OHA Work on Rural Transitional Models

Redefining Rural Health Summit, Oklahoma City, April 2015 

Convened rural health focused staff from 12 state hospital associations (OK, TX, MS, MO, IL, MN, KS, CO, NM, WA, and CA) to learn from each other and identify common themes and discern elements for sustaining rural health services. The group discussed models/ideas states are investigating for sustaining future rural health services. After the summit, a detailed summary report for states that were not in attendance was distributed through AHA channels.

Report to OHA Board, May 2015

Presented a report on the summit and the two promising models chosen for further investigation: the 24-hour outpatient hospital, and the CAH-FQHC hybrid.

OHA’s Council on Rural Health 

The CoRH met several times to look at potential transitional models. At the first meeting a detailed overview and discussion of the Oklahoma City Summit was followed with in-depth discussion of 24-hour outpatient hospital and collocated hospital-FQHC models. The CoRH met again in August to review the Redefining Rural Health Part II (August meeting in Nashville, Tenn.) take-aways, pending federal legislation and next steps in OHA's process. A recurring question from CoRH members has been how they would "engage their communities in the transition discussion."  A simple three-question survey community engagement was put together in the fall. The answers have been tabulated, and it is being put together in a usable form.

Ongoing Work with Transitional Models

24-Hour Outpatient Hospital

The Oklahoma State Department of Health has a current definition for an “Emergency Hospital."  Unfortunately, this was written approximately in 1993 and is much more restrictive in nature than would suit for the model of the 24-hour outpatient hospital. The current emergency hospital license would not allow for outpatient surgical procedures or observation beds. It is our position that the observation beds are crucial for the 24-hour model success. Additionally, if outpatient surgery is supported by the Community Health Needs Assessment, it should be on option for that provider. OHA continues to look at ways that language can be amended to allow more flexibility if a hospital chooses to convert.

CAH-FQHC Hybrid 

While the idea of co-locating an FQHC with a Critical Access Hospital (CAH) (or small rural PPS hospital) is not new, very few examples exist, and there are none in Oklahoma. The model that OHA is working on would constitute an alteration of the common governance structure of a hospital and a slight wavier of the governance requirement of an FQHC. Under this arrangement, the FQHC would be operated as a department of the hospital, and would share administration, back office, lab, imaging, and providers. The benefit for the hospital would be the access to grant funds to expand services to include oral and behavioral health, as well as enhanced reimbursement and access to funds for uncompensated care. In partnership with the Oklahoma State Department of Health, OHA is currently working with three hospitals interested in applying for an FQHC new access point grant.