Survey shows most rural doctors in Southern Kentucky aren’t ready for electronic health records; grant will help them switch

A recent survey found that 63 percent of rural health providers in Southern Kentucky have not installed electronic health records software, so more than 280 of the small and rural doctor practices surveyed could face financial penalties from Medicaid and Medicare if they do not install it by 2015. Federal grant money will help them make the switch.

Many rural Kentucky providers are near retirement and are deciding between making the necessary investment of capital and personnel that is required to make the switch to electronic records or to just close their practice, according to a release from Kentucky Highlands Investment Corp., which led the effort to get the grant

Decisions to close practices and to avoid using electronic health records could be problematic to rural areas in Kentucky, since the state already has doctor shortages, especially in rural areas. If the state expands the Medicaid program under federal health reform, the number of insured patients could increase much more than the number of physicians in Southern Kentucky, an area where many people are uninsured.

“Large hospitals in the region such as ARH, Baptist Regional and others have successfully installed this software, and they are using the system with quality results,” Richard Murch, an IT consultant who specializes in electronic health records and is working on the project, said in teh release. But he said the process is complicated and requires extra staff and resources that are sometimes difficult to find in the area.

The U.S. Department of Agriculture has funded a project called Stronger Economies Together to improve the biomedical and life-science practices in the region. SET plans to provide resources and training to help providers and health systems make a successful switch to electronic health records, which the release said could create about 100 jobs over the next few years.

The survey showed 73 percent of doctors’ practices have asked for help transferring to and using electronic records. “SET reviewed industry sector research to determine health care and health related businesses as the fastest growing business segment of our rural economy,” said Jerry Rickett, president and CEO of Kentucky Highlands. For more information about SET and its partner programs, click here.

Report says veteran suicide rate is up from 2007

Almost every hour in this country, on average, a veteran commits suicide. The Department of Veterans Affairs reported that 22 veterans per day took their own lives in 2010, up four a day from the 2007 rate. Perhaps contrary to public perception, the report said most suicides occurred among veterans over 50. It recognized Vietnam-era veterans as a risk group, as well as female veterans.

Military service members come disproportionately from rural areas. Kentucky has two army posts, Fort Knox and Fort Campbell.

(Among active service members in 2012, more died from suicide than in combat, we reported here. The Army said Friday that 325 soldiers committed suicides last year; if the tentative number is confirmed, it would be a historical high. "If that bleak total remains at 325, the toll in 2012 would have risen by 15 percent over 2011 when the Army sustained 283 suicides," NBC News reported.)

Reactions to the VA report ranged from encouragement to outrage. The VA pointed out that the daily veteran suicide rate has "remained relatively stable over the past 12 years," but the percentage of the overall national suicide rate accounted for by veteran suicide has actually decreased.  Veteran suicides accounted for about one-fifth of American suicides in 2010, down from one-fourth of suicides in 1999.

The VA said that showed its programs are working, but promised to take "immediate actions." NBC reported that "the top strategy" on the VA's agenda was an already-established task force that could help suicide screening identify warning signs earlier.

Some groups were dismayed by the VA report and demanded more action. Iraq and Afghanistan Veterans of America called for more research and collaboration. "The country should be outraged that we are allowing this tragedy to continue," IAVA found and CEO Paul Rieckhoff told NBC.

On Feb. 13, the U.S. House Committee on Veterans' Affairs will hold a hearing on veterans and mental health care. The Veterans Crisis Line -- 800-273-TALK -- is available for veterans who are concerned about their mental health. (Read more)

Fiscal-cliff deal revives program that helps rural hospitals dependent on Medicare; 200 in nation, 10 in Kentucky

Even though most of the hospital industry wasn't happy with the fiscal-cliff deal that will only pay half the $30 billion needed to avoid a 27 percent Medicare fee cut for doctors, the deal gave about 200 rural hospitals, including 10 in Kentucky, reason to celebrate. It extends a program that pays hospitals up to several millions of dollars a year because they have fewer than 100 beds, are located in rural areas and have a high percentage of Medicare patients, Phil Galewitz of Kaiser Health News reports.

The Medicare Dependent Hospital Program was created in 1990 and is one of several payment programs designed to help small, rural hospitals deal with financial challenges that larger hospitals don't face. The program is based on the idea that "some rural hospitals have such a high percentage of Medicare patients they are unable to get enough money from higher paying privately insured patients to make up for the lower government reimbursements," health lawyer Eric Zimmerman told Galewitz.

The program has come under scrutiny. Congress allowed it to expire in September 2012, but two senators from New York and Iowa made sure $100 million for the program made it into the budget deal. The Medicare Payment Advisory Commission said hospitals in the program will receive about 25 percent higher reimbursements as a result of the funding. (Read more)

The Kentucky hospitals in the program are Clinton County Hospital, Fleming County Hospital, Harrison Memorial Hospital, Jewish Hospital Shelbyville, Logan Memorial Hospital, Monroe County Medical Center, Parkway Regional Hospital in Fulton, Rockcastle Regional Hospital, Taylor Regional Hospital and Westlake Regional Hospital in Columbia. The Appalachian Regional Hospital in Williamson, W.Va., is also considered a Kentucky hospital in the program.

Dollar General to sell tobacco in most of its stores by mid-2013, reflecting 'customer demand' and 'competition pressure'

By the middle of 2013, most of Dollar General's 10,000 U.S. stores will carry cigarettes and other tobacco products.. The company has made the decision in response to “competitive pressures” which came about when Family Dollar Stores, a key competitor, began adding cigarettes to its stores last year. In a press release issued by Dollar General, customer demand also drove the company's decision, citing their perception that their core customers -- mostly based in rural America -- are more likely to smoke than the national average.

A 2012 study by the American Lung Association indicated that while rural Americans do smoke more than urban Americans, geography is less a factor in determining who smokes than socioeconomic status. The study also found that pregnant rural women are far more likely to smoke than their urban counterparts. (See actual numbers from the Centers for Disease Control and the American Lung Association study here.)

G. Chambers Williams III of The Tennessean in Nashville reports that business analysts think the idea is a good one for the company, which tested the product placement last year in Nevada. Analyst Mark Montagna with Avondale Partners in Nashville explained that the company found that the average purchase per customer was $14 where tobacco was sold, versus an average of $11 otherwise. But, he added, the one challenge the company will face with tobacco products, additional shoplifting.
Anti-smoking advocates expressed regret at the business choice. (Read more)

Rural Obesity Prevention Tool Kit created to tackle epidemic: 40 percent of rural adults in U.S. are obese

When the Journal of Rural Health recently reported that 40 percent of adults living in rural areas are obese, compared with 33 percent of adults living in urban areas, the size of the disparity was larger than expected and previously estimated. In response to the severity and urgency of the obesity epidemic, the Rural Assistance Center of the U.S. Department of Health and Human Services has created a Rural Obesity Prevention tool kit which contains resources to help communities develop obesity prevention programs. (Read more)

National Rural Health Day to be celebrated Nov. 15 with free week-long issue-based webinar series

Those almost 60 million Americans who live in rural America do not have as much ready access to health care or to the vast number of health care providers than those who live in more urbanized America. Rural Americans are more likely to arrive on the doorstep of health care facilities without insurance, and that number is growing. These challenges and more have prompted the National Organization of State Offices of Rural Health (NOSORH) to designate Thursday, Nov. 15 as National Rural Health Day. The day, explains NOSORH director Teryl Eisinger, is an effort to increase awareness of rural health-related issues. The event has stretched to a week of activities, celebrations and a daily webinar series on rural health-care issues accessible to anyone interested nationwide.

Here's a schedule of free webinars. All times are Eastern Standard.
Monday, Nov. 12, 3-4 p.m., Basics of Rural Health, with Kristine Sande, program director, Rural Assistance Center; Rebecca David, executive director, National Cooperation of Health Networks; Mike Shimmens, executive director, Rural Recruitment and Retention Network.
Tuesday, Nov. 13, 1-2 p.m., Cultural Awareness While Serving Rural Veterans with Jay H. Shore, MPH, Associate Professor, University of Colorado, Denver.
Wednesday, Nov. 14, 2:30-3:15 p.m., Health Resources and Services Administration Rural Health Update with Mary Wakefield, HRSA administrator.
Thursday, Nov. 15, 3-4 p.m., HRSA's Office of Rural Public Health Policy, Celebrating 25 Years.
Friday, Nov. 16, 3 p.m. Looking Towards the Future of Rural Health Care with Randall Longenecker, MD, Rural Training Track Technical Assistance Program and Jim DeTienne, Montana EMS and Trauma Systems.

All webinars will be recorded and made available to the public at www.celebratepowerofrural.org.(Read more)

Tenn. study suggests rural residents have as much access to care as anyone, if they're insured and don't mind the drive

A health-care study in Tennessee, which started with the premise that people in rural areas have less access to care than urban dwellers, ended with a rather surprising conclusion: They don't. Not if they have health insurance. "When it comes to commercially insured patients, there’s little disparity in access to health care between residents of rural communities and urban areas in Tennessee," said Dr. Steven L. Counter, president of the BlueCross BlueShield of Tennessee Health Institute.

How can this be? The study found that almost half of rural residents pass up the hospitals closest to their homes to go to larger urban hospitals, even if the same services are available locally, writes Getahn Ward of The Tenneseean. "The conclusion we came to is that we’re living in a very mobile society, and the distance is not necessarily a determinant factor in whether people get care or not," said Coulter.

Because the survey did not include consumers, it's only a guess about why they chose to take the time and trouble to go to the big town, but experts says it's a combination of services not being available or a perception that they aren't, even if they are. This raises, again, age-old questions about the viability of rural hospitals, some of which often don’t have the money for capital-intensive technology and services. However, Coulter told the Tennessean that "a recent increase in alliances between rural hospitals and larger hospitals and urban health systems raises hopes that non-urban hospitals may be able to expand their menus of services."

Such partnerships between non-profits and for-profit chains are becoming more common, reports Ward, and some say those efforts will change the perception of those in far-flung regions that great medicine is being practiced close-by. This could be especially important, said Wes Littrell, chief strategy officer and president of Nashville-based Saint Thomas Health, in the new world of health reform. “We expect that when you get more into population management that you need to take care of the patient closer to home in the lower-cost setting,” he said. (Read more)

Looking for 'a few short-term wins' to start, Kentucky Oral Health Coalition formally reorganizes

By Amy Wilson
Kentucky Health News

LOUISVILLE, July 25 – There was no whitewashing the ruinous state of the state's teeth Wednesday when the Kentucky Oral Health Coalition formally reorganized with the goal of fixing as much as they can as fast as it can. With almost a fourth of Kentuckians over 65 having complete tooth loss and almost half of children between 2 and 4 already having twice the national average of cavities, there is work to be done on every front.

As the state with the 49th worst-looking mouths in the country, explained Andrea Bennett, senior policy analyst for Kentucky Youth Advocates, "What we're looking for is a few short-term wins."

It appears that the top priority, as voted by the coalition's members, is to improve oral health literacy and education. That means that members will be looking for ways – including maybe getting themselves a celebrity spokesperson – to explain what good oral hygiene is and how to get it.

Close behind in priorities will be efforts to expand school-based oral health services, including for those in Head Start and all child-care settings. Members also expressed a desire to increase the number of Kentucky dentists who accept Medicaid, thus expanding the numbers of those who can be treated.

How they do that is under discussion. The group, which existed a decade ago but lost momentum, has decided to revitalize into a more active, more inclusive, perhaps even more legislatively inclined group. It all depends on its new leadership, said Dr. James Cecil, a national leader in public health and a former University of Kentucky dental school professor.

Cecil, who now works with KYA, a nonprofit whose staff will handle a lot of the coalition's workload, explained that funding for the initial work of the group is expected to come from the renewal of a grant from DentaQuest, a continuous source of funding for Kentucky dental projects for three years. New programs, as drawn up by and agreed to by the new executive committee elected Wednesday, will seek other sources of funding through corporations and other grants, Cecil said. In their current treasury is $20,000, left over from the old KOHC.

The coaltion is now chaired by Laura Hancock Jones, Western Kentucky Dental Outreach Program director in the University of Kentucky College of Dentistry's Division of Public Health. A well-known and well-respected practicing pediatric dentist, she is self-described "passionate" advocate for education and literacy about oral health. She runs a program that provides a fluoride varnish on children as young as 2.

"I have seen how much we've done and it's not been enough," Hancock-Jones said. "We have not moved the needle." The answer, she said, is "from the bottom. You have to talk to the kids." In her own health-department experience, she dogged one family for three years, she said, through the school Family Resource and Service Center, social workers, and eventually the judicial system, to get their children care. Eventually, she did and "the kids are" getting care and thinking "It really is a good thing to go to the dentist."
 
Members of the coalition include dentists, dental hygienists, insurance providers, public health officers, school nurses and students. Donna Ruley, executive director of the Kentucky Dental Hygienist Association, was elected secretary of the group Wednesday. She said she believes it's important that her profession is at the table when talking about dental priorities and potential scope of job description legislation. "Our impact on education is huge," said Ruley. "The legislature just recently passed a public-health hygienist role that would allow for a greater number of people to be taught prevention services without a dentist's supervision." That, she added, is a great need in a lot of far-flung rural reaches of the state.

The vice chair of the group is Linda Poynter of the Kenton County Health Department. The treasurer is Dr. Lee Mayer of the University of Louisville dental school.

Rural health care is a notch below care in urban areas, but its costs are lower and its emergency rooms are faster, study finds

A national study has found a narrow gap between the quality of health care in rural and urban settings, but it does recognize the "significant differences" differences between urban and rural care.

The report is an update to "Rural Relevance Under Healthcare Reform: A Tracking Study," by iVantage Health Analytics, and evaluates performance measures across physician, outpatient, hospital and emergency room settings. According to a press release, the report reveals that in Medicare could save about $7.2 billion if costs per patient were the same in rural and urban settings. The report also finds that for rural patients, physician payments are 18 percent lower and hospital payments are 2 percent lower than in urban areas, but outpatient payments are 14 percent higher. The overall cost per Medicare patient is 3.7 percent lower for rural patients.

Rural emergency care is faster overall than urban emergency room care, with rural patients seeing a doctor 30 percent faster (once the patient gets to the hospital, we should add). This results in fewer hospital admissions. The full report can be accessed here.

Online training could help rural doctors offer better mental health care

More than half of all U.S. mental health care takes place at the primary-care level, and that percentage is even higher in rural areas, where mental-health doctors are often hundreds of miles away, reports Newswise, a research-reporting service. A new online training program could help rural primary-care doctors better treat patients with mental health issues, and that could be important in Kentucky.

The Behavioral Health Education Center of Nebraska, a part of the University of Nebraska Medical Center, designed the program. Educational Director Howard Liu said primary care doctors are overwhelmed by the amount of mental health care they must provide. Newswise reports "the goal is to help primary care providers get more comfortable as they prescribe medications and refer patients to psychiatrists and therapists." The adolescent version of the program was released last fall and is being used by doctors worldwide. The adult and geriatric version will be released this spring.

Primary care doctor Angie Brennan estimates 35 percent of all visits to her practice have been mental health related. She said there are specific rural challenges to treatment, including "reluctance to see a counselor and a lack of mental health insurance coverage – combined with an intensified fear that someone in the community will find out a patient has mental health issues." (Read more)

Sept. 13 forum in Somerset will explore how rural communities can get healthier and get better care at lower cost

"In an era of tight budgets and strained resources, Kentucky and its rural communities can no longer afford 'business as usual' in the delivery of health care services," write Susan Zepeda and Amy Watts of the Foundation for a Healthy Kentucky. "As health care costs increase and health status declines, the question becomes: How can we ensure rural Kentuckians get better health care at lower costs?"

Zepeda, the foundation's president, and Watts, is senior program officer, see "promising opportunities" for rural communities to reshape health care, such as working with local health departments and civic leaders to "create communities that support healthy behaviors" and better integrate the health system, with special attention for the chronically ill.

These and other issues and ideas for rural health are on the agenda of the foundation's ninth annual Howard L. Bost Memorial Health Policy Forum, to be held Tuesday, Sept. 13 at the Center for Rural Development in Somerset. The forum will include state and national leaders. "Rather than wait for solutions from Washington, forum speakers will share strategies Kentucky’s civic leaders can put into place at the local, state and regional levels. Many will share ways that Kentucky is already doing this," Zepeda and Watts write in an op-ed article distributed to Kentucky newspapers.

The keynote speaker will be Dr. Len Nichols, who founded and directed Health CEOs for Health Reform, a group that helped policymakers see that reform of health insurance and health-care can be reformed together. Dr. Kavita Patel, a physician and former RAND Corp. researcher now at the Brookings Institution, will bring insights on how to achieve better care and better health at lower costs. Other experts from Kentucky, Virginia, Tennessee and North Carolina will share "practical policy strategies for positive health change in these challenging times," and smaller sessions will allow participants to engage with the speakers, Zepeda and Watts write, saying the forum's goal is to "provide accessible, safe and effective health care to nearly half of Kentucky’s citizens who call rural Kentucky home." More information is available on the foundation’s website, http://www.healthy-ky.org/.

Patients in isolated rural areas have higher rates of death from chronic obstructive pulmonary disease

Patients with chronic obstructive pulmonary disease living in isolated rural areas "seem to be at greater risk" of death from COPD than those living in urban areas, even when "hospital rurality and volume" are taken into account, says a new study published in the latest issue of the Annals of Internal Medicine.

Researchers from Iowa City Veterans Affairs Medical Center collected data from COPD patients at 129 veterans' hospitals measuring first, 30-day mortality and then adusting for patient rurality, hospital volume, and hospital rurality. The results indicate "mortality was significantly elevated in patients living in isolated rural areas compared with those living in urban areas," regardless of patient and hospital characteristics, reports Doctors Lounge, an online medical resource for physicians, students and allied clinical professionals. (Read more)

Defenders of small, rural hospitals take issue with study that found poor patient outcomes

A recent study that concluded small, rural "critical access hospitals" have poorer patient outcomes and lower quality of care is making waves in the medical community. A federally funded monitoring team from three universities issued a response noting certain weaknesses of the study, which was published in the Journal of the American Medical Association earlier this month.

It's not news that critical-access hospitals "have room for improvement," the team wrote. "What the JAMA authors fail to report is how much CAH scores on the process of care measures have improved over time," it writes. "Our most recent trend analysis, for example, shows that CAH scores on each of the pneumonia measures increased between 9 and 22 percentage points between 2005 and 2009."

The analysis in question was performed by researchers at the Harvard School of Public Health. It focused on nearly 1,300 critical access hospitals and looked at the outcomes of Medicare patients who have congestive heart failure, heart attacks and pneumonia. For all three conditions, CAHs performed at a lower standard. Patients at CAHs were more likely to die, and the facilities were behind in implementing electronic health records. It also found CAHs had a smaller number of specialists like cardiologists working at them than at non-CAHs. "That doesn't sound like news to us, either," said Al Cross, director of the Institiute for Rural Journalism and Community Issues.

"Issues such as the limited supply of primary care providers, home health and hospice services, rather than the supply of specialists, should be the focus of interventions to improve rural health quality," said the Flex Monitoring Team, named after its assignment, to evaluate the Medicare Rural Hospital Flexibility Grant Program. The team is made up of researchers from the University of Southern Maine, the University of Minnesota and the University of North Carolina-Chapel Hill. (Read more)

Writing for the Daily Yonder, Dr. Robert C. Bowman, family-medicine professor at the A.T. Still University School of Osteopathic Medicine in Arizona, also took issue with the study, in part because its findings ran counter to an article that was also published in JAMA last year. That article concluded that "greater proportions of underinsured, minority, and non-English-speaking patients were associated with lower quality rankings for primary-care physicians," Bowman quotes.

"Now JAMA has an article this year claiming lower quality of care in certain types of rural hospitals that are completely different in location, population, funding, and workforce," Bowman writes. "So what happened between last year, when patients made the difference in quality, and this year when it was location of the hospital? ... Why do sophisticated researchers, reviewers, and editors maximize the context of care sometimes (in 2010) and minimize it at other times (in 2011)?"

Bowman, founder of the Rural Medical Educators Group of the National Rural Health Association, took a jab at the researchers. "Do Harvard University researchers associated with hospitals with the most sources of income and the highest reimbursement rates even have the perspective to write about hospitals with the least lines of funding and the lowest reimbursement in each line?"

Though he takes issue with the article, Bowman said the topic "about high and lower quality critical access hospitals" is worthy of research. "Perhaps one of the problems with attempting such research is that there is little variation across rural hospitals. Perhaps that's because the system is designed to spend uniformly less on health care across rural America. . . . The end result is less care and less economic impact from health care in 30,000 zip codes with 65 percent of the U.S. population. And more care delivered in 3,400 zip codes in 4 percent of the land area." (Read more)

Small, rural hospitals with 'critical access' designation have poorer patient outcomes and lower quality of care, study finds

A study has found that small, rural hospitals with the "critical access" designation have poorer patient outcomes and lower quality of care.

The analysis, performed by researchers at the Harvard School of Public Health, focused on nearly 1,300 critical access hospitals, a designation is given to facilities that have 25 or fewer acute-care beds and are more than 35 miles away from another hospital. In return for such concessions as limiting patient stays, CAHs get extra Medicare and Medicaid reimbursements. The Rural Assistance Center reports there are 30 CAHs in Kentucky.

The study looked at the outcomes of Medicare patients who have congestive heart failure, heart attacks and pneumonia. For all three conditions, CAHs performed at a lower standard. For patients treated for heart attacks, CAHs provided care in keeping with Hospital Quality Alliance standards 91 percent of the time, compared to 98 percent at other hospitals. The difference was even larger for patients with congestive heart failure patients (80.6 percent vs. 93.5 percent) and smaller "but still significant" for pneumonia (89.3 percent vs. 93.7 percent), the report says.

Patients at CAHs were also more likely to die. They had higher 30-day risk-adjusted mortality rates for all three conditions than patients admitted to other hospitals. The study also found CAHs behind in the implementation of electronic health records, 6.5 percent to nearly 14 percent.

"Despite more than a decade of concerted policy efforts to improve rural health care, our findings suggest that substantial challenges remain," the study authors write. "Although CAHs provide much-needed access to care for many of the nation's rural citizens, we found that these hospitals, with their fewer clinical and technological resources, less often provided care consistent with standard quality metrics and generally had worse outcomes than non-CAHs." (Read more)

Rural emergency rooms frequented by the poor and uninsured

A new report from the federal Agency for Healthcare Research and Quality shows that low-income adults accounted for 56 percent of the 8 million rural emergency room visits in 2008. In nonrural hospitals, low-income adults accounted for only 30 percent of emergency room visits. According to the report, 44 percent of adult visits to rural emergency departments were paid for by Medicaid, were uncompensated, or billed to uninsured patients. Only 31 percent were paid for by private health plans. In nonrural hospitals, 37 percent of adult visits were paid for by private health plans, and 42 percent were paid for by Medicaid, uncompensated or billed to uninsured patients.

Emergency business is mainly just that for rural hospitals. Only 8.3 percent of rural emergency department visits resulted in a hospital admission, compared to 16 percent of non-rural emergency department visits.

The report also noted the lack of rural hospitals with trauma-level emergency departments. Nationally, only 2.4 of rural emergency departments held any level of trauma designation. Among non-rural emergency departments, 35.5 percent had a trauma designation. Read more here.

In Kentucky, approximately 75 of the state's 130 hospitals are in rural areas, according to the Kentucky Hospital Association. The state has been working to improve its trauma system and will soon begin designating level IV trauma centers in some of the state's smallest hospitals, said Dick Bartlett, emergency preparedness and trauma coordinator for the Kentucky Hospital Association. Already, Marcum & Wallace in Irvine and Livingston Hospital in have met requirements for the designation and will be certified, once the state approves the new level IV designation. (The national report focused on levels I-III; in Kentucky, level I-III are certified by the American College of Surgeons.)

The new designation is part of an effort by Kentucky to improve trauma care statewide. Having a level IV trauma center means better trauma care for Kentuckians injured in rural areas, Bartlett said. "It improves your potential for survival," he said. These hospitals have committed to providing certain levels of staffing, including a board-certified emergency room physician, and to following protocols to quickly decide whether a patient can be treated at their facility or if a patient should be transported to another, higher-level facility.

A map showing Kentucky's current trauma hospitals and those hospitals seeking trauma certification is available here.

Rural Training Track programs get more health professionals to rural areas, but live 'on the edge' of funding and personnel

By Tara Kaprowy
Kentucky Health News

With the Obama administration offering more funding to improve rural health care, Rural Training Track programs to steer medical students to rural areas are hoping to expand, a move that would benefit underserved areas of Kentucky.

"Over 62 million Americans live in rural America and there is a significant crisis in terms of having access to care for these people," said Amy Elizondo, vice president of program services at the National Rural Health Association. "There is a very uneven distribution of health care professionals and an acute shortage of primary care physicians in rural areas. If we can recruit and retain physicians to serve rural areas, we improve access for rural America." (University of Washington map; click for larger version)

RTT programs aim to educate family physician residents in rural environments with the hope they will continue to practice there, Candi Helseth reports in a deailed article for the Rural Assistance Center. "These residency programs are a proven model for addressing rural family physician workforce shortages, with more than 70 percent of graduates praticing in rural areas," Helseth reports. The first such program started in Colville, Wash., in 1985. There are 25 RTTs in 17 states, including one in Morehead by the University of Kentucky and St. Claire Regional Medical Center. Eight physicians have graduated from the program there since it was established in 2000, five of whom are practicing in Kentucky. Of those five, three have joined the SCR medical staff.

There are similar success stories across the country. In Caldwell, Idaho, 95 percent of graduates have chosen to practice in rural areas over the past 16 years. "We heavily recruit residents who are rural-oriented," said Dr. Samantha Portenier, a practicing physician and director of the Caldwell RTT. "We've had some who were not and we converted them. Part of it was that they really saw where the training we give them and the skills they learn are so needed in rural areas. I emphasize that in rural areas you can specialize in areas that particularly interest you."

Despite the success, 10 RTT programs have closed in the past 10 years. "Every RTT lives on the edge in terms of funding," said Dr. Randall Longenecker, who is project director of Rural Training Track Assistance Demonstration Project. "In general RTTs are small, have limited faculty and are vulnerable to personnel changes, a bad year for recruiting, loss of funding and many other factors beyond their control."

Morehead's RTT is funded by St. Claire. Residents spend their first year at the UK College of Medicine in Lexington and their second and third years at St. Claire, which is accredited by the Accreditation Council for Graduate Education. Carla Terry, St. Claire's graduate medical education coordinator, acknowledged the difficulty in maintaining an RTT program. "The reason why the RTTs are in jeopardy is that all the faculty that teach them are voluntary," she told Kentucky Health News. "They are not paid to teach, they still have to keep their patient load. If it were a university program, all the faculty would be paid."

But St. Claire physicians believe strongly in rural-based education and also see how they can benefit from their investment. "We actually had a physician that when he came here he was interested in starting a residency because he wanted to use that as future recruitment," she said. "We look at it as training future partners."

Now, RTTs are under a federal microscope. The health care reform law created the Rural Training Track Assistance Demonstration Project, a three-year pilot program that plans to "collect comprehensive information to better understand the collective forces challenging RTT models and develop solutions that will strengthen existing RTTs and encourage development of new RTTs," Helseth reports.

The time is ripe, given that more medical students are choosing to be family medicine physicians, up by 11 percent last year and 8 percent the year before. "We have a real opportunity here to redefine the importance of primary care being foundational in rural workforces," Dr. Ted Epperly, past president and past board chairman of the American Academy of Family Physicians, told Helseth. "Right now, only 9 percent of physicians are choosing to practice in rural areas while 20 percent of the population lives there. RTTs offer a way to give family physicians a broad scope of practice, which they need practicing in a rural area, and to get them to stay in those rural areas." (Read more)