Coordinator
All sites please stand by. Today's teleconference
is about to begin. Hello and welcome to the RHCTA teleconference.
At the request of the company, this call is being recorded and if
you have any objections, you may disconnect at this time. All lines
will remain in the listen-only mode until the question and answer
session.
At this time, I would like to turn the meeting
over to our leader, Mr. Craig Williamson. Sir, please go ahead.
C. Williamson
Sure. Hello, everyone and welcome to the third
and final in a series of three conference calls on Rural Health
Clinic Quality Improvement. My name is Craig Williamson and I'm
doing a Fellowship here at the Office of Rural Health Policy.
We're going to start today's call with some news
from CMS about the status of the rural health clinic regulations
and after that, we're going to finish up our discussion about quality
with a presentation on the Role of Health Literacy in Quality Improvement
by Linda Johnston-Lloyd, who is chair of the HRSA Health Literacy
Work Group. And finally, we're going to respond to several of the
questions that the office has received from people and we're going
to talk about funding resources that are available for RHC quality
improvement. Kristine Sande, Program Manager of the Rural Assistance
Center, will describe how RHC's can use RAC as a resource to identify
funding sources and other information to support QAPI programs.
And I'm going to talk briefly about a few other funding programs,
federal and non-federal, that are available for RAC quality improvement.
The call is scheduled to last about an hour and
fifteen minutes. There is some time built in if there are additional
questions. And we'll be stopping along the way after sections to
take questions from audience and also, there will be a final question
and answer time at the end.
A recording of this call is available if you
would like to listen to it again afterwards. You can dial 1(800)
262-4859 and within a few days, we'll also have a transcript up
on the Office of Rural Health Policy Website.
So, with that said, I'm just going to go ahead
and turn things over to David Worgo from CMS. David?
D. Worgo
I guess I have just a quick announcement to make
and I suspect that some of the participants already know this. CMS
has recently decided to suspend implementation of the Rural Health
Clinic Rule that was published on December 24, 2003. Consequently,
CMS regional offices and state surveying agencies should not disqualify
clinics that no longer meet basic location requirements, i.e., rural
and underserved, from the rural health clinic program. Furthermore,
they should not enforce the quality assessment and performance improvement
program.
We hope very soon to formally communicate this
in writing to our regional offices and state surveying agencies.
B. Finerfrock
Yes. Will that be on in the federal register,
then, David? This is Bill Finerfrock.
D. Worgo
To the best of my knowledge, we will not communicate
this with - it appears at this point, we do not need to issue a
notice in the federal register.
B. Finerfrock
Will there be a letter?
D. Worgo
Well, as I just mentioned, I think our plan is
to communicate this in writing to the regional offices in the state
surveying agencies.
J. Suber
This is Jackie Suber. We did announce last month
at our Central Office/Regional Office Rural Health Clinics call
that we have nationally every month to all our regional offices
to disseminate this information down to our state surveyors. And
monthly, we have discussions on this issue, which we'll be meeting
again on Friday for further clarification for the regions and the
states on this matter.
B. Finerfrock
What I'm - I think we need something in writing,
whether it's a regional office letter or a surveyor letter that
can be made available to clinics, because folks aren't going to
believe it just because they've been told that by me or by a State
Office of Rural Health or somebody else like that. We're going to
need - … say I need something in writing. And to the extent that
you do a letter to the regional offices or to a surveyor and you
can make that letter public, that we can then distribute, I think
would be extremely helpful.
D. Worgo
That is our plan. We realize we need to communicate
this in writing.
B. Finerfrock
Will that letter be available?
J. Suber
If the letter is a Survey and Cert letter, those
letters are available on the CMS/Medicare Website.
B. Finerfrock
Okay. And can we get a link to that at some point?
Or where do we find that?
J. Suber
Well, I'm not definitely sure if it's going to
be a letter coming from Survey and Cert or from CMM. But if it does
come from Survey and Cert, we'll give that link to Craig's office
so he can put it up on the Website.
B. Finerfrock
Great.
C. Williamson
And Jacqueline and David, to the best of your
knowledge, sort of, how is CMS expecting or planning to proceed
from here after the regulation is withdrawn? When can clinics expect
to see further action on revising and putting out additional reg
if that's what the intention is to do?
D. Worgo
Well, let me see if I can explain where we're
at at this point. Some members of Congress have questioned whether
the final REC rule is in compliance with the MMA, specifically Section
902, which requires CMS to issue regs or publish regs in a timely
manner, within three years. As I understand, we have suspended implementation
of this rule to give CMS and our general counsel additional time
to review and evaluate those concerns.
If CMS concludes that we need to reissue this
final rule, I suspect we will reissue it as a Notice of Proposed
Rulemaking and that rule may contain additional updates and changes.
In other words, it may go beyond just reissuing the final RHC rule
that was published on December 24th.
C. Williamson
Okay, thank you very much, David.
D. Worgo
Okay.
B. Finerfrock
Sorry, Dave. What you just said is a little different
than what I think the impression that at least has been out there,
which is, you're saying that this is a suspension in order to review
whether the rule was in compliance with the statutory provisions
of the Medicare Reform legislation. And that a decision with respect
to compliance with that had not been made and one possible action
would just simply be a lifting of the suspension and the immediate
implementation of what was issued on December 24th?
D. Worgo
I guess what we're saying, Bill, is that we are
evaluating these concerns and if we conclude that we're in violation
of this new provision in the MMA, the likely outcome will be to
reissue the final rule. But let me see if I can add to that.
The decision to reissue, it will be made - there's
several layers. You have CMS, you have the Department, you have
OMB and all I can tell you at this point is that at the CMS level,
we're evaluating this issue and there is a possibility we're going
to reissue. But there's no guarantee that as it works its way up
the process up to the Department of LNB, I cannot guarantee that
it will be reissued. I guess that's what I'm saying.
C. Williamson
Well, David and Jacqueline, thank you very much
for coming on and making the announcement and letting people know
what the status with this.
I think we're going to go ahead and move on with
the agenda. And I mean, just sort of emphasize that no matter what
happens, RACs are still going to have some form of quality required.
It may not be identical to the QAPI requirement that came out now,
we'll just have to wait and see what that is. But we'd like to go
ahead and sort of finish up this series of calls and fill in a little
bit of gaps of what our discussion about RAC quality has been so
far.
So I'm going to go ahead and turn things over
to Linda Johnston-Lloyd to talk a little bit about health literacy
and its role in quality improvement, and we're going to move on
and then talk for a while about some funding sources that RACs have
to do quality improvement activities.
D. Worgo
Craig, do you mind if I make one more -
C. Williamson
Sure. Go right ahead.
D. Worgo
If, under the scenario where we do reissue the
final rule as a Notice of Proposed Rulemaking, I suspect that the
intent of reissuing that rule is to open up these final provisions
for additional comments, public comments. And our intent will be
to allow the public, the RHC industry to comment on issues that
they were not given an opportunity to comment on such as any new
policies that were established in that final rule. And the point
I'm trying to make is that the basic provisions and the basic requirements
under the BBA and under this final rule, if we do reissue, will
not be going away.
It sounded, by your description and your segue
into this next topic, it sounded like you were implying that some
of these requirements were going to go away.
C. Williamson
No. That's an excellent point, David. Thank you
for filling in. The quality requirement is part of the BBA and RHCs
are still going to have to have a quality improvement program of
some kind. And you bring up a great point that RACs may have an
opportunity now to give CMS a little more comment and input onto
what the form of the regulations should be. So, thank you for filling
us in on that.
David, Jacqueline, do you guys have any final
comments before we hand things over to Linda?
J. Suber
Actually, Craig, I do have one final comment.
I did want to remind all the rural health clinics that Phase 1 of
the BBA requirements - there were two specific provisions that required
implementation that was not contingent upon the regulations and
we have had some gray areas, some cloudiness with understanding
of that and I want to make sure that everyone understands that even
though this regulation is suspended, if it's withdrawn, that the
two provisions of the refinements of shortest area requirements
and the mid-level staffing waivers, specifically with the refinement
of shortage area, it was implemented in January 1, 1998, that only
participating rural health clinics in outdated shortage areas will
continue to be grandfathered and protected from certification. New
applicants for rural health clinic status must be in a current,
shortage designation that is a HPSA, MUA or government designation,
in order to come into the program.
The second provision was the provision for staffing
waiver for mid-level providers. Only participating rural health
clinics can request a waiver. The new applicants cannot come on
board the program requesting a waiver for mid-level provider.
C. Williamson
Okay, thank you, Jacqueline. That was also a very
important point. Alright. Well, let's go ahead and there will also
be a time for open questions at the end of the call. So if listeners
have additional questions, hold off on those until we get through
these presentations and there will be some open time for question
and answer.
Linda, why don't you go ahead and take things
away, then?
L. Johnston-Lloyd
Thank you. Good afternoon to everybody. I wanted
to start by giving you some history on where health literacy has
come in the departments since the fall of 2002.
We have, here at HRSA, in the fall of '02, we
took the lead - well, actually, I was asked to take the lead on
the Healthy People 2010 Objective on Health Literacy, so we started
working internally to create an awareness of the topic here in HRSA.
And then in January of '03, we had officially established a workgroup,
which was representative and is still representative of the offices
and bureaus across the agency.
In April of 2003, about a year ago, the IOM began
their study on Health Literacy, the yearlong study. In September
2003, the secretary came out with a statement that said, "The health
of our country depends on how people can understand basic health
information to live their lives in a healthy way."
So Secretary Thompson has now continued to emphasize
health literacy and had recently included it in his annual conference,
Steps to a Healthier U.S. And at that conference, there was a blueprint
for action release and within that document there are action steps
for health literacy.
So in a little more than a year, we've come a
long way. I believe that we're at the tipping point now where we're
going to hear health literacy mentioned everywhere we go, in every
newspaper and it should become just part of our daily life.
And you all are in a position to really help us
with this, because you reach out to the rural areas of … who are
not always on the low end of health literacy, but certainly have
a need for letting us know what is important to them and how we
can help them and how we can make it easier for them to access care.
And that's what I want to start to talk to you about today.
You have the slides and basically, my job here
has been to really look at how we can link health literacy to quality.
And there's no doubt in my mind or anybody else's mind that it's
not an important component of quality of health care and of the
mission of HRSA, of which you are all a part of.
There's several definitions for quality health
care and I've highlighted the ones that I think really make a case
for its link to health literacy. And if you look at the IOM study,
the IOM definition, where they talk about providing health services
for individuals and populations in a quality manner increases the
likelihood of desired health outcomes. And that's what we're talking
about. If we're working with people with limited literacy, how can
we make sure that they have the outcomes that we'd like to see?
How can we make sure that we avoid medical errors and that we continue
to provide quality care?
Another definition is from a later IOM study,
which was, Crossing the Quality Chasms and that is "good quality
means providing patients with appropriate services in a technically
competent manner." But more importantly, it goes on to say, "with
good communication, shared decision-making and cultural sensitivity"
which is really one of the key points of health literacy; making
sure that we value the patient's gender, ethnicity, and their culture
and are cognizant of their needs.
In that same definition, the Institute of Medicine
described components of quality health care meaning, "safe, effective,
patient-centered, timely, efficient, and equitable." And if we're
working with people of limited literacy, we really need to look
at those components and see how we can work with them more successfully
to make sure that we are providing patient-centered care and that
it is effective and equitable.
Sometimes physicians feel like they're hanging
on a cliff, or maybe the patient's feel like they're hanging on
a cliff and there's an actual group in Australia called the Royal
Flying Navy and I used one of their cartoons, which is actually
a cartoon that is featured in some of the Australian newspapers
on a regular basis. But these doctors fly out to the outback area
to provide health care. But I think oftentimes the patients and
health care professionals become frustrated and they may feel like
they're hanging off the cliff, and where do I go from here and how
can I help that person, or what do I ask the doctor?
The really simple definition for quality health
care that AHRQ, the Agency for Heathcare, Research and Quality used
in one of their publications is, "Doing the right thing at the right
time in a right way for the right person." And that, really, is
looking at the patient and the person and all aspects of that person.
Not just whether they can read, but what their culture is, what
their values might be. Do you have the ability to hear what they're
saying, etc.?
And then that brings us to if we think about the
concept of quality, and then as I continue, just try and go back
to the concept of quality and see how this makes sense to you and
I'm sure you'll be thinking that hey, I'm doing some of this work
already. And if you are, I'd like you to let us know so we can post
it on the Health Literacy Website. We'd really like to come up with
some demonstration projects that we can, in the future or maybe
even now, we know that they work, we have evaluations on them and
that we can put them out as model programs for Health Literacy and
quality.
The whole definition of literacy came from the
Department of Education and when they began to do their national
assessment of adult literacy, they used a definition, which was
the ability to use printed and written information to function in
society. And from that definition, they started to look at how people
function in the job, so they gave them an assessment test in '91.
And from that assessment tests, the data showed that about 90 million
Americans tested at the lowest two levels. That means that if you
were to give them a map to find a bus stop, they couldn't locate
it. They couldn't determine how to navigate a hospital. They would
have problems reading their medication directions.
And when they assessed that there were 90 million
Americans that were functioning on those lower two levels, we started
to think about how these people were relating to health information.
And remember that, this is a written assessment, in other words,
people have to be able to read to take this. So that does leave
out a certain percent of the population, they have to be able to
at least read English in a fairly moderate, in the mid-level English
reading.
So what happened was this. As they got ready to
begin the next assessment, which was in 2003, the Department of
Health and Human Services worked closely with the Department of
Education to include some health literacy, health-related items
in this instrument and we should have that data out about 2005.
And that will give us a baseline to see exactly what types of problems
do these people have.
Generally, when they're given the assessment test,
they have to locate a piece of information, let's say, in a newspaper
paragraph. That's one example of what they have to do. There's some
mathematic skills; basic subtraction and addition that they do,
etc. So this will give us some sense about what are some of the
issues out there and the problems that people have.
But also, I wanted to make sure that people understand
that it's not just people who test low on these assessment tests
who have limited health literacy. There are many people with Ph.D.'s,
highly educated who really have limited health literacy. Just like
many of us have limited financial literacy. And today, we're hearing
about all types of literacy as far as the subject matter goes.
So, with the national assessment of adult literacy,
the folks who are preparing Healthy People 2010 said, "You know,
maybe it's time that we look at health literacy." And so that's
when the Communications Chapter in Healthy People 2010 evolved and
the definition that you see there on slide 18 is a consensus definition,
which is used by the Department and most other organizations use
this definition. You may see some deviations from it.
Our definition reads, "The degree to which individuals
have the capacity to obtain process and understand basic information
and services needed to make appropriate health decisions."
One definition I recently read said, "The degree
to which individuals have the capacity to read, process and understand."
I want to make it clear that it's more than reading. People obtain
information in many, many different ways, as you know. So, it's
much more than reading. It involves listening skills. In fact, one
of the key points I recently heard a physician who's done much research
in the area of health literacy make is she said, "What I found is
most helpful and meaningful to the people I serve is that I have
the ability to listen to them."
And that relates to a companion objective that's
in that chapter, Objective 11.4 is improve patient-provider communication.
So those two are really intertwined as far as being successful working
with limited literacy people.
The IOM just came out with a report on slide 19,
and I have that - just a little quote from there. "What they're
saying to our country is that we need programs to reduce the negative
effects of limited health literacy. And that it should be a concerted
effort by education, health care systems, public health and the
media." And you might find that real interesting to scan. You have
a link to that on your list of resources that I've provided for
you.
Another report that has information on health
literacy is the IOM report on Transforming Health Care Quality,
which came out in 2002. They've identified 20 areas for national
action. Self-management and health literacy is one of those 20 areas;
it's one of the two cross-cutting areas cited in that report. If
people aren't health literate, they're going to have problems managing
their own health and complying with their health directions.
If we go on to Healthy People 2010, I just want
to make a comment that the objective reads, "Improve the health
literacy of persons with inadequate or marginal literacy skills."
And you might think that that is focusing on just low-literate people,
and it is. But what we want people to begin to realize is that the
data we'll be collecting will be on that objective, but we want
it to reach all areas; all people that are maybe don't test low,
but you might suspect need some help.
I don't have too much time left, but let me just
point out some of the other highlights that I have. You have the
slides so you can go through them.
If you talk about the written word, then think
about Webster's definition of language, because here at HRSA we've
been calling it the language of health. Promote health literacy.
If you look at the definition of the term language, it's more than
words. It's how we say them, it's how we write them, of course,
but it could be signs, it could be ideas, it could be feelings,
it could be sounds and marks that you use. Simple signs that people
don't have to read. So you can do something very simple to make
a difference and that could be a health literacy component of your
quality work. And maybe if you did something each month in the area
of literacy, you might find yourself making a difference.
We do know that people with limited literacy skills
use the ER more often. They present later in disease, they're more
likely to have overall health problems. They're more likely to not
comply with their treatments; they may not understand their treatments
and they're less likely to come in for screenings. We know that
some of the major populations that low health literacy is found
in are the elderly, those living in poverty, people who may not
speak English. We also know from research that if you address health
literacy, it improves your access for information and to care, your
ability to provide informed consent.
There's one example of a woman who was embarrassed
that she did not read and so she signed her informed consent. She
ended up having a hysterectomy, had no idea she'd had it. She didn't
know what she had had. She was embarrassed to say she could not
read. So, problems like that are still happening and we need to
really work hard to help reduce those problems.
You can go to our Website and you can see what
some of our program areas are doing. There are some Rural Health
programs listed there, however, yours may not be there. And within
Rural Health, we have a member of our HRSA workgroup, Lily Simintana
and you can let her know or you can e-mail me and my e-mail address
is on the first slide, because we would love to hear from you and
we would love to be able to support you in some of your efforts.
The list of resources I gave you is pretty extensive.
I want to highlight just one or two that I think are very good.
The Hardway School of Public Health Department has a short video
up there and they have some excellent ideas for health literacy
programming. And that's very good. The National Library of Medicine
has a bibliography on their site. The Institute of Medicine, of
course, and there are direct links on those resources so you can
link to them and see what ones you might want to use.
People are always asking for tools. The Partnership
for Clear Health Communication has an Ask Me Three program and they're
asking you to focus on getting your patients to ask you three questions.
What is my problem? What should I do? And how do I do it? If you
go to the Website, they have a kit there, too. You might be interested
in that.
The AMA has a kit out that's excellent. It's called,
Helping Your Patients Understand. They also have grants for health
literacy programs. And the, I believe Pfizer has some grants, too,
also.
The National Institute for Literacy is excellent.
They have a special health and literacy collection. And one that
I really like is the State Official's Guide to Health Literacy.
And they have a tool kit with fact sheets and ideas for programs
and they have a CD ROM that shows patients and the problems that
they've faced. In other words, one person was taking so many medications,
they couldn't remember when to take them, so the provider taped
each pill to a card and in simple language wrote when they should
take it. So it was color-coded by the pills, and in simple instructions
like, "Once at lunchtime." And many, many mistakes happen with prescriptions.
Many, many mistakes with people.
There was recently an article about a woman who
was - her baby had an ear infection so she was given drops. And
she didn't know she should put the drops in the ear, so she gave
them to her by mouth. And those things happen, because it's just
not clear and people don't take the time to ask the patients, to
say, "Can you read? Do you understand?"
And as I said, I think the one key that one of
the physicians recently mentioned is to listen to your patients.
If you take an egg timer for two minutes, if you just give the patients
two minutes when they come in to listen to everything they have
to say. And it's not only the physician; it's when they walk into
the clinic. Or when the first person that meets them. So, if I had
more time, I could give you many more hints, but I'd like to give
you a chance to ask questions.
C. Williamson
Forrest Calico is here and I think he had a comment
that he wanted to make.
F. Calico
Hi, folks. Thanks, Craig. I just wanted to just
thank Linda for addressing what is really a huge problem nationwide.
This certainly isn't rural-specific. But, you know, earlier in our
conversations, we talked about patient-centeredness as being one
component of high-quality care, one of the six aims that sort of
defines quality.
In my mind, patient-centeredness certainly requires
culturally appropriate care giving on our part, but it also requires
what Linda's been talking about, that we help our patients to grasp
and comprehend the things that they need to know about their health
and that's what health literacy is all about. So to me, combining
culturally appropriate care giving with health literacy enables
us to engage in therapeutic communication, which is one of the most
important components of the healing art.
So I just wanted to mention that. I think that
clearly projects to enhance the communication between caregivers
and rural health clinics and your patients will clearly improve
quality; that that link is absolutely indisputable and unquestionable
and would make some great performance improvement projects (background
noise).
C. Williamson
Well, thank you very much as always, Forrest,
for your input and your words. At this time, let's open things up,
Operator, and see if there are a few questions for either Linda
or Forrest relevant to health literacy.
Coordinator
Thank you. One moment, please. Our first question
comes from Jill Doyle.
J. Doyle
Good morning. I'm just wondering where we can
find some of Linda's brochures for some of the patient literacy
programs?
C. Williamson
Great question, Jill. All of that stuff is up
on the Office of the Rural Health Policy Website along with all
of the other materials and resources that will be discussed on this
call. If you haven't been there, the Website for that is http://ruralhealth.hrsa.gov.
So if you just type in ruralhealth.hrsa.gov into your browser, it
will come up and click on the link for Technical Assistance for
rural health clinics on Quality Improvement. And if you don't have
access to the Internet, go ahead and give us a call here at the
office, (301) 443-0835 and we can see about printing that stuff
up ourselves and faxing it to you or finding some way to get you
those materials.
J. Doyle
Thank you.
L. Johnston-Lloyd
You also could, after the next month is up, check
the Quality Website. We have a health literacy page on that site
and that's hrsa.gov/quality. And on our front page, there's a link
to health literacy.
J. Doyle
Okay, thank you.
L. Johnston-Lloyd
You're welcome.
Coordinator
Thank you. Our next question comes from Tidy Langford.
T. Langford
Yes, my question was the same about the Website
and I didn't get - what was the, after rural health, what were the
letters?
C. Williamson
It's dot hrsa. So, ruralhealth.hrsa then .gov
for dot government.
T. Langford
Thank you very much.
C. Williamson
No problem.
Coordinator
Thank you. We have no further questions at this
time.
C. Williamson
Alright. Well, thank you for your questions, everyone.
And let's just go ahead and turn things over to Kristine Sande,
then, from the Rural Assistance Center, which is a wonderful resource
that you should all know about for getting all kinds of rural health
care information. So, Christine, why don't you take things away?
K. Sande
Okay. Just a little bit of background information
for those of you who may not be familiar with the Rural Assistance
Center. The Rural Assistance Center, which you might also hear referred
to the R-A-C or RAC, it was a product of the Department of Health
and Human Services Rural Initiative and was established in December
of 2002. It's intended to be a rural health and human services information
portal.
What we do is we help rural communities to access
the full range of available programs, funding and research, which
will allow them to provide quality health and human services to
people in their rural areas. In order to do this, we gather and
streamline information from many sources and try to provide easy
access to that information.
The Rural Assistance Center is a collaboration
of several different organizations; the lead partner is the Center
for Rural Health, located at the University of North Dakota School
of Medicine and Health Sciences. We also work with the Rural Policy
Research Institute at the University of Missouri Columbia and the
University of Nebraska Medical Center as well as the Welfare Information
Network in Washington D.C. And we're funded through HRSA's Office
of Rural Health Policy.
RAC users can be anyone who is looking to maintain
or improve the access, quality and financial viability of rural
health and human services delivery systems. Some of the services
that we provide are Websites, lists or postings, as well as customized
assistance. The RAC Website is available at www.raconline.org. That
link is also available off of the Office of Rural Health Policy
Website on their Links page, if you didn't catch the link.
We try to make all of our information accessible
via the Web as much as possible just for ease of people trying to
access that information. Features on the Website that can be of
assistance to grant seekers are funding opportunities, recent news,
information guides and our rural documents index.
The funding section of the RAC Website allows
users to access funding announcements and summaries of funding opportunities
sponsored by federal and state governments as well as private foundations.
This includes both limited time and ongoing funding opportunities.
Summaries of funding opportunities that you might
find on the RAC Website will include things like the program Website,
the sponsor of the program, the purpose of the program, eligibility
requirements, the geographic coverage, amount of funding available,
details about the application process and contact information.
When you get to the Website, you can browse these
funding opportunities either by the sponsoring agency or organization
such as the Office for Rural Health Policy, the Department of Agriculture,
the Robert Wood Johnson Foundation, etc. Or also, we have a set
of preselected topics or categories such as community development,
emergency services, and health research by which you can browse.
In addition, news items related to these funding opportunities can
be browsed by deadline date or announcement date.
You can search funding opportunities as well,
which a lot of people like to do to find targeted funding opportunities
and things you can search by include the topic of your choice, the
sponsoring organization. You can search for only entries flagged
as health-related or human services related. You can search for
only entries that are rural-specific or by active programs only
or you could also include inactive programs.
The reason you might want to include the inactive
programs is so that you can identify programs that might not be
currently accepting applications, but may be offered in the future.
And if you find those, there's generally a contact person listed
on those opportunities that you might want to give a call and see
if they think those opportunities will be offered again in the future.
And when you're searching, you can use only one
of these search criteria that I've mentioned to do a broad search,
or you can use the criteria in combination to do a more targeted
search.
We do have a Funding Tips page that can be accessed
from any page within the Funding section of the Website and I would
really recommend that new users of this section of our Website browse
that Funding Tips page to learn how they can make the optimal use
of the RAC site to help with their funding needs. Most of the information
that I'm covering today is included on that page, so some good information
there.
The Recent News section of our site might also
be of interest to you. RAC staff does do a daily search for news
and announcements that might be of interest to anyone concerned
with rural health and human services, such as Federal Register notices
that could affect rural stakeholders are posted to the RAC site.
These include funding announcements, proposed and final rules concerning
regulations, as well as notices regarding meetings, government information
collection and other miscellaneous items.
Also, on the Recent News section, you'll find
press releases from HHS and other federal agencies announcing studies,
grant awards, new programs that are available, new resources, comments
from the Secretary and other types of press releases. You'll also
find press releases from other organizations as well as media coverage
of rural health and human services issues such as articles from
newspapers, press releases from foundations or organizations.
The Information Guide section of our Website is
something that we're continually working on improving the information
found there. The Information Guides are pages that provide information
including links and resources available on a variety of rural health
and human services topics. Among those topics are a broad grant
and funding guide, as well as detailed guides on some key funding
topics. The grants in the funding resources guide show many links
to resources available on the RAC site, as well as elsewhere on
the Internet. And from that Guide, a user can enter the more detailed
funding guides.
Several other funding information guides that
are available in a more detailed format include capital funding,
grant writing, and scholarships and loan repayment for health professionals.
Included on the detailed guides, you'll find things like Frequently
Asked Questions, tools, funding opportunities, relevant documents
and regulations, journals, organizations, terms and acronyms, and
contacts.
But the Information Guide topics are not just
limited to funding. Other information guides that are available
that might be of particular interest to this group include the Rural
Health Clinic Guide and our Health Care Quality Guide. And these
and other information guides and the RAC document search can help
users identify resources such as maps and statistics that can assist
them in writing strong grant applications.
I just mentioned our documents database, so I'll
talk about that a little bit. The RAC site includes a searchable
document database, which now has over 2300 entries related to rural
health and human services. Types of documents that you might find
in the database include Rural Health Research Center reports, State
Rural Health Association and SORE newsletters, federal and state
government publications, and foundation reports and briefs. The
document database can be searched to find documents that can provide
background information and statistics. The Document Search Tip page
is available that can assist you in using that document search to
its fullest and I would recommend checking that out before you try
to use the document search. I think it's helpful for most users.
Another thing that we offer is our list/serve
postings. These postings help our users keep abreast of current
happenings and these list/serve postings have things on them such
as new funding opportunities, recent news articles, new documents
and upcoming events. We have a rural health list/serve posting that
goes out every two weeks and our rural human services posting that
goes out once a month. And you can sign up for both of those list/serves
on the RAC Website. And really, those list/serve postings are the
things that we get the most feedback from our users about as far
as being really a useful resource, so I would encourage you to sign
up for those.
Another thing that the Rural Assistance Center
provides is customized assistance. This is particularly useful to
people who don't have Internet access or people who might have questions
that they can't find the answers for on the Internet anywhere, and
you can give our information specialists a call and they can try
to help you hunt down answers.
Some of the types of information or assistance
that the information specialists can provide is that they can perform
detailed searches for funding opportunities using many resources
including our RAC funding database, government Websites, the foundation
directory, which can identify foundations who might fund certain
types of projects in certain areas. They can also point callers
to appropriate government contacts for various programs, funding
and otherwise.
The information specialists can also find print
and electronic documents as well as statistics, data sources, and
maps that are useful to grant writers. They can also identify experts,
organizations and colleagues who might be able to assist you in
your grant writing efforts or otherwise help you find information.
The information specialists are all Masters-trained
librarians so they're really good at trying to track down that information.
We do ask that when you call, you give us adequate information about
exactly what your question is. If you're looking for funding opportunities,
it's really important that you tell us things like the topic of
your program, if you're doing a QI program; are you looking at patient
education for diabetes or other chronic diseases, or information
technology or smoking cessation, because that really helps us find
targeted information and funding opportunities. Whereas if you just
tell us that you want information on quality improvement, we probably
won't find as many opportunities for you, or they may not apply
to what you really want to do.
Also helpful to know is the location of your facility;
including city, county and state. That helps us search for some
of the opportunities that may be more regional in nature. Also,
it's helpful for us to know if your status as a not-for-profit or
a for profit organization just because that may affect your eligibility
for certain programs.
So that's a brief rundown of what the Rural Assistance
Center can do for you. Again, the RAC Website is www.raconline.org.
Customized assistance is available Monday through Friday, 8:00 a.m.
to 5:00 p.m. and that's Central time. And so I would encourage all
of you to use these resources.
If there are any questions, I'd be happy to answer.
Coordinator
Thank you. One moment please. We have no questions
at this time.
C. Williamson
Okay. Well, thank you very much, Christine. I
just encourage all of you out there, if you haven't checked out
Rural Assistance Center before, go online. There is a whole host
of information that's updated very regularly. It's a very wonderful
resource for rural providers.
I'm just going to go through and talk very briefly
about some other grant opportunities, both federal and non-federal,
that are out there for rural health clinics to apply to that could
garner some funding for a quality improvement project. And a lot
of these I actually found by asking the Rural Assistance Center
to go through and do a search for what rural health clinics were
eligible for. So, that's sort of a real-time example of what RAC
can do for you.
There's a set of slides that are up on our Website
at ruralhealth.hrsa.gov that list about six different grant programs
that we were able to find that RHCs may find relevant to them. These
include grants from the National Library of Medicine for Information
Systems; the Agency for Health Care, Research and Quality's Demonstrating
the Value of Health Information Technology grants; Rural Health
Outreach and Network Development grants that are sponsored by the
Office of Rural Health Policy; and some grants from private foundations
including the Quality Health Foundation, Robert Wood Johnson and
The Commonwealth Fund. So, I'm just going to go through these real
briefly and if you want more detailed information, I'm going to
provide a link to their Website and also a contact person and phone
number … available for you for those of you who may have limited
Internet access out there.
So the first program is the National Library
of Medicine sponsored Information System grants and one of their
priorities are these grants can be used to deliver information resources
and services to underserved rural populations. And so the way that
that can be useful for RACs is some of their grantees include consortiums
of health centers in rural southern Illinois and rural western Pennsylvania
that have received funding for high-speed Internet access and information
sharing between clinics, which the Internet can be a wonderful resource,
both for you to offer information to your patients and for you yourself
to find information about quality improvement ideas and best practices
and all of those. So, this program can provide funding for that.
And the Website for the National Library of Medicine
is www.nlm.nih.gov. So that's nlm.nih.gov/ep. And the contact person
there is Dr. Valerie Florence and her number is (301) 594-4882.
And if you don't get all this, all this will be up on a transcript
later or you can call in and listen or contact me after the call.
The Agency for Health Care, Research and Quality
has just kicked off an initiative to study the value of health information
technology. And for the 2004 fiscal year, their focus was actually
on the challenges and opportunities to increase information technology
in rural areas. So, they're strongly encouraging primary care research
networks and networks of rural primary care providers and are providing
some funding for FY04 to implement an IT program, and also study
and evaluate that.
And I should mention that most of these grants
I'm going to talk about, the funding, the FY04 deadline has passed,
so keep a look out for next year, and the same thing with the ARC
program. The applications for that closed April 22nd and winners
will be announced September 30th. But I think it will be interesting
to follow this program and see what some of the examples of programs
are and what the evaluations of them show. And you can access information
from that from the Agency for Heath Care, Research and Quality page,
which is www.AHRQ.gov. And a contact person there is Eduardo Ortiz
and his number is (301) 427-1585.
And a lot of you are probably already aware of
Rural Health Outreach and Network Development grants that are sponsored
here at HRSA in the Office of Rural Health Policy. These grant programs
fund innovative ways of delivering care to rural populations. Both
of them require, like a lot of other programs that we are going
to talk about, a network of some providers. The Outreach program
requires a network of at least three different partner organizations:
rural health clinics, local public health department, hospital or
schools or safe-based organizations as well. The Network Development
program gives money to develop information sharing and formal networks
between different provider types.
And rural health clinics in a lot of towns are
very situated, because you have close partnerships with hospitals
and other health providers in the community to really put together
an effective network and also an outreach program. One example of
a rural health clinic outreach grantee is an RAC in rural Alabama
that's the lead entity of a group of between schools and some other
organizations in this town to conduct wellness outreach programs
for the community. And funding for an outreach product could go
into supporting a quality program or a health literacy program.
I see Linda nodding over there. It could be key component doing
that.
So I'm just going to go through and tell you
a few other private foundation grants out there that RAC found for
me. There are Quality Health Foundation grants and providers in
Maryland, District of Columbia, Virginia, West Virginia, Vermont,
Florida, Michigan and California are eligible for these $50,000
one-year grants for improved patient care. This focuses on use of
best practices to improve care, improve access to health services
and improve communication of health knowledge.
Robert Wood Johnson also has a health e-technologies
initiative that you might want to look into. The Website for that
is www.hetinitiatitive.org. So, hetinitiative.org. And a contact
person there is phone number (617) 525-6167.
And again, if you don't catch all this information
I'm throwing at you, feel free to give me a call at ORHP or send
me an e-mail later on.
One more program, The Commonwealth Fund has several
different grants for quality improvement. These include quality
improvement grants, quality of care for underserved populations,
child development and preventative care, and quality of care for
frail elders. I've got the Website for that is up on our Web and
the phone number there is (212) 606-3800. That's (212) 606-3800.
And again, if you have questions about these,
you can contact me at ORHP. The number at the office is (301) 443-0835
and my e-mail is cwilliamson@hrsa.gov. So, cwilliamson@hrsa.gov.
And again, all of this information is up on our Website for you
to download as well.
With that, I don't have anything else to add.
What I'd like to do is go ahead and open things up and see if participants
out there have any final questions for anyone who has presented
today. So, Operator, can we just go ahead and open up the lines
and see if there are any final questions about quality improvement
stuff I have talked about or also the status of the RHC regulation
as well.
So, Operator, could you go ahead and open up
lines for questions.
Coordinator
Thank you. One moment please.
M Craig, while we're waiting for the calls to
line up, did you want me to talk about …?
C. Williamson
Let's hold off until the end of the call and you'll
have a chance to make some final comments, Bill, at the very end.
… as well.
M Okay.
Coordinator
Thank you. A question comes from Mark Lynn.
M. Lynn
Yes. This is Mark Lynn from Healthcare Business
Specialists in Chattanooga. My question is about the rescinding
of the QAPI rules. Prior to those rules, … required to do an annual
evaluation and I guess we're sort of in a quandary of do we continue
to go ahead and continue doing annual evaluations like we have in
the past, or, I guess, what do we need to do about annual evaluations
now that you guys are suspending the regulations on quality improvement?
J. Suber
Yes, this is Jackie Suber. Clinics will go back
and continue to do the annual program evaluation as they did in
the past.
M. Lynn
Okay. That's what we'll do.
Coordinator
Thank you.
C. Williamson
Okay. Well, if we're waiting for some questions
to queue up, Forrest, I think you had a few words that you wanted
to say before the end of the call?
F. Calico
Oh, very little. My final comment is just to encourage
everybody to really not be discouraged because the regulations are
sort of in flux right now. But I think that by far the best and
most important reasons for improving our quality and our performance
is really in the interest of our patients and our own ethical standards
as health care givers. So your efforts at improvement certainly
have not been wasted and they need to continue, and as I think it's
been made clear, also, once the current questions are resolved in
some form or another, we will be continuing the requirement for
quality assessment and performance improvement. And so I guess you
can just think of it as a chance to be even better by the time that
things become mandatory.
C. Williamson
Operator, are there any more questions queued
up?
Coordinator
No questions, sir.
C. Williamson
Alright. Bill, I believe you had some final comments
as well. This is Bill Finerfrock from the National Association of
Rural Health Clinics.
B. Finerfrock
Thanks, Craig. First, I just want to echo what
Forrest just said, which is that I think while the regs have been
suspended, particularly as it relates to the QAPI, I think it's
merely a delay in something that will eventually come to pass. And
so, I think clinics should continue their preparations with the
anticipation that QAPI will become a reality; exactly when that
occurs is obviously CMS's timetable. But within those regulations,
I think there are other provisions, particularly dealing with decertification
and things of that nature, that some of those may be subject to
change or significant comment. But I think as it relates to the
QAPI initiative, I think it's something that I think is going to
occur and folks would be well advised to at least continue with
preparations for that initiative.
And as Forrest mentioned that the ultimate beneficiary
of this is the patient, and so whatever you're doing that accrues
to the benefit of the patients is not necessarily a bad thing.
Along those lines, there was discussion about
grants and there was legislation authorizing a new grant program,
it was about a year and a half ago, it was passed by Congress as
part of the safety-net legislation that was adopted, and it's specifically
targeted towards small providers with the intention of providing
grant dollars for implementation and development of QA initiatives
within those facilities. And it specifically identifies rural health
clinics and critical access hospitals as the two identified providers
and then authorizes the Secretary to open that up to other providers
that the Secretary may deem appropriate, but specifically references
rural health clinics and critical access hospitals.
Now, that program has not been appropriated as
of yet. So even though it exists as an authorization, Congress has
not specifically put money into that account. A couple of weeks
ago, Denny Geitner, the President of the National Association of
Rural Health Clinics testified before the House Appropriations Subcommittee
urging them to fund this particular initiative, particularly in
light of the effort at CMS to move ahead with the QAPI initiatives
that these programs will cost money for clinics and to the extent
that those grant dollars can be made available, it would help to
either ease some of the financial burden and allow us to develop
a more extensive library of resources and examples of what clinics
are doing in this area to comply with the QAPI initiative.
We've asked for between $5 and $10 million to
be put into that account. I can't tell you right now whether or
not we'll be successful, but if we were able to get that money in
there, we'd, I think, make a significant amount of money available
for grants in that the expectation would be that they typical grant
would be somewhere less than $50,000. So, at $5 million to $10 million,
it would allow a number of grants to be funded throughout the United
States.
C. Williamson
Okay. Well, Bill, thank you for your comments
from the perspective of the National Association of Rural Health
Clinics. And we appreciate you participating in this call.
CMS, David or Jacqueline, do you have any final
things you'd like to add?
D. Worgo
No. No, we don't.
C. Williamson
Okay. Are there any more questions out there?
Coordinator
No.
B. Finerfrock
David or Jacqueline, do you guy have any sense
of timing on when some of these decisions are going to get made?
As Mark's question alluded to, folks are kind of in this situation
of having to continue to comply with the existing requirements with
the expectation that at some point, they're going to convert over
to QAPI and not have to do an annual evaluation, and obviously,
those decisions have financial implications for the RHC community.
Can you give us any sense of what your timetable may be?
J. Suber
David's already left the room, and we really can't
give you an idea. I know that the review of this is already up in
the upper echelon of directors and we're just expecting a response
any day now. Dave will be presenting at the National Rural Health
Association Conference, I think, next Friday. He may have some more
information for you at that time.
B. Finerfrock
Okay.
J. Suber
As I said earlier, I realize there are a lot of
clinics that may have already merged into the QAPI program and I
don't think they should have any difficulty meeting the basic program
evaluations. When you look at the basic elements and you compare
both programs, they both look at requiring the clinics to do a self-assessment,
a review of utilization of services, their volume served, their
medical records. Everything pretty much kind of mirrors except for
with the QAPI program, they're looking at specific projects. But
they should be able to still do a total program evaluation of their
program and do an analysis of the QAPI program as a part of it.
C. Williamson
Okay. Well, thank you very much for that question,
Bill, and for your answers, Jacqueline. I guess if there's no further
questions that brings this call to a close. So I just want to thank
everyone who has participated in these quality improvement calls
for all your help. That includes everyone from CMS and Bill at National
Association of Rural Health Clinics and also other folks here at
ORHP as well as Linda and Christine who presented on the call today.
So, thank you for taking the time out of your schedule to come in
and share your resources and information with the rural health clinics.
And again, I'd just like to reiterate what Forrest
and Bill have both said, that no matter what you do for quality,
quality is the end outcome of providing good health care and there's
few things that are more important than that.
If you guys have any questions, don't hesitate
to contact our office and we will help you however we can. Again,
the number is (301) 443-0835. And we will have information up and
we'll continue updating more information as it comes in for the
next month on quality improvement stuff.
B. Finerfrock
Craig, if I could, I just want to, on behalf of
the rural health clinics community, thank the Office of Rural Health
Policy for organizing these calls over the last three months. I
think they've been extremely valuable to the RHC community and a
very cost-effective way for individuals to get information and for
that we thank you for doing that. And also, to the folks at CMS
who've made themselves available for these calls and allowed folks
to ask questions and get additional information. I think it's been
extremely beneficial and I hope that this is something that we can
try and continue to do in the future and again, just thank you and
your colleagues at ORHP and CMS for taking the time and effort to
put this all together.
C. Williamson
Alright. Well, thank you again, Bill, for everything.
On that note, I think that's a good point to end this. So, thank
you, everyone for calling in and for participating. And good luck
with everything.
B. Finerfrock
Thank you.
Coordinator
Thank you for joining today's teleconference.
You may disconnect at this time.
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