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fall 2012 a publication of Texas Organization of Rural & Community Hospitals

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Texas Organization of Rural & Community Hospitals

fall 2012

Volume 1, Number 3



Feature Story


Judey Dozeto


e d i to r s













Ruth Cook, Fairfield (Chair) Keith Butler, Sonora and Dennis Jack, FACHE, Borger

Determining the Real Value in Health Care IT

Products & Services






Hospital Profile

8 T O R C H E D U C AT I O N C O M M I T T E E





David Pearson, FACHE Quang Ngo, MPH, PMP

President’s Message Sound Off: HIT

Advertiser Index


End Note

Technology T O R C H B OA R D O F F I C E R S Chuck Norris, Chairman Gonzales Healthcare Systems Gonzales Linda Rasor, Vice Chairman Plains Memorial Hospital Dimmitt David Byrom, Secretary/Treasurer Coreyell Memorial Healthcare System Gatesville

TORCH B O A R D O F D I R E C T O R S Frank Beaman, Jacksboro; Donna Boatright, Sweetwater; Harris W. Brooks, Mineral Wells; Teresa Callahan, Iraan; Chris Ekrem , Denver City; Jack Endres, TMSI Vice Chair, Jacksonville; Ernest Flores, Jr., Carrizo Springs; John Hart, Clarksville; John Henderson, Childress; Grady Hooper, Smithville; Letha Hughes, Lamesa; T. Kim Lee, Bowie; Ted Matthews, Eastland; Thalia Muñoz, Rio Grande City; Jan Reed, CPA, Electra; Jeff Turner, Dumas; James Vanek, Foundation President, Hallettsville Rural Matters is published four times per year by the Texas Organization of Rural & Community Hospitals (TORCH), 11675 Jollyville Rd., Suite 300, Austin, Texas 78759, PHONE: (512) 873-0045, FAX (512) 873-0046. Copyright © 2012 by the Texas Organization of Rural & Community Hospitals. Inquiries should be sent to Rural Matters, P.O. Box 203878, Austin, TX 78720-3878. POSTMASTER: Send address changes to Rural Matters, P.O. Box 203878, Austin, TX 78720-3878. Phone: (512) 873-0045. Printed in the U.S.A. No part of this publication may be reproduced in any form without written permission of the Publisher. Opinions expressed in this publication do not necessarily reflect official policy of TORCH. According to Texas Government Code 305.027, portions of this material may be considered “legislative advertising.” Authorization for its publication is made by David Pearson, President/Chief Executive Officer, Texas Organization of Rural & Community Hospitals, P.O. Box 203878, Austin, TX 78720-3878.

/torchnet @torchnet /

Upcoming Events


NOVEMBER 2012 S M T W 4 11 18 25

T F 1 2 5 6 7 8 9 12 13 14 15 16 19 20 21 22 23 26 27 28 29 30

S 3 10 17 24

National Rural Health Day

NOVEMBER 22-23 Thanksgiving Holiday (TORCH Office Closed)


DECEMBER 2012 S M T W T F S 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29


JANUARY 2013 S M T W 1 2 6 7 8 9 13 14 15 16 20 21 22 23 27 28 29 30

JANUARY 1 T 3 10 17 24 31

F 4 11 18 25

S 5 12 19 26

NRHA Rural Multiracial and Multicultural Health Conference Asheville, NC

DECEMBER 25 Christmas Holiday (TORCH Office Closed)

New Year’s Holiday (TORCH Office Closed)

JANUARY 14 Martin Luther King, Jr’s Day


R E S I D E N T ’ S



In this edition of Rural Matters, our focus is on health information

and how worthwhile it has been since they reached their destination.

technology, better known as HIT. Hospitals have been thrust into a

The value is there and the potential benefits are simply too great to

revolution of sorts, when it comes to how data is being collected,

pass up. So look around. Talk to your colleagues who have scaled

analyzed and applied to the systems and processes that are currently

this mountain and ask them what they now see. My guess is that

utilized in the health care setting. The series of ongoing changes

they will all say that you need to stay focused on the goal; having the

that hospitals and other health care providers are going through to

right information at the right time for the right patient when critical

implement electronic health records, health information exchanges

decisions are being made. The promise that HIT holds for our staff

and others, will do more to enhance quality and improve outcomes

and patients is truly remarkable and herein, you will find several

in the U.S. than we can possibly foresee. Because of this delay, it is

opinions and articles that expand on the topic of technology in the

difficult sometimes to justify either the upfront expense or the level

rural health care setting. I hope you enjoy it and please remember

of effort that is necessary to guarantee success. However, we must

to share a copy with your staff and trustees. I look forward to any

press on. At this year’s HITCON we heard from numerous hospitals

comments or suggestions that you may have for our next issue.

that have made it all the way to meaningful use and now completed their attestation. Each of them recounted how long the journey was

David Pearson, MPA, FACHE, is President/Chief Executive Officer of TORCH and a contributing editor of Rural Matters.

Sound Off: How have the investments you’ve made in information technology benefited your staff and your patients?

“Our investment in IT has made it possible to streamline our board, medical staff and QA meetings. The seamless transition in patient care activity between doctors and nurses via the EMR has lowered incidents of medication errors and allowed more consistent progress notes between nursing shifts. The clinic EMR allows for quick access to patient records, consistent documentation in the record and electronic transmission of prescriptions to area pharmacies. As we advance towards Stage Two of Meaningful Use, I have high expectations of an increasing return on our investment in IT.” Frank Beaman, CEO Faith Community Hospital

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“While most people like to consider themselves computer literate, we recognized early on that we were on the learning curve. The advent of requirements under the EHR essentials were being invented as fast as we were learning what they were. We put our investments into analysis of hardware and software, along with development of programmatic needs. As a result of those two focus areas we developed an in-depth understanding of the distinction between a variety of software programs, a comparison of the capability and cost of hardware products, a distinction in costs regarding housing your own server or going cloud-based and a skill set among our staff to evaluate the complexity of needs with a software program and the ability to discern whether a program meets our needs.” David Conejo, CEO Red River Regional Hospital

“Our HIT investments over the past few years have given our leaders and managers the opportunity to better analyze information and make better use of the data. We can now plan for how best to utilize out facility’s resources, including both financial and clinical. Also we have been able to standardize our processes throughout our operation. It’s money well spent and has a definite impact on the care that patients receive.” James Vanek, CEO Lavaca Medical Center, Hallettsville






The Death of Rural Health Care: Exaggerated or Real??


Dr. Michael Williams, CEO, Hill Country Memorial Hospital

Many years ago after his obituary was

quality, safety, and personal service. These

mistakenly published, Mark Twain sent a

are areas where rural providers can easily

cable from London to the guilty newspaper

shine! Specifically, in terms of patient safety

publisher stating, “The reports of my death

and quality, I believe we need to revive

are greatly exaggerated.” Today, similar

the spirit of the Texas CARES initiative,

exaggerations and rumors about the death

started more than one year ago. Nearly

of rural health care are impacting everyone

twenty rural hospitals banded together in

providing care to our rural communities. As

spirit and action with one thing in mind:

we sift through varied reports from sources

serving the patient. We need many more

that span members of government, outside

to join us to fully capture the progress we

health care “experts,” larger health care

can achieve together and elevate the levels

providers and even a few rural providers one

of patient safety and quality care in every

question continually comes to mind. Are

rural community.

these exaggerations or the accurate truth?

This initiative can only work with the

Certainly, much of what we know as rural

collective effort of TORCH members. Led

health care appears to be under attack or

by TORCH leaders and the TORCH board

changing rapidly. While we strive to secure

we can all achieve great things in this

health care access for the communities

extremely important area. The resources

we serve, the landscape of health care is

needed, the willingness to implement and

changing. Facing real or perceived threats

use technological advances to bolster our

to our professional survival, we have the

efforts as well as collective data gathering

opportunity to choose two things – how

can only be achieved together. Together we

we evaluate the accuracy of the threat and

can accomplish much. Separate we will

how we react.

not survive!

Related to accuracy, our best path is

Now is the time to make a choice. Peter

to leverage conversations both inside and

Drucker, the father of modern business

outside rural health care to determine the

management, said two very important things

truth. Verifying the truth is no small feat,

relevant to this conversation. First, the

given that these threats are more frequent

American hospital is the most difficult and

and pervasive each day as evidenced by

complex organization to manage in the U.S.

health care publications, national and state

Secondly, the only way to predict the future

industry meetings and other media sources.

is to create it. If we focus on patient safety

While determining accuracy is a substantial

and quality together, we can transform

first step, outlining our reaction plan is even

rumors and dire predictions into a much

more critical.

brighter future for everyone!

For me, the choice is clear for rural health care. We must build a competitive strategy focused on what makes us different

Michael Williams, MD, is the CEO at Hill Country Memorial Hospital in Fredericksburg.

and leverage these unique qualities. Now, more than ever, we must focus our energies on delivering the highest level of patient




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The Road for Texas Rural Hospitals is Getting Foggier


Texas rural hospitals are going through one of

Congress will move to at least delay the

payments when certain quality measures

their toughest and most uncertain financial

implementation of the cuts and possibly

are met by hospitals. Medicare payments

cycles ever, fueled by not knowing what

soften some of the cuts if they do become

to hospitals that do not have acceptable

will happen with Medicare and Medicaid

reality at some future date.

quality will be reduced an additional 0.25

payments in the near future, and aggravated

Besides payment cuts, rural hospitals

until reaching two percent in 2017.

by more mandated requirements and an

continue to wrestle with payment system

Medicare pushed yet another new system

uncertainty on Medicaid expansion to cover

modifications and underfunded mandates.

onto hospitals also in October. Most all

much of the uninsured. Some hospitals have

Starting this past October 1, hospitals in

hospitals (again the Critical Access Hospitals

reported that they are developing multiple

the U.S. (with the exception of rural Critical

exempted) with higher than expected

budgets for their next fiscal year based on

Access Hospitals—which is about half of the

Medicare patient readmission rates for

a myriad of scenarios that could develop

rural hospitals—and a few other exceptions)

certain medical problems will experience

depending on the Texas Legislature and

have been pushed by Medicare into a new

decreased payments for services. Hospital

the U.S. Congress. Some of those budget

payment system based on quality of care

performance will be evaluated based on

scenarios hold layoffs and reduced services.

rather than standardized rates for services

the 30-day readmission measures for

The situation is especially challenging

performed. While hospitals support the

heart attack, heart failure and pneumonia.

as the issues of uncertainty from both the

concept of rewarding better health care

Hospitals with higher than expected

federal and state level are near simultaneous

and penalizing sub-standard care, the

readmission rates will be penalized with a

and imminent.

hospitals fear the criteria developed by the

reduction in their overall Medicare payments.

At the Federal level, the issues are that

government could financially ding hospitals

The reduction amounts are capped at one

several special payment provisions for

that still generally do a good job. The new

percent for FY 2013, two percent for FY

rural hospitals have or will soon expire.

system is known as value Based Purchasing.

2014 and three percent for FY 2015 and

Additionally, all Medicare providers —

Under the system, discharge payments for

beyond. Starting in FY 2015, Medicare

including rural hospitals — face a two

Medicare patients will be reduced by one

may expand the list of conditions to include

percent payment reduction in January

percent to create a pool of money to be

chronic obstructive pulmonary disorder

unless stopped by the Congress. This is

used for

and several cardiac and vascular surgical

from the so-called sequestration, which is an


procedures, as well as any other condition

action put into place more than a year ago when Congress failed to enact major

or procedure the agency deems appropriate. Based on recent hospital readmission data,

budget cuts to rein in the growing

the Kaiser Foundation has predicted

deficit. Consequently, across-the-

more than 2,000 hospitals across the

board cuts were put into place

U.S. will be penalized $280 million in

starting in January 2013 including

the first year. The frustration for many

the Medicare cut. Faced with the

hospitals with this new policy is that a

imminent reality now, many

hospital has little or no control over

citizens, providers and members

issues that can drive a patient

of Congress are clamoring that

back into the hospital too soon

the cuts are too severe and too sudden. Congress may or may not

for the same condition. Hospital administrators are quick to point out that

delay, or even stop the cuts. Some action

many readmissions are due to a patient

is expected by Congress following the

failing to comply with a prescribed drug

general election. Speculation is that

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Continued on page 19 R U R A L




E G A C Y :



Ben Durr: May 23, 1933 - September 29, 2012


Bennie “Ben” Monroe Durr passed away on September 22, 2012

College of Healthcare

at the age of 79. Ben was a graduate of Copiah-Lincoln Community

Executives in 1999 and was

College; Mississippi State University; and Trinity University. He

the 2000 Gordon Russell

received his Fellowship from the American College of Hospital

Merit Award recognizing

Executives. Durr began his career as Assistant Administrator

outstanding achievement by

at University Hospital in Jackson. He then became Health and

TORCH. One of his proudest

Welfare Administrator at Ingall’s Shipbuilding Corp. in Pascagoula,

achievements was authoring

Mississippi. In 1961, he became CEO of Park Place Hospital in Port

the book, Miss Emily: The

Arthur. He was transferred, with Lifemark Corporation, as regional

Yellow Rose of Texas.

vice president for hospital procurement and construction, where

He is survived by his wife

he was responsible for the construction of Park Plaza Hospital

Carolyn Leman Durr of 50

in Houston and Northeast Medical Center Hospital in Humble.

years, son Benjamin and

Following a transfer to Denton, where he served as CEO of Westgate

his wife Victoria Durr and

Hospital. In 1981, Durr accepted the position of CEO of the Uvalde

daughters Benca Hronas

Memorial Hospital Authority until his retirement in 2004.

and Bethany McDaris.

Ben served on the Texas Board of Health for 12 years. He was

In lieu of flowers, memorials can be made to the 854th Medical

a Charter Member and served on the Board of Texas Organization

Collecting Company’s Nursing Scholarship Fund at Copiah-Lincoln

of Rural and Community Hospitals (TORCH). He guest lectured in

Community College in Wesson, Mississippi.

Allied Health Programs at Trinity University, Lamar University, Texas Women’s University, University of North Texas and Fudan University in Shanghai, China. He served as a consultant to Labor Unions and Health and Welfare insurance programs. He was a member of the United States/Mexico Border Health Association and a past chairman of Texas Hospital Associations rural and small hospital constituency. He was chairman of the Greater San Antonio Hospital Council and a member of the Texas Higher Education Coordinating Board’s Family Practice Residency Advisory Committee. He was involved in the Rotary Club of four different cities and a Paul Harris Fellow. He was a member of the Chamber of Commerce in Port Arthur and a member of the Board of Directors of East Texas Baptist College. He received the Regent’s award from the American

“He was a truly great man and, truth be told, none of us would be here doing what we do to support rural and community hospitals today, if not for the bold thinking and passion of a few folks, but most notably Ben.” - David Pearson, President/CEO, TORCH




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The 2012 TLMI Conference & Retreat Steered Towards Success


The 2012 TORCH Leadership & Management Institute (TLMI) Conference & Retreat was a huge success! This year’s event took place at the tranquil Lakeway Resort & Spa in Austin Texas, which offered attendees a beautiful location and serene atmosphere for optimum reflection, relaxation and growth. This TLMI event truly had it all from quality professional and personal development education to relaxed relationship-building and networking opportunities to fun-filled, interactive activities to a bowl full of laughs! This year’s lineup of presenters, composed of a healthy mix of motivational coaches, industry experts, authors, hospital executives, hospital staff and academic professors, delivered dynamic presentations on a variety of essential leadership topics. This year’s theme, “Anchor’s Away - Charting a Course of Success, Excellence and Fulfillment,” hit home with attendees, with focused attention on topics favoring: leadership development, improved communications, teambuilding, execution and follow-through, conflict resolution, emotional and social intelligence, staff engagement, servant leadership, stress management, crucial conversations, strategies for effective human resources management and other critical skills-development. We expanded the TLMI conference program this year to include

to their organizations, patients and communities. We congratulate

two new elements. First-off, through our partnership with On-Demand

the recipients on their accomplishments and examples they set for

Leadership, we offered participants the opportunity to register for a

others to follow and be inspired by.

special “Leading with your Strengths” workshop. This two and a half

We would like to express our appreciation to our attendees,

hour course utilized the popular book, Strength-Based Leadership, to

presenters and TLMI Council Members for their participation

help individuals identify their natural leadership strengths and learn

and support of the TLMI Program. We would also like to send

how to apply them to improve their leadership effectiveness. This

a very special “thank you” to our 2012 TLMI event sponsors:

was a unique opportunity and participants found it both enlightening

Aris Teleradiology, CSS Health Technologies, Diagnostic Health

and helpful with takeaways to bring back to their jobs, organizations

Services, Gravely & Pearson, LLP, maxIT Healthcare, LLC, NextGen

and personal lives.

Healthcare, Prognosis Health Information Systems, Rural Physicians

As an added feature, we held the inaugural TLMI Leadership

Group, Stillwater National Bank, TORCH Management Services,

Awards Luncheon to recognize outstanding leaders and encourage

Inc. and Texas Healthcare Trustees for making this event possible!

the development of future healthcare leaders. Two separate award

They are pivotal to the success of the program and we value their

categories were created. Three rural and community hospital staff,


including one CEO and two COOs, were presented the “Essence of

The feedback we received from the 2012 TLMI Conference

Leadership Award,” a tribute that highlights individual success and

participants revealed that they left energized and motivationally

demonstration of outstanding leadership, service and contribution,

charged to move their leadership capabilities to the next level. Our

and whose achievements have had a significant impact in his or her

hope is to continue to increase the value of the TLMI Program for

organization and community. On an organizational level, two rural

hospitals and their teams in years to come and we look forward to

hospital teams received the “Leadership Culture Award,” celebrating

building our program for 2013. If you were not able to attend, we

collective efforts that have resulted in considerable contributions

hope you consider joining us next year!

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Provider Agreements – To Assume or Not To Assume



When acquiring a physician practice, rural

even if the overpayment occurred prior to

health clinic, nursing home or other health

the CHOW. In addition to potential Medicare

care facility, hospitals are commonly faced

payment adjustments, the new owner will

with the dilemma of whether or not to

also be responsible for any unpaid civil

accept automatic assignment of the previous

money penalties resulting from quality of

owner’s CMS provider agreement. There are

care deficiencies.

both benefits and burdens of accepting the

The main benefit of refusing automatic

assignment of an existing CMS provider

assignment is that because the new owner

agreement and hospitals should carefully

is applying for initial certification to the

consider each before making a final decision.

Medicare program and obtaining a new

Typically, in a change of ownership

provider agreement, it is not responsible

(“CHOW”), the existing CMS provider

for any overpayments made to the former

agreement is automatically assigned to

owner. Further, the new owner will not have

the new owner. However, CMS policy does

the former owner’s quality history.

permit the new owner to refuse automatic

The main burden of refusing automatic

assignment of the CMS provider agreement.

assignment is that refusing assignment

If refused, the existing CMS provider

terminates the existing provider agreement

agreement terminates effective the date

and CMS Certification Number (“CCN”).

ownership changes and the new owner will

In refusing automatic assignment the

then be treated as an initial applicant to the

new owner will also lose special payment

Medicare program. As such, Medicare will

statuses and all grandfathering statuses

not reimburse the new owner for services it

of the former owner, if any. The new owner

provides until the new owner qualifies as an

will be treated as an initial applicant to

initial applicant.

the Medicare program and will not be

The main benefit of automatic assignment

reimbursed for services it provides until the

is that there is no break or interruption in

new owner meets all Medicare requirements

Medicare participation. Another benefit

as determined by CMS Regional Office. No

of automatic assignment is that special

survey can take place until after the former

payment statuses and grandfathering, if any,

owner’s provider agreement is terminated,

will continue in favor of the new owner as

the new owner has ownership and control of

long as the conditions are met.

the facility, and the Medicare Administrative

The main burden of automatic assignment

Contractor has determined that the Form

is that the new owner is now responsible

855 is complete.

for the former owner’s Medicare liabilities,

Although new owners cannot have

including any overpayments that may have

benefits of a CHOW without some burdens,

been made to the former owner. This can

the purchase or transfer agreement

impact Medicare payments to the new

between the parties can be drafted to

owner because payments made to the new

help reduce the burdens. For example,

owner can be adjusted to account for the

the purchase or transfer agreement can

overpayments made to the former owner.

provide indemnification to the new owner

The payment adjustments can be made

by the former owner for any pre-CHOW



overpayments, or can provide that some of the purchase price be placed into escrow pending resolution of pre-transfer cost periods. When a decision is made whether or not to accept automatic assignment of the former owner’s CMS provider agreement, CMS suggests that the new owner notify the CMS Regional Office 45 days in advance. If the new owner chooses not to assume the former owner’s CMS provider agreement then the former owner’s CMS provider agreement will be voluntarily terminated by CMS, effective the date ownership changes. If the new owner accepts assignment, it should indicate on the Form 855 that this is a CHOW and that it is accepting assignment of the existing CMS provider agreement. Whatever decision is ultimately made regarding assignment of the provider agreement, hospitals should examine the pros and cons and, if necessary, discuss the issues at a board meeting. Trent B. Krienke and Robert Spurck represent clients in the health care, long term care and retirement housing fields at Davis & Wright, P.C.

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Specializing in Staffing for Rural Hospitals Emergency Department Urgent Care • Clinics


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ONC Commits Resources for Meaningful Use Rural and CAH Hospitals


More rural and Critical Access Hospitals are in the process of implementing their chosen EHR system and attesting for meaningful use. Such hospitals play a crucial role in extending the reach of this technology to remote rural and frontier locations across Texas and the rest of the nation. It will also improve the quality of care for residents of rural communities. However, by and large, rural hospitals and physicians are adopting at a much lower rate than their urban counterparts. The Office of the National Coordinator (ONC) on HIT has made moving rural providers toward attestation a higher priority. ONC points out that Critical Access Hospitals and other small, rural hospitals often have a more difficult path to get to Meaningful Use. These hospitals — especially Critical Access Hospitals and rural hospitals with less than 50 beds — face unique challenges because of their remote geographic location; small size and low patient-volume; limited

To date, more than 1,200 Critical Access and rural hospitals across

workforce; shortage of clinicians; constrained financial resources;

the nation and 5,500 clinicians that work in these hospitals have

and a lack of adequate, affordable connectivity. Given all of these

enrolled with a REC for assistance with HIT adoption and meaningful

constraints, the value of health IT becomes particularly evident.

use. If you or your physicians have not yet taken advantage of these

ONC would like to see 1,000 Critical Access Hospitals and

services, please go to get started. There are a number

small, rural hospitals meaningfully using certified EHR technology

of free and reduced cost-consulting services to assist your hospital

by the end of 2014. They recently committed to providing up to

and physicians to prepare for and implement HIT improvements.

$30 million in additional

Each of the four RECs in Texas provide a different set of services,

funding for Regional

so please go to to find yours.

Extension Centers

Also, don’t forget to contact TORCH directly to learn more about

(REC) to target

the additional support for EHR implementation and meaning use that

Critical Access

is available to you through your own association. We currently support

Hospitals and small,

activities from EHR selection, education, privacy and security and

rural hospitals. These

MU assessment. TORCH supports the ONC’s goal of greater adoption

supplemental grant funds are

among our rural and Critical Access Hospitals. Please don’t miss

for RECs to help as many as

this opportunity to enhance the quality of care in your community

1,501 of these hospitals to get to

through technology adoption and process improvement.

meaningful use. That’s about 90 percent of hospitals covered by the Small Hospital Improvement Program and 30 percent of all hospitals nationwide. f a l l

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HB 300 and HIT Privacy and Security: Urban Legend Edition


House Bill 300 is the omnibus health information technology privacy

HB 300 states that a health

and security bill that was passed in 2011 during the 82nd Texas

care provider using an

Legislature’s regular session. Authored by Representative Lois Kolkhorst

electronic health records

(R-Brenham) and sponsored by Senator Jane Nelson (R-Flower Mound),

system capable of providing

HB 300 continued Texas’ historical approach of having strong statutory

an electronic record to a

protections around the use of protected health information (PHI) that

consumer must fulfill a

go above and beyond the requirements of HIPAA.

request for an electronic

However, as with any new piece of legislation, a number of “urban

copy of a person’s record in

legends” have been circulating about HB 300. This list is intended

no more than 15 business

to reassure hospital providers that HB 300 does

days AND in electronic form,

not create a massive new regulatory burden for

unless the person agrees to accept another form. This does not mean

hospitals, and that most of the bill’s requirements

that a hospital must purchase new software or modify their existing

will already be addressed by your HIPAA compliance

system in order to meet the 15 day deadline. It only applies to EMRs


that have that capacity already available. Hospitals should be aware that there are vendors attempting to sell additional products for compliance

Urban Legend #1

with this provision.

“HB 300 created a new definition of covered entity, regulating entire new classes of providers and

Urban Legend #4

businesses that were previously unregulated.”

“HB 300 created a duplicative breach notification requirement, especially

HB 300 used the existing definition of covered entity from the Chapter 181

if a patient lives outside of Texas.”

of the Texas Health and Safety Code, which was created by the passage

HB 300 amended the existing rules to clarify that breach notification is

of the Texas Medical Records Privacy Act in 2001. It is true that the bill

required to Texas residents AND residents of a state that does not have

creates new requirements for covered entities, but those requirements

its own breach notification law. If the individual impacted is a resident

primarily impact covered entities that are not covered by HIPAA.

of a state that does have its own related breach notification law, notice under that state’s law satisfies the Texas requirement.

Urban Legend #2 “HB 300 created a new, unreasonable training requirement for covered

Urban Legend #5

entities that will be impossible to implement.”

“HB 300 created a new regulatory structure for health information exchange.”

HB 300 requires CEs to provide training every two years about

HB 300 charged the Texas Health Services Authority, our state health

state and federal laws on protected health

information exchange, with developing

information related to the line of business and

state-level privacy and security standards.

the employee’s scope of employment. Training

The bill also permits THSA to establish

must be completed within in 60 days of hiring,

a voluntary certification program for

and documented. For most hospitals, their

entities that want to be certified as

existing HIPAA training will suffice to fulfill

meeting those standards.

this requirement, and they should review their training to make sure it is in compliance.

Nora Belcher is executive director at Texas e-Health Alliance.

Urban Legend #3 “HB 300 created a new requirement for hospitals to provide electronic records to patients that will cost hospitals in order to comply.”




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TORCH and TMF Health Quality Institute Team Up To Tackle Hospital Quality Reporting


The Texas Organization of Rural &

time to think differently about whether or

is a step-by-step process and the good news

Community Hospitals (TORCH) and TMF

not to participate in quality data reporting.

is that you can begin by slowly integrating

Health Quality Institute recently announced

The benefits go well beyond mere

voluntary public reporting, as you gain overall

a new partnership aimed at supporting rural

compliance. Behind all those numbers are

proficiency. The upside is that by reporting,

hospitals in their efforts to provide quality

patient outcomes. The information hospitals

it will eventually enable you to see where

care to the patients they serve. According

gather can be used to target areas for

your hospital stands among your peers,

to David Pearson, TORCH President/CEO,

once you begin to receive regional, state

“We know that our member hospitals are

and national quality comparison reports and

committed to continuing to improve care

other benchmarking data.

at the local level and that they will do

TMF Health Quality Institute is

that by focusing more on quality

the designated Medicare Quality

and patient outcomes.”

Improvement Organization

As it stands today, Texas

f o r t h e S t a t e o f Te x a s

ranks among the bottom

and has already worked

six states for quality data

with hundreds of Texas

reporting by Critical Access

hospitals on their data

Hospitals (CAH). One of the

reporting efforts. TMF

most important components

HQI is ready to provide

of an effective quality

the tools hospitals need

improvement program is the

to start implementing

reporting of data. Big changes

this important process.

in state and federal health

They offer free training

care legislation continue to

and individualized technical

roll out and it is clear that even

assistance on all aspects of

more reporting will be required in the

reporting, including CART, the

future. Without collecting, analyzing and

free CMS data collection tool. TMF’s

reporting data, it becomes significantly

in-house experts also provide one-on-one

harder to truly gauge quality of care or

coaching and guidance.

to succeed under an outcomes-based

improvement and to zero in on processes

payment system.

and workflows that create potential gaps in

should voluntarily begin to show that we

Tom Manley, Chief Executive Officer

care. Also, data helps to improve outcomes

provide excellent care and the about adoption

of TMF HQI, poses this question, “How

by reducing adverse events. Ultimately,

of best practices. Our rural communities need

confident can your patients and community

data can help reduce costs, protect the

to know that we care about the quality of

be that you are the best choice for their

bottom line and it is one of the surest

patient care we provide.” TORCH and TMF

healthcare when you don’t report data

ways to demonstrate to the community

HQI strongly encourage hospitals to contact

regarding your care quality?” He went on to

and stakeholders that rural hospitals are

them and to begin to realize the benefits

say, “The best and most accurate data must

committed to quality patient care.

of reporting quality data. To get started,

be made available in order to help healthcare

hospitals can call (866) 439-0863 or send

providers and consumers make informed

both a low priority and a daunting task, with

decisions about quality.” So perhaps it’s

no real return on investment. However, this

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In many ways, reporting may seem like

Pearson states, “Texas rural hospitals

an e-mail to







alth car


Det er

e lu va

h t e g r n e i a n l i m


Amidst a national priority for the widespread adoption of health

• Revenue generation and cost optimization: With better care,

information technology and the meaningful use of electronic

enabled by the optimal and meaningful use of health IT, it

health records (EHRs), much has been made about the value of

is possible for organizations and providers to achieve greater

health IT as an engine for health care transformation. With the

efficiency and productivity with its workforce, while lowering costs

unprecedented $36 billion carrot of incentives from the federal

associated with medical errors and liability.

government for the adoption of EHR, it seems that we should all be

• Compliance: Effective utilization of standards-based solutions

enamored with health IT. Yet, there remains a powerful question:

enable health care organizations and providers to better track,

Where’s the value in HIT?

monitor and report auditable measures, outcomes and processes

Indeed, there has been no shortage of attention or interest to

to meet regulatory compliance.

the question, yet it is fair to say that many are still in search of a

These are some of the common, expected benefits in support

consensus value proposition. Research, studies and surveys have

of health IT investments. While not all benefits are quantifiable

been conducted yielding data that supports both sides of the

(some are qualitative and intangible), and that not all quantifiable

debate. With time, no doubt, the increased implementation and

benefits have a monetizable or measurable financial impact,

use of EHR and other advanced information technology tools will

there are benefits, however qualitative or intangible, that are truly

give us insight into the question of value and return on investment.

valuable to the meaningful use of health IT in health care. We are

For the purpose of this article, we aim to give a sense of why or

able to glean a sense of its true value in the following examples

how this remains an important question, and to suggest what may

from some of our TORCH member hospitals.

lie beyond the question that matters most.

Faith Community Hospital was among the first 66 hospitals

Most of us are familiar with the challenges and benefits of health

in the nation to achieve attestation of phase one Meaningful

IT. The promise of health IT, many generally agree and believe,

Use. Having met Stage One, the hospital charged full-speed

can result in improving the delivery of high-quality, efficient and

ahead in the direction of the next phases with a program that

affordable health care services across the continuum of care. Some

blends discharge planning, case management and a host of other

of the benefits for health IT commonly cited include:

innovative technology solutions. The program allows patients the

• Quality of care: Health IT can enhance the delivery of the right

ability to view images that inform them about their disease process,

services at the right time in the right manner to patients and

helps them with online applications for prescription eligibility and

enable collaboration in real time among health care organizations,

assistance, provides patient education, and gives them access to

systems and clinicians across care processes.

patient portal containing information on medication list, summary

• Patient safety: The effective use of health IT, such as electronic

of blood glucose testing, diet and weight log, and other valuable

health records (EHRs) and computerized provider order entry

personal health data. These activities have helped the hospital

(CPOE), along with practice management and clinical workflow

continue its reputation as a leader and crucial force in the progress

solutions, can result in significantly reducing or preventing the

of health information technology.

risk of medical errors and adverse events, and thereby improving

Crane Memorial Hospital implemented its certified electronic

patient safety.

health record in 2011, beginning with the financial portion in

• Patient and provider satisfaction: Effective HIT-enabled clinical

phase one, the clinical portion in phase two, CPOE early this

environments can improve patient satisfaction, as well as staff and

year and attested successfully in July 2012. The hospital’s

provider satisfaction.

mission statement includes providing quality health care services,

• Patient access and engagement: By providing capabilities that

including education to the citizens of Crane County in a manner

allow patients to view, download and transmit certain aspect of their

where patients and their families receive personalized, efficient

health record, health IT can enable patients to interact efficiently

care under high standards, and their staff and EHR system help

and effectively with the health care system that results in better

them to accomplish that and function efficiently. Recently the

health outcome, satisfaction and overall patient experience.

hospital was notified by the National Rural Health Association that

• Productivity: Health IT has the enormous potential to improve

it was selected in the top 20 Critical Access Hospitals (CAH) in

physician and staff productivity by reducing duplication and

the nation for financial stability. Their community holds them in


high regards because they know the hospital take health care in

• Strategic business value: Well implemented health IT initiatives

Crane County seriously. In their own words: “We can honestly say

and systems can deliver strategic value to organizations and

our team is the Best in the West!”

providers by enabling efficiencies in key administrative, operational

Ballinger Memorial Hospital’s accomplishments in health

financial and clinical domains.

information technology are quite impressive. For a small Critical

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Access Hospital, its IT infrastructure includes an entirely wireless

technology systems that allowed them to streamline and automate

hospital and clinic; computers on wheels; virtual servers hosting

the facility’s business and clinical processes. This allowed the

e-mail, internet and file servers; integrated copiers and scanners;

hospital a more effective way to manage accounts payables,

interconnected Healthland EHR (with 17 separate modules) and

accounts receivables, billing, medical records, budgeting, cash

financial system; Dragon Dictation; LabCorp Reference Lab; ReDoc

management and much more. On the clinical side, several clinical

Physical Therapy EMR; MDG Medication System; and SMAART

and departmental applications were implemented, including

PACS. Additionally, Ballinger participates in a remote pharmacy

eMARS, electronic record to track Home Medications, Materials

project and utilize teleradiology services. Utilizing the appropriate

management, Laboratory information system, Microbiology module,

technology solutions, Ballinger Memorial Hospital is able to ensure

Radiology module with a PACS system interface, Pharmacy module,

high quality patient care for its patients and community and is

Scheduling module, transcription module, care management

seen as one of the progressive leaders in information technology.

system and EHR, along with software programs to support patient

Sutton County Hospital District made the commitment in 2006 to

and staff satisfaction—all this because they realized the true value

adopt a completely

that information technology can

integrated electronic health

r e c o r d





care for their community. Te c h n o l o g y

h a s h e l p e d the for





and clinic that included the full

complement of modules. Even though the financial commitment






gap that often exist between physicians, hospital staff, HIPAA Privacy and Security Officers, and more

and learning curve was significant, the success of the conversion

importantly, the patient.

was realized immediately, from administrative efficiency in

Coon Memorial Hospital’s journey to implement health information

business office automation, to significant reduction of paper

technology and achieve the meaningful use of electronic health

records, to the elimination of medication errors, to increased

records can truly boast a host of great accomplishments. A leader

billing accuracy. In addition, documentation and compliance has

and early adopter of health IT, the hospital started implementation

greatly improved. The implementation of the fully integrated EHR

of Order Entry and the financial system back in 1997. By 2010,

system, coupled with the complete medical imaging PACS system

the hospital had installed nursing documentation with electronic

has allowed the facility to reach Stage 6 of the HIMSS Analytic

patient education document, CPOE, electronic forms in laboratory

Adoption Model, which places the hospital in the 99th percentile

and radiology departments, Electronic T System in the Emergency

of adoption nationwide.

Department with ADT and bidirectional interfaces, and electronic

Lavaca Medical Center was among one of the first early adopters

medication management and reconciliation system. By early 2011,

of health IT. As early as 2003, the hospital implemented information

the hospital successfully met Stage One Meaningful Use.



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Memorial Medical Center first started its progress toward

quality of care, patient safety and an overall improved patient

an electronic medical record in 1994 and has not stopped its

experience. Perhaps that IS the real value of HIT.

technological advancements for improved patient care since. The

In an industry and a time when there are a number of important

hospital has fully implemented its EHR system, including Point-

macros trends, the implementation of HIT/EHR has never been

of-Care System, Medication Administration Verification System

more necessary or compelling. With the shift toward greater

and Patient Education Module. All of these integrated applications

accountability for cost and quality of care, with technology deeply

have helped the hospital achieve Meaningful Use and receive its

integrated in virtually all aspects of the care processes, and with

incentive funds. The hospital continuously strives to improve and

mobile technology becoming more pervasive at the point of care,

provide the highest possible patient safety and quality of care.

for example, health care as an industry is increasingly becoming an

Medical Arts Hospital’s rapid march to Meaningful Use is

information-based/information-intensive enterprise. From patient

reaping the success of a very focused and highly functioning

records to clinical reference materials to health information

implementation system and team of professionals, and is allowing

exchange and data warehouses, hospital and providers everywhere

them to hail the success of the “little hospital that could.”

rely on data analytics to derive business and clinical intelligence

Implementation of appropriate technology has allowed the hospital

to affect quality measures, patient outcomes and health status, as

to see immediate improvements in core measures and patient care

well as operational and financial sustainability and success.

in a variety of areas. Their success is a testament to progressive

As health care moves increasingly from volume to value, we

leadership at many levels (management, staff and physicians) that

are faced with the imperative to balance the many challenges

see the value, whole-heartedly embrace the technology and the

and opportunities presented by health IT. The promise and value

tools to provide a higher standard of care for our patients.

(perceived or real) for health IT, at its heart, perhaps comes down

Finally, Hamilton General Hospital is a leader in rural Texas health

to a question of the consumers’ trust and value of their most

care and is on the cutting edge of technology. The hospital is one

personal health information. By some measure, the hospitals and

of the early adopters of health IT and successfully implemented its

health care providers have made great strides in digitizing data

EHR system, which allowed it to attest successfully for Meaningful

for electronic health records and there is momentum towards the

Use early among the first one percent of rural hospitals in the

aggregation of relevant health information for real time decision-

nation. The hospital continues to exceed well beyond the required

making that coordinates and delivers the best possible care. It can

threshold of MU. Through it all, the implementation and use of

be said that the value of health IT is many, and that IT investments

the various technology solutions has helped the staff to grow as

are business investments that supports strategic priorities and

a department and as a health care system. Today, the hospital is

delivers a sustainable advantage to the organization. But perhaps,

known as a leader among its peer group and in its region.

more importantly, it is received and seen patients as an essential

There is no shortage of examples of many rural and community

element for positively affecting quality of care, patient satisfaction

hospitals making great progress in the adoption and use of health

and patient experience overall. Coupled with its ability to facility

IT. While it has not been easy for many, they’ve all attested to

collaboration and information sharing across disparate systems,

the many great advantages of health IT for their facility and

providers and processes, from this perspective, the investment in

community. For each of them, the investment in health information

and benefits of health IT should be seen from the perspective of

technology is clearly an important factor in vastly improving the

patient value rather and a cost center.

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You Can Bank on it!


TORCH and Texas Health Institute (THI) have partnered to make The

Effective November 11, 2012, The Veteran’s Education and Training

Benefit Bank of Texas (TBB-TX) available to community and rural

Program will also be available through TBB-TX. Additional worker

hospitals across the state. TBB-TX is a secure web-based portal that

supports and resources can and will be added to the system as they

simultaneously submits applications electronically in a one-stop fashion

are identified.

to appropriate federal and state programs. This system is designed to

THI began implementation of TBB-TX one year ago, conducting a

help low to moderate income individuals and families connect with

pilot in the Amarillo area. It proved successful and implementation

worker supports and benefits through a simplified, on-site, counselor-

throughout Texas has begun with the goal of assisting families in

assisted program. It is:

accessing healthcare, helping hungry people get the food they need,

• an eligibility determination calculator

working moms and dads provide for their families and assisting people

• an application completion tool

in getting into college to achieve living-wage jobs.

• a free income tax assistance program

Thus far, THI has raised $1.2 million for the implementation of

• an educational outreach program

The Benefit Bank of Texas. This $1.2 million investment has yielded

Eligibility and application assistance, along with electronic

$2,051,824 in benefits into the hands of low-and-moderate income

submission is available for the following programs: Supplemental

families in Texas. Furthermore, we are excited to announce that funding

Nutrition Assistance Program (SNAP); Free Application for Federal

from the Houston Endowment has allowed for the addition of Veterans

Student Aid (FAFSA); Medicaid; Children’s Health Insurance Program

Training and Education benefit applications to the current TBB-TX cadre

(CHIP); TANF; and Earned Income and Additional Child Tax Credits.

of benefits and programs. Continued on page 23

TORCH Management Ser vices, Inc. (TMSI)

…supporting rural and community hospitals for decades.

In addition to providing advocacy, education, resources and publications, TORCH has a subsidiary that provides vital membership, management and operational services to rural and community hospitals in Texas. TMSI is committed to the long-term success of rural hospitals. The organization was formed in response to the requests of rural hospitals and other providers as a cost-effective solution to their needs in the areas of: Administrative Consulting, Benchmarking, Board Education/Orientation, Community Needs Analysis/Benefits, Executive-Level Searches, Fundraising, Managed Care Consulting, Operations Consulting, Permanent/Interim, Physician Recruiting, RHC Assessment, Strategic Planning TMSI “Endorsed Partners” A specially selected group of companies whose experience working with rural hospitals has undergone a thorough verification process. TORCH Insurance Program HealthSure administers and markets: ➤ Professional and D&O Liability ➤ Property and Workers Comp ➤ Employee Health Benefits & more

Group Purchasing Organization Working with FirstChoice, a TX-based GPO, hospitals receive competitive prices on equipment, medical and surgical supplies, pharmaceuticals, dietary and much more.

TORCH Management Services, Inc. (TMSI)

Vicki Pascasio, FACHE, President/CEO | P.O. Box 203878, Austin, TX 78720-3878 p: 512.750.4128 | f: 512.873.0046 | |

TMSI supports member hospitals and TORCH initiatives




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D V O C A C Y,


“Advocacy” continued from page 5

regiment or other activities once discharged.

optional with state, and Texas leadership pronouncing a big “no” to

Adding to all the federal aggravation is the ongoing requirement

expansion, hospitals will only continue to scramble to find ways to

for all hospitals to implement standardized electronic health record

cover the cost of the uninsured – usually with local property taxes.

system as well as using a revised and expanded international

Although all the near simultaneous federal and state upheaval

disease coding system known as ICD-10 including a standardized

may not been a planned intention of the Legislative bodies, it is

numbering system for all health insurance plans. The requirement

the reality of their actions. And, all the moving parts and changes

to phase-in electronic health records is long overdue and will provide

seem to fall into two general policy areas which rural hospitals have

many long term benefits for health care. It also carries some extra

historically been exempt from:

reimbursement payments from Medicare which most all hospitals

• “ONE SIZE FITS ALL” - The biggest state and federal policy

agree is woefully inadequate to cover the true cost.

challenge for rural hospitals is a gradual shift away from rural specific

A dialogue about all the payment cuts and mandates cannot

reimbursement and rules that take into consideration the unique

pass without a mention that federal law still requires hospitals to

operating dynamics of rural hospitals (such as low and varying patient

provide emergency care for all persons – with and without insurance

levels, limited health services, small purchasing volume, a lesser

or any other form of payment. While non-emergency patients could

availability of ancillary services such as primary care, therapy, home

be turned away at some point, the process to fully diagnose and

health, and other such dynamics). Government policy trends, many

protect treating parties from federal or patient litigation results in

driven by budget cuts, seem to be reverting back toward a “one size

the non-emergency patients being treated anyway. In the same mix

fits all” which does not mesh with the operating environment for most

is the fact that the law also results in many hospitals treating many

rural hospitals and will slowly lead to the financial demise of many.

undocumented and illegal aliens for no compensation.

• “NICKEL AND DIMING” – While substantial cuts in payments

The state level for rural hospitals is not much better. They already

and elimination of special payment considerations for rural hospitals

face treating one of four patients with no coverage based on the state

under Medicare and Medicaid are constantly being discussed at

average (it is closer to one of two in many rural counties). “Salt in

the state and federal levels as part of budget discussions, a more

the wounds” came from the last session of the Legislature where

imminent threat is ongoing small payment cuts. These cuts often

direct and indirect steps were taken to reduce outpatient Medicaid

come at the Medicaid and Medicare program levels through rule

payments to hospitals by eight percent, shift inpatient Medicaid into

changes, audit practices, shifting interpretations of rules and law,

a more standardized system which does not generally recognize the

etc. While these cuts are often small in nature, sometimes impacting

wide variances in rural hospitals, reduce emergency room Medicaid

rural hospitals no more than $5,000 to $25,000 a year, the

payments to hospitals by 40 percent if the situation is not ultimately

growing trend of such cuts is collectively and methodically eroding

deemed an emergency (yet federal law still requires the hospitals to

the financial stability of rural hospitals because of their narrower

evaluate), and dictate radical changes in the supplemental payment

financial margins.

system known as Upper Payment Limit leaving hospitals uncertain

Similar policies and budget cuts from the early 1980s lead to

and disrupted about their future Medicaid income.

approximately 1,000 hospital closures across the country from the

With swirling payment cuts, threats of more cuts, and a long list

80s into the mid-90s, half of which were rural hospitals. More than

of mandates, one of the few positives for hospitals appears to have

80 of the hospital closures were in Texas – mostly rural. Special

been blotted out. Hospitals, both urban and rural, are perplexed by

payment provisions for rural hospitals, mostly under Medicare and

rapid cries of no expansion of Medicaid under the Affordable Care

Medicaid, along with public policy awareness that the operating

Act (ACA), commonly referred to federal health reform. Hospitals had

dynamics for rural hospitals were different stopped the closures.

viewed the expansion of Medicaid as a bold step to reduce the 26

Since that time, only a handful of hospitals have been boarded up.

percent uninsured rate, which spikes in many rural and border Texas

Only time will tell if Congress and the Texas Legislature create a

counties to more than 50 percent. Texas Medicaid is already one of

repeat of the 1980s.

the most restrictive plans in the country covering only poor pregnant women, poor children, and the poor and disabled. With the U.S. Supreme Court ruling that the required Medicaid expansion is now f a l l

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HIT’ing New Heights


In this age of technological transformation in the health care industry, it

While those goals keep changing, his efforts to assure that our systems

is truly remarkable to see how Texas rural and community hospitals have

are secure have been recognized. He is committed to being the best

stepped up to take on massive and wide-ranging health IT challenges.

in his field and continues to go above and beyond what is expected of

There has been commendable progress made and to help recognize the

him. No matter how high we raise the bar, he is the first to let us know

effort, dedication and perseverance that our hospitals, their leadership

it can go even higher.”

teams and IT staff have demonstrated over the past year. The 2012

“For an organization of our size, our CIO, Holly Schmidt, has led Hill

HITCON Awards were announced during the Rural Hospital Information

Country Memorial Hospital to a point at the head of the pack. Her total

Technology Conference & Exhibition (HITCON12), held October 17-18

dedication to team success has made her an invaluable team member

in San Antonio, Texas.

and outstanding leader,” says Steve Sosland, COO; Jayne Pope, CNO;

One award category announced was the Rural Hospital IT Award

Debbye Wallace, CSO; Jim Partin, CMO; and Michael Williams, CEO of

of Excellence. This award recognizes a health care facility that has

Hill Country Memorial Hospital.

successfully implemented certified electronic health record (EHR)

Laurie Quitta, Director of Medical/Surgical Services of St. Mark’s

technology; has attested for meaningful use; embodies a culture of

Medical Center says,“Patti Sulak has been the driving force behind

innovation; has improved quality care and hospital operations; and is held

the successful implementation of our EHR since day one. Vision,

in high regards by the community it serves. The 2012 recipient is Crane

enthusiasm, and perseverance: Patti sets the bar high in the IT world,

Memorial Hospital. Crane Memorial Hospital has had several notable

and clearly demonstrates that where there’s a will, there’s a way.”

HIT successes in 2011 and 2012. Selecting an EHR in August 2011,

We applaud the recipients’ outstanding achievements and successful

they quickly moved their transition forward allowing them to successfully

efforts. Congratulations!

attest in July 2012. To add to this major feat, the National Rural Health Association (NRHA) selected Crane as one of the top 20 Critical Access Hospitals in the nation for financial stability. Drawing attention to their collaboration as a team, their CEO, Dianne Yeager, said it best, “There were a few tears along the way, but our staff bit the bullet and got it done! Our community holds us in high regards because they know we take health care in Crane County seriously.” The other category announced was the Rural Health IT Leadership Award. This award focuses on individuals who have played an instrumental role in their health care facilities’ successful adoption of certified EHR technology and attestation for meaningful use; exhibit high levels of initiative, technical competency and effective team collaboration; embody the spirit of service and innovation; are committed to continual learning and growth, with a willingness to go beyond the call of duty; and who have made a significant contribution to their organizations’ health IT goals. This year, three recipients were awarded: Brandon Huffstutler, CIO at Electra Memorial Hospital; Holly Schmidt, CIO at Hill Country Memorial Hospital; and Patti Sulak, IT Director at St. Mark’s Medical Center. All three individuals had outstanding nominations and have shown tremendous leadership in health IT and in their respective hospitals. Jan Reed, CEO of Electra Memorial Hospital says, “Brandon Huffstutler is dedicated to our organization’s IT goals and has been the driving force.




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Celebrate the Power of Rural!


Rural communities are wonderful places to live and work, which is why nearly 59.5 million people – nearly one in five Americans – call them home. These small towns, farming communities and frontier areas are places where neighbors know each other, listen to each other, respect each other and work together to benefit the greater good. They are also some of the best places to start a business and test your “entrepreneurial spirit.” These communities provide the rest of the country with a wealth of services and commodities, and they are the economic engines that have helped the United State become the world economic power it is today. These rural communities also have unique healthcare needs. Today more than ever, rural communities must address accessibility issues, a lack of healthcare providers, the needs of an aging population suffering from a greater number of chronic conditions, and larger percentages of un-and-underinsured citizens. And rural hospitals – which are often the economic foundation of their communities in addition to being the primary providers of care – struggle daily as declining reimbursement rates and disproportionate funding levels make it challenging to serve their residents. That is why the National Organization of State Offices of Rural set aside November 15, 2012 to celebrate National Rural Health Day. First and foremost, National Rural Health Day is an opportunity to “Celebrate the Power of Rural” by honoring the selfless, communityminded, “can do” spirit of that prevails in rural America. But it also gives us a chance to bring to light the unique health care challenges that rural citizens face – and showcase the efforts of rural health care providers, State Offices of Rural Health and other rural stakeholders to address those challenges. We know there is work to be done, but we also believe there are plenty to celebrate – and we invite you to join the celebration! For more information on ways to celebrate in your community, please visit

Why Care About Rural Health in America? General Statistics: • Approximately 62 million people live in rural and frontier areas. • Rural Americans reside in 80 percent of the total U.S. land area but only comprise 20 percent of the U.S. population. • There are 4,118 primary care Health Professional Shortage Areas (HPSAs) in rural and frontier areas of all U.S. states and territories compared to 1,960 in metropolitan areas. • Approximately 15.4 percent of rural U.S. residents live in poverty compared to 11.9 percent of urban residents. Rural Health Workforce: • There is a more holistic, patient-centered approach to health care in rural communities – providers have the opportunity to provide more comprehensive care to their patients. • Despite this opportunity, only nine percent of all physicians and 12 percent of all pharmacists practice in those settings. • There were 55 primary care physicians per 100,000 residents in rural areas in 2005, compared with 72 per 100,000 in urban areas – a figure which decreases to 36 per 100,000 in isolated, small rural areas. • There are only half as many specialists per 100,000 residents in rural areas compared to urban areas. • Rural areas average about 30 dentists per 100,000 residents; urban areas average approximately twice that number. Health Care/Health Insurance Accessibility: • While nearly 85 percent of U.S. residents can reach a Level I or Level II trauma center within an hour, only 24 percent of residents living in rural areas can do so within that time frame – this despite the fact that 60 percent of all trauma deaths in the United States occur in rural areas. • Approximately 21.9 percent of residents in remote rural counties are uninsured, compared to 17.5 percent in rural counties adjacent to urban counties and 14.3 percent in urban counties. • Rural residents spend more on health care out of pocket than their urban counterparts; on average, rural residents pay or 40 percent of their health care costs out of their own pocket compared with the urban share of one-third. One-in-five rural residents spend more than $1,000 out of pocket in a year. Rural Hospitals: • Rural hospitals are sources of innovation and resourcefulness that reach beyond geographical boundaries to deliver quality care. They are also typically the economic foundation of their communities – every dollar spent on rural hospitals generates about $2.20 for the local economy. • Critical Access Hospitals care for a higher percentage of Medicare patients than other hospitals because rural populations are typically older than urban populations.

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R O F I L E :




Crane: Not your Ordinary West Texas Town Located in the Heart of West Texas with current county population of 4,383, Crane is not your ordinary oil-producing Texas town. Crane is the only significant town in sparsely-populated Crane County and also contains the county’s only post office. While the existing 25-bed Critical Access Hospital was built in 1983, the first hospital was built in the 1950s and is the only hospital serving Crane County and the surrounding areas. In 2008, the citizens voted to establish a hospital district, which has proven to be beneficial to all of Crane’s citizens. “It’s our desire to meet those demands and provide the best care possible,” said Dianne Yeager, the hospital’s CEO. Crane Memorial Hospital and Rural Health Clinic offer a variety of services to the community. In addition to the medical unit, they offer surgery, lab and radiology including CT, emergency care, a swing bed program and clinical services. The RHC services include the specialty services of cardiology and podiatry. Additionally, the hospital district is in the process of building an Outpatient Physical Therapy Clinic. Crane Memorial Hospital is highly focused on delivering to highest level of service and hospital administration understands health care is evolving. In that spirit, Crane Memorial Hospital has had several notable HIT successes in 2011 and 2012. In October 2012, the TORCH honored Crane Memorial Hospital with the Rural Hospital IT Award of Excellence.




Crane was also recently selected as one of the National Rural Health Association’s Top 20 Critical Access Hospitals in the nation for financial stability. “The honor of being selected in the top 20 CAH’s in the Nation for financial stability and The Rural Hospital IT Award of Excellence has been amazing,” stated Yeager. Crane Memorial Hospital has applied and received numerous grants this year totaling $175,000. With grant assistance, the facility has been able to upgrade antiquated equipment including a nurse call system, digital x-ray machine, portable x-ray machine, anesthesia machine and an IT Security Assessment. The hospital/clinic also hosted their 14th Annual Health Fair for the community with the assistance of grants. There were over 139 applicants and only four awards were granted. Drawing attention to their collaboration as a team, CEO Dianne Yeager, said it best, “There were a few tears along the way, but our staff bit the bullet and got it done! Our community holds us in high regards because they know we take health care in Crane County seriously. I am so proud of our staff! They have continued to excel at the many demands that healthcare has placed on them. Crane Memorial Hospital and Rural Health Clinic Staff are the Best in the West,” added Yeager.

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AIM Radiology............................................................................20 832-296-9361

Alliant-HAS................................................................................ IFC 325-668-8254

Discovery Healthcare Consulting Grp........................................IBC 888-776-0620

Government Capital......................................................................6 817-722-0217

HealthSure..................................................................................10 512-292-3315

Prognosis.....................................................................................2 281-822-2378

TORCH Member Hospitals Named to Top Critical Access Hospital list The National Rural Health Association (NRHA) announced the names of the Top Critical Access Hospitals (CAHs) in America and five TORCH Member Hospitals were named to that list. The list was announced September 28 during the National Rural Health Association’s Critical Access Hospital Conference in Kansas City, Mo. CAHs that have achieved success in one of three areas of performance, based on iVantage Health Analytics tabulation, were announced at the annual meeting attended by rural hospital leaders from every state. The three performance indicators used to create the categories are: • Quality Index: A rating of hospital performance based on the percentile ranks across the five categories of Hospital Compare process of care measures. • Patient Perspective Index: A rating of hospital performance based on the percentile ranks on two Hospital Compare HCAHPS measures (“overall rating” and “highly recommend”). • Financial Stability Index: A rating of hospital performance based on the percentile ranks on a set of balance sheet and income statement financial ratios. The Torch Member Hospitals named are in recognition of their Financial Stability Index: Concho County Hospital in Eden and Crane County Hospital District in Crane. For Patient Perspective Index: Electra Memorial Hospital in Electra; and for Quality Index: Big Bend Regional Medical Center in Alpine and Seton Edgar B. Davis Hospital in Luling. “These facilities rose to the top in some key areas of success for Critical Access Hospitals,” said David Pearson, TORCH President/CEO. “The hard work they do day in and day out often times goes unrecognized, but we’re proud to reaffirm NRHA’s acknowledgement of these TORCH Member Hospitals. Job well done and we look forward to more great things from Texas Critical Access Hospitals.”

Southwest Medical Associates, Inc...............................................9 800-929-4854

“Bank on it!” continued from page 18

TBB-TX sites can be located in community and rural hospitals.

Texas Mutual...............................................................................10 800-859-5995

Hospital staff or volunteers can receive minimal training to utilize the system to assist their clients, and unlimited numbers of computers and counselors are allowed access at a site. Site fees are nominal and range between $500-to-$1,000 a year, which includes training and all

Texas Hospital Insurance Exchange..............................................9 512-451-5775

regular updates for the programs, both federal and state. For more information, please contact Camille D. Miller, President/ CEO at or Diana Maldonado, State Director at TORCH is excited to partner with THI to bring such a valuable community service to rural Texas.

Sherry Wilkie-Conway is chief operating officer at Texas Health Institute.

f a l l

2 0 1 2







EHRs and the Long Road to Quality Excellence


My mom often told me, “The road to hell is paved with good

used to this by now. Health policy makers have historically

intentions.” Her words come to mind now, as I consider rural

overlooked rural in most of their major plans and policies?

hospitals’ long, bumpy road to meaningful use of electronic

Instead of lamenting the unfairness of the circumstances,

records. In the past several years, our National Rural Health

let’s look instead at what rural hospitals can control with EHR

Resource Center has worked with more than sixty rural hospitals

implementation. At the top of the list is the crafting an inspiring

across the United States. Almost all have struggled to meet the

vision as to why all of this disruption is necessary. And, this must

challenging deadlines, with insufficient resources and inadequate

be developed and communicated by top leadership, and cannot

understanding of how it’s all going to work. Rural hospitals started

be delegated to others. Ultimately, EHR implementation has to be

out in EHR adoption significantly behind their urban counterparts,

about quality and patient safety, not technology. At its best, an EHR

and they continue to trail in the race to meaningful use and

system can hardwire quality. Paper medical records have proven

the associated financial incentives.

to be dangerous and inefficient, and are archaic holdovers from

Many of the obstacles and breakdowns

the twentieth century. Almost all other industries have moved on

are beyond the control of individual

to electronic records because they are more accurate and provide

hospitals. National legislation locked in some

vastly superior information for decision making. Health care is not an

of the deadlines, incentives and processes,

exception; numerous studies have shown the benefits of EHRs, and

and federal agencies such as the Office of the

their role in improving quality and safety is no longer in question.

National Coordinator (ONC) have good intentions, but

After leadership develops the compelling EHR vision, it is

limited understanding of rural hospital

necessary to plan the road from where the hospital is now, to where

circumstances. We

it wants to be. This strategic plan for EHR implementation must

should all be

include improving clinical quality processes, providing education, and communicating to staff why this difficult change is eventually going to be worth the time and effort. In short, IT HAS TO BE ABOUT QUALITY! In most hospitals we work with, this key message is not adequately communicated. The road to meaningful use, to financial incentives or to some techie’s vision of nirvana, does not inspire the staff, nor does it enlist the physicians.

Determining the inspiring destination, charting

the course and getting the right people on the bus does not mean that the road will be easy, but it will mean that arrival at the final destination will be worth the long trip, and you may enjoy yourself more along the way. In this approach to EHR adoption, technology will be appropriately used as a tool and not as a destination. Improved patient care will be the big payoff, and staff and leadership will look back proudly at having survived the turmoil and making their local health care system safer and more efficient. With this approach my mom’s road to hell will turn out to be the road not taken.

Terry Hill, MPA, is executive director at National Health Resource Center.


S E T A D E SAVE TH w nce & Trade Sho re fe n o C l a u n n TORCH A 3 April 17-19, 201 s Omni Hotel Dalla nce

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tion Conference a c u d E l a u n n A TARHC , 2013 July 30-August 1 Hotel Austin Omni Downtown nce & Retreat re fe n o C l a u n n A TLMI 2013 September 3-5, n Technology o ti a rm fo In l a it Rural Hosp how N/13) & Trade S O C IT (H e c n re fe Con October 2013 ociation Annual s s A h lt a e H l ra Texas Ru Conference October 2013

Texas Organization of Rural & Community Hospitals PO Box 203878 | Austin, TX | 78720-3878 P: (512) 873-0045 | F: (512) 873-0046 | /torchnet



Rural Matters Fall 2012: Determining the Real Value in Health Care IT  

Rural Matters Fall 2012: Determining the Real Value in Health Care IT

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