Rural Wisconsin Health Cooperative

Policy & Opinion Papers/Presentations by or with RWHC Input

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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.

"Density of HIT Adoption in Wisconsin Rural Hospitals," prepared by Louis Wenzlow, Director of Health Information Technology, Rural Wisconsin Health Cooperative, 11/04/08

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. (pdf file)

"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" b y 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. (Click here for a pdf file.)

"ACT NOW: Oppose Medicare’s Proposed Construction Ban." For talking points go to http://www.rwhc.com/ACTNOW.doc (Word) or to http://www.rwhc.com/ACTNOW.pdf (Adobe Acrobat).

“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 here 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 (as a 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”, Click here for a copy of the handout of this 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, 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 here for a copy of the 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," 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 Sizefor 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 here 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 (or as a 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

2002

WHA Dental Access Work Group Report: Local Models Hospitals Can Use To Improve Dental Access, Adopted November 20th, 2002

Improving Partnership Synergy (pdf file) is a brief talk given to the Advisory Board of the University of Wisconsin Center for Cooperatives based on “Partnership Synergy: A Practical Framework for Studying and Strengthening the Collaborative Advantage” by Lasker, Weiss & Miller in The Milbank Quarterly, Vol. 79, No. 2, 2001 with examples and commentary from RWHC senior staff.

The Final Report of DHHS Secretary Tommy Thompson's Advisory Committee on Regulatory Reform was approved at its November 21, 2002 meeting. Recommendations specific to rural in the "The Master List Of Adopted Recommendations" (Appendix B, starting on page 89), are noted in bold font.

RWHC Appeal To FCC (RWHC has appealed to the Federal Communications Commission a decision by the Rural Health Care Division of the Universal Service Administrative Company that the Rural Wisconsin Health Cooperative’s (RWHC) is not eligibility for Universal Service Support.) November, 2002.

Upcoming Challenges For Hospitals Serving Rural Communities--a PowerPoint presentation by Tim Size, October, 2002.

Advance Beneficiary Notices--a PowerPoint presentation by Richard Donkle, CPA, Rural Wisconsin Health Cooperative, for the Wisconsin Health Information Management Association, September, 2002.

Quality Improvement in Rural Hospitals: How Networking Can Help This excellent technical monograph by the Academy for Health Services Research and Health Policy and was supported by a grant from the Robert Wood Johnson Foundation. Written by Kerry Kemp, it discusses "the challenges and obstacles that small rural hospitals face, as well as the assets and advantages that are often overlooked." The RWHC Quality Indicators Program, highlighted in the monograph, was started with help from the Robert Wood Johnson Foundation in 1988, and now "specializes in data collection for small to mid-size health care organizations. The fees for the RWHC program are considerably lower than those for other programs. JCAHO has accepted the RWHC Quality Indicators Program as a performance measurement system authorized for use in JCAHO’s ORYX initiative, which focuses on outcome measurement as part of the accreditation process." August, 2002

"National Rural Health Snapshot," August, 2002.

"Opinions-Commentary: The way to pay for rural care" by Tim Size in Modern Healthcare, 8/5/02

"Opportunities For Rural Community Partnerships" presented by Tim Size at the Summit On Rural America, The Secretary’s Rural Initiative, Denver, Colorado; July 26th, 2002.

A Cooperative Advantage In Cyberspace , This is a brief summary (pdf file) of a major new RWHC initiative. The goal of the RWHC Data Network is for rural hospitals and other providers to achieve a cooperative advantage in the rapidly developing world of electronic transactions as they have historically done through RWHC in traditional arenas. 5/02

Measuring Local Maternity Outcomes and Developing Capacity for Improvement a grant funded by the The Alliance Provider Quality Investment Fund. 5/02

Wisconsin's Rural Counties Are America's Future Today; Too Few Workers To Pay The Medicare Shortfall. This map shows a key challenge to health care in Wisconsin's rural counties, and other rural counties across the country--the waning ability of the private sector to absorb the Medicare induced cost shift. 5/02

The Rural View -- This Power Point presentation was prepared by RWHC for the Medicare Reimbursement Summit sponsored by the Wisconsin Office of the Commissioner of Insurance on April 29th in Madison. (You may need to increase your Monitor's resolution and/or hide browser tool bars to fit all of each image into smaller screens.) 4/02

RWHC Testimony to the Department of Health and Human Services (DHHS), Secretary's Advisory Committee on Regulatory Reform, Regional Hearing #3, Wednesday, April 17th, Pittsburgh, Pennsylvania. 4/02

How Networks Grow, a presentation for the 2002 National Conference of State Flex Programs. (This is an online "Power Point" presentation; you may need to close some of your browser's tool bars (under your "view" options) to to see the full slide.) 4/02

2001

"Creating a 'Culture' of Safety To Improve Patient Safety In Rural Hospitals"; notes from an AHRQ sponsored invitational workshop at the, Edgewater Hotel, Madison, Wisconsin, 10/22-23/01

Feasibility And Design Study For A RWHC Virtual Private Network 10/01

Recommendations for the Department of Health & Human Services Rural Task Force, (pdf file) 9/01

Rural Hope For Medicare—Become More A Partner, Less An Adversary (pdf file) 7/01

Wisconsin Youth Apprenticeship Program Health Services Guide, (pdf file) 5/01

Medical Record Audits, What's All The Fuss?, an online power point presentation on this topical issue by RWHC Coding Consultant, Sheila Goethel, 4/01

Rural Essential Access Community Hospitals (REACH) For Rural America is a proposal to allow rural hospital with fewer than 50 beds the option of being reimbursed cost by Medicare, (pdf file) 3/01

Medication Safety Recommendations For Wisconsin Health Care Providers from Patient Safety Wisconsin, (pdf file) 2/01

2000

The Science and Art of Business Planning for Rural Health Networks by Tony Wellever and Bob Cameron, (input from RWHC), (pdf file)11/00

The Economic Value of the Health Care Industry In Sauk County, Wisconsin (pdf file) 11/00

Communicating Value To Network Members (PowerPoint Presentation)11/00

RWHC Testimony before the Wisconsin Special Committee on Dental Care Access (9/00)

1998

Medicare: a $2 Billion State Biennial Shortfall (11/98) (pdf file available)

Rural HIV/AIDS. Rural Health, FYI (5/98)

Would John Wayne Ask for Prozac? Rural Health FYI (3/98) images98

Annual Conferences--Not Just Cheesehead Hats (1/98)

Rural Minority Health: How do we respond to a voice of audacious and unjustified hope?"Rural Health FYI (1/98

1997

Developing Relevant Health Policy (11/97)

GME Reform & Rural Shortages,Rural Health FYI (11/97)

The One Choice We Don't Have Is Not Choosing, Rural Health FYI (9/97)

Guidelines To Enhance Cooperation and Executive Summary (8/97)

Our Organization and Community: Coming Together for Rural America, Rural Health FYI (7/97)

Testimony before the U.S. Senate Finance Committee on Medicare. (2/97)

RWHC Business Advisory Letter from Federal Department of Justice (2/97)