This document discusses the use of telehealth in rural Nebraska to connect critical access hospitals. It describes a network of 14 critical access hospitals that collaborate on various quality improvement initiatives using telehealth. It also discusses the Mid West Telehealth Network operated out of Good Samaritan Hospital, which connects 23 rural hospitals. Finally, it provides an overview of the statewide telehealth network in Nebraska that connects all hospitals and health departments through a hub and spoke model to increase access to care in rural areas of the state.
This document is a classified ad section from a local newspaper. It includes various advertisements for services, items for sale, real estate listings, job postings, and community/church announcements. Some of the ads featured are for deer processing, tree service, furnace cleaning, vacuum repair, computer support, and real estate agencies. Community events advertised include Knights of Columbus dinners and notices.
The document discusses the challenges facing family businesses in the third generation. It provides an overview of Major Brands, a large Missouri-based distributor of alcoholic and non-alcoholic beverages. Major Brands has experienced over 10 years of continuous revenue growth, reaching $410 million in sales, and distributes products across Missouri. It sources from both public and private suppliers and has a wide customer base in off-premise and on-premise retail. The document emphasizes the importance of community involvement and pursuing inconsistent strategies to avoid failure due to success.
This document discusses how to design complete streets that accommodate all users. It defines complete streets as those that provide safe access and mobility for pedestrians, bicyclists, motorists and transit users. It notes that current street conditions are often unsafe and inadequate for non-motorized users, lacking features like sidewalks, bike lanes and safe pedestrian crossings. The document advocates for context sensitive, complete street design and higher connectivity between streets to improve walkability and accessibility.
The aging population in North Carolina is growing rapidly, with the number of those aged 65 and older expected to double over the next 20 years. This demographic shift presents challenges around ensuring seniors have access to necessary support services. Effective care transitions between medical settings and the community are important to support senior well-being and reduce healthcare costs. Many communities in the state are working to develop coordinated systems and partnerships to help seniors navigate these transitions.
The document analyzes the labor market for biopharma manufacturing in the Greater Charlotte region, which includes 12 counties in North Carolina and 3 counties in South Carolina. It identifies the specific counties that make up the Greater Charlotte laborshed for biopharma manufacturing labor. The document was sponsored by the Charlotte Regional Partnership, North Carolina Biotechnology Center, and Duke Energy to provide insights into the biopharma manufacturing labor market in the Charlotte region.
Biggins Lacy Shapiro & Co, (BLS & Co), a New Jerseybased site selection and economic development consultancy, was engaged by the North Carolina Biotechnology Center and its economic development partners in and around Charlotte, N.C. (Greater Charlotte), to gauge the capability of the region’s labor force to sustain significant biopharmaceutical manufacturing plant investments.
It is our conclusion that the Central Piedmont regional labor market possesses the necessary skills, if not the direct experience, to support a number of biopharma manufacturing plants. Scale-up of the first plant, in particular, should be managed at pace that would enable the recruiting, training and development staff to understand and adjust to local market conditions and to assimilate new employees.
The document contains classified advertisements for pets including AKC registered Labrador and Siberian Husky puppies for sale, as well as public notices for a foreclosure sale by Bank of America for property located in Rochester, Minnesota. Contact information is provided for purchasing the puppies and obtaining additional details on the foreclosure sale.
This document contains legal notices and classified advertisements from the Cass City Chronicle newspaper on March 28, 2012. It includes notices of mortgage foreclosure sales for two properties and advertisements for goods and services such as flags, Knights of Columbus fish dinners, carpet cleaning, electric work, and a Christian retirement home.
This document is a classified ad section from a local newspaper. It includes various advertisements for services, items for sale, real estate listings, job postings, and community/church announcements. Some of the ads featured are for deer processing, tree service, furnace cleaning, vacuum repair, computer support, and real estate agencies. Community events advertised include Knights of Columbus dinners and notices.
The document discusses the challenges facing family businesses in the third generation. It provides an overview of Major Brands, a large Missouri-based distributor of alcoholic and non-alcoholic beverages. Major Brands has experienced over 10 years of continuous revenue growth, reaching $410 million in sales, and distributes products across Missouri. It sources from both public and private suppliers and has a wide customer base in off-premise and on-premise retail. The document emphasizes the importance of community involvement and pursuing inconsistent strategies to avoid failure due to success.
This document discusses how to design complete streets that accommodate all users. It defines complete streets as those that provide safe access and mobility for pedestrians, bicyclists, motorists and transit users. It notes that current street conditions are often unsafe and inadequate for non-motorized users, lacking features like sidewalks, bike lanes and safe pedestrian crossings. The document advocates for context sensitive, complete street design and higher connectivity between streets to improve walkability and accessibility.
The aging population in North Carolina is growing rapidly, with the number of those aged 65 and older expected to double over the next 20 years. This demographic shift presents challenges around ensuring seniors have access to necessary support services. Effective care transitions between medical settings and the community are important to support senior well-being and reduce healthcare costs. Many communities in the state are working to develop coordinated systems and partnerships to help seniors navigate these transitions.
The document analyzes the labor market for biopharma manufacturing in the Greater Charlotte region, which includes 12 counties in North Carolina and 3 counties in South Carolina. It identifies the specific counties that make up the Greater Charlotte laborshed for biopharma manufacturing labor. The document was sponsored by the Charlotte Regional Partnership, North Carolina Biotechnology Center, and Duke Energy to provide insights into the biopharma manufacturing labor market in the Charlotte region.
Biggins Lacy Shapiro & Co, (BLS & Co), a New Jerseybased site selection and economic development consultancy, was engaged by the North Carolina Biotechnology Center and its economic development partners in and around Charlotte, N.C. (Greater Charlotte), to gauge the capability of the region’s labor force to sustain significant biopharmaceutical manufacturing plant investments.
It is our conclusion that the Central Piedmont regional labor market possesses the necessary skills, if not the direct experience, to support a number of biopharma manufacturing plants. Scale-up of the first plant, in particular, should be managed at pace that would enable the recruiting, training and development staff to understand and adjust to local market conditions and to assimilate new employees.
The document contains classified advertisements for pets including AKC registered Labrador and Siberian Husky puppies for sale, as well as public notices for a foreclosure sale by Bank of America for property located in Rochester, Minnesota. Contact information is provided for purchasing the puppies and obtaining additional details on the foreclosure sale.
This document contains legal notices and classified advertisements from the Cass City Chronicle newspaper on March 28, 2012. It includes notices of mortgage foreclosure sales for two properties and advertisements for goods and services such as flags, Knights of Columbus fish dinners, carpet cleaning, electric work, and a Christian retirement home.
The document provides information about the WIC (Special Supplemental Nutrition Program for Women, Infants, & Children) program. WIC is a federally funded program that provides nutritious foods, nutrition education, breastfeeding promotion and support, and screening/referrals to improve the health of pregnant/breastfeeding women, infants, and children under 5 who are at nutritional risk and below 185% of the federal poverty level. The document outlines WIC's income eligibility guidelines and describes the types of nutritious foods, nutrition education, breastfeeding support, and referrals provided through the program.
This document provides information and instructions for responding to an opioid overdose emergency using naloxone. It begins with an overview of the REVIVE program and training objectives. It then discusses opioid overdoses, how to recognize one, and risk factors. Myths about reversing overdoses are dispelled. The document emphasizes that naloxone is the only effective response and provides step-by-step instructions: check responsiveness and give rescue breaths if needed, call 911, administer naloxone, continue rescue breathing, and give a second dose of naloxone if needed. Proper positioning and calling for emergency help are also described.
This document provides an overview of the Balanced Living with Diabetes (BLD) program, a community-based lifestyle intervention for improving blood glucose control among people with diabetes. BLD is based on social cognitive theory and community-based participatory research principles. It involves weekly 2-hour classes over 4 weeks that teach diabetes self-management skills like healthy eating, physical activity, and goal setting using interactive lessons and activities. Pilot programs of BLD found improvements in A1c, diet, and physical activity. A large randomized controlled trial of BLD found it effective at lowering A1c levels among African Americans with diabetes in medically underserved areas when delivered in faith-based community settings.
This document discusses telehealth, health information technology (HIT), and mobile health (mHealth). It defines these terms and explores their use and potential benefits in rural healthcare settings for improving access to care, care coordination, patient-centered care, and physician mentorship. The document addresses challenges like patient migration, health literacy, and lack of providers in rural areas. It also discusses considerations for vendors and technologies like assessing return on investment and ensuring clinical and financial benefits. The need for pilot testing, feedback loops, and adapting implementation processes is emphasized. In summary, the document provides an overview of digital health innovations and how they can help address rural healthcare challenges if properly planned and evaluated.
This document provides an overview of attention deficit hyperactivity disorder (ADHD), including diagnostic criteria, incidence rates, treatment options, and recent Virginia Medicaid data on ADHD diagnoses and medication rates. It begins with the goals of reviewing the ADHD diagnosis, latest treatment algorithms, and Virginia Medicaid data compared to other states and nationally. Diagnostic criteria and symptoms from the DSM-V are outlined. Treatment options discussed include behavioral therapy and FDA-approved medications like stimulants. Virginia Medicaid data on ADHD diagnoses and medication rates among children and adults is presented compared to other state Medicaid plans.
The document discusses Virginia's health and human services programs and delivery system. It provides an overview map of the various state agencies and programs involved, including Medicaid, social services, behavioral health, public health, and more. It emphasizes moving from a program-focused model to a more coordinated, customer-centric model to better serve individuals and families. Key challenges discussed include demographic changes, technological shifts, workforce issues, balancing specialization and integration, and coordinating complex federal, state and private systems and requirements.
This document summarizes a presentation given by Gina Capra, Director of the Office of Rural Health at the Veterans Health Administration. The presentation provided an overview of the VA, including its mission to care for veterans and strategic goals. It also discussed the rural veteran population and challenges they face accessing care. Additionally, it described the VA's efforts to engage community providers through programs like the Community Based Outpatient Clinics and the Veterans Choice Program.
This document discusses the challenges facing rural healthcare in the United States. It notes that rural residents generally have worse health outcomes and less access to care compared to urban residents, due to issues like physician and specialist shortages. Many rural hospitals are financially vulnerable and at risk of closure. The document outlines advocacy efforts by the National Rural Health Association to raise awareness of the crisis of rural hospital closures and develop legislative solutions to stabilize rural healthcare.
Virginia hospitals face serious financial challenges that threaten their ability to continue serving their communities. Rising costs of caring for an aging population combined with inadequate Medicare and Medicaid reimbursement have led to annual funding shortfalls approaching $1 billion for Virginia hospitals. This has resulted in one-third of Virginia's acute care hospitals operating in the red. If these challenges are not addressed, further hospital closures and service reductions are possible. A public awareness campaign called "Virginia Hospitals: Our Lifeline" aims to educate lawmakers and the public about these issues facing local hospitals.
Melody Counts, M.D., M.H.M. presented information on resources for affordable prescription medications. The presentation identified multiple patient assistance programs (PAPs), 340B programs, private organizations, and pharmacy discount programs that provide low-cost or free prescription drugs. It provided details on eligibility requirements and application processes for several specific programs and resources patients and doctors can access. The goal was to help participants identify affordable prescription medication options to provide to patients and understand why this is an important service.
1) The document provides guidance on federal and state loan repayment programs for healthcare practitioners and practice sites.
2) It discusses Health Professional Shortage Areas (HPSAs), their structure and types, and how they are used to determine eligibility for programs like the National Health Service Corps Loan Repayment Program and Virginia State Loan Repayment Program.
3) The National Health Service Corps Loan Repayment Program and Virginia State Loan Repayment Program are described in detail, including eligibility requirements for participants and approved sites, available funding amounts, and application processes.
Joshua Kaywood discusses interstate telehealth regulation and licensure issues. He outlines the current status, including common issues around medical board jurisdiction over residents. Landmark decisions established that providers must be licensed in the state where the patient resides. Rules generally require knowing a patient's residency and obtaining licenses in multiple states. Virginia extends reciprocity to bordering states, while others may require full licensing or allow exemptions. The FSMB Compact and PSYPACT aim to enhance license portability across states through compacts, but telehealth regulation remains complex due to varying state laws.
This document provides an overview of telehealth and the Mid-Atlantic Telehealth Resource Center (MATRC). It discusses what telehealth is, including videoconferencing, store-and-forward, remote patient monitoring, and mobile health. Models that effectively use telehealth for rural healthcare are presented, such as telestroke, Parkinson's care, and high-risk obstetrics. The document outlines MATRC's goals of assisting rural sites in developing telehealth programs and describes the technical assistance they provide through their website, social media, in-person meetings, and email support.
This document discusses challenges facing rural healthcare providers. It notes that 62 million patients rely on rural providers who face unique population, geographic, cultural and healthcare delivery challenges. Rural providers and patients are disproportionately dependent on federal programs like Medicare and Medicaid. Recent federal policies have enacted Medicare cuts that negatively impact rural hospitals. The document examines characteristics of rural hospitals that have closed since 2010 and potential factors contributing to closures. It also reviews characteristics of rural hospitals that have merged with other providers and whether mergers improved financial performance. The document advocates policy solutions to stabilize rural hospitals and ensure their future viability.
This document summarizes resources for conducting research on rural populations in Virginia. It identifies several key public data sources for studying chronic disease in central Appalachia, including the Appalachian Regional Commission, Centers for Disease Control and Prevention, and various state-level sources. It also describes a case study using Virginia College of Osteopathic Medicine's study of chronic health conditions in central Appalachia as an example. This involved collecting both primary data through medical record reviews and secondary data from sources like the U.S. Energy Information Administration and Virginia Department of Health. It concludes by discussing future directions for continuing this research.
This document outlines a framework for population health management. It discusses fundamentals of population health including individual behavior, community health outcomes, and managing population health. It describes benefits of population health management like prevention and chronic disease management. Critical access hospitals can play a role as conveners by collaborating with local health departments and EMS providers. They can assist with developing population health plans and focus community engagement on key local health issues. The document provides templates for community engagement plans and implementation timelines.
This document provides an overview and summary of Virginia's public behavioral health system challenges and opportunities presented by James M. Martinez Jr., Director of the Office of Mental Health Services at DBHDS, to the Virginia Rural Health Association on December 11, 2014. The presentation discusses the current environment of behavioral health reform in Virginia, new laws affecting behavioral healthcare in the state, and DBHDS's vision, mission and transformation process. Key points include the drivers of recent reforms, current demand and utilization of services, new laws on emergency custody, temporary detention facilities, and the psychiatric bed registry.
This document summarizes differences between rural and urban health care and challenges facing rural areas. Key points include: infrastructure and resources are more limited in rural areas; poverty and health disparities are higher; and the aging population presents issues. Federal programs aim to address rural needs, but top-down solutions have had mixed results. Ensuring a rural voice in policymaking is important. Upcoming opportunities include the 2015 open enrollment period under the Affordable Care Act and workforce development programs.
The document discusses the evolving rural healthcare environment, including increased affiliations between rural and urban providers, changes to payment models under the Affordable Care Act, and a transition to value-based and managed care. It notes pressures on state budgets, the growth of high-deductible health plans, reduced readmissions, and declining inpatient volumes. The document also summarizes the expansion of Medicaid, Medicare payment reductions, quality reporting programs, accountable care organizations, and the financial challenges rural hospitals may face in this changing environment if they maintain a fee-for-service model.
The document summarizes the New River Valley Livability Initiative, a 3-year regional planning process that developed a vision and strategies for the future of the New River Valley region. It describes the funding and team involved, including working groups on topics like housing, economic development, and health. Public outreach included surveys and meetings. The final report identifies trends in areas like housing, transportation and demographics, and establishes goals and strategies to enhance living and working environments and preserve rural character in the region.
The document provides information about the WIC (Special Supplemental Nutrition Program for Women, Infants, & Children) program. WIC is a federally funded program that provides nutritious foods, nutrition education, breastfeeding promotion and support, and screening/referrals to improve the health of pregnant/breastfeeding women, infants, and children under 5 who are at nutritional risk and below 185% of the federal poverty level. The document outlines WIC's income eligibility guidelines and describes the types of nutritious foods, nutrition education, breastfeeding support, and referrals provided through the program.
This document provides information and instructions for responding to an opioid overdose emergency using naloxone. It begins with an overview of the REVIVE program and training objectives. It then discusses opioid overdoses, how to recognize one, and risk factors. Myths about reversing overdoses are dispelled. The document emphasizes that naloxone is the only effective response and provides step-by-step instructions: check responsiveness and give rescue breaths if needed, call 911, administer naloxone, continue rescue breathing, and give a second dose of naloxone if needed. Proper positioning and calling for emergency help are also described.
This document provides an overview of the Balanced Living with Diabetes (BLD) program, a community-based lifestyle intervention for improving blood glucose control among people with diabetes. BLD is based on social cognitive theory and community-based participatory research principles. It involves weekly 2-hour classes over 4 weeks that teach diabetes self-management skills like healthy eating, physical activity, and goal setting using interactive lessons and activities. Pilot programs of BLD found improvements in A1c, diet, and physical activity. A large randomized controlled trial of BLD found it effective at lowering A1c levels among African Americans with diabetes in medically underserved areas when delivered in faith-based community settings.
This document discusses telehealth, health information technology (HIT), and mobile health (mHealth). It defines these terms and explores their use and potential benefits in rural healthcare settings for improving access to care, care coordination, patient-centered care, and physician mentorship. The document addresses challenges like patient migration, health literacy, and lack of providers in rural areas. It also discusses considerations for vendors and technologies like assessing return on investment and ensuring clinical and financial benefits. The need for pilot testing, feedback loops, and adapting implementation processes is emphasized. In summary, the document provides an overview of digital health innovations and how they can help address rural healthcare challenges if properly planned and evaluated.
This document provides an overview of attention deficit hyperactivity disorder (ADHD), including diagnostic criteria, incidence rates, treatment options, and recent Virginia Medicaid data on ADHD diagnoses and medication rates. It begins with the goals of reviewing the ADHD diagnosis, latest treatment algorithms, and Virginia Medicaid data compared to other states and nationally. Diagnostic criteria and symptoms from the DSM-V are outlined. Treatment options discussed include behavioral therapy and FDA-approved medications like stimulants. Virginia Medicaid data on ADHD diagnoses and medication rates among children and adults is presented compared to other state Medicaid plans.
The document discusses Virginia's health and human services programs and delivery system. It provides an overview map of the various state agencies and programs involved, including Medicaid, social services, behavioral health, public health, and more. It emphasizes moving from a program-focused model to a more coordinated, customer-centric model to better serve individuals and families. Key challenges discussed include demographic changes, technological shifts, workforce issues, balancing specialization and integration, and coordinating complex federal, state and private systems and requirements.
This document summarizes a presentation given by Gina Capra, Director of the Office of Rural Health at the Veterans Health Administration. The presentation provided an overview of the VA, including its mission to care for veterans and strategic goals. It also discussed the rural veteran population and challenges they face accessing care. Additionally, it described the VA's efforts to engage community providers through programs like the Community Based Outpatient Clinics and the Veterans Choice Program.
This document discusses the challenges facing rural healthcare in the United States. It notes that rural residents generally have worse health outcomes and less access to care compared to urban residents, due to issues like physician and specialist shortages. Many rural hospitals are financially vulnerable and at risk of closure. The document outlines advocacy efforts by the National Rural Health Association to raise awareness of the crisis of rural hospital closures and develop legislative solutions to stabilize rural healthcare.
Virginia hospitals face serious financial challenges that threaten their ability to continue serving their communities. Rising costs of caring for an aging population combined with inadequate Medicare and Medicaid reimbursement have led to annual funding shortfalls approaching $1 billion for Virginia hospitals. This has resulted in one-third of Virginia's acute care hospitals operating in the red. If these challenges are not addressed, further hospital closures and service reductions are possible. A public awareness campaign called "Virginia Hospitals: Our Lifeline" aims to educate lawmakers and the public about these issues facing local hospitals.
Melody Counts, M.D., M.H.M. presented information on resources for affordable prescription medications. The presentation identified multiple patient assistance programs (PAPs), 340B programs, private organizations, and pharmacy discount programs that provide low-cost or free prescription drugs. It provided details on eligibility requirements and application processes for several specific programs and resources patients and doctors can access. The goal was to help participants identify affordable prescription medication options to provide to patients and understand why this is an important service.
1) The document provides guidance on federal and state loan repayment programs for healthcare practitioners and practice sites.
2) It discusses Health Professional Shortage Areas (HPSAs), their structure and types, and how they are used to determine eligibility for programs like the National Health Service Corps Loan Repayment Program and Virginia State Loan Repayment Program.
3) The National Health Service Corps Loan Repayment Program and Virginia State Loan Repayment Program are described in detail, including eligibility requirements for participants and approved sites, available funding amounts, and application processes.
Joshua Kaywood discusses interstate telehealth regulation and licensure issues. He outlines the current status, including common issues around medical board jurisdiction over residents. Landmark decisions established that providers must be licensed in the state where the patient resides. Rules generally require knowing a patient's residency and obtaining licenses in multiple states. Virginia extends reciprocity to bordering states, while others may require full licensing or allow exemptions. The FSMB Compact and PSYPACT aim to enhance license portability across states through compacts, but telehealth regulation remains complex due to varying state laws.
This document provides an overview of telehealth and the Mid-Atlantic Telehealth Resource Center (MATRC). It discusses what telehealth is, including videoconferencing, store-and-forward, remote patient monitoring, and mobile health. Models that effectively use telehealth for rural healthcare are presented, such as telestroke, Parkinson's care, and high-risk obstetrics. The document outlines MATRC's goals of assisting rural sites in developing telehealth programs and describes the technical assistance they provide through their website, social media, in-person meetings, and email support.
This document discusses challenges facing rural healthcare providers. It notes that 62 million patients rely on rural providers who face unique population, geographic, cultural and healthcare delivery challenges. Rural providers and patients are disproportionately dependent on federal programs like Medicare and Medicaid. Recent federal policies have enacted Medicare cuts that negatively impact rural hospitals. The document examines characteristics of rural hospitals that have closed since 2010 and potential factors contributing to closures. It also reviews characteristics of rural hospitals that have merged with other providers and whether mergers improved financial performance. The document advocates policy solutions to stabilize rural hospitals and ensure their future viability.
This document summarizes resources for conducting research on rural populations in Virginia. It identifies several key public data sources for studying chronic disease in central Appalachia, including the Appalachian Regional Commission, Centers for Disease Control and Prevention, and various state-level sources. It also describes a case study using Virginia College of Osteopathic Medicine's study of chronic health conditions in central Appalachia as an example. This involved collecting both primary data through medical record reviews and secondary data from sources like the U.S. Energy Information Administration and Virginia Department of Health. It concludes by discussing future directions for continuing this research.
This document outlines a framework for population health management. It discusses fundamentals of population health including individual behavior, community health outcomes, and managing population health. It describes benefits of population health management like prevention and chronic disease management. Critical access hospitals can play a role as conveners by collaborating with local health departments and EMS providers. They can assist with developing population health plans and focus community engagement on key local health issues. The document provides templates for community engagement plans and implementation timelines.
This document provides an overview and summary of Virginia's public behavioral health system challenges and opportunities presented by James M. Martinez Jr., Director of the Office of Mental Health Services at DBHDS, to the Virginia Rural Health Association on December 11, 2014. The presentation discusses the current environment of behavioral health reform in Virginia, new laws affecting behavioral healthcare in the state, and DBHDS's vision, mission and transformation process. Key points include the drivers of recent reforms, current demand and utilization of services, new laws on emergency custody, temporary detention facilities, and the psychiatric bed registry.
This document summarizes differences between rural and urban health care and challenges facing rural areas. Key points include: infrastructure and resources are more limited in rural areas; poverty and health disparities are higher; and the aging population presents issues. Federal programs aim to address rural needs, but top-down solutions have had mixed results. Ensuring a rural voice in policymaking is important. Upcoming opportunities include the 2015 open enrollment period under the Affordable Care Act and workforce development programs.
The document discusses the evolving rural healthcare environment, including increased affiliations between rural and urban providers, changes to payment models under the Affordable Care Act, and a transition to value-based and managed care. It notes pressures on state budgets, the growth of high-deductible health plans, reduced readmissions, and declining inpatient volumes. The document also summarizes the expansion of Medicaid, Medicare payment reductions, quality reporting programs, accountable care organizations, and the financial challenges rural hospitals may face in this changing environment if they maintain a fee-for-service model.
The document summarizes the New River Valley Livability Initiative, a 3-year regional planning process that developed a vision and strategies for the future of the New River Valley region. It describes the funding and team involved, including working groups on topics like housing, economic development, and health. Public outreach included surveys and meetings. The final report identifies trends in areas like housing, transportation and demographics, and establishes goals and strategies to enhance living and working environments and preserve rural character in the region.
1. Critical Access Hospitals and
Telehealth in Rural Nebraska
Virginia Rural Health Summit
March 18, 2010
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. 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. 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. 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. 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. 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. 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
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
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. 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. 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. Nebraska Statewide Telehealth
Network
• www.netelehealth.net
• 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. 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. 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. Dale Gibbs
Good Samaritan Hospital
Kearney Nebraska
dalegibbs@catholichealth.net
308-865-7494