Organization Newsletter

Nov. 2017

In this issue...

  1. Member/Sponsor Activity Highlights
  2. Getting to Know Your Board Member - Teresa Gall, Treasurer
  3. Dedicated Student Wins Rural Health Scholarship
  4. National Rural Health Day!
  5. Ocean Beach Hospital Goes Live on Epic
  6. 2017 Values Recognition Award
  7. St. Luke's Receives Region's Only Driving Simulator
  8. Healthier WA Hub Updates
  9. Keeping You in the Know
  10. A Rural Epiphany
  11. Photo Contest!
  12. Last but Not Least....


Welcome to the
November 2017 issue of the Washington Rural Health Association e-Newsletter.
Inside this issue you will find news and information from the Executive Director and board of directors, members, and community partners from across the state of Washington. 

If you would like to submit your own story, please click here.

The WRHA e-newsletter is a publication of Washington Rural Health Association, a not-for-profit association composed of individual and organization members who share a common interest in rural health. This e-newsletter seeks to disseminate news and information of interest to rural health professionals and stakeholders to help establish a state and national network of rural health care advocates.

WRHA Members

WRHA members include administrators, educators, students, researchers, government agencies and workers, physicians, hospitals, clinics, migrant and community clinics, public health departments, insurers, professional associations and educational institutions. If you are interested in joining or renewing your membership with WRHA click here.


Member and Sponsor Activity Highlights!

Submitted by:  Beionka Moore
[email protected]


The Washington Rural Health Association views its relationship with sponsors and underwriters as a partnership that is vital to our mission.  Sponsors to the WRHA are a visible embodiment of our commitment to change and improvement in rural communities.  Your investment generates dividends for WRHA by supporting its mission of advocacy, preservation and improvement of rural health!   Please consider becoming an organizational sponsor TODAY!


Pfizer, Inc.

Washington Academy of Family Physicians


Health Facilities & Planning Management

Ocean Beach Hospital & Medical Clinics

Office of Rural Programs at the University of Washington School of Medicine 

Summit Pacific Medical Center

Willapa Harbor Hospital 

Welcome New Organizational Sponsor!! 

Wilderness Medical Staffing, Inc.

After working as a Nurse Practitioner in Alaska and Montana for nearly 20 years, Mary Ellen Doty—President and founder of WMS—came to understand the importance of providing high-quality healthcare in remote and rural areas.  She also came to understand the need for a northwest-based healthcare staffing company that could specialize in staffing these areas with top-notch medical personnel.

With this knowledge and understanding, Mary Ellen started Wilderness Medical Staffing. WMS began as a grassroots Alaska company with the mission to provide excellence in locum tenens medical care in any location, under any circumstances. And now, they have expanded their services to Washington! WMS has grown exponentially over the past 6 years, but they continue to maintain a personal touch and 24/7 availability. Wilderness Medical Staffing has an abundance of experienced, available providers ready to serve rural Washington.

WRHA is excited to welcome Wilderness Medical Staffing, Inc. to its list of corporate sponsors and to Washington State!  They've already begun making an impact working with rural hospitals in Moses Lake, Republic, and Zillah.  We look forward to working together!  

For more information contact: 
Doug Kelley
Director of Operations
Wilderness Medical Staffing, Inc.
Phone: (406) 241-0492
Fax: (406) 794-0687

  Welcome to Autumn!  Now the duration of daylight becomes noticeably shorter and the temperatures cool down considerably.

  One thing is certain, that’s change.  Like the leaves change their colors, so do the times.  I hope we are strong enough to endure what’s to come.
  Speaking of change, we’ve been working hard at revitalizing the association website. 


  Our website now has a newer, fresher look and even more resources to assist you.
Take a look at the new today!

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Getting to Know your Board Member!

We'd like to introduce the Board of Directors Treasurer, Teresa Gall:

Q:      Please tell me your name, where you work, title, your role with WRHA and how long you have been a board member?
Teresa Gall, Tri-State Memorial Hospital, Controller, Treasurer at WRHA and been a board member for 7 months

Q:     How did you first become involved with the Washington Rural Health Association?
I first learned about the WRHA after I started at Tri-State.  In the last 7 months I have had the opportunity to become more involved.

Q:      There are several rural health organizations in Washington State. Why did you choose to work with WRHA?
WRHA is a smaller organization which is trying to make a difference in rural health.  I wanted to be involved in making a difference.

Q:      Why is Rural Health important to you?
Rural health is important to me because I was born and raised in a rural area.  My family still lives in a rural area.  Without access to rural health patients would have to travel long distances to reach the necessary services.

Q:     What has surprised you most about working with Washington Rural Health Association?
The number of Washington hospitals which are not members of the association.

Q:     What is the best part of working with WRHA?
WRHA is out to make a difference in health care no matter how big or small.

Q:     What do you see as some of the most challenging issues facing WRHA and Rural Health in our state?
One of the most challenging issues is the decrease in the amount of reimbursement for services.  The insurance companies are continually trying to cut the reimbursement while patients are getting sicker and supply costs are increasing.

Q:     What do you wish other people knew about Washington Rural Health Association?
WRHA is driven to make a difference in regards to rural health and the legislation.

Q:     If you could change one thing about Washington Rural Health Association what would it be?
A:     Nothing at this time.

Q:    Do you volunteer for any other organizations? Why do you feel it is important to volunteer?
I am the treasurer for Parkway Elementary where my children attend school.  I am also the treasurer for the Warabay Booster Club.  This is a non-profit which supports the karate school my husband and children attend.  It is important to volunteer and get involved to make a difference for my community, family and friends.

Q:    How do you like to spend your time outside of work and volunteering?
A:    Outside of work and volunteering I spend my time camping, fishing and most of all spending time with my family.

Q:    What might (someone) be surprised to know about you?
I like to garden.  It is relaxing after a long day in the office.

Q:    What do you think will change about Washington Rural Health Association over the next five years?
A:    In the next 5 years the WRHA will continue to grow its membership and take a stance for rural health care.

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Pacific Northwest University Student Has Rural Healthcare Commitment Rewarded with NHSC Scholarship

Submitted by:  Paul Bubluski
[email protected]

"I feel honored to be chosen as one of this years' scholars," said PNWU's Renae Hepfner (OMS III), smiling as she reflected on the goals that she's placed before herself.  Recently, Hepfner was awarded the National Health Service Corps (NHSC) Scholarship, a competitive award gifted to exceptional students pursuing primary care health professions training in Health Professional Shortage Areas.  "There are a very small number of people who apply that actually receive the award, so I was very surprised to find out that I was a finalist."  Less surprised at the news was Erin Hepner, an Assistant Professor of Family Medicine at PNWU who has seen the commitment of the award-winning student firsthand.  "Aside from being hardworking, intelligent, sensitive, self-aware, compassionate, and concerned for others well-being, Renae comes from a small, rural community that has few qualified medical clinicians," said Professor Hepner.  "She personally experienced living and working in a low-resource setting, both as a community member and as an EMT.  She genuinely desires to help people and improve the profession through service to others by providing primary healthcare in a shortage area such as the one she grew up and later worked in as a medical professional."  "I know that I wouldn't have received the scholarship if I didn't have the support from my family, friends and professors," added Hepfner.  "The mission of the National Health Service Corp is to bring health care to rural and underserved areas, and that is also the mission of PNWU and the main reason why I chose this University.  My goals and dreams have always been focused on serving a community in need.  This scholarship will be a great avenue for me to accomplish those goals."
Congratulations to Renae!

       National Rural Health Day!

Submitted by: Pat Justis
[email protected]

Please join Washington State Office of Rural Health in the celebration of National Rural Health day on Thursday, November 16th.  Each year the National Organization of State Offices of Rural Health and its partners set aside the third Thursday of November to celebrate National Rural Health Day (NRHD).  NRHD is an opportunity to “Celebrate the Power of Rural.”   The National Organization of State Offices of Rural Health is the membership association of the nation’s 50 State Offices of Rural Health.  State Offices of Rural Health are anchors of information and support for rural communities, health professionals, hospitals and clinics across the nation.  They are dedicated to collaboration, education, communication and innovation to improve health in small towns around the country.


At the link above you can find a National Rural Health Day toolkit with:

  • social media messages
  • press releases
  • public service announcements
  • postcards
  • table tent cards
  • posters
  • display ads
  • a coloring book
  • ideas on ways to celebrate
  • NRHD swag
  • logos
  • Walk with a Doc

What will the Washington State Office of Rural Health do?
For the second year we are pleased to partner with the Eastern WA Area Health Education Center to offer an elementary and middle school curriculum on rural health. Students complete the classroom activity together and conclude by drawing what rural health means, and selected drawings will make it into our 2nd annual 2018 National Rural Health Day Calendar, which we plan to distribute far and wide.  Our team cherishes our 2017 National Rural Health Day Calendar which has some of best looking carrots we have ever seen. As Elizabeth in 4th grade said, " Rural health means the love of our town." Or as Carter in 4th grade said, " In a rural town you live close to family and friends and wide-open spaces to breathe in the fresh air."  Kids told us rural health means "Farm wheat, nurses, good hospitals, the ambulance that goes to faraway places to help someone that's hurt, healthy and safe family, growing your own food, clean water, healthy food, clean air, people helping others even if they live in a different town" and more.  Our workforce team members and their colleagues in Washington Resource Group will host a National Rural Health Day Event at Pacific Northwest University in Yakima with the Family Medicine Club.  Fourteen rural Washington healthcare employers will be meeting with medical, physician assistant, nursing and pharmacy students about opportunities.  Students will also have a lunch time talk about state and federal scholarship/loan repayment programs.

We have also nominated some Washington State Community Stars to be featured in a national book and visual display.  Please consider joining us and plan your own activity to celebrate the power of rural.


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Ocean Beach Hospital Goes Live on Epic

Submitted by:  Larry Cohen, CEO
Ocean Beach Hospital, Ilwaco, WA
[email protected]

Ocean Beach Hospital and Medical Clinics "OBHMC" has signed an agreement with Providence Health & Services Community Connect to implement a shared electronic health record (EHR) system known as the Providence build of Epic.  Epic is the most highly rated EHR available today.  The EHR will connect patients and providers electronically, enabling higher quality, more personalized care throughout the region.  Whenever patients are seen at OBHMC or a Providence facility, health care providers will be able to work from the same comprehensive, continuously updated electronic record, creating real-time access to information.  The ability to access patient records online will help providers deliver coordinated care and improve the quality of health care available across the region.  Once a record has been entered into the EHR, it will be available system wide for Epic users to view, utilize, and update as needed.  Lab tests ordered in the clinic will now be automatically resulted back the clinic, eliminating the manual process under which we've had to work.  In Epic, the record follows the patient, so any Epic user or facility will have access to the most current patient information.  Implementation of the new EHR at OBHMC was scheduled for October 21, 2017.  Once the system connects physicians from more than 34 hospitals and 475 clinics from Alaska to Montana and as far south as Southern California.  Every facility will have secure and immediate access to the same medical records which will result in maximized efficiency and highly coordinated care for patients. 

ABOUT OCEAN BEACH HOSPITAL AND MEDICAL CLINICS: Ocean Beach Hospital and Medical Clinics (OBHMC) was founded in 1934 and currently resides in its third location.  OBMHC is committed to providing you with quality, patient focused care.  Our teams of skilled healthcare professionals are here to help meet your medical needs and answer questions you may have about your health and care needs.  OBHMC provides its community a 24/7 Emergency Department staffed by trained emergency medicine physicians.  As a Critical Access Hospital, OBHMC is licensed for 25 inpatient beds and boasts an active 'Swing Bed' program, where patients needing a lower acuity care setting can rehabilitate (if medical necessity is met) from surgeries, hospital stays and other healthcare events.  OBHMC is home to state of the art laboratory equipment and a full suite of diagnostic imaging services including X-ray, CT, MRI, Ultrasound, Mammography, Nuclear Medicine, Cardiac Echo and Bone Density testing.  The Ocean Beach Medical Clinics (OBMC) is comprised of 4 physicians (Internal Medicine, General Surgery, Medical Oncology and Orthopedic Surgery), 4 Nurse Practitioners and a Physician Assistant (more are being recruited to staff the Ocean Park Clinic to open in January, 2018).  Additionally, we provide ambulatory cardiology, urology, podiatry and cataract/laser services.  OBMC is here to provide high quality primary care and specialty services, there is no need to leave the County to receive quality and cost effective care (call 360-642-3747). 

ABOUT PROVIDENCE HEALTH & SERVICES: Providence Health & Services is the third largest not-for-profit health system in the United States and its services include 34 hospitals, 475 physician clinics, senior services, supportive housing, and many other health and educational services.

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 Pat Justis Receives 2017 NOSORH Values Recognition Award

Submitted by:  Ashley Muninger
National Organization of State Offices of Rural Health
[email protected]

Pat Justis, Executive Director of the Washington State Office of Rural Health, has received the 2017 NOSORH Values Recognition Award from the National Organization of State Offices of Rural Health (NOSORH).  Justis received her award during a ceremony at the organization's annual meeting in Savannah, GA.  NOSORH was established in 1995 to serve as an influential voice for rural health concerns and promote a healthy rural America through state and community leadership.  The organization presents its Recognition Award each year to an individual or group who has been supportive of State Offices of Rural Health at the state, regional and national level, and has assisted them in their efforts to improve the health status of rural Americans.
Nominations for the award are accepted each year from NOSORH members and several national and federal partners.  Lindy Vincent, FLEX Program Coordinator, nominated Justis for this award and says, "While always a strong support for rural, this past year Pat has taken the lead on several policy issues in Washington and moved rural health policy and quality of care further.  She has worked to help design new payment models for the smallest, most vulnerable Critical Access Hospitals and Rural Health Clinics in the state, always considering the issues and needs of the most vulnerable populations in her work.  She also started an initiative to ensure that rural residents in Washington have access to care across the lifespan and across the health spectrum." 

For more information on NOSORH, visit: 

For more information on the Washington State Office of Rural Health, visit:

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 St. Luke's Receives Region's Only Driving Simulator to Address Community Needs


Submitted by: Meagan Pierluissi
[email protected]

The region's first and only virtual reality driving simulator is in place at St. Luke's Rehabilitation Institute, giving patients realistic experiences and practice behind the wheel after an injury or illness.  St. Luke's acquired the simulator thanks to grants from the Craig H. Neilsen Foundation, Empire Health Foundation and Providence Health Care Foundation.  The STISIM Drive-Occupational Therapy (OT) system is an interactive, virtual reality driving simulator that allows St. Luke's therapists to help patients with spinal cord injuries, brain injuries, strokes and other physical injuries.  With this in-clinic technology, in- and outpatient participants are able to regain confidence and independence re-learning safe driving skills without the stress of potential hazards of on-road driving.  "We value the collaboration and contributions of these generous organizations to help St. Luke's support a community need with this advanced driving simulator," said Nancy Webster, hospital administrator for St. Luke's Rehabilitation Institute.  "Part of our patients' recovery is to gain confidence and independence as they return to their communities, and simulated driving may be part of their therapy goals."  The STISIM Drive-OT system includes approximately 80 scenarios resulting in an accurate and realistic road simulation.  The simulator tests patients for vehicle control and reaction time; divided attention; memory, planning and navigation; passing/merging/hazard perception; and longer more complete drives with the goal of assessing driving ability before an on-road driving evaluation.  Find out more at


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Healthier Washington Practice Transformation Support Hub Updates

Submitted by:  Rebecca Snyders, Qualis Health
[email protected]

CMS Proposes New Medicare Payment Billing Codes for Behavioral Health Integration in FQHCs and RHCs

Good news for Federally Qualified Health Centers (FQHC) and Rural Health Centers (RHC) that are integrating behavioral health and primary care!  The Centers for Medicare and Medicaid Services has proposed rules for 2018 that would allow FQHCs and RHCs to bill for behavioral health integration services, chronic care management and the Collaborative Care Model using two new codes specific for the FQHC/RHC settings.

The two codes are GCCC1 (General Care Management Services, minimum of 20 minutes per month) and GCCC2 (Psychiatric CoCM, minimum of 60 minutes per month).

The final rule is likely to be published in early November for January 2018 implementation.  More information about the proposed rules and a “cheat sheet” are available from the University of Washington’s Advancing Integrated Mental Health Solutions (AIMS) Center here.

Upcoming Learning Opportunities from the Healthier Washington Practice Transformation Support Hub

Save the Date!

“Integrated Care and the Expanding Role of Nurses”
January 9, 2018
SeaTac Marriott Hotel

This one-day workshop offers ideas to expand the skillsets of nurses and nursing supervisors working with behavioral health patients in integrated care settings. Tracks include:

  • The role of nurses in integrated behavioral health or primary care settings
  • Addressing opioid use disorders
  • Supervising nurses on an integrated care team

Registration and location information will be available soon!

For more information contact the Hub Help Desk:  [email protected]


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 Keeping You in the Know


Supplemental Medical Review Contractor (SMRC): 
StrategicHealthSoutions, LLC, was selected by CMS to conduct nationwide medical reviews on vulnerabilities identified by CMS. StrategicHealthSolutions offer a variety of important information from their website including Completed Medical Review Projects, Current Projects, Discussion/Education Periods, Documentation Requests and Hot Topics. 
Learn More:  JE   JF

The New Medicare Card:
There is a name change for the project formerly known as the Social Security Number Removal Initiative (SSNRI).  CMS worked with Medicare Administrative Contractors (MACs) to mail a letter in September with a Fact Sheet on this topic for provider preparation and timeliness activities.  This letter indicates the Medicare Beneficiary Indicator (MBI) will be available as an inquiry option on MAC portals beginning June 2018.  CMS outreach commercials regarding “Guard Your Card” have begun.
Learn More:   JE     JF

Noridian Medicare Portal (NMP) Cost Report Functionality:
Noridian’s portal now offers Part A provider’s access to submit cost reports through the portal and to follow the status of those portal-submitted cost reports. Training is planned for October/November and details are available on their websites:

Now Available: Qualifying APM Participant Look-Up Tool:
CMS has announced the results of the first Qualifying APM Participant (QP) determinations based on eligible clinician participation in the 2017 Advanced Alternative Payment Models (APMs).  We have unveiled an interactive look-up tool where many 2017 Advanced APM participants can look up their QP status based on calculations from claims with dates of service between 1/1/17 and 3/31/17 for the first QP snapshot.

Under the Quality Payment Program, eligible clinicians who meet certain criteria are considered QPs in Advanced APMs, and are therefore excluded from the MIPS quality reporting program. QPs identified based on the 2017 performance year will receive a 5 percent lump sum Medicare incentive payment in 2019.  The tool will be updated soon with calculations from claims with dates of services between 1/1/17 and 6/30/17.

The Methodology Fact Sheet is an excellent resource to understand how we determine QP Status.  In addition, the supplemental service payments fact sheet, which reflects the supplemental service payments included in our APM Incentive Payment calculations, is now available.

Medicaid enrollment opened Nov. 1 — Are You Ready?
Open enrollment for Medicaid and private plans started November 1. The federal budget for promoting enrollment was dramatically cut this year, so it’s going to be up to states and providers to ensure that residents get signed up for health coverage.

NRHA member focused on prevention of rural suicides
In her latest piece for RAC Monitor, NRHA member Janelle Ali-Dinar, PhD, focuses on the reasons behind the rising rural suicide rate.  “With a growing shortage of mental and behavioral health providers, in rural areas a primary care provider is the often the only care provider available,” she writes.  “Also, since many use the emergency room as their first point of entry, they might not ‘self-identify’ with mental health symptoms but rather seek care for other physical symptoms that have underlying mental health causes.”

Hospital licensing fee increase of $15 per bed effective November 30
Hospitals are beginning to receive hospital bed licensure renewals, reflecting the $15 per bed increase.  The fee increase is to cover fire safety inspections required by state law and performed by the State Fire Marshal’s Office.

CMS and SAMHSA have released “A Roadmap to Behavioral Health,” a guide to using mental health and substance use disorder services that may be helpful in rural communities.

62 Critical Access Hospitals to Know 2017
Becker's Healthcare announced the 2017 edition of the "62 critical access hospitals to know" list, highlighting 62 of the nation's certified critical access hospitals.  Two CAH’s in Washington State are amongst the esteemed list.
Critical access hospitals have 25 or fewer inpatient beds and the annual average length of stay is 96 hours or fewer for acute care.  These hospitals also offer 24/7 emergency care and must be located at least 35 miles away from any other hospital.

The hospitals featured on this list were chosen based on superior performance and reputation.  Becker's Healthcare editors selected the following hospitals based on awards and rankings for respected organizations, including iVantage Health Analytics, Healthgrades, the National Rural Health Association, Women's Choice Award, Leapfrog Group and Medicare star ratings.  The team also considered the hospital's community impact and reputation for innovation.

Kittitas Valley Healthcare Hospital (Ellensburg, Wash.). Kittitas Valley Healthcare Hospital serves 41,000 residents in Kittitas County, Wash. The hospital holds community roundtables several times a year to discuss local health initiatives and collect feedback. KVH Hospital received the American Heart Association and American Stroke Association's Get With The Guidelines-Stroke Gold Plus Quality Achievement Award in 2017. The hospital plans to open a new occupational service line in fall 2017.

Whitman Hospital and Medical Center (Colfax, Wash.). Whitman Hospital and Medical Center serves a 1,200-square-mile district and includes 47 physicians on staff. The 25-bed critical access hospital opened in 1968 and is governed by five elected commissioners who serve six-year terms. The National Rural Health Association named Whitman Hospital and Medical Center one of the Top 20 Critical Access Hospitals in the U.S. in 2013 and 2014, and iVantage Health Analytics named the hospital a HEALTHSTRONG Hospital in 2014. 

Average dental premium costs $350 per year – is that worth it?
The average individual dental premium costs $350 a year and oftentimes patients have to spend more in out-of-pocket costs every year because of the rising prices of dental care, according to The San Diego Union-Tribune

Here's what you need to know:
1. Most dental premiums emphasize prevention and diagnostics, covering two annual exams and cleanings, as well as additional x-rays for children and older adults.  However, dental premiums can also cover larger expenses, such as fillings, root canals and crowns.
2. While dental premiums range from $228 to $384 annually, the average individual pays an additional $500 in out-of-pocket dental expenses.
3. Most dental plans cap coverage at $1,500 a year and unlike health insurance dental plans don't deny coverage for pre-existing conditions.
4. Dental insurance comes in three varieties: health maintenance organizations, preferred provider organizations and indemnity plans.
5. At the end of 2016, around 66 percent of Americans had dental benefits.

Rural Health Care Services Outreach Program Accepting Applications  
The Federal Office of Rural Health Policy (FORHP) has announced that it will be accepting applications for its Rural Health Care Services Outreach Program through December 6, 2017. Successful awardees will receive up to $200,000 a year for three years to improve healthcare access in rural communities by implementing evidence-based or promising practice models. Applicants may apply under the regular Outreach track for projects that focus on any health-related topic, or under the newly created track addressing cardiovascular disease called Health Improvement Special Project (HISP).  
Source: Federal Office of Rural Health Policy

Here is the updated version of the Emergency Preparedness Manual including Policy and Procedures for RHCs.  This version will help you complete the process of documenting your efforts to comply with Emergency Preparedness regulations.
Here is the link:
Emergency Preparedness Policies and Procedures Template (124 page Word File)

The following link below is a special webpage with just Emergency Preparedness resources for RHCs.
Here is the link:
Emergency Preparedness Resources Webpage

Two actions Trump took on Healthcare

President Donald Trump signed an executive order Thursday, October 12, to ease restrictions on association health plans, short-term insurance coverage and health reimbursement agreements.  Later in the day, he ended cost-sharing reduction subsidies to insurers — a move that will take effect immediately with no transition period.

Here are nine things to know about the cost-sharing reductions and the executive order:

1. The Trump administration announced Thursday that it will no longer reimburse insurers for cost-sharing reductions, which help offset the cost of providing health insurance to low-income Americans on the exchanges.
2. The administration shared the following on its reasoning for the change: "Based on guidance from the Department of Justice, the Department of Health and Human Services has concluded that there is no appropriation for cost-sharing reduction payments to insurance companies under Obamacare. In light of this analysis, the Government cannot lawfully make the cost-sharing reduction payments."
3. The House of Representatives sued the Obama administration in 2014, claiming CSR payments to insurers were never appropriated by Congress, thus making them illegal. Judge Rosemary M. Collyer of the U.S. District Court in Washington sided with the House, finding Congress had never appropriated the money. The Obama administration appealed, arguing that there was in fact an appropriation. Since then, the Trump administration continued the payments from month to month, even though Mr. Trump has made his opposition to the payments clear.
4. The administration will discontinue the payments immediately. Without the payments, which were expected to total $9 billion next year, payers will likely increase premiums or exit the exchanges altogether in 2019, according to The New York Times. Payers already increased premiums for 2018 in anticipation of discontinued subsidies and are locked into providing coverage next year.
5. With his executive order on health plans, President Trump provided directions to several federal agencies to draft changes in their own regulations and align them to do three things: allow more employers to form association health plans, expand the maximum length of short-term health insurance coverage and increase the usability of HRAs and employers’ ability to offer HRAs.
6. Under part one, the EO directs the Labor Department to change its rules and allow small businesses in the same line of work or the same trade organization to band together and purchase insurance plans, according to The Hill. These Proposed association health plans would be exempt from ACA regulations, including essential benefit requirements, according to The Washington Post.
7. The order also instructs the HHS, the Treasury Department and the Labor Department to expand the limit on short-term health plans from their current three-month cap to 12 months.
8. President Trump also asked the agencies to reduce regulations on health reimbursement arrangements, which allow employers to put pre-tax dollars in employee accounts to cover future medical expenses. The order wants HRAs be able to help cover premium costs.
9. President Trump instructs HHS, the Labor Department and the Treasury Department to report to him within 60 days with their proposed rule changes for association and short-term plans, while he set a 120-day timeline for the HRAs. However, changes will likely not affect insurance coverage until 2019, according to The New York Times. The federal agencies must now go through a rule-making and comment process to implement the directives, which typically takes several months

CDC releases strategies for implementing antibiotic stewardship at small hospitals

The Centers for Disease Control and Prevention (CDC) recently released Core Elements for Implementation of Antibiotic Stewardship Core Elements at Small and Critical Access Hospitals.
Read this PDF for more information.

Improving antibiotic stewardship in hospitals is critical to improving patient outcomes. Antibiotic use has well-known unintended consequences, including Clostridium difficile infection and
other adverse events. Additionally, antibiotic use is an important driving factor in the growing crisis of antibiotic resistance.

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A Rural Epiphany

Submitted by: Danielle Bienz, M.Ed.
[email protected]

Just a little over 100 miles east of Seattle sits the city of Ellensburg, WA.  Here, local residents enjoy the city's historic buildings, a Labor Day rodeo, as well as year-round recreation.  This was the last place University of Washington medical student Alex Martinez told me he thought he would be spending his summer.  Alex grew up in Warden, a small town east of Ellensburg, home to about 2,600 people.  At a young age, Alex knew that medicine was his passion.  He remembers becoming aware of the differences in resources in urban versus rural areas.  This difference in the access to care sparked 'an appreciation for the value of doctors'.  Medical school was always part Alex's journey and during his first year at the University of Washington School of Medicine, he participated in the Rural Underserved Opportunities Program (RUOP).  Placed at Community Health of Central Washington, Alex found himself in a familiar setting. "At first I wasn't excited about my placement.  I grew up in Eastern Washington and enjoyed Seattle and urban living," Alex told me during our interview, "But I'm so glad I was placed there."   As part of the RUOP curriculum, Alex was paired with Dr. John Asriel, a family medicine physician, for a four-week clinical immersion experience.  Throughout his experience, Alex noticed a very common theme among the healthcare providers.  " The clinic and the hospital are very involved in the community.  A lot of the residents and the attendants are very involved in the community, and would tell me about events, where I should go, what I should see.  That part was my favorite, how close knit the community was."  Those four weeks in Ellensburg had a larger impact on his medical education than Alex could have ever imagined.  He had not thought about practicing in a rural area or in family medicine.  When asked if his RUOP experience changed his ideas about being a rural physician Alex was quick to reply, "It really did!  I feel like being in an area that's more resource limited, the family medicine doctors are responsible for a lot.  The breadth of everything they were responsible for,  they're the main resource for their patients."  Alex was, in his words, 'bummed' as his final days of RUOP approached.  He was enjoying his time in the clinic and spending time in the community.  When Dr. Asriel informed Alex that the clinic was a new WRITE site, doors of opportunity opened.  WRITE is the WWAMI Rural Integrated Training Experience, a 22-week longitudinal clerkship, that pairs students interested in rural primary care with a site for an integrated clinical experience.  "One day I got an email that there was an opening in Ellensburg and I had to fight the urge to say yes right then.  After taking the weekend to think about it I knew I had to do it.  I immediately wanted to say yes, and I couldn't come up with a reason why I don't want to go because I really loved it over there."  Alex will begin his WRITE rotation in September of 2018 at Community Health of Central Washington.  I joked with him that it sounded like he had a 'rural epiphany' last summer.  He laughed, explaining, "My training in Ellensburg will be beneficial where ever I end up practicing medicine.  I'll learn valuable skills that will stay with me."   And although he is still not set on a specialty and rural practice is not a 'for sure' just yet, he is excited to return to Ellensburg.  "I'm looking forward to the longitudinal experience, seeing patients several times over, and the fact that we remember each other is awesome.  That's what I love most about primary care, building relationships with patients and being able to be in Ellensburg for five months, it will be an even better experience." 

RUOP and WRITE are two of the three rural programs within the newly established Office of Rural Programs at the UW School of Medicine, led by Assistant Dean of Rural Programs, Dr. John McCarthy. 
For more information please contact Danielle Bienz at [email protected].

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National Rural Health Day Photo Contest!




The third Thursday in November has been set aside to highlight rural communities as wonderful places to live and work, increase awareness of rural health-related issues, and promote the great work that is happening in those communities.  Washington Rural Health Association is having a photo contest to celebrate National Rural Health Day on November 16th!  Show us how you Celebrate the Power of Rural! 

Send your photos to: wrhadir[email protected], along with a photo title no later than Friday, November 10th.  Photos will be posted on our website and our Facebook page.  Voting will begin Monday, November 13th and end Wednesday, November 15th.  The winner will be announced on National Rural Health Day. 

The winning photo will be set as our Facebook cover photo and featured in our December e-Newsletter!  No more than 2 entries per person.  Let's see how YOU celebrate the Power of Rural!

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Last but not Least, More Items of Interest....




After 25+ years of service, WRHA understands the unique challenges of reaching rural health professionals.  They trust us to advocate for them, provide education and share opportunities.  WRHA enhanced its sponsorship offerings by adding a NEW advertising opportunity to engage and excite rural health leaders and build brand loyalty for your company.

WRHA’s e-Newsletter is sent bi-monthly to all subscribers with valid email addresses.  The electronic newsletter provides updates on government updates, funding, and educational opportunities, as well as national news that impact rural health.  Become a featured contributor and write an article or contribute a photo/video feature!

Article Guidelines:

Suggested word count is usually ballpark of 500 words, but shorter (video with a unique intro or personal, patient stories) or longer is always fine if you feel you’ve kept the readers’ interest. Guideline for rural health news: it should be accessible, understandable, and there must be a point or message that’s worth sharing.

Submit your Newsletter article via our ONLINE FORM. URLs and email addresses within each ad will be live links. Ads without URLs in the copy can be linked to your site if a web address is provided.


  • QUARTER page advertisement in the WRHA e-Newsletter for one-year (6 publications)


  • HALF page advertisement in the WRHA e-Newsletter for one-year (6 publications)
  • Recognition and logo placement on WRHA printed marketing materials
  • Social Media recognition on Facebook, LinkedIn, and Twitter

WRHA has over 150 professionals who are: hospital CEOs, CFOs, CIOs, CNOs, clinic administrators and staffs, state policy makers, physicians, nurse practitioners, physician assistants, nurse midwives, dentists, pharmacists, optometrists, specialists, educators, researchers, state health officials, public health and nonprofit leaders, recruiters, students, financial service providers, all interested in rural health care.  Join your voice with other WRHA supporters by completing the form below to become a sponsor or join the membership.  See all sponsorship levels & benefits on our website!!

The Washington Rural Health Association (WRHA) is a nonprofit 501(c)(3) organization.  Your contributions are tax deductible to the extent allowed by law.  Consult your tax adviser for more information.


Monday, March 26-March 28, 2018 the Northwest Rural Health Conference will take place. This popular event is co-hosted by Washington Rural Health Association (WRHA).  This largest gathering of rural health professionals in the Northwest will be held in beautiful Spokane, Washington at the Davenport Grand Hotel.  With more than 350 conference goers, it is a robust atmosphere filled with hard-working rural health advocates sharing best practices and ideas to leverage valuable resources and achieve organizational and community goals.  Once again, sessions will be content-rich and delivered by experts doing the work! Complete details will be available online at the end of November.

Call for Presentation Abstracts for the Northwest Rural Health Conference
The 2018 Northwest Rural Health Conference Call for Abstracts is out and ready for you to read and distribute as you like. You can follow this link  ...or see our:   'CALL FOR PRESENTATION' FLYER

WRHA awards ceremony honors true examples of authentic leadership, genuine dedication, and commitment to the rural health community. One of the best experiences in your professional life may be when the people that you work with or for acknowledge your efforts. 

The award is given each year at the conference to outstanding individuals and organizations in the field of rural health who have dedicated their time and talents to improving the health and well-being of others.  We are looking to recognize individuals and organizations that are not just serving patients, but are making their entire communities healthier.

Please consider nominating an individual or organization that has made a significant positive impact on rural health in Washington State for this year's ceremony. Nominees do not have to be members of WRHA to be eligible for these awards. Nominations may be made by any member of WRHA.

Awards ceremony will take place on Tuesday, March 27th, from Noon to 1:00 PM. WRHA will accept online submissions only. Send all nominations and supporting materials to: Nominations.

The Categories Include: Leadership; Outstanding Contribution; Friend; Future of Rural Health and Outstanding Practitioner. What better way to encourage and keep great people in the field of rural health than to recognize their contributions. To make the process even easier for all of you – the association has created an on-line submission form (http:// The page describes the categories for nomination and at the bottom lists past winners.

Nomination Deadline: February 1, 2018. Additional information, questions or requests can be directed to:  Beionka Moore, WRHA, Executive Director, [email protected]

Also, we encourage you to join us your annual membership meeting. Come see how membership has grown and reestablish connections at our Annual Membership Meeting, March 27, 2018. 


Join the discussion, connect with us! Share your stories and ideas, get the latest news, and act to help preserve rural health care and access in Washington state!  Please head over to Facebook, Twitter or LinkedIn and look us up at WASHINGTONRURALHEALTH!  

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