Title: Health Care Quality for Rural America: Recommendations from the IOM Report Third Annual Western Regi
1Health Care Quality for Rural America
Recommendations from the IOM Report Third
Annual Western RegionFlex Conference
June 9, 2005
Ira Moscovice, Ph.D.
2One in a Series
http//www.nap.edu
3Key Questions
- Why should you be interested in the IOM Report?
- What can CAHs do now in response to the IOM
Report?
4Specific Charge to Committee
- Undertake an independent, unbiased assessment
of the condition of health and health care in
rural America, and formulate an action plan for
quality-focused rural community health systems.
5Addressing the Quality Challenge in a Rural
Context
- Although the evidence pertaining specifically
to rural areas is sparse, what does exist
corroborates the general finding that, as
documented for the nation overall in the Quality
Chasm report, the level of quality falls far
short of what it should be.
6Principles Underlying the Recommendations
- Rural communities should focus greater attention
on improving population health in addition to
meeting personal health care needs. - When care cannot be delivered locally, links
should be established to services in other
locales. - The services available in rural communities
should be based on the population health needs of
the local community.
7Principles Underlying the Recommendations
- Provision of rural health services should be
shaped and guided by local community and rural
organizations and institutions. - Rural health care requires a team of well-trained
health care clinicians, managers and leaders
working together.
8Principles Underlying the Recommendations
- Health care financing should explicitly address
the special circumstances of rural areas. - Efforts to develop local and national health
information technology infrastructure should
focus specific attention on rural communities.
95-Part Strategy to Address Quality Challenges in
Rural Communities
- Adopt an integrated, prioritized approach to
addressing personal and population health needs
at the community-level. - 2. Establish a stronger quality improvement
support structure to assist rural health systems
and professionals.
105-Part Strategy
- 3. Enhance human resource capacity of rural
communities - - health care professionals
- rural residents
- Monitor and assure that rural health care systems
are financially stable. - Invest in building an information and
communications technology (ICT) infrastructure.
11Addressing Personal and Population Health Needs
12 Need to develop a new cadre of health care
leaders capable of viewing clinical care in the
broader context of population health.
13Recommendation 1
- Congress should provide resources to the DHHS to
support comprehensive health system reform
demonstrations in five rural communities. - Demonstrations should evaluate alternative models
for achieving greater integration of personal and
population health services and innovative
approaches to the financing and delivery of
health services, with the goal of meeting the six
quality improvement aims.
14Six Aims for Quality Improvement
- Safety avoid injuries
- Effectiveness evidence based care
- Patient centeredness
- Timeliness avoid harmful delays
- Efficiency avoid waste
- Equity prevent quality differences
15- Establishing a
- Quality Improvement
- Support Structure
16Recommendation 2
- Establish a Rural Quality Initiative in HHS to
coordinate and accelerate efforts to measure and
improve the quality of personal and population
health care programs in rural areas.
17Rural Quality Initiative Agenda
- Apply evidence to rural practice
- Create standardized quality measures for rural
communities - Include rural areas in public reporting
initiatives for fair and meaningful comparisons - Provide rural technical assistance
- CMS should provide data repositories with
rural-specific data and benchmarks for quality
18So what could this mean in real life?Examples
from the IOM Workshop
- Bolster the rural health professional workforce
- Create networks of Critical Access Hospitals
- Adopt Electronic Health Records that can talk to
one another - Create ambulatory delivery systems that pursue
and embrace quality in every dimension
19- Strengthening
- Human Resources
20Recommendation 3
- Congress should provide resources to HRSA to
expand experientially based workforce training
programs in rural areas to ensure that all health
care professionals master necessary core
competencies.
21Core Competencies forHealth Professionals
- Provide patient-centered care
- Work in inter-disciplinary teams
- Employ evidence-based practice
- Apply quality improvement
- Utilize informatics
22The Rural Workforce Pipeline
Locate education and training programs in rural
areas and use rural relevant curricula
Prepare rural students in basic science expose
to appropriate role models
Encourage students to seek employment in rural
areas
Recruit students from rural areas
Sustain the rural workforce!
23Recommendation 4
- Health professions schools should
- Work collaboratively to establish outreach
programs to rural areas to attract applicants. - Locate a meaningful portion of education in rural
communities.
24 Recommendation 4 (cont.)
- Make greater effort to recruit faculty with
experience in rural practice, and develop
rural-relevant curricula. - Develop rural training tracks and fellowships
that - 1) provide students with rotations in rural
provider sites - 2) emphasize primary care practice
- 3) provide cross-training in key areas of
shortage in rural communities.
25 Recommendation 4 (cont.)
- The federal government should provide financial
incentives for residency training programs to
provide rural tracks by linking some portion of
graduate medical education payments under
Medicare to achieve this goal.
26- Providing Adequate
- and Targeted
- Financial Resources
27Recommendation 5
- CMS should establish 5-year pay-for performance
demonstration projects in five rural communities
starting 2006. - Selected communities should be diverse with
respect to socio-demographic variables, as well
as the degree and type of formal integration of
local and regional providers.
28Recommendation 6
- AHRQ should produce a report no later than FY 06
analyzing the aggregate impact of changes in the
Medicare program, state Medicaid programs,
private health plans and insurance coverage on
the financial stability of rural health care
providers. -
29Recommendation 7
- HRSA and SAMHSA should conduct a comprehensive
assessment of the availability and quality of
mental health and substance abuse services in
rural areas. - This assessment should evaluate current funding
adequacy and analyze alternative options for
better aligning funding sources and programs to
improve access and quality of mental health
services.
30- Utilizing Information
- and Communications
- Technology
31The Building Blocks of an ICT Infrastructure
- The National Health Information Plan
- National data standards
- Electronic health records
- Patient-maintained health records
- Secure information exchange networks
32Strategy to Include Rural Communities
- Include a rural component in the National
Coordinator for Health Information Technology
(NCHIT) plan, - Provide all rural communities with high-speed
access to the Internet, - Eliminate regulatory barriers to the use of
telemedicine,
33Strategy (cont.)
- Provide financial assistance to rural providers
for investments in EHRs and ICT, - Foster ICT collaborations and demonstrations in
rural areas - Provide ongoing educational and technical
assistance to rural communities to maximize the
use of ICT.
34Recommendation 8
- The Office of the National Coordinator for Health
Information Technology should incorporate a rural
focus, including frontier areas, into planning
and development activities.
35Recommendation 9
- Congress should ensure that rural communities are
able to use the Internet for the full range of
health-related applications. Consideration
should be given to - Expand and coordinate federal agency efforts to
extend broadband networks into rural areas. - Prohibit LATAs from imposing surcharges for the
transfer of health messages across regions. - Expand the USFs Rural Health Care Program to
allow all rural providers to participate, and
increase the subsidy amount. -
36Recommendation 10
- Congress should provide direction and financial
resources to assist rural providers in converting
to EHRs over the next 5 years. Working
collaboratively with the NCHIT - IHS should develop a strategy for transitioning
all of its provider sites from paper to e-health
records.
37Recommendation 10 (cont.)
- HRSA should develop a strategy to transition
CHCs, RHCs, CAHs and other rural providers from
paper to e-health records. - CMS and state governments should consider
providing financial rewards to providers
participating in Medicare and Medicaid programs
that invest in EHRs. - These two programs should work together to
reexamine their benefit and payment programs to
ensure appropriate coverage of telehealth and
other e-health services.
38Recommendation 11
- AHRQs Health Information Technology Program
should be expanded. - Resources should be provided to AHRQ to sponsor
development programs for ICT in rural areas. The
five-year developmental programs should begin in
2006 and establish state-of-the-art ICT
infrastructure, accessible to all providers and
consumers in those communities.
39Recommendation 12
- NLM, with the NCHIT and AHRQ, should establish
regional ICT/ telehealth resource centers
interconnected with the National Network of
Libraries of Medicine.
40Conclusion
- Rural America can lead in testing strategies for
improving population health and personal health
care delivery. - The Flex Program can serve as a foundation for
these efforts.
41What can CAHs do now in response to the IOM
Report?
- Link QI to your mission and strategic plan
- Establish an organizational culture that actively
supports QI - Reorient QI strategies from patient or
provider-centered approach to one that also
embraces a community/population approach - Define a relevant quality measure set for your
hospital - Invest in MIS that supports QI
42What can CAHs do now in response to the IOM
Report?
- Participate in public reporting initiatives
- Develop QI teams in your hospital that address
quality and patient safety issues - Work with your support hospital on QI activities
- Join/develop a network that facilitates QI
activities for CAHs - Work with your QIO, state hospital association,
SORH, and universities on QI activities - Apply for QI-related grants