1. Oklahoma State University Center for Rural Health

2. Where does Oklahoma rank nationally for its health status (1 st is best and 50 th is worst)? 1.33 rd 2.43 rd 3.46 th 4.49th 1 United Health Foundation. 2010. “America’s Health Rankings: 2010 Edition.”

3. Where does Oklahoma rank nationally for its ratio of primary care physicians to total population? 1 1.5 th 2.23 rd 3.39 th 4.49 th 1 United Health Foundation. 2010. “America’s Health Rankings: 2010 Edition.”

4. © 2009 Oklahoma State University The Health Status of Oklahomans 1 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 1 United Health Foundation. 2010. “America’s Health Rankings: 2010 Edition.”

5. What About Rural Oklahoma?

7. How many more people are there per primary care physician in rural Oklahoma compared to urban Oklahoma? 1.25% more 2.50% more 3.75% more 4.100% more

9. © 2009 Oklahoma State UniversityMission 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.

11. © 2009 Oklahoma State University Presentation Overview Center for Rural Health Departments and Program Areas  Medical Education  Clinical Services  Grants and Research  Advocacy

12. Rural Medical Education

13. On average, approximately what % of all graduates from OSU-COM have entered primary care following graduation? 1.45% 2.55% 3.65% 4.75%

15. Approximately what % of graduates from OSU-COM have entered primary care following graduation since 2006? 1.40% 2.50% 3.60% 4.70%

19. © 2009 Oklahoma State University Community Clinic Rotation Sites 2010

20. © 2009 Oklahoma State University Rural Clinic Rotation Sites 2010

21. © 2009 Oklahoma State University Community Hospital Rotation Sites 2010

22. © 2009 Oklahoma State University E.R. Rotation Sites 2010

23. © 2009 Oklahoma State University Medical 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

24. Clinical Services

25. © 2009 Oklahoma State University Clinical Services  Enid Clinic  Primarily Medicare, Medicaid, and SoonerCare

26. Grants and Research

27. © 2009 Oklahoma State University Grant Funded Activities  Annual Grants  State Office of Rural Health  Area Health Education Center  Project Grants  Health Information Technology

28. © 2009 Oklahoma State University Grant 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)

29. Grant 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.

31. © 2009 Oklahoma State University Grant 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

32. At most, how many beds may a Critical Access Hospital have? 1.10 2.25 3.50 4.100

33. May a Critical Access Hospital have an average length of stay of more than 96 hours? 1.Yes 2.No

35. How much more money annually does a typical Oklahoma hospital make by converting to critical access status? 1.$ 42,071.00 2.$ 186,106.00 3.$ 227,449.00 4.$ 291,470.00

36. © 2009 Oklahoma State University Impact 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.

37. © 2009 Oklahoma State University Critical Access Hospitals Flex Monitoring Team. Statewide Financial Performance of CAHs – Oklahoma, www.flexmonitoringteam.org/documents/BriefingPaper7_FinancialIndicators.pdf www.flexmonitoringteam.org/documents/BriefingPaper7_FinancialIndicators.pdf

38. © 2009 Oklahoma State University Critical Access Hospitals Flex Monitoring Team. Statewide Financial Performance of CAHs – Oklahoma, www.flexmonitoringteam.org/documents/BriefingPaper7_FinancialIndicators.pdf www.flexmonitoringteam.org/documents/BriefingPaper7_FinancialIndicators.pdf

39. © 2009 Oklahoma State University Critical Access Hospitals Flex Monitoring Team. Statewide Financial Performance of CAHs – Oklahoma, www.flexmonitoringteam.org/documents/BriefingPaper7_FinancialIndicators.pdf www.flexmonitoringteam.org/documents/BriefingPaper7_FinancialIndicators.pdf

40. © 2009 Oklahoma State University Grant Funded Activities - Annual  Area Health Education Center (AHEC)  Model AHEC Program  State Matching Funds???????  Geriatric Education Center Program

41. © 2009 Oklahoma State University OSU Center for Rural Health’s Services and Activities February 2010

42. © 2009 Oklahoma State University Grant Funded Activities - Project  Health Information Technology  USDA Distance Learning and Telemedicine Grant  Tobacco Tax Funding for Telemedicine

44. Research

45. © 2009 Oklahoma State UniversityResearch  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

46. Advocacy

47. © 2009 Oklahoma State University Advocacy Efforts  Collaborative Response  State  OOA  National  AOA  NRHA  Propose legislation  React to proposed legislation  Connect legislators and rural providers

48. © 2009 Oklahoma State University Advocacy 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

49. © 2009 Oklahoma State University Why should you consider a rural practice?

50. After adjusting for cost of living, who earns a higher income? 1.Rural Physicians 2.Urban Physicians

51. © 2009 Oklahoma State University Physician Incomes in Urban and Rural Areas Reschovsky JD, Staiti A. Physician Incomes in Rural and Urban America. Center for Studying Health System Change. 2005.

54. Who is more likely to be satisfied with being a primary care physician? 1.Urban Physician 2.Rural Physician

55. © 2009 Oklahoma State University Physician Satisfaction in Urban and Rural Areas UrbanRural Pressure to see more patients74%60% Pressure to limit referrals44%32% Pressure to limit treatment options30%15% Satisfied with being a physician79%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.