such as Arkansas, Massachusetts, Florida, West Virginia, Kentucky and Idaho. The various state plans feature different approaches, including coverage paid by a government-employer hybrid, personal health accounts that offer credits for good health behavior, and some that let recipients select from a menu of managed care plans.
       Paid for by state and federal funds, Medicaid insures patients such as pregnant women, children and seniors with long-term care needs. Texas leads the country in the percentage of its residents who are uninsured, at nearly 25 percent, the group says.
      The article fails to mention that nearly every healthcare provider association has agreed in principle to participate in the Medicaid Provider Coalition. Representatives from the various healthcare organizations met recently to discuss their legislative priorities as they relate to Medicaid and identify areas of common interest. Payment rates, however, were not discussed, as they are a top priority for everyone involved.
      Several common themes emerged - cost pressures of the uninsured, reaching out to the business community to explain implications of cost shifting, program simplification, improving eligibility and enrollment, maximizing federal dollars, and ensuring/protecting tax equity. There is agreement amongst the organizations involved that the Medicaid Provider Coalition should be re-established and build upon success from previous Legislative sessions. TORCH will continue to play an active part in this important effort.

All Texas public hospitals have recently been asked by letter to submit information about the indigent health care program administered by their city, county, authority or district. Morningside Research has requested information similar to what is collected on the Form 300 from DSHS (required for counties to complete). Once they’ve retrieved and analyzed the information, they plan to make an inexpensive summary report available sometime in September.
      The letter states that in accordance with the Texas Public Information Act, Morningside Research requests this information about your County Indigent Health Care Program.

• Federal Poverty Guideline percentage used to determine eligibility
• Type of entity administering the indigent health care program (County, Public hospital, Hospital District)
• Total Expenditures for FY 2005
• Total number of unduplicated clients for FY 2005 (to get the number of unduplicated clients, do not count the same individual more than once)
• Top 5 diagnostic codes for FY 2005 (please provide DRG or ICD-9 codes, otherwise, provide a written description)
• Where do your enrollees get the services they need (private providers, public hospitals, county-run clinics, other)
• If you have written policies or a handbook that you use to administer your CIHCP other than the state handbook would you please send them to us?

TORCH staff met with Shari Holland earlier this year in regards to a separate, independent project for the urban hospital districts. Ms. Holland has asked that we let our members know that this is a friendly request. Morningside had assistance from the Texas Indigent Healthcare Association in collecting this information from the counties, but they forgot to notify us in advance that a similar request would be sent to our members.
       For more information, please feel free to contact Shari Holland, President of Morningside Research and Consulting at 512-302-4413 or sholland@morningsideresearch.com.

The Rural Assistance Center (RAC), a national resource for rural health and human services information, has launched State Resources on its Web site allowing easy access to continuously updated demographics and statistics, documents and resources, contacts and success stories for all 50 states.
       "People using our services are often looking for state-level contacts, resources or information that can help them to maintain and improve services in their local communities," said Kristine Sande, RAC's director. "The new part of the RAC Web site has been developed in response to these information needs."
The new State Resources, located at http://www.raconline.org/states, feature an overview of each state and its rural health and human services environment. In addition, the pages include:

• State-level contacts and organizations relevant to rural health and human services;
• Tools, such as web sites with demographic and statistical information for the state;
• Possible funding sources for rural health and human service projects;
• Documents, articles and journals written about the state;
• Success Stories from the state that can serve as model projects in rural communities; and
• News and upcoming events from the rural community.

"The new State Resources help rural communities find information and resources that can assist them in important activities such as locating and competing for funding opportunities and networking within their state," said Sande. "We are working with state-level partners, such as the State Offices of Rural Health, to ensure that these pages remain current and feature the best information available for each state."
       "In small towns, health care providers and human services representatives juggle many responsibilities," explained Mary Wakefield, director of the Center for Rural Health which houses the Rural Assistance Center. "The federally-funded Rural Assistance Center's State Resources is a one stop shop to help these individuals quickly find local resources and information. It's about helping them to do their jobs more efficiently and serve their rural communities even better."
       The Rural Assistance Center (RAC) serves as a rural health and human services information portal which helps rural communities access the full range of available programs, funding, and research that can enable them to provide quality health and human services. RAC is a collaboration of the University of North Dakota Center for Rural Health and the Rural Policy Research Institute (RUPRI). It is funded through HRSA's Office of Rural Health Policy.
       Since its launch in December 2002, RAC's web site has received over 680,000 visits, with over 335,000 of those visits coming in the last year. In addition, RAC has responded to nearly 3,600 customized assistance requests from people in all 50 states, Puerto Rico and several foreign countries.
       RAC's other web-based services, available at www.raconline.org, include an online clearinghouse of news, documents, maps and success stories; a calendar of events; a directory of rural contacts and organizations; and a searchable database of funding opportunities. Also available on the web site are Information Guides, which provide in-depth information focusing on rural aspects of an issue or topic. RAC's electronic updates on rural health and human services keep subscribers abreast of new happenings and resources available. RAC also provides free customized assistance on topics related to rural health or human services. Contact RAC at 1-800-270-1898 or info@raconline.org to request customized assistance from RAC's information specialists.

A brief hold will be placed on Medicare payments for all claims during the last nine days of the Federal fiscal year (September 22 through September 30, 2006). These payment delays are mandated by section 5203 of the Deficit Reduction Act of 2005. No interest will be accrued and no late penalties will be paid to an entity or individual by reason of this one-time hold on payments. All claims held during this time will be paid on October 2, 2006. Please note, however, that contractors handling large volumes of paper checks may have some difficulty putting all checks in the mail in a single day. Consequently, delivery of checks to providers may take a few extra days.
       This policy only applies to claims subject to payment. It does not apply to full denials, no-pay claims, and other non-claim payments such as periodic interim payments, home health requests for anticipated payments, and cost report settlements.
       Please note that payments will not be staggered and no advance payments will be allowed during this 9-day hold.
       For more information, go to www.trailblazerhealth.com/notices.asp?action=detail&id=3774 or refer your questions to your Fiscal Intermediary.

Sometimes it helps to know a little about the background of our various corporate members. Fuji traces its roots to Pyne X-ray Corporation, a U.S. distributor of medical products that was founded in 1965. Pyne X-ray began distributing Fuji's radiological film in 1965, serving as Fuji's exclusive distributor in the United States. In 1986, the company was purchased by Fuji Photo Film Co. and renamed FUJIFILM Medical Systems USA.

Fuji Computed Radiography (FCR®)
In 1983, Fuji Photo Film Co. introduced to the United States a revolutionary technology, Computed Radiography (CR), along with a complementary line of laser imagers, bringing x-rays into the digital domain for the very first time. Fuji's innovative approach to digital radiographs, coupled with a well-developed, clinically validated library of image processing algorithms, established a new standard in x-ray image quality. Today, Fuji maintains the largest market share in CR with more than 35,000 systems installed worldwide, producing over 2 million images per day. Fuji is continually improving CR technology and introducing new readers and imagers with expanded imaging capabilities. We recently received FDA approval to release our CR Digital Mammography solution.

Synapse® PACS
While more than 20 years ago Fuji recognized the importance of digital imaging with the development of CR, in 1999 the company reaffirmed its commitment to the softcopy future with the introduction of Synapse PACS. Synapse surpassed legacy systems as then the industry's only true Web-integrated PACS. Offering numerous architectural advantages, Synapse is the first next-generation PACS with a unique technology platform that includes: On Demand Information Access; Cascadable™ Architecture; Integrated Web Technology; and a Consistent Desktop User Interface. Synapse is installed in more than 300 facilities across the U.S.

No matter where a healthcare provider is located on the path to the digital future, Fuji's conventional and digital radiographic products combined with Synapse PACS will help simplify and successfully manage diagnostic images now - and well into the future. For more information, please contact Eddie Albert at (800)446-5450 x-6579.

In this ever changing medical climate, healthcare organizations must run as efficiently as possible in order to survive. Collecting revenues on unpaid Medicaid accounts continues to be a time consuming task for receivable professionals. Anderson Consultation understands the importance of maximizing time. To that end, they are proud to offer A-Quest to the healthcare community. By integrating A-Quest into their accounts receivable systems, hospitals around the country are discovering that they will never lose another billable Medicaid account.
       A-quest is a comprehensive, hi-tech program used to retrieve Medicaid numbers on the back end, by scanning a database of registered Medicaid recipients. A-quest will identify patient eligibility by processing open accounts on a regularly scheduled basis. This program is designed exclusively to yield fast results and improve that all-important bottom line. And, best of all, healthcare organizations only pay for returned results.
       A-quest integrates seamlessly into the accounts receivable process. Healthcare organizations utilizing A-quest into their collections process begin by downloading of all accounts in the “self pay” or “Medicaid pending” financial class, along with all accounts that have been written off to charity. The first download will contain all accounts that are up to 60 days old and all following downloads will come weekly to include all accounts 30 days after discharge or final bill. A mapping format is enclosed to outline the fields required. A-quest takes it from there by uploading all account information and link it to the state’s database and running each account weekly to search for Medicaid and/or Medicare coverage. In the next step, A-quest reports to the user all accounts where Medicaid and/or Medicare eligibility has been discovered. The information is provided to the user via e-mail on an Excel spreadsheet.
       A-quest will then notify the user immediately upon obtaining eligibility information on “self pay” and “charity” accounts. However, if the account is “Medicaid pending”, A-quest will notify the user of the billing information 40 days from the add date, giving your “eligibility company” or “hospital employee” working open “Medicaid pending” accounts time to provide the billing department with the necessary information. If an account that has been given to user with Medicaid and/or Medicare coverage can not be billed or is disputed, A-quest asks to be notified immediately to avoid invoicing “problem” accounts. At the close of collections, A-quest will invoice the using healthcare organization for 15% of the reimbursed amounts on accounts retrieved for “self pay” and “charity” accounts, as well as 8% reimbursed on “Medicaid pending” accounts.
       Customers are unanimous in their agreement that A-quest is an integral part of their collections process.

“In a true partnership relationship, the Anderson staff we work with have been able to provide what was lacking (with our selfpay AR accounts), an expert approach to accomplish our goals while providing the necessary resources on the working and daily level.”
Bill Emery, COO, Lavaca Medical Center

“It is my pleasure to wholeheartedly endorse and give my highest recommendation for Anderson Consulting. They have had a long track record of great performance for ETMC. I personally have worked with them at ETMC Pittsburg for three years and have been very pleased with their performance. I look forward to working with them a long time into the future.”
Tommy O'Gorman, CFO, ETMC Pittsburg

The Anderson Consultation Services, LLC, serves both the patient and the hospital. They are proud to provide a range of services to hospital and patient partners with a proven record of success. They offer a complete program designed to obtain third party reimbursements for self-pay patients and determine alternatives for lost money or self-pay accounts, and improve an organization's bottom line and help them achieve their fiscal goals. For more information, please contact Robert Seale at (866) 790-8025.

Find out how St. Peter Community Hospital, a 17-bed critical access hospital in rural Minnesota, successfully implemented quality and patient safety initiatives to reduce transfers to another facility by 28%, saving $6210 per transfer; reduce mortality by 70-85%; decrease surgical site infections by 50%; and other noteworthy achievements which resulted from implementing the interventions of the 100K Lives Campaign.
       On Tuesday, September 19th at 12:00 Noon, Benjamin W. Chaska, MD, will be giving a free one-hour presentation. Dr. Chaska is the medical director, patient safety officer, and medical staff president-elect of St. Peter Community Hospital in St. Peter, MN. Dr. Chaska received his MD from Harvard in 1983, completed his residency at the Mayo Clinic, and has an MBA in Medical Group Management from the University of St. Thomas in Minneapolis.
       The second part of the presentation is shared with Colleen Spike, RN, CEO of St. Peter Community Hospital, who adds an interesting administrative perspective. To access the presentation, dial 1-800-394-5972 and ask for the TMF call. Downloads for this event will be posted here once they are available. TMF estimates they will be posted on Friday, September 15, 2006.
       For more information or questions about this presentation, please contact Lori Brandes at lbrandes@txqio.sdps.org or (512) 329-6610.