oklahoma state university center for rural health

Oklahoma State UniversityCenter for Rural Health

Where does Oklahoma rank Where does Oklahoma rank nationally for its health status nationally for its health status (1(1stst is best and 50 is best and 50thth is worst)? is worst)?

0% 0% 0% 0%

1. 33rd

2. 43rd 3. 46th 4. 49th

1United Health Foundation. 2010. “America’s Health Rankings: 2010 Edition.”

Where does Oklahoma rank Where does Oklahoma rank nationally for its ratio of primary nationally for its ratio of primary

care physicians to total care physicians to total population?population?11

0% 0% 0% 0%

1. 5th 2. 23rd 3. 39th 4. 49th

1United Health Foundation. 2010. “America’s Health Rankings: 2010 Edition.”

© 2009 Oklahoma State University

The Health Status of OklahomansThe Health Status of Oklahomans11

• 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

1United Health Foundation. 2010. “America’s Health Rankings: 2010 Edition.”

What About Rural Oklahoma?What About Rural Oklahoma?

How many more people are there How many more people are there per primary care physician in rural per primary care physician in rural

Oklahoma compared to urban Oklahoma compared to urban Oklahoma?Oklahoma?

0% 0% 0% 0%

1. 25% more2. 50% more3. 75% more4. 100% more

© 2009 Oklahoma State University

MissionMission

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.

© 2009 Oklahoma State University

Presentation OverviewPresentation Overview

Center for Rural Health Departments and Program Areas

Medical Education Clinical Services Grants and Research Advocacy

Rural Medical EducationRural Medical Education

On average, approximately what % On average, approximately what % of all graduates from OSU-COM of all graduates from OSU-COM

have entered primary care have entered primary care following graduation?following graduation?

0% 0% 0% 0%

1. 45%2. 55%3. 65%4. 75%

Approximately what % of Approximately what % of graduates from OSU-COM have graduates from OSU-COM have entered primary care following entered primary care following

graduation since 2006?graduation since 2006?

0% 0% 0% 0%

1. 40%2. 50%3. 60%4. 70%

79%

58%

71%

65%

59%

72%

65%

61%

61%

63%

71%

53%

57%

53%

64%64%

71%

65%

64% 63%

69%

64%

73%

56%

69%

57%

70%66%

43%

53%

51%

55%

54%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1977

1978

1979

1980

1981

1982

1983

1984*

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

Perc

ent o

f Cla

ssEn

terin

g a

Prim

ary

Care

Res

iden

cy

Graduating Class (Year)

OSU College of Osteopathic Medicine Graduates Entering Primary Care ResidenciesGraduating Classes 1977 to 2010

© 2009 Oklahoma State University

Community Clinic Rotation SitesCommunity Clinic Rotation Sites20102010

© 2009 Oklahoma State University

Rural Clinic Rotation SitesRural Clinic Rotation Sites20102010

© 2009 Oklahoma State University

Community Hospital Rotation SitesCommunity Hospital Rotation Sites20102010

© 2009 Oklahoma State University

E.R. Rotation SitesE.R. Rotation Sites20102010

© 2009 Oklahoma State University

Medical EducationMedical 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

Clinical ServicesClinical Services

© 2009 Oklahoma State University

Clinical ServicesClinical Services

Enid Clinic Primarily Medicare, Medicaid, and

SoonerCare

Grants and ResearchGrants and Research

© 2009 Oklahoma State University

Grant Funded ActivitiesGrant Funded Activities

Annual Grants State Office of Rural Health Area Health Education Center

Project GrantsHealth Information Technology

© 2009 Oklahoma State University

Grant Funded Activities - AnnualGrant 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)

Grant Funded Activities - AnnualGrant 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.

© 2009 Oklahoma State University

Grant Funded Activities - AnnualGrant 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

At most, how many beds may a At most, how many beds may a Critical Access Hospital have?Critical Access Hospital have?

0% 0% 0% 0%

1. 102. 253. 504. 100

May a Critical Access Hospital May a Critical Access Hospital have an average length of stay have an average length of stay

of more than 96 hours?of more than 96 hours?

0% 0%

1. Yes2. No

How much more money annually How much more money annually does a typical Oklahoma hospital does a typical Oklahoma hospital

make by converting to critical make by converting to critical access status?access status?

$42,071.00 $186,106.00 $227,449.00 $291,470.00

0% 0% 0% 0%

1. $ 42,071.002. $ 186,106.003. $ 227,449.004. $ 291,470.00

© 2009 Oklahoma State University

Impact of CAH ConversionImpact 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.

© 2009 Oklahoma State University

Critical Access HospitalsCritical Access Hospitals

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

© 2009 Oklahoma State University

Critical Access HospitalsCritical Access Hospitals

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

© 2009 Oklahoma State University

Critical Access HospitalsCritical Access Hospitals

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

© 2009 Oklahoma State University

Grant Funded Activities - AnnualGrant Funded Activities - Annual

Area Health Education Center (AHEC) Model AHEC Program State Matching Funds??????? Geriatric Education Center Program

© 2009 Oklahoma State University

OSU Center for Rural Health’s Services and OSU Center for Rural Health’s Services and ActivitiesActivities

February 2010February 2010

© 2009 Oklahoma State University

Grant Funded Activities - ProjectGrant Funded Activities - Project

Health Information Technology USDA Distance Learning and

Telemedicine Grant Tobacco Tax Funding for

Telemedicine

ResearchResearch

© 2009 Oklahoma State University

ResearchResearch

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

AdvocacyAdvocacy

© 2009 Oklahoma State University

Advocacy EffortsAdvocacy Efforts

Collaborative Response State

OOA National

AOA NRHA

Propose legislation React to proposed legislation Connect legislators and rural providers

© 2009 Oklahoma State University

Advocacy AgendaAdvocacy 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

© 2009 Oklahoma State University

Why should you consider a rural

practice?

After adjusting for cost of living, After adjusting for cost of living, who earns a higher income?who earns a higher income?

0% 0%

1. Rural Physicians

2. Urban Physicians

© 2009 Oklahoma State University

Physician Incomes in Urban and Physician Incomes in Urban and Rural AreasRural Areas

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

Who is more likely to be Who is more likely to be satisfied with being a primary satisfied with being a primary

care physician?care physician?

0% 0%

1. Urban Physician2. Rural Physician

© 2009 Oklahoma State University

Physician Satisfaction in Urban and Physician Satisfaction in Urban and Rural AreasRural Areas

Urban Rural

Pressure to see more patients 74% 60%

Pressure to limit referrals 44% 32%

Pressure to limit treatment options 30% 15%

Satisfied with being a physician 79% 91%

The overall practice climate in my community is excellent/good

32% 47%

Luman K, Zweifler J, and Grumbach K. Physician Perceptions of Practice Environment and Professional Satisfaction in California: From Urban to Rural. The Journal of Rural Health. Summer 2007.