The hospital administrators, trustees and staff who braved the summer heat (and humidity?) in Abilene, were awarded for their trouble with an educational meeting, golf, poker, food and festivities. We had near record attendance this year, as the total population rose by nearly 160 people. Here is an overview of the 78th Annual Convention on the Northwest Texas Hospital Association.
       As always, the event started with the annual golf tournament at the unusually green Diamond Back Golf Club. The field of 44 finished the course in a little over five hours. The winners posted a score of 61, second was a 62 and third place was awarded in a scorecard playoff. Many thanks to Diagnostic Health Services for sponsoring and delivering the refreshments to all the competitors. After the tournament, everyone headed out to the Perini Ranch in Buffalo Gap for an evening BBQ.
       The educational sessions began with a presentation by Jodie Cunningham of Press Ganey. Her presentation focused on the things that hospitals can and are doing to improve their patient satisfaction scores. Next, Steve Collins of the West Central Workforce Development Board discussed the ways in which hospitals and TWC can partner to create more qualified healthcare professionals to the area.
        After a short break, Kevin Reed and Fletcher Brown performed their annual legal issues roundup, which earned them the dubious distinction of being named ‘official buckaroos’ later that evening. They are always informative and entertaining to boot. Following that, the participants were treated to lunch and got to meet all the sponsors and exhibitors that supported this year’s convention.
        After lunch, John Montaine of BKD gave a great overview of the importance of really managing your managed care contracts. A little attention, both before and after the negotiation process, can go a long way. Later, Rod Troutman helped explain the nuances of selecting an electronic medical record system. It was a hard topic to handle, but he kept everyone’s interest right up until recess.
       There was no shootout this year, because the sporting clays course had been underwater for much of the week, but the Poker Tournament nearly doubled in size this year attracting over 30 contenders. Afterward, everyone headed to the President’s reception and then to the Annual Awards Banquet. John Boff was named the Honorary Member for 2007 (see the next article) and prizes were given out after an excellent presentation by Michael Patrick, DMin, Chaplain at Hendrick Medical Center.
       The last day began with an overview of the Texas Legislature by both David Pearson and Kevin Reed. They flew through the provisions of some of the most relevant bills of the session for rural hospitals to consider. Next, Richard Shannon and Carol Warkoczewski taught the attendees how best to resolve conflict without weaponry upon returning to their local communities. Last, Ann Fagan Cook was kind enough to share some personal pictures from an excursion she took while attending the NRHA Annual Conference in Alaska. She and her husband joined a dozen other people on Kodiak Island for a peek into the healthcare system of a native fishing village.
       After a brief membership meeting, everyone said their goodbyes and returned to their places of origin. We want to thank everyone who attended the convention for making it a great networking and educational experience. We couldn’t have done it without you.

Every year, the NWTHA honors one of their own with an Honorary Membership. This status allows the individual to attend future conferences and participate as a lifelong friend of the association. Unfortunately, John won’t be able to participate, but John’s son Paul, his wife Devon, their son Brayden, and the TORCH staff were there to receive the award on his behalf. After a short video remembrance, Paul took the podium to share his family’s appreciation for the recognition of his father’s long and illustrious career in rural healthcare. Paul conveyed his mother Gladys’s desire to be a part of the occasion and was given a standing ovation for his heartfelt remarks.
       At the TRHA Conference in a couple of weeks, John will receive yet another recognition in the form of the Marion Zetzman Award given annually to a person who makes a difference in the health of rural communities. John was nominated for his work with TORCH and his career of service to the needs of rural communities in Texas and beyond. We want to thank the Texas Rural Health Association for bestowing this recognition on the Boff family as well. The award presentation will take place at 12:00 noon on Wednesday, August 1, in Austin. Marion Zetzman was a rural healthcare leader, on the faculty at UT Southwestern Medical Center, and the original Chair of the Center for Rural Health Initiatives.
      You can still make a donation to the John F. Boff Endowed Fellowship Fund if you’d like. Contributions should be made payable to the HSC Foundation and sent to the Texas A&M University Health Science Center, School of Rural Public Health, 1266 TAMU, College Station, TX, 77843. Your contribution of any amount will help provide scholarships for students preparing for careers in the rural healthcare field.

As a follow-up to the successful hospital survey seminar series we sponsored over a year ago, TORCH and THA are working with the leadership at the DSHS health facility program to organize four additional meetings focused on the latest rule revisions. These meetings will last approximately six hours and will give you the opportunity to ask questions and learn about all the changes along with the survey staff from your region.

These meetings are being planned throughout the month of September in four locations around the state. Please check your calendar to see which one that you would like to attend:

• Sept. 6 – Houston (Memorial Hermann Healthcare System)
• Sept. 7 – San Antonio (Airport Hilton)
• Sept. 11 – Arlington (Texas Health Resources)
• Sept. 12 – Lubbock (Holiday Inn & Towers)

Registration information will be made available soon. We have included below a tentative list of topics and speakers. As you can see, almost all of the presenters are from the central office in Austin, which means that you can be assured that you are getting your information from the source. Also, this will be an interactive session with plenty of time for questions before, during and after the presentations.

Please MARK YOUR CALENDAR and be on the lookout for more detailed registration information in the very near future.

If you've ever wondered what the people who review records for Medicare are thinking, here's your chance to find out. Let’s face it. As a utilization review or case management professional, you’re different. You can make sense of all that admission screening mumbo-jumbo. Or at least that’s the expectation.
       Yet even the best of the best can use a refresher course now and then. That’s why you’re smart to take advantage of this free skill-sharpening opportunity. This new TMF-sponsored workshop exposes the thinking of our reviewers — the reviewers that Medicare has contracted with to decide compliance (and whether or not your hospital gets reimbursed). You’ll learn:

• How to help physicians look brilliant for correctly determining admission status and documenting medical necessity the right way every time
• Timesaving tips for quickly identifying appropriate patients for inpatient stays
• Exercises tied to actual case examples that illustrate common mistakes and how to avoid them.

Bring your admission screening criteria to the workshop. Learn how to determine if a patient should be an inpatient or outpatient given actual case examples from blinded charts.
      Don’t be in Denial - Your hospital administrator will be pleased that you’re taking this workshop, too, because you’ll learn strategies for avoiding Medicare denials (potentially saving your hospital thousands of dollars).
      Work Smarter, Not Harder - Come learn how to correctly determine medical necessity.
      We offer the workshop at five different locations and on various dates for your convenience:

• August 2 - Houston, TX
• August 22 - Corpus Christi, TX
• August 23 - Midland, TX
• August 28 - Dallas, TX
• August 30 - Dallas, TX
• September 20 - Austin, TX

Don’t miss this chance to get inside a TMF reviewer’s head (you’ll never see things quite the same way again). Space is limited so we suggest you register early. You must register by the registration deadline posted on the registration page.
      Brought to you by TMF Health Quality Institute, the organization selected by CMS to perform Medicare record review in Texas. More info at http://hpmp.tmfhqi.net/.

From Texas Nursing Student magazine
By Paula Faulk Maness, MSN, RN
Nursing Faculty, Tarleton State University

Many of those who are new to nursing have set their sights on a future career in a big city hospital. Houston, Austin, San Antonio, El Paso, Lubbock, and the Dallas-Fort Worth area all have attractive things to offer besides huge facilities with the latest in technology.
       But a select few – those who often take the road less traveled – send resumes to hospitals in rural areas, accept jobs there, and find something they weren’t quite prepared for: Quality of life.
       Researchers have made many attempts to classify rural nursing by location, population density, or the distance required to travel or commute to an urban area.
However, rural nursing may be best defined by those who actually do it. In this story they will answer the question, “Why is a nursing job in Rural, Texas, so satisfying?”
       But first, let’s be pragmatic about comparisons. Rural areas pay less than urban settings. However, the cost of living is significantly higher in urban areas.
Lifestyles may also differ radically from rural to urban settings, but being able to leave your car unlocked, your windows open at night, and your children playing safely in the front yard are just a few of the many advantages rural living has to offer.
       Yes, there may be fewer shopping malls, the grocery may not be open 24 hours a day, and the nearest sushi bar might require an overnight stay. But nurses say there are bigger differences.
       Patricia Hoffman, BSN, RN, has an interesting take on rural nursing as she saw it in Brownwood, Texas. She feels the training nurses receive in a rural setting better prepares them for a future at an urban hospital. “My rural experience prepared me to use critical thinking skills,” Patricia says. “To look at the patient first – not the equipment – and be a patient advocate.”
       Sherry Clements, BS, RN, a nursing administrator who went from a busy urban Houston hospital setting to a rural health care facility in Eastland, Texas, says her strategy for recruiting nurses and encouraging them to maintain a high standard of practice can be expressed in one word: Resources.
       The standards of care do not change from urban to rural settings, but the availability of resources does. Funding differences between urban and rural areas often require rural nurses to be more innovative, self reliant, and crafty in order to accomplish the same patient outcomes.
      “The challenge for me,” Sherry says, “is to make sure my nurses know how important their contribution is to the community at large. It is like the adage about a pebble [being] thrown into the water. Rural areas are such [little] ponds that even a small pebble creates tidal waves.”
       Sherry says in the city you wouldn’t know your patients outside the hospital. “But in a rural setting, you work together, worship together, shop together, laugh together and grieve together. One life affects another.”
       DeVonna McNeill, MSN, RN, has worked as the OB supervisor in a rural hospital, as a faculty member at Tarleton State University, and as an in-service educator at a large urban hospital. “Having worked in both large urban hospitals and the small rural hospital in the town where I grew up taught me to value some experiences in a different way. There is a lot to be said for knowing your patients as friends and neighbors. Familiarity and a sense of family and community, are some of the greatest differences between urban and rural nursing. Caring for people you knew in school, or their kids or parents, or the person who teaches your kids lends a different sort of character to nursing that I did not feel in my big city hospital experiences.”
       The consideration of a nursing practice in a rural setting is something every nurse must explore for themselves. This exploration should include what motivates an individual about nursing, their expectations of co-workers and themselves, and their goals for the future – both personally and financially.
       The community surrounding any hospital will define a nurse’s experiences. Therefore, the environment where a nurse works will affect their outlook on life, and this is perhaps one of the most difficult things for an ambitious young nurse to contemplate when considering a career in rural Texas.
       Although it is not for everyone, a nurse who practices in a rural setting is certain to gain something special from it. The rewards are many, and furthermore, the demand is high.
       Texas Nursing Student is published monthly and is distributed free of charge to students enrolled in ADN or BSN programs at 77 schools of nursing in Texas. For subscription information, visit the Texas Nursing Student website located on the web at: http://texasnursingstudent.com.

Rural hospital executives often over estimate the number of individuals needed to support adding a specialist to the hospital’s medical staff. The truth is there are some maxims when you are considering expanding your medical staff. At the National Organization of State Offices of Rural Health Regional Meeting in Austin, Gerald Doeksen, Director and Regents Professor of the National Center for Rural Health Works, discussed how to project needs for specialists in rural areas.
      The Center looked at a number of studies that appeared in peer-reviewed journals and found the population needed to support a given specialist varies quite a bit:

To figure out your typical need for a specialist in any one of these categories, take the population of your market service area and divide by the corresponding number above to arrive a percent of FTE (.10 = ½ day). For example, if a local service area contains 8,000 people and you are considering a cardiologist, then 8,000 / 26,000 = .3077. The service area should include enough patients to support a cardiologist for at least 1 ½ days per week. More information on this and other related topics can be found at www.ruralhealthworks.org.

Each year, Hospitals & Health Networks magazine announces the ‘Most Wired’ hospitals in the country. As usual, large healthcare systems which have been on the list for many years make up a majority of this year’s winners. So what is it that separates the ‘wireds’ from the ‘unwireds’? The list is based on the Most Wired Survey and Benchmarking Study that asks hospitals to report on how they use information technology to address five key areas: safety and quality, customer service, business processes, workforce, and public health and safety.
      Once the survey responses are submitted, the Most Wired team evaluates the initial responses and identifies organizations whose scores indicate extreme variance in year-over-year analysis. The team chooses 10 percent of the respondents to review certain questions, provide modifications and/or explanations for their answers. Organizations can modify their answers and are asked to sign a form stating that their survey answers accurately reflect the technological ability of their organization. This year, all organizations were also asked to verify their responses to two alert system-related questions by submitting screenshots. The survey results are the basis for several awards:

• Most Wired: The 100 organizations that scored highest on the survey
• Most Wireless: The 25 organizations that scored highest on the survey questions focused on wireless applications
• Most Improved: The 25 organizations not appearing on the Most Wired list whose score improved the most from 2006 to 2007
• Most Wired-Small and Rural: The 25 small and rural organizations not appearing on the Most Wired list that scored highest on the survey

While no rural Texas hospitals appeared on this year’s Small and Rural list, ETMC, Children’s Medical Center of Dallas, Memorial Hermann and Texas Health Resources were all listed among the ‘Top 100’ and the Seton Family of Hospitals was also selected as one of the ‘Most Improved’.
       While you may feel that there is no reason to even apply, remember this. Each organization completing the survey receives a customized report comparing its responses with the 100 Most Wired organizations. This year, 568 hospitals and health systems completed the survey, representing 1,284 hospitals. If you are looking to make improvements to your facility’s I.T. infrastructure, this is a valuable resource for you and your staff to consider.
       Go to www.hhnmag.com and click on ‘Current Issue’ for access to the lists as well as an article called Ten Lessons from the Top 100 and some useful charts based on the 2007 benchmarking data.