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  1. 1. Critical Access Hospitals and Telehealth in Rural Nebraska Virginia Rural Health Summit March 18, 2010
  2. 2. Some Perspective First • Kearney, at 30,000, is Nebraska’s fifth largest city. • Good Samaritan Hospital’s service area is about 350,000 and the size of Indiana without the “toe”. • 287-bed, GSH is ACS Level II Trauma Center and the only open heart facility between Lincoln and Denver. • Helicopter and ground ambulance (911 and transfer) • More than half of inpatients come from outside of Buffalo County which has a population of 37,000.
  3. 3. Mid Nebraska CAH Network • Fourteen Critical Access Hospital network • One is 27 and three are 165 miles away • Activities – Med Recon, TeamSTEPPS, Transitions of care – Reduce LOS, mortality, readmissions – Education, Quality initiative to improve core measures – HIE connected to NHIN
  4. 4. Good Samaritan Hospital • Critical Access Hospitals Sioux Dawes Sheridan Cherry Keya Paha Boyd Knox Cedar Holt Dixon Brown Rock Bassett Box Butte Ainsworth Dakota Antelope Pierce Wayne Thurston Madison Stanton Cuming Grant Hooker Thomas Blaine Loup Garfield Wheeler Scotts Bluff Morrill Garden Burt Boone Arthur Custer Greeley Platte Colfax Dodge Banner McPherson Logan Valley Washington Ord Broken Bow Nance Saunders Douglas Cheyenne Sherman Howard Butler Kimball Keith Lincoln Polk Deuel Callaway Merrick Sarpy Dawson York Seward Lancaster Cass Perkins Buffalo Hall Gothenburg Hamilton Cozad Kearney Otoe . ● Chase Hayes Frontier Gosper Adams Clay Fillmore Saline Phelps Imperial Gage Johnson Nemaha Minden Dundy Hitchcock Red Willow Furnas Harlan Franklin Webster Nuckolls Thayer Jefferson Pawnee Richardson Cambridge Alma Franklin Red Cloud Benkelman
  5. 5. Rural Nebraska Regional Ambulance Network • Three-year HRSA grant by GSH and Regional West Medical Center in Scottsbluff Nebraska • Strengthen the volunteer and paid ambulance services • Purchase consortium • More National Registry testing sites with more seats • Leadership classes • Centralized dispatch for air and ground transfers
  6. 6. Rural Nebraska Regional Ambulance Network Chadron Gordon Ainsworth Bassett Alliance Scottsbluff Oshkosh Columbus Omaha Kimball Lincoln Kearney Imperial Minden Holdrege McCook Benkelman Alma Franklin
  7. 7. Rural Nebraska Regional Ambulance Network • Region is larger than 24 states • Cherry County is larger than Connecticut • 50 of Nebraska’s 93 counties • 33 counties designated as Medically Underserved Populations • 19 classified as Health Provider Shortage Areas for primary care • 377,350 and 53,051 square miles (70% of state)
  8. 8. Mid West Telehealth Network • 1995 OAT grant and 5 site hospitals • Today 23 hospitals • Funding since 1995 – Three OAT Competitive grants: $3,517,073 – Two Congressionally Mandated grants – OAT: $550,000 – Four USDA grants: $721,306 • TOTAL: $4,788,379
  9. 9. Mid West Telehealth Network
  10. 10. Mid West Telehealth Network • Calendar year 2009 – 71% of the telehealth clinical consults of state – 530,000 miles not traveled • $291,500 mileage costs saved • 815 hours saved – @ $25/hour = $20,375 • $311,875 total saved. • Total GSH Telehealth Services 2009 operating budget is approximately $200,000
  11. 11. Mid West Telehealth Network • 37 cameras on GSH campus • Clinical consults – Tele-emergency • Stroke, trauma, STEMI, sudden cardiac death, psych – Patient follow-ups in cardiology, oncology, orthopedics, neurology, behavioral health, med checks, • Education • Meetings • Compassionate calls
  12. 12. Nebraska Statewide Telehealth Network • All hospitals and public health departments have been connected through a hub and spoke network since 2005. • A successful collaboration of eight hub hospitals, the Nebraska Hospital Association and UNL. • Not a legal entity • Monthly Governing Committee and subcommittees meetings.
  13. 13. Nebraska Statewide Telehealth Network • Yearly, the Nebraska Public Service Commission gives up to $900,000 for equipment and T-1 subsidies. – After USAC funding this brings a hospital’s monthly cost down to $100 per month • 2009 – OAT competitive grant of $735,000 • 2007 and 2008 – Two congressionally mandated OAT grants totaling $704,911
  14. 14. Nebraska Telehealth Network Valentine Lynch 17 Gordon 45 Chadron 75 31 Atkinson Creighton Sioux City, Iowa 5 aa Ainsworth 21 Bassett 1 8 O’Neill H 57 S Osmond 61 Dakota City B 64 Hemingford Neligh Plainview X 77 49 Pender 81 Wayne 63 3 Winneabago Alliance Tilden 74 Wisner Y Norfolk 78 J 67 Scottsbluff 12 Bridgeport C Burwell Gering 50 Westpoint 52 Oakland 2 Albion Schuyler 6T Columbus 1s 11 58 66 Blair Broken Bow E Fremont Ord Genoa 19 I 27 13 30 54 60 4 T1 David City 80 s Wahoo Oshkosh Osceola G 23 55 U St. Paul 76 41 Sidney Q 14 Central City 56 53 70 59 Kimball 69 Callaway 16 R Ogallala North Platte s 6 T1 51 iv 32 vii Public Health Labs P Gothenburg Grand Island York 79 Z Seward 68 20 44 Nebraska Critical Access Hospitals Cozad K 33 7 vii 34 42 Kearney Aurora 3 T1s 43 Lincoln Kansas Critical Access Hospitals Grant Lexington vii 40 Six T1s 82 37 Henderson N Rural Hospitals 72 48 Geneva Syracuse Nebraska City Regional Hub Hospital 35 L 22 39 M 47 28 F Crete University Hub Hastings 29 v DFS Network Hub Imperial Holdrege 38 Minden Friend ii 73 6 Wilber Tecumseh A Auburn T-1 Connection 9 Single T-1 Connection between Hub Hospitals 46 O 15 Hebron Fairbury Beatrice Cambridge Alma Red Cloud Superior 36 Falls City Aggregate T-1 Connection between Hub Hospitals McCook 26 24 Benkleman 10 4 65 ByranLGH/HHA FastEthernet Franklin 71 25 Pawnee City 62 DFS T-1 connection Cable connection Smith Oberlin, Ks Norton, Ks Phillipsburg, Ks dd Mankato ff ff cc bb Center ee Nebraska Hospitals Nebraska Public Health Depts. 1. Ainsworth Brown County 30. Genoa Genoa Community 57. O'Neill Avera St. Anthony's 2. Albion Boone County 31. Gordon Gordon Memorial 58. Ord Valley County A. Auburn Southeast District Health Dept. 3. Alliance Box Butte General 32. Gothenberg Gothenberg Memorial 59. Osceola Annie Jeffrey B. Hemingford Panhandle Public Health Dept. 4. Alma Harlan County Health Sys 33. Grand Island St. Francis Medical Center 60. Oskosh Garden County C. Burwell Loup Basin Public Health Dept 5. Atkinson West Holt 34. Grant Perkins County 61. Osmond Osmond General 6. Auburn Nemaha County 35. Hastings Mary Lanning Memorial E. Columbus East Central District Health Dept. 62. Pawnee City Pawnee County 7. Aurora Memorial 36. Hebron Thayer County 63. Pender Pender Community F. Crete Public Health Solutions 8. Bassett Rock County 37. Henderson Henderson Health Services 64. Plainview Plainview Public G. David City Butler County Health Dept 9. Beatrice Beatrice Community 38. Holdrege Phelps Memorial 65. Red Cloud Webster County H. Dakota City Dakota County Health Dept. 10. Benkelman Dundy County 39. Imperial Chase County 66. Schuyler Alegent Health I. Fremont Three Rivers Health Dept. 11. Blair Memorial Community 40. Kearney Good Samaritan Health Sys 67. Scottsbluff Regional West Medical Center 12. Bridgeport Morrill County 41. Kimball Kimball County J. Gering Scotts Bluff County Health Dept. 68. Seward Seward Memorial 13. Broken Bow Jennie Melham 42. Lexington Tri-County 69. Sidney Memorial Health K. Grand Island Central District Health Dept. 14. Callaway Callaway District 43. Lincoln Bryan/LGH 70. St. Paul Howard County L. Hastings South Heartland District Health Dept. 15. Cambridge Tri-Valley Health System 44. Lincoln St. Elizabeth's 71. Superior Broadstone Memorial M. Holdrege Two Rivers Public Health Dept. 16. Central City Litzenberg Memorial 45. Lynch Niobrara Valley 72. Syracuse Community Memorial N. Lincoln Lincoln-Lancaster County Health Dept. 17. Chadron Chadron Community 46. McCook Community Hospital 73. Tecumseh Johnson County Hospital 19. Columbus Columbus Community 47. Minden Kearney County O. McCook Red Willow County Health Dept. 74. Tilden Tilden Community 20. Cozad Cozad Community 48. Nebraska City St. Mary's 75. Valentine Cherry County P. North Platte West Central District Health Dept. 21. Creighton Creighton Area 49. Neligh Antelope Memorial 76. Wahoo Saunders County Q. Ogallala Sandhills District Health Dept. 22. Crete Crete Area 50. Norfolk Faith Regional Health Srvcs 77. Wayne Providence R. Omaha Douglas County Health Dept. 23. David City Butler Area 51. North Platte Great Plains Regional Medical Ctr 78. West Point St. Francis S. O’Neill North Central District Health Dept. 24. Fairbury Jefferson County 52. Oakland Oakland Memorial 79. York York General 25. Falls City Community Medical Ctr. 53. Ogallala Ogallala Community Hospital U. Papillion Sarpy/Cass Dept. of Health and Wellness 80. Omaha Creighton Hospital 26. Franklin Franklin County 54. Omaha Methodist Hospital 81. Winnebago Winnebago Indian Hospital X. Wayne Northeast Nebraska Public Health Dept. 27. Fremont Fremont Area 55. Omaha University of Nebraska Medical Ctr 82. Grand Island College Park Y. Wisner Elkhorn Logan Valley Public Health Dept. 28. Friend Warren Memorial 56. Omaha Alegant Health Immanuel Z. York Four Corners Health Dept. 29. Geneva Fillmore County Hospitals From Other States Dark Fiber Solutions Network Hubs aa. Sioux City, Iowa bb. Norton, Ks Norton County Hospital i. Lincoln Bryan LGH, 1600 S. 48th iv. NP GPRMC, 601 W. Leota St., North Platte cc. Oberlin, Ks Decatur County Hospital ii. Wilber Head End, 901 N. Main, Wilber v. Geneva Head End, 300 C. St, Geneva dd. Phillipsburg, Ks Phillips County Hospital iii. DFS York, 600 ½ Grand Ave, York vi. Kearney Head End, 804 Ave. A., Kearney ff. Mankato, Ks Jewell County Hospital
  15. 15. Nebraska Statewide Telehealth Network • • Statewide scheduling system • 55 of 65 CAH have tele-emergency cameras – Children’s Hospital, one burn center, one Level I and all Level II Trauma Centers • Discussions and a pilot project to connect the NSTN to the Nebraska VA Health System
  16. 16. Nebraska Statewide Telehealth Network • State disaster communication – Health Alert Network – Monthly testing • Joint Commission telehealth delegated credentialing agreement. – Recognized by the State of Nebraska for CAHs reviewed by the state
  17. 17. Nebraska Telehealth Problems • CMS and the telehealth delegated agreements – Danger of stopping 99% of all telehealth clinical consults in Nebraska • FCC grandfathered definition of “rural” – Three hub sites in Nebraska are in danger of losing their rural status and USAC funding – Will be the end of the Nebraska Statewide Telehealth Network • Fast approaching needing to be a legal entity
  18. 18. Dale Gibbs Good Samaritan Hospital Kearney Nebraska 308-865-7494