Rural EMS Summit: Sharing Solutions and Strategies

December 10-11, 2009
Central Virginia Community College
Lynchburg, Virginia

Who should attend? Local Government Officials, EMS Leaders and Providers and Community Healthcare Providers

Register Before November 30, 2009.

The Virginia Office of EMS is sponsoring The Rural EMS Summit to develop strategic initiatives and objectives for a state plan to address the needs of rural EMS agencies in Virginia. The summit is scheduled for December 10 and 11, 2009 in Lynchburg, Virginia.

Despite the improvement in EMS service to the rural areas of Virginia there are some looming problems. In March 2009, participants at a Rural EMS Roundtable function identified a number of deficiencies and prioritized the top three challenges facing EMS agencies in rural areas as

1. EMS Agency Leadership and Management
2. Local government involvement/accountability, and
3. Recruitment and Retention of EMS personnel.

Kevin McGinnis, MPS, EMT-P will be the key note speaker and meeting facilitator. Kevin is the Program Advisor to the National Association of State EMS Officials, a former state EMS director and the author of the Rural and Frontier Emergency Medical Services Agenda for the Future.

This meeting is a collaborative effort of the Virginia Department of Health, Office of Emergency Medical Services and the Office of Minority Health and Public Health Policy Division of Primary Care and Rural Health. Funding for this event is provided through a Health Resources and Services Administration (HRSA) Flex Grant.

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Practicing Excellence: A small-town, rural doctor embraces technology

Here is one small rural doctor's experience with Electronic Health Records!

Practicing medicine takes on a different feel when you're the only doctor in town. But Jim Selenke, MD, the lone physician in Hudson, Iowa, wouldn't have it any other way.

"The rural practitioner has to be incredibly confident in his skills and able to address the unpredictable," says Selenke, a family physician. "You have a lot less control over your schedule. Patients often walk in unannounced with a wide variety of ailments."

One man hurt himself while securing a load to his truck and showed up at Selenke's door with the metal hook of a bungee cord still stuck in his eyelid. There was the elderly woman whose car veered off the road near Selenke's practice before a passerby brought her—unresponsive and without a pulse—to his office. In the midst of performing a well-baby exam, Selenke dashed outside, intubated the woman, and performed CPR before an ambulance arrived to stabilize her.

But patient care is only part of Selenke's job. He handles the landscaping outside his practice, fixes its plumbing, maintains his office computer systems—he even changed the tire on a patient's car recently, a deed that was rewarded with a batch of what he calls the best cookies around.

"In primary care and in a small town, if you want to survive, you put on multiple hats," says Selenke, who is known to everyone in town as "Dr. Jim."

Rural patients tend to be older, poorer, less likely to have private insurance, and more likely to suffer serious injury from accidents compared to their urban counterparts, according to the National Rural Health Association. Plus, Medicare reimbursement tends to be lower, and providers are harder to come by, ratcheting up the pressure on those who serve such areas.

For the most part, Selenke's patient population mirrors the trends typical of rural America: About 40 percent of his 4,000 patients are on Medicare. He practices five days a week and manages to see about 35 patients per day.

He keeps up that prodigious pace with help from his electronic health record system, an investment he made five years ago when he first opened his own practice. He also decided then to maximize his efficiency and lower his overhead by teaching himself what he needed to know to maintain his IT systems. Though going high-tech—and mostly going it alone—was a choice few others in his shoes would likely make, it has made all the difference for Selenke.

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Congratulations to the Shenandoah Area Agency on Aging!

The Shenandoah Area Agency on Aging in Front Royal, VA was honored at the National Association of Area Agencies on Aging (n4a) conference for their "At Home" program, that provides chronic disease management and support to rural homebound seniors.

The National Association of Area Agencies on Aging (n4a) announced the recipients of the 2009 n4a Aging Innovations and Achievement Awards at its annual conference in Minneapolis, MN. This awards program recognizes n4a members and showcases innovative and successful aging services programs that assist older adults and caregivers in communities across the country. The need for successful cost–effective aging services programs is especially important in light of our rapidly growing aging population.

Fifty-three programs received Aging Achievement Awards, of which 16 were honored with Aging Innovations Awards. In addition, the four programs that scored the highest in the review process received monetary awards. Jeffrey Prough, President and CEO of Critical Signal Technologies (CST), sponsor of the awards program, announced the following monetary awards: $2,500 to Tarrant County Area Agencies on Aging (Ft. Worth, TX) for Diabetes Identification and Management Program, a partnership with the local Meals on Wheels program that enables diabetic seniors to receive monthly diabetic education in their homes; $1,500 to Region IV Area Agency on Aging (St. Joseph, MI) for Custom Care—Care Connections of Southwest Michigan, a private pay options to help AAAs respond to customers who are able to pay for customized attention to their needs; $1,500 to the Oklahoma Association of Area Agencies on Aging (Shawnee, OK) for O4A Masonic Assistance Program for Seniors, a program that leverages local resources to fund direct assistance that help older adults maintain their independence; and $1,000 to the Central Plains Area Agency on Aging (Wichita, KS) for Client Assessment Program for Seniors (CAPS), a program that offers free professional in-home mental health assessment and counseling.

“As a company that believes in innovations, CST is thrilled to be involved with the Aging Innovations and Achievement Awards program because we know that the solutions to the aging services needs and challenges all lie in the innovation initiatives at the local level,” Prough said.

The Aging Innovations Awards recognize ground-breaking programs that are innovative and bring fresh ideas to aging programs. The honored programs serve as models for other agencies looking for new approaches to serve the older population within their own communities.

“Area Agencies on Aging (AAAs) and Title VI Native American aging programs are the trusted resources for assistance to older adults and caregivers in their communities. These organizations are the lifeline that provide critical resources that help older adults remain in their homes and stay active and contributing members of their communities as long as possible,” stated Sandy Markwood, n4a CEO.

Sixteen Aging Innovations Awards, the highest honor, were presented to the following:

Shenandoah Area Agency on Aging/Front Royal, VA for At Home – (a program that provide chronic disease management and support to rural homebound seniors)

Alliance for Aging, Inc./Miami, FL for Team Miami: A Community Partnership for Evidence-Based Solutions to Improving Elders’ Health – (a collaborative initiative that addresses the issues of elder Hispanic health disparities)

Central Plains Area Agency on Aging/Wichita, KS for Client Assessment Program for Seniors (CAPS) – (a program that offers free professional in-home mental health assessment and counseling to eligible participants)

Tarrant County Area Agency on Aging/Ft. Worth, TX for Diabetes Identification and Management Program – (a partnership with the local Meals on Wheels program that enables diabetic seniors to receive monthly diabetic education in their homes)

Region IV Area Agency on Aging/St. Joseph, MI for Costume Care—Care Connections of Southwest Michigan – (a private pay option to help AAAs respond to customers who are able to pay for customized attention to their needs)

Elder Services of the Merrimack Valley/Lawrence, MA for Enhanced Supportive Homemaker Program – (a program that increases the capability of homemakers to work with elders who have difficult behaviors)

REAL Services, Inc./Area 2 Agency on Agency/South Bend, IN for Options Counseling and Pre-Screening – (a program that offer long-term care information and education about options to nursing home care)

Aging & Disability Resource Center of Broward County/Sunrise, FL for Senior Intervention and Education Program (SIEP) – (an outreach initiative that evaluates the independent living environment of homebound and isolated seniors)

Southern Maine Agency on Aging/Scarborough, ME for Community Links – (this program offers assistance to older adults being discharged back into the community with unmet physical and social needs)

Area Agency on Aging of Palm Beach/Treasure Coast, Inc./West Palm Beach, FL for Jupiter HeadStart Godparent Program – (volunteer godparents provide resources and assistance to children from low-income families)

InterTribal Council of Arizona, Inc.—Area Agency on Aging/Phoenix, AZ for ITCA-AAA Public Benefits Outreach Project – (a program that educates and counsels tribal elders and individuals with disabilities about Medicare and public benefits)

Generations, Area 13 Agency on Aging/Vincennes, IN for Long Term Care Team – (Case managers work to insure resources and referrals for older discharged patients)

Area Office on Aging of Northwestern Ohio/Toledo, OH for Expedited Meal Delivery for Our Seniors – (program utilizes UPS expertise to delivery nutrition meals to homebound seniors)

Bergen County Division of Senior Services/Hackensack, NJ for Outreach Volunteer Associates Program – (this program advocates for Asian-American seniors and helps them learn about and access available resources)

Metropolitan Area Agency on Aging/St. Paul, MN for Dementia Care Project – (a systems change initiative to increase the detection, diagnosis and care management of dementia)

Oklahoma Association of Area Agencies on Aging/Shawnee, OK for O4A Masonic Assistance Programs for Seniors – (a program that leverages local resources to fund direct assistance that help older adults maintain their independence)

In addition, the 2009 Aging Achievement Awards were given to 37 programs in 14 categories that included caregiving, community planning, ethnic and cultural diversity, elder abuse, healthy aging, intergenerational programs, nutrition, technology, transportation and volunteerism/civic engagement.

The National Association of Area Agencies on Aging (n4a) is the umbrella organization for 629 Area Agencies on Aging (AAAs) and a voice for the 246 Title VI Native American aging programs in the U.S. The fundamental mission of the AAAs and Title VI aging programs is to provide services that make it possible for older individuals to remain in their homes, thereby preserving their independence and dignity. These agencies coordinate and support a wide range of home and community-based services, including information and referral, home-delivered and congregate meals, transportation, employment services, senior centers, adult day care and a long-term care ombudsman program. (www.n4a.org).

Taken from RAC News and Events

Health Care Stories: Western Mass

Could this story have been written about rural Virginia? What do you think? What's different? What's the same?

Taken from: http://bootynovelbill.blogspot.com/2009/08/health-care-stories-western-mass.html

Paula gives us her assessment of rural care in the only state of the Union that requires everybody has health coverage.

Although we each certainly tried our best to burn out at a young age, my husband and I believe we are healthier than many of our contemporaries. He’s 69 and I’m 65. So far, so good. Aside from some predictable conditions that accompany normal aging, we’re fine and hope to keep it that way for a long, long time.

That said, I don’t resent paying for health care. Like most worker bees, I paid for insurance throughout my working days and well into semi-retirement. While I worked for a newspaper, I paid anywhere from 10 to 25 percent of my insurance premium. Later, as a freelancer, I bought my own policy for $615 a month for a mid-level HMO plan, purchased at a discount through a business association. Without group rates, I probably would have paid closer to $900 for an individual policy. That’s per month.

When I was young, single, and had an employer subsidizing my health insurance, I lived near New York City, an area blessed with an abundance of medical resources. There must have been a dozen hospitals in my county alone, and specialists were plentiful. Coincidentally, I was treated for one of each on the menu of all those things you-hope-you never-get. In every single case, I sought out the best medical care available, no matter where it was or what the cost. I had no fear of my insurer not coming up with the goods.

Now, I’m older, married, and self-employed, living in a much poorer, rural area. We each pay about $220 for a combination of Medicare and Medicare supplement, which includes prescription drugs. Compared to what we paid before we qualified for Medicare, it’s a pittance. Plus, under Medicare, our co-pays are smaller. Life is good.

Considering my unhealthy youth, I’m thrilled to say that, at 65, I’m relatively fit and healthy. A hearty thank you to all the docs who’ve treated me over the years, and to the health care plans that paid them.

It’s no exaggeration when I say I owe my current healthy state to good doctoring, prevention, and a strong dose of fear. A couple of scares in my early 50s forced me to get my body under control. Now, the only pills I take on a regular basis are vitamins and occasional OTC pain medication for arthritis.

In this household, we adhere to the Mediterranean diet as much as possible, and we’ve been buying the bulk of our food from local farmers for years. That’s an accident of location, not a political statement. Maybe the best thing my husband and I do for ourselves is spend a few mornings a week at the local YMCA, fending off old age.

In spite of relative good health, my biggest concern involves lack of resources. Where we live, there’s only one hospital (and ER) per county, and that one doesn’t offer a high level of care. Most towns have volunteer ambulance corps. If you think you might want to switch primary care physicians, think again because it’s hard to find one willing to take on a new patient. People often travel 40 miles or more to see a specialist, and they may wait for months for an appointment. That's just the way it is, because there are so few docs and so many old people. You have to work hard to stay healthy, and that's probably a good thing. (According to the obits, many people around here live well into their 80s and 90s. Could be the cold weather, or just the hard life.)

It’s my understanding that Medicare and our Blue Cross/Blue Shield supplement will cover our care at a high-level medical center – Massachusetts General Hospital, for example – if it's necessary and our primary care physician refers us. We’ll see.

I should add that the doctors we do have here out in the hinterlands are accessible, well-trained, and devoted to their patients. They’d have to be, because they work long hours and receive much lower compensation than they would if they practiced near a big city.

Paula
Western Massachusetts