2009
"Calm in the Eye of the Healthcare Hurricane" by Tim Size, a RWHC Quarterly Editorial for Member Newsletters: December, 2009
“Health insurance for all is necessary, but not sufficient, for rural America” by Lynda Waddington in the Iowa Independent, 10/14/09.
"The Financial Effects of Wisconsin Critical Access Hospital Conversion" by Dale Gullickson, FHFMA and Richard Donkle, CPA, Rural Wisconsin Health Cooperative for the Wisconsin Office of Rural Health, August, 2009.
Telemedicine in Wisconsin: A report on the Wisconsin environment for patient care at a distance in 2009. The Project was initiated and funded by the Wisconsin Office of Rural Health with findings and report generated by RWHC, 7/09.
"What Do We Want When Our Time Comes?" by Tim Size, a RWHC Quarterly Editorial for Member Newsletters: June, 2009
“A Rural Perspective on Physician Workforce Planning” by Tim Size, RWHC Executive Director for the WHA Board Planning Session, 7/23/09 PPT or PDF (The PDF is a large file so be patient.)
"Wisconsin’s Urgent Need for Collaborative Health Workforce Planning," a statement of the Wisconsin Department of Workforce Development’s Select Committee on Healthcare Workforce developed by the Wisconsin Health Workforce Data Collaborative, 6/29/09.
"Three Rural Health Priorities and Key Threats to Rural Health in Current Congressional Reform Proposals" by Tim Size, Rural Wisconsin Health Cooperative, 6/29/09. One page talking points and four page expanded remarks available on line.
Rural Wisconsin Health Cooperative (RWHC) comments regarding the preliminary definition of “Meaningful Use” as presented to the Health Information Technology (HIT) Policy Committee on June 16, 2009. The American Reinvestment & Recovery Act HIT incentives, if properly structured, have the potential to profoundly increase all provider HIT adoption and care quality. But by setting the bar at a place within reach of the average large facility yet out of reach of the average small facility, the federal government will effectively exclude the providers that serve predominantly rural areas. This will have a severely negative impact on rural providers, as well as on the rural communities and the 62 million rural residents that rely on them for healthcare.
"Fight Recession With Health" by Tim Size, a RWHC Quarterly Editorial for Member Newsletters: June, 2009
RWHC submitted comments in response to the United States Senate Committee on Finance white paper, Description of Policy Options, Financing Comprehensive Health Care Reform: Proposed Health System Savings and Revenue Options on 5/26/09.
Rural America and the American Recovery and Reinvestment Act of 2009: Summaries Now Available–“A valuable resource direct from the National Rural Health Association's Annual Conference is now available for the rural health community at large. The document provides a comprehensive summary of the investment the Federal Government is making in rural areas, and rural health in particular, through the American Recovery and Reinvestment Act of 2009."
Thrive Releases Healthcare Snapshot 2009. Thrive is an eight county collaborative economic development enterprise in southern Wisconsin that includes the state capital, Madison. Under Thrive’s leadership, thirty-plus healthcare visionaries have formed the region’s Healthcare Leadership Collaborative ( HLC), and in late March endorsed a bold plan to improve the health of the region’s workforce. This and other initiatives are cover in the 2009 "Snap Shot." 5/21/09
“ ‘Meaningful EHR Use,’ ‘Certified EHR,’ And ‘Open Source’ Recommendations” We hope this initial paper begins a discussion in the wider rural health community re ARRA implementation issues for CAHs and other small rural hospitals. Please feel free to share your comments on our blog at http://www.ruraladvocate.org/ or email lwenzlow@rwhc.com. Thanks to Louis Wenzlow, RWHC Director of Health Information Technology, who is the primary drafter and to other senior staff at RWHC who provided significant input. 5/20/09
Collaborative Rural Health Workforce Recruitment & Retention Opportunities. Talk give by Tim Size, RWHC Executive Director, at the National Rural Health Association annual meeting, 5/6/09 PPT
"Density of HIT Adoption in Wisconsin Rural Hospitals," prepared by Louis Wenzlow, Director of Health Information Technology, Rural Wisconsin Health Cooperative, updated 2/23/09
"A Personal View of Rural Health Leadership: It’s All About Collaboration & Advocacy" by Tim Size, RWHC Executive Director for a HRSA "Rural Voices Leadership & Policy Meeting," Washington DC, 3/30 – 4/1/09. PPT slide or PDF handout version.
“How are Federal & State Policies Likely to Affect Rural Health?” by Tim Size to the Sauk County Institute of Leadership, 3/12/09. PPT slide or PDF handout version.
"A Commentary re Critical Access Hospitals and Health Information Technology Incentives in
the Economic Recovery Bill" by Louis Wenzlow, Tim Size and Rich Donkle at the Rural Wisconsin Health Cooperative, updated 3/17/09.
"What's Next?" by Tim Size, a RWHC Quarterly Editorial for Member Newsletters: March, 2009
2008
Rural Wisconsin Health Cooperative Recommendations for HIT Stimulus Package
Our smallest rural hospitals are struggling to implement HIT systems, including
EMRs (Electronic Medical Records), which have shown the potential to enhance care
quality. These hospitals provide a critical service for rural and underserved communities
and should not be left behind in the ongoing HIT revolution.
"An Opportunity for American Healthcare" by Tim Size, a RWHC Quarterly Editorial for Member Newsletters: December, 2008
RWHC has developed a hospital based “grow your own” Pre-Employee Educational Loan Program sample loan agreement as well as the template of the policy document needed to manage such a program. Click here for a template of the loan agreement as well as a template for the policy document.
RWHC Recommended Narrative for the IRS Form 990. Each rural hospital is unique and depending upon a hospital’s distance from another hospital, this recommended supplemental narrative text may make sense to include in a rural hospital’s IRS Form 990, Schedule H, Part VI, 11/09
Observations Regarding the Interface of Politics, Policy & Research: As Illustrated in Recent Issues of RWHC's Eye On Health by Tim Size, Executive Director for the University of Wisconsin-Madison, Robert Wood Johnson Health and Society Scholars Seminar, 9/27/08. (pdf file)
"It's Our Country, Whether We Like It or Not" by Tim Size, a RWHC Quarterly Editorial for Member Newsletters: September, 2008
Testimony: “Assuring Healthcare ‘Reform’ Doesn’t Bypass Rural America” by Tim Size before the U.S. Senate Special Committee on Aging, A Hearing on “Growing Old in Rural America” July 31st, 2008. Executive Summary or Complete Testimony as Submitted.
Wisconsin’s Strong Rural Community Initiative: Discussion Paper #1: Statewide Support for Business Sector to Expand Wellness Initiatives. This paper is the first in a series of five discussion papers with policy recommendations promised by the Strong Rural Communities Initiative as a deliverable in commitments made to its major funders–the Wisconsin Partnership Fund and the Wisconsin Office of Rural Health at the University of Wisconsin and the Healthier Wisconsin Partnership Fund at the Medical College of Wisconsin. July, 2008
"Rural Hospitals' Charitable Exemption" by Tim Size, a RWHC Quarterly Editorial for Member Newsletters: June, 2008
“What Were They Smoking?” by Tim Size, a RWHC Quarterly Editorial for Member Newsletters: March, 2008
2007
"Does Healthcare Reform Affect Rural Health?" by Tim Size, a RWHC Quarterly Editorial for Member Newsletters: December, 2007
Observations from the Interface of Politics, Policy & Research: As Illustrated in Recent Issues of RWHC's Eye On Health by Tim Size, Executive Director for the University of Wisconsin-Madison, Robert Wood Johnson Health and Society Scholars Seminar, 11/19/07.
"Healthcare Reform Without Communitywide Prevention Misses The Target" by Tim Size, a RWHC Quarterly Editorial for Member Newsletters: September, 2007
“Seeking SatisfACTION: Personal reflections of a recent graduate” was written by Stacey Lindenau, MPH, MSIE as a narrative summarizing her experience as a graduate student with the Rural Wisconsin Health Cooperative. For a year she did an extensive literature review and over forty key informant interviews to form the foundation of a policy development agenda for the Rural Health Development Council’s Strong Rural Communities Initiative at Wisconsin’s Department of Commerce. Her field placement was generously supported by the Robert Wood Johnson Health & Society Scholars Program at the University of Wisconsin-Madison. 6/20/07
"Innovative Community Partnerships: Jackson County’s proACTIVE Wellness Initiative" Jackson County recognizes that strategies and approaches to overcome obesity and preventable health problems cannot be developed and implemented by health agencies alone. This summary describes a community initiative that is successfully incorporating the hospital, public health, school district, and local businesses to build and launch worksite wellness programs that are making a difference. 6/19/07
“Rural Hospital Leadership & Quality Improvement” by Tim Size for the
WHA Rural Hospital Surgical Infection Prevention Project, 6/20/07 (PPT and PDF).
" Small Numbers Are a Big Deal " by Tim Size, a RWHC Quarterly Editorial for Member Newsletters: March 2007
“Pay 4 Performance & Consumer Driven Health Care” by Tim Size for the Stoughton Hospital Board of Directors, 5/21/07 (PPT) (PDF-large file!)
The Federal Pay 4 Perfomance Initiative: Congress has mandated that the Centers for Medicare & Medicaid (CMS) develop a plan to implement a Value-Based Purchasing (VBP) Program for all hospitals (other than Critical Access Hospitals) for implementation starting in late 2009. Given the immediate importance of this initiative to rural hospitals under the Prospective Payment System hospital and eventually, we believe, to all hospitals, RWHC submitted testimony in January and April of 2007.
"Small Numbers Matter" by Tim Size, Executive Director, Rural Wisconsin Health Cooperative, 4/2/07. "A diverse crowd of clinicians, administrators, academics, consultants and policy makers met in Dallas-Fort Worth in late March at the wonky but well named National Conference on Small Numbers. Thanks to the Federal Agency for Health Research and Quality for being the primary sponsor as “small numbers” is an issue that rural health and rural health providers need to address in a big way."
“The Role of Critical Access Hospitals?” St. Joseph’s Advisory Task Force, Hillsboro Wisconsin
Tim Size, 3/21/07 (PDF file of PPT This may take a couple minutes, it is a large file.)
“Don’t tax you, don’t tax me, tax that man behind the tree” by Tim Size, a RWHC Quarterly Editorial for Member Newsletters: March 2007
2006
Newly Muscular Middle to Define Health Agenda? by Tim Size, a RWHC Quarterly Editorial for Member Newsletters: December 2006
"Rural Population Health, Hospital Balanced Scorecards and Community Collaboration" by Tim Size, RWHC Executive Director for the Second Annual Rural Hospital Performance Improvement Conference, San Antonio, Texas, November 16th, 2006 . Available on line as PPT file and a PDF of the PPT in handout format (a large file, may take a couple minues.)
Rural Will Exceed Rising Quality Expectations by Tim Size, a RWHC Quarterly Editorial for Member Newsletters: September 2006
"The Art & Science of Rural Health Network Development" by Tim Size, RWHC Executive Director, for HRSA Rural Health Network Planning Grantees, Washington, D.C., August 9th, 2006. Available on line as PPT or PDF (large file, will take a moment to down load).
"It Takes a Community" by Jessica Zigmond in Modern Healthcare, 6/12/06: "As the federal government pushes the healthcare industry to adopt pay-for-performance measures, rural hospitals could have an advantage over their urban counterparts in one area: working collaboratively to improve the overall health of their community populations. One area where experts say rural hospitals could thrive is in their ability to use their strong set of connections in engaging other community players to improve the health of the area's population. While rural hospital leaders recognize that a pay-for-performance model to measure quality outcomes is imminent, they say it is too early to assess progress because the movement is in its infancy and many rural hospitals are not yet equipped with electronic systems to report data." Available from Modern Healthcare archive at http://www.modernhealthcare.com/
Strong Rural Communities Are Made, Not Born by Tim Size, a RWHC Quarterly Editorial for Member Newsletters: June 2006
"Rural Health Advocacy, 24 hours a day, 7 days a week" is a presentation by Tim Size, RWHC Executive Director, for Pennsylvania's 2006 Rural Health Conference. It addresses rural myths, the “Almost Worst Rural Health Policy” Awards for 2005," a cross section of public-private rural health issues and how to be a more effective & active advocate. Click here for a copy of the PowerPoint file.
VIEW FROM THE COUNTRY by Joseph Mantone, Modern Healthcare, March 13th, 2006, pages 40-41.
COMMENTARY: POPULATION HEALTH IMPROVEMENT & RURAL HOSPITAL BALANCED SCORECARDS by Tim Size, MBA, David Kindig, MD, PhD & Clint MacKinney, MD, MS. The text is as submitted by the authors to the Journal of Rural Health on March 25th, 2005. The version of this article edited after peer review can be found in the Spring 2006 Issue of the Journal of Rural Health published by the National Rural Health Association. The definitive version is available at http://www.blackwell-synergy.com
“Leadership Development for Rural Health” by Tim Size, NC Med J 2006;67(1):71-76
2005
National Advisory Committee on Rural Health and Human Services: The 2005 Report to the Secretary: Rural Health and Human Service Issues, May 2005. "The 2005 report focuses on four important issues. The first is the value of promoting collaboration in rural communities. The second is how to improve administration of the Temporary Assistance to Needy Families (TANF) in rural communities. The third is access to obstetrical services in rural communities and the fourth is the impact of obesity in rural communities."
"Public Reporting of Hospital Quality in Rural Communities: an Initial Set of Key Issues," A Policy Brief adopted by The National Rural Health Association (NRHA) on May 20th, 2005 (pdf file).
An Open Letter Regarding a Rural Perspective for the University of Wisconsin's Medical School Dean Search, Screen and Selection Process, May 17th, 2005. (pdf file)
"ACT NOW: Oppose Medicare’s Proposed Construction Ban." For talking points download Word doc. or Adobe Acrobat PDF.
“Rural Perspective On “Hospital Compare,” an editorial by Tim Size, RWHC Executive Director, 3/31/05 (pdf file).
“Rural Hospital Networks: Stability & Growth In Challenging Times” A talk by Tim Size, RWHC Executive Director, for the Iowa Medicare Rural Hospital Flexibility Program, May 4th, 2005. Click for PPT or PDF.
"Rural Can Lead Through Individual and Community Care Collaboration" A talk by Tim Size, RWHC Executive Director, for the 18th Annual NW Regional Rural Health Conference, Spokane, Washington, March 25th, 2005. Click here for PPT or PDF.
"Rural Heath Trends: Opportunities & Threats " A talk by Tim Size, RWHC Executive Director to the annual meeting of the Sauk County Development Corporation, 2/21/05. Click here for the PPT file.
2004
RWHC Eye On Health Special Edition, November 1st, 2004 (pdf file) "Quality Through Collaboration: The Future of Rural Health" from the Institute of Medicine was released November 1st, 2004. The 200+ page report can be viewed on line or purchased at http://www.nap.edu.
“Rural Hospital Networks: Stability & Growth In Challenging Times”, PDF handout of presentation by Tim Size
Rural Wisconsin Health Cooperative comments on the proposed rules implementing the new Medicare Drug Benefit and the Medicare Advantage Program (Ref. File Code CMS-4068-P and CMS-4069-P) published in the August 3, 2004, Federal Register, 10/1/04.
Cooperative Opportunities for Balanced Scorecard Driven Strategic Planning and the Potential Relevance to Population Health Initiatives (PDF), An Analysis by A. Clinton MacKinney, MD, MS & Gregory Wolf, MBA of Stroudwater Associates for and with the Rural Wisconsin Health Cooperative, April 30, 2004 (With July 9th and September 3rd Additions)
"Balanced Scorecards & Population Health." Click for PDF handout of this presentation by Tim Size to the Midwest Regional Meeting of the National Organization of State Offices of Rural Health in Madison, Wisconsin on August 12th, 2004.
"State of Our State, The 'Calm' Before The Storm," PDF handout of presentation by Tim Size at Wisconsin's annual Rural Health Conference, 6/24/04
“Who Will Care for Our Patients?” a major new study by the Wisconsin Hospital Association and the Wisconsin Medical Society. The Task Force on Wisconsin’s Future Physician Workforce identified major initiatives that must occur if Wisconsin is to avert a major crisis. The complete report is available at <http://www.wha.org/physicianshortage3-04.pdf>.
"The Art & Science of Networks" (PPT slides as a pdf file) by Tim Size for the Rural Health Network Development Planning Grantee Meeting, Chicago, 3/22/04
"Eleven Rural Health Hot Spots" (PPT slides as a pdf file), a presentation by Tim Size for the Association of Health Care Journalists, Minneapolis, 3/28/03
“MESH/Cooperative Nursing Staff Sampling Project 2003” by Dick Reynolds & Cheryl Pedersen at the University of Wisconsin Hospital and Clinics MESH program, 2/2/04
Is Your Hospital Board Considering Becoming A CAH?—Click links to download a twelve slide PowerPoint presentation entitled “Critical Access Hospitals: Better Medicare Financing For Smaller Hospitals Serving Rural Communities” (color and black & white).
2003
"Wisconsin can prepare and support rural physicians," a Guest Editorial by Tim Size in WMJ (the journal of the Wisconsin Medical Society), 12/03.
"Grant Writing—Nine Lessons Learned From Twenty Years Writing & Reviewing Grants" by Tim Size, Executive Director, Rural Wisconsin Health Cooperative, 3/18/03
Rural Health SWOT Analysis Results Respondents were asked to reflect on the Strengths and Weaknesses of providers in their community and the Opportunities and Threats faced by these providers. 12/3/03
The Financial Effects of Critical Access Hospital Conversion, by Richard Donkle, CPA
and Dale Gullickson, FHFMA, 7/23/03. Available in full text version (pdf ) or a PowerPoint presentation.
"The Art & Science of Networks" by Tim Size for the Office of Rural Health Policy All Programs Meeting Session for Rural Health Network Development Grantees, August 19th, 2003. Available as a PowerPoint Presentation or PDF Handout.
"Health Care Quality: The Rural Context, A Report to the Secretary, U.S. Department of Health and Human Services," April 2003. Click here to download this import report.
Letter to Governor Jim Doyle and the Wisconsin Legislature from Eric O. Stanchfield, Secretary of the Department of Employee Trust Funds, and Tim Size, Chair of the Private Employer Health Care Coverage Program Board, dated 3/28/03
The Potential for a Small-Employer Purchasing Pool in Wisconsin:Issues and Options for Overcoming Barriers to the Development of the Private Employer Health Care Coverage Program (PEHCCP), Prepared for the Wisconsin Department of Employee Trust Fund by Rick Curtis, Rafe Forland and Ed Neuschler Institute for Health Policy Solutions, 3/03.
The Argument For The Rural Community Hospital Assistance Act (pdf file) by Tim Size, Executive Director, Rural Wisconsin Health Cooperative and Past President, National Rural Health Association presented on 2/14/03 in Washington D.C. in a briefing for staffers of Members of the U.S. Senate Rural Health Caucus and House Rural Health Coalition. This is an update of an editorial published by Modern Healthcare, (8/5/02), as “The way to pay for rural care: Cost-based payment would stabilize finances for a class of troubled hospitals.”
Summary of the Rural Community Hospital Assistance Act--The proposed Rural Community Hospital Assistance Act (RCHAA) has a number of facets. It strengthens the Critical Access Hospital (CAH) program by enhancing CAH reimbursement and permitting some needed changes in their operations. It also creates a new hospital payment status called Rural Community Hospital (RCH) and establishes reimbursement mechanisms that will allow these small hospitals to continue to serve the needs of their communities. This "side by side" comparison of the two programs, whether existing or proposed was prepared by John Sheehan, BKD Health Care Group, BKD, LLP for a Congressional briefing on 2/14/03.
Same Tax, Same Part B Premium Different Medicare Benefit, a chart showing Medicare Payments By State Of Residence Per Enrollee in 2000, 2/10/03