Dear Colleague:

The activity level here at the Network continues to skyrocket! We have completed our second year and are in the process of finalizing year three plans. At our next Board of Directors meeting on November 23rd the year three strategic plan will be set in motion.

Since August of this year we have added three new partners to NMRHN. Our new partners are the Linn, Putnam and Clark County Health Departments. We are very excited to welcome our new members and look forward to welcoming the other eight county Health Departments as well as our eleven county Ambulance Districts in the NMRHN service area in the near future.

If you recall in the last issue of the Network News, which appeared in late August, one of our recent projects provided 130 scholarships to help fund Advanced Cardiac Life Support (ACLS) computer training for area health providers. This project was developed in conjunction with the Northeast Missouri Area Health Education Center (NEMO AHEC) office in Macon. The project was so well received that through further investigation the Network members put together a plan to fund traveling courses to help our area health providers meet their continuing education requirements. The courses that are to be offered include an ACLS course, two Pediatric Advanced Life Support (PALS) courses, and a Trauma Nurse Core Course (TNCC). This project will be submitted for Board approval in November.

Other Network projects include ongoing involvement in planning a series of managed care forums in the year 2000. This project evolved due to the positive feedback the Network received as a result of co-sponsorship of a managed care forum during Kirksville College of Osteopathic Medicine's (KCOM) Founders Day events in September.

We are also pleased to report valuable Network relationship building activity occurring with the Federal Outreach Grant project to build a prenatal care network in six counties within our service area. We want to thank everyone that has offered his/her expertise and time to assist in this planning process. We look forward to continuing to work with area health providers to develop a strong network. There has also been a great deal of progress with the Heartland Physicians Corporation (HPC), the local Independent Practice Association (IPA). NMRHN is helping to build a provider network through assisting in HPC development. We will continue to assist with this effort any way we can. Another ongoing collaborative effort in the Network is with PIRMCA (Providing Improved Rural Medical Care Assess, Inc.), a non-profit corporation newly established to serve Sullivan, Putnam and Mercer Counties. We look forward to strengthening this relationship in the future.

As you can see we have much to be excited about here at NMRHN, and I am sure you will agree there are many tremendous possibilities for continued growth and progress in improving health care delivery in our service area. With your help, we can achieve our mission! Please do not hesitate to offer suggestions and/or comments at any time. We value your support!

Robert Jackson, D.O.
NMRHN Project Director

As discussed in the August issue of Network News, the Critical Access Hospital State Plan continues to be a top priority of NMRHN. Monitoring of the state plan has been ongoing at the Network. At our August Board of Directors Meeting members passed a resolution to set aside the remaining funding in the year two budget for critical access conversion expenses, if needed, for our three qualifying rural hospital partners. These expenses may include community education on Critical Access Hospitals (CAHs).

In September the Network sent a letter to Marc D. Smith, President, Missouri Hospital Association (MHA), listing concerns of the Network members regarding the CAH State Plan status and the delay in implementation. Mr. Smith promptly replied with a letter addressing the member concerns. According to the letter, the CAH process was interceded earlier this year with MHA and its members, Governor Carnahan, several state legislators, and the director of the State Department of Health (DOH) to move the process forward more rapidly.

As of April 29, 1999, senior DOH staff and MHA's Task Force on Rural Hospital Issues agreed on the criteria for CAHs and had received tentative approval of these criteria from the Health Care Financing Administration (HCFA) on July 16, 1999. In the interim, MHA also funded preliminary feasibility studies at two rural hospitals to assist DOH in understanding the key operating and financial characteristics of facilities that might benefit from the program. NMRHN provided the funding for two Network members' feasibility studies and MHA funded the third member's study.

On August 6, 1999, CAH packets were forwarded by MHA to all Missouri hospitals. The three CAH qualifying Network members are currently in early stages of completing applications. Mr. Smith stated that it would appear that several of the six Missouri institutions completing applications could qualify for conversion to critical access status by the end of 1999. Also, it is Mr. Smith's understanding that DOH intends to make potentially necessary statutory or regulatory changes after CAH applications have been received to ensure that the specific needs of these communities are accommodated. We will continue to provide updates on CAHs in future additions of Network News.

A forum entitled, "Managed Care Aspects for Osteopathic Medicine", was held on September 30 from 6-9 p.m. at the Travelers Hotel in Kirksville. The event was co-sponsored by the Northeast Missouri Rural Health Network, Kirksville College of Osteopathic Medicine (KCOM), KCOM's Pre-Doctoral Training and Faculty Development in Family Medicine Grant Program and Northeast Regional Medical Center.

Margaret Wilson, D.O., served as moderator for the program following a dinner. Ray Stowers, D.O., spoke on the "National Study of the Impact of Managed Care on Osteopathic Physicians", and "OMT Coding" was covered by Judith O'Connell, D.O. Roundtable discussions and leaders were: "Insights from the Colorado Study" by Harold Magoun, D.O., "Legal Aspects of Managed Care" by Bruce Dubin, D.O., "Tips on Contracting" by Jill Williams and "Peer Review in the Next Millennium" by Gregory Laiben, M.D. The evening concluded with Dixie Tooke-Rawlins, D.O. speaking on the topic of "The Impact of Managed Care on Medical Education".

NMRHN will be continuing its effort to provide educational opportunities on Managed Care by co-sponsoring a monthly series on the related topics and aspects beginning in January of 2000. KCOM's Pre-Doctoral Training and Faculty Development in Family Medicine Grant Program will be coordinating these events. Sessions planned include Patient-Physician Relationships, Quality Management in Healthcare, and Prevention and Health Maintenance. Additional informational will be included in our next issue of Network News. If you are interested in attending please contact the Network office.

Kirksville College of Osteopathic Medicine
Robert Jackson, D.O., NMRHN Director
Richard Mercer, D.O.
Frank Colton, Ed.D.

Northeast Missouri Health Council
Brooks Miller
Margaret Wilson, D.O.
Joan Brundage

Northeast Regional Health System
Charles M. Boughton
Ranee Brayton
Richard Valuck, D.O.

Hospice 2000
Ron McCullough
Gaylah Sublette

Pershing Memorial Hospital
Phil Hamilton

Putnam County Memorial Hospital
Ray Magers

Sullivan County Memorial Hospital
Martha Gragg

Linn County Health Department
Dean Gordon

Putnam County Health Department
Nettie Lewis

Clark County Health Department
Janet Nixon

Staff
Tania Sharp, NMRHN Coordinator
Glenna Daniels, Adm. Assistant

As you may recall, NMRHN provided funding in the amount $4,000 to each of the eleven county ambulance districts in the Network service area to be used for emergency service training and equipment purchases.

On behalf of NMRHN we wish to apologize to Marcia Dial, Administrator, Scotland County Ambulance District, for emitting the ambulance district name from the August issue of the Network News. The Schuyler County Ambulance District name was mistakenly attached to the Scotland County Ambulance District report and the Schuyler County report was emitted altogether. The Adair County and Macon County reports also had some equipment purchases emitted. We have corrected our errors in this article. In our rush to publicize the success of the ambulance districts we overlooked some important items. Please accept our sincerest apologies. Thank you all for submitting these reports in a timely manner.

Scotland County Ambulance District utilized the funding to purchase the following equipment: crisis manikin, Tutor I ECG data selector, Tutor Module 35 ACLS, Tutor Module 42 CCU/ICCU, intraosseous simulator, cricothyrotomy simulator, Rescue Randy manikin, casualty simulation kit, pneumothorax manikin, mini torso model, four EMS 12th edition field guides, five BLS intermediate field guides, human skeleton and a heart model.

Schuyler County Ambulance District used funds for two instructors' training registration, lodging and BLS CPR course instructor fees, BTLS training costs, and rescue diving classes. Equipment purchased included an intubation manikin, updating CPR manikins, TV and VCR for training tapes, TVIEW XGA cable and copier.

Adair County Ambulance District distributed the funding for dispatcher training including tuition, instructional materials, instructors' fees, and travel expenses. Also purchased was a Laerdal Airway manikin and Bronchial Tree assessory for airway management training.

Macon County Ambulance District disbursed funding for both adult and pediatric training equipment including intubation manikins, laryngoscope with case, Rush Miller and MacIntosh blades (plus Simulaids replacement arms, hands, bones, skin and lungs), and an automatic external defibrillator/combitude trainer. Video training tapes/CD software were also purchased.

Knox County Ambulance District purchased a crisis manikin, PALS update kit, ECG Tutor I Data Selector, Tutor Module 35 ACLS and a farm tractor for training with the funding. Also, update training expenses for BTLS, ACLS refresher course, critical care class and training videos for CEU classes were provided.

Look for reports from the Putnam and Sullivan Counties Ambulance Districts in the next issue of Network News. Thanks again to all individuals who submitted funding reports.

Thanks to the telemedicine lines NMRHN members have been able to attend three additional meetings this past quarter from their home facilities. This linkage has saved members valuable work time by allowing them to participate and not spend the time driving to Kirksville from Unionville, Milan and Brookfield.

This equipment is also beneficial to Network members by allowing local physicians to give and receive pertinent information from doctors in other areas.

KCOM and Pershing Memorial Hospital are currently being converted to the new lines. NMRHN plans to continue in the financial support of the telemedicine program to insure availability of usage to our members.

To date NMRHN has expended $2,600 to provide Advanced Cardiac Life Support (ACLS) computer training to area healthcare providers. An additional $2,600 remains in this fund for the training. If there are others in the Network service area in need of this training, please submit requests to NMRHN office at (660) 626-2500. This project was developed in conjunction with the Northeast Missouri Area Health Education Center (NEMO AHEC) Office in Macon.

Pending approval additional traveling courses may soon be offered on Advanced Cardiac Life Support, Pediatric Advanced Life Support and Trauma Nurse Core Courses.

The Northeast Missouri Rural Health Network is dedicated to improving the health of the residents and communities and the education of health care professional. Its service area is the northeast region of Missouri and includes the counties of Adair, Clark, Knox, Lewis, Linn, Macon, Putnam, Schuyler, Scotland, Shelby, and Sullivan. It is committed to achieving improvement through collaboration, coordination, and sharing of services and resources among its members. This commitment includes agreement on mutual goals, a jointly developed organizational structure, shared responsibilities, mutual authority and accountability, and a sharing of resources in the best interest of the residents and communities being served.