Oklahoma State University Center for Rural Health

1. Oklahoma State University Center for Rural Health

2. Where does Oklahoma rank nationally for its health status (1st is best and 50th is worst)? • 33rd • 43rd • 46th • 49th 1United Health Foundation. 2010. “America’s Health Rankings: 2010 Edition.”

3. Where does Oklahoma rank nationally for its ratio of primary care physicians to total population?1 • 5th • 23rd • 39th • 49th 1United Health Foundation. 2010. “America’s Health Rankings: 2010 Edition.”

4. 25% of the state’s population smokes (improving) • 32% of the state’s population is considered obese (increasing) • 16% of Oklahomans do not have health insurance (was improving) • Dead last for the percent of the population that has had a recent dental visit • Dead last for the percent of the population that meets its recommended intake of fruits and vegetables The Health Status of Oklahomans1 1United Health Foundation. 2010. “America’s Health Rankings: 2010 Edition.”

5. What About Rural Oklahoma?

7. How many more people are there per primary care physician in rural Oklahoma compared to urban Oklahoma? • 25% more • 50% more • 75% more • 100% more

9. Mission Our mission is to support the Oklahoma State University Center for Health Sciences and its College of Osteopathic Medicine by seeking to improve healthcare in rural Oklahoma through: • Student education, • Residency training, • Research, • Program applications, • Advocacy, and • Alliances with others who share our goals.

11. Presentation Overview Center for Rural Health Departments and Program Areas • Medical Education • Clinical Services • Grants and Research • Advocacy

12. Rural Medical Education

13. On average, approximately what % of all graduates from OSU-COM have entered primary care following graduation? • 45% • 55% • 65% • 75%

15. Approximately what % of graduates from OSU-COM have entered primary care following graduation since 2006? • 40% • 50% • 60% • 70%

18. Community Clinic Rotation Sites2010

19. Rural Clinic Rotation Sites2010

20. Community Hospital Rotation Sites2010

21. E.R. Rotation Sites2010

22. Medical Education • Pre-Doctoral Training in Primary Care Grant • Medical School • Earlier exposure to rural practice • Expanded rural rotations • Expanded rural didactics • Increased experiences with simulators • Residency • Rural residency programs

23. Clinical Services

24. Clinical Services • Enid Clinic • Primarily Medicare, Medicaid, and SoonerCare

25. Grants and Research

26. Grant Funded Activities • Annual Grants • State Office of Rural Health • Area Health Education Center • Project Grants • Health Information Technology

27. Grant Funded Activities - Annual • State Office of Rural Health • State Office of Rural Health (SORH) • Small Hospital Improvement Program (SHIP) • Medicare Rural Hospital Flexibility Program (FLEX)

28. Grant Funded Activities - Annual Small Hospital Improvement Program (SHIP) • Eligibility • Small (49 beds or less) • Rural (outside of an MSA) • Authorized Expenditures • Prospective payment systems (PPS); • Value-based purchasing programs (VBP); • Accountable care organizations (ACO); and • Payment Bundling.

30. Grant Funded Activities - Annual • Flex Program • Conversion to Critical Access Hospital (CAH) status • Support for Quality Improvement • Support for Operational and Financial Improvement • Support for Health System Development and Community Engagement

31. At most, how many beds may a Critical Access Hospital have? • 10 • 25 • 50 • 100

32. May a Critical Access Hospital have an average length of stay of more than 96 hours? • Yes • No

34. How much more money annually does a typical Oklahoma hospital make by converting to critical access status? • $ 42,071.00 • $ 186,106.00 • $ 227,449.00 • $ 291,470.00

35. Impact of CAH Conversion RN Lawler, GA Doeksen, and V Schott. Impact of Conversion to Critical Access Hospital Status for Oklahoma’s Rural Hospitals. The Journal of Rural Health. 2003.

36. Critical Access Hospitals Flex Monitoring Team. Statewide Financial Performance of CAHs – Oklahoma, www.flexmonitoringteam.org/documents/BriefingPaper7_FinancialIndicators.pdf

37. Critical Access Hospitals Flex Monitoring Team. Statewide Financial Performance of CAHs – Oklahoma, www.flexmonitoringteam.org/documents/BriefingPaper7_FinancialIndicators.pdf

38. Critical Access Hospitals Flex Monitoring Team. Statewide Financial Performance of CAHs – Oklahoma, www.flexmonitoringteam.org/documents/BriefingPaper7_FinancialIndicators.pdf

39. Grant Funded Activities - Annual • Area Health Education Center (AHEC) • Model AHEC Program • State Matching Funds??????? • Geriatric Education Center Program

40. OSU Center for Rural Health’s Services and Activities February 2010

41. Grant Funded Activities - Project • Health Information Technology • USDA Distance Learning and Telemedicine Grant • Tobacco Tax Funding for Telemedicine

43. Research

44. Research • State • Effectiveness of rural medical training programs at OSU • State of the State’s Rural Health • National • Gender and generational issues related to physician recruitment and retention • The efficacy of telemedicine in the provision of mental health in rural areas

45. Advocacy

46. Advocacy Efforts • Collaborative Response • State • OOA • National • AOA • NRHA • Propose legislation • React to proposed legislation • Connect legislators and rural providers

47. Advocacy Agenda • State • Medicaid reimbursement for telemedicine • Reinstate funding for OkAHEC • National • Retain increased reimbursement for primary care physicians • Interest-free loans for starting residency programs in rural, underserved areas

48. Why should you consider a rural practice?

49. After adjusting for cost of living, who earns a higher income? • Rural Physicians • Urban Physicians

50. Physician Incomes in Urban and Rural Areas Reschovsky JD, Staiti A. Physician Incomes in Rural and Urban America. Center for Studying Health System Change. 2005.