T H E U N I V E R S I T Y O F A R I Z O N A

Center for Rural HealthA N N U A L R E P O R T 2 0 1 3 - 2 0 1 4

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The Center for Rural Health (CRH) - serves Arizona through its mission to “improve the health and well-ness of rural populations.” Established as the Rural Health Office in 1981 with funding from the U.S. Department

of Health and Human Services, it coordinates statewide rural

health initiatives. Center staff, faculty and collaborators have

expertise in population, rural and border health; rural and

critical access hospitals; community health centers includ-

ing rural health clinics (RHCs) and federally qualified health

centers (FQHCs); health workforce assessment, planning and

policy development; community engagement; service-learn-

ing training; practice based research; and rural health policy

development, implementation and assessment.

The Center houses programs funded in part by the state, the Health

Resources Services Administration (HRSA) and other sources to

support the Arizona State Office of Rural Health (AzSORH), the Ar-

izona Rural Hospital Flexibility Program (AzFlex), and the Arizona

Small Rural Hospital Improvement Program (AzSHIP). In 2014,

CRH collaborated with Dr. Doug Taren as Principal Investigator for

the Western Region Public Health Training Center, with other State

Offices of Rural Health, awarded for fiscal years 2015-17.

From the Rural Health Office (RHO) founding director - Dr. Andy

Nichols, to Alison Hughes MPA who transitioned the RHO, found-

ed the Center for Rural Health (CRH) and served as its first Director,

to Dr. Gary Hart and Dr. Neil MacKinnon, to its current Director,

Dr. Dan Derksen - the Center has worked closely with community

partners to improve health outcomes and access to quality health-

care, and reduce health disparities. Attribution for success extends

broadly to these leaders, particularly the partners, staff and faculty

who have tirelessly committed to the Center’s mission for more

than three decades.

The 2014 Center for Rural Health Annual Report highlights

achievements over the last year, identifies challenges and oppor-

tunities for 2015, and builds on the storied history of the partners

dedicated to improve the health of all Arizonans, but especially

those living in rural areas.

A classic get-together with Alison Hughes, Andy

Nichols and others.

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The Arizona State Office of Rural Health (AzSORH) – addresses ongoing and emerging health needs in rural Arizona. Continuously

funded since 1990, AzSORH is an initiative of the Federal Office of

Rural Health Policy (ORHP), Health Resources and Services Admin-

istration (HRSA), U.S. Department of Health and Human Services

(DHHS). SORHs are a focal point in each state for rural health. The

program provides an institutional framework linking rural com-

munities with State and Federal resources to develop long-term

partnerships and solutions to improve rural health.

The AzSORH five core activities are to:

1 Serve as a clearinghouse of information and innovative

approaches to rural health services delivery – such as

collecting and disseminating innovative approaches to

providing high quality, cost efficient care, distributing trusted

health insurance coverage information, and improving access

to rural women’s health;

2 Coordinate state activities related to rural health to avoid

duplication of efforts and resources - engaging and convening

rural stakeholders in policy development, strengthening rural

health planning and collaboration;

3 Identify Federal, State, and nongovernmental rural health

programs and provide technical assistance to public and

private, nonprofit entities serving rural populations - building

local skills and capacities;

4 Strengthen Federal, State, and other partnerships in rural

health – working with individuals, policy makers, state and

federal agencies, health providers and institutions;

5 Promote recruitment and retention of a well trained health

workforce - training the next generation of rural health

professionals, enhancing the rural health workforce,

collecting and analyzing data to inform health policy, using

3RNet to recruit health professionals to rural areas, providing

state loan and scholarship information to health professional

students and residents to encourage practice in rural Arizona

after graduation.

The nation’s health system is undergo-

ing dramatic transformation. Arizona is

at the leading edge of change, and faces

unique challenges and opportunities.

The 2014 Top Five Factors Improving the

Health and Wellness of Rural Arizonans

Included:

1 Restoring Medicaid coverage to uninsured childless adults < Federal Poverty Level (FPL).

• 2014 Outcome: Restored Medicaid cover-age to 266,504 uninsured childless adults from 1/1/14 through 10/30/14 in AHCCCS (Arizona Health Care Cost Containment System).

2 Expanding Medicaid coverage from 100% FPL to 138% FPL as allowed by the ACA.

• 2014 Outcome: Covered 31,019 Arizo-nans.

3 Covering the uninsured in Arizona’s Feder-ally Facilitated Health Insurance Marketplace.

• 2014 Outcome: 120,071 selected plans; 85% paid premiums.

4 Enhancing choice, decreasing premiums in Arizona Marketplace health plan offerings.

• 2014 Outcome: Insurer and plan choices increased from the first enrollment period 10/1/13 to 4/30/14 to the second 11/15/14 to 2/15/15; plan premiums dropped 10%; Arizona is the 2nd lowest state in silver pre-miums and 5th lowest in bronze premiums.

5 Reversing the rise in hospital uncompensat-ed care seen during the great recession when hospital uncompensated care skyrocketed from 3.5 to 8.2% of revenue from 2009 to 2012.

• 2014 Outcome: State and federal policy interventions 2013-14 increased Critical Access Hospital Pool funding, decreased uncompensated care, and covered more uninsured in AHCCCS and the Marketplace. The federal/state AHCCCS payments to CAHs will increase from $1.7 million in FY 2014 to $8.8 million in FY 2015.

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COLLECTING AND DISSEMINATING INFORMATION

Conference and Forum Updates - the 2014 Center for Rural Health stakeholder survey and conference evaluation summaries

reveal that the Center’s two large conferences receive high marks,

provide timely information, allow for important networking

between individuals and organizations, and serve a crucial

convening function for leaders to advance rural health.

a) Annual Arizona Rural Health Conferences - The 40th An-nual Arizona Rural Health Conference was held August 2013 in Prescott, Arizona. More than 160 attendees participated from across Arizona. The 41st Annual Rural Health Conference

was for the first time held in conjunction with the 9th Annual

Performance Improvement Summit for Critical Access Hospi-

tals, with over 175 attendees. The PI Summit brings together

Critical Access Hospital CEOs, CFOs, CNOs, Quality Managers,

and IT personnel.

b) Rural and Public Health Policy Forum – is held at the state capitol in Phoenix in partnership with the Arizona Rural

Health Association and the Arizona Public Health Association.

The Forum addresses current rural and public health policy

issues and their impact on Arizona’s rural and tribal commu-

nities and provide information on organizations legislative

priorities for the upcoming session. Over 75 people attended the January 17, 2014 Forum.

Engaging and Convening Rural Stakeholders in Policy Development - AzSORH attends, facilitates and convenes public meetings, webinars, round tables and forums for ongoing and

emergent rural health issues, beyond the two large meetings each

year. The Center Director serves on the Board of the Arizona Rural

Health Association, the Arizona Academy of Family Physicians,

the SPS Telemedicine/Telehealth National Advisory Board,

and the Presbyterian Health System Quality Board and Chaired

the American Academy of Family Physicians Commission on

Governmental Advocacy, is on the Arizona Hospital and Healthcare

Association Small and Rural Hospital Constituency Group, and

serves on the Steering Committee for the Arizona Department of

Health Services initiative – the Arizona Health Improvement Plan

(AzHIP). All Center Staff are in AzHIP working groups including

Access to Well Care/Health Insurance, Healthcare Associated

Infections, Oral Health, Overweight/Obesity, and others.

Rebecca Ruiz at the annual Rural Health

Conference.

MPH students Jay Smitt and Sara Andrus were

active participants in the 41st Annual Rural

Health Conference.

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The Center actively worked with other state and national groups

advancing rural health in the last year including the National

Rural Health Association, the National Governors Association,

the Arizona Public Health Association, Arizona Alliance for

Community Health Centers, St. Luke’s Health Initiative, Children’s

Action Alliance Arizona, Pew Charitable Trusts, the National

Association of State Offices of Rural Health, Arizona Area Health

Education Center, and the new Center for Population Science and

Discovery at the Arizona Health Sciences Center.

Disseminating Coverage, Access and Quality Rural Health Information – about Medicaid Restoration, Medicaid Expansion, Arizona Marketplace, Access to Health Care, and the Uninsured.

Dr. Derksen gave 30 invited presentations to 2,300 attendees in 15

communities in 2013-14, and was quoted and interviewed in more

than 60 print, radio and television media articles and programs.

Dr. Eng provided information at public events to educate, inform

and assist uninsured Asian Americans/Pacific Islanders in Pima

County with coverage options, as PI of a CMS Navigator grant. CRH

staff gave public presentations, posted information on the CRH

website, shared information in letters and publications, provided

webinars, gave in-depth telephone and email technical assistance,

and used social media to disseminate information. The Center

provided one-third more technical assistance than the previous

fiscal year, to 455 clients.

Table 1. AzSORH Technical Assistance 7/1/13-6/30/14 7/1/12-6/30/13

In-Depth Telephone, Email Interactions 545 695

Webinars 140 109

Teleconference 312 403

Face to Face 2343 1278

Other 216 192

TOTAL 3556 2677

Total Clients Receiving TA 455 415

Strengthening Rural Health Collaboration and Planning - AzSORH builds and sustains vital connections between groups

with similar goals, providing technical expertise for new and es-

tablished rural health networks, and community health planning

efforts.  For example, in 2014 AzSORH worked with communities to

develop plans to reduce health disparities in Pima County, San Luis

and Flagstaff. In addition, AzSORH collaborates extensively with

the Arizona Department of Health Services to recruit and retain

health professionals to practice in Arizona, to educate health pro-

viders about appropriate opiate prescribing and to reduce deaths

from prescription drugs, to improve health outcomes (AzHIP), and

to develop a statewide network of community coalitions focused

on reducing health disparities for racial and ethnic communities. 

Will Humble, Director of the Arizona Depart-

ment of Health Services (ADHS), speaking at the

41st Annual Rural Health Conference.

Tuly Medina, Thomas Ryan and Amanda

Aguirre from the Regional Center for Border

Health listen intently during a general session.

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Improving Access to Rural Women’s Health - AzSORH is a founding member of the Arizona Rural Women’s Health Network,

which coordinates programs and services to improve access to

evidence-based, culturally relevant care for women and their

families. The Arizona Alliance for Community Health was awarded

a 3-year network development grant this year to enhance rural

women’s health in Arizona.

BUILDING SKILLS AND CAPACITIES

Providing Technical Assistance – the AzSORH and AzFlex offered webinars on funding opportunities through the Federal Office of

Rural Health Policy. Webinars included ‘Review of HRSA’s Rural

Health Network Development Planning Grant Program’ (Dec 2013

and Nov 2014), ‘Review of HRSA’s Rural Health Care Services Out-

reach Grant Program’ (Sept 2014), and recorded and posted on the

Center website.

Training the Next Generation of Rural Health Providers / Enhancing the Rural Health Workforce - the Center for Rural Health manages Arizona’s component of the National Rural

Recruitment and Retention Network (3RNet) for Healthcare

Professionals - a clearinghouse for over 5,000 communities across

the country. Medical professionals connect with federal, state,

local, and other medical staff recruiters. Arizona 3RNet provides

assistance to medical professionals seeking positions in rural

and/or underserved Arizona facilities, and to medical facilities

offering employment opportunities. AzSORH collaborates with the

Arizona Department of Health Services, Bureau of Health Systems

Development, and the Arizona Alliance for Community Health

Centers to recruit and retain healthcare professionals in rural

areas. Rural communities receive technical assistance on retention

strategies such as analyzing the benefits and challenges of living

in rural areas, addressing workforce shortages, and meeting

professional development needs.

COLLECTING AND DISSEMINATING DATA TO INFORM HEALTH POLICY

Arizona Rural Health Workforce Research - The CRH released “The Supply of Physician Assistants, Nurse Practitioners, and

Certified Nurse Midwives in Arizona” in 2014. Partially funded

by the Arizona Area Health Education Center (AHEC), such health

workforce data, analysis and reports underscore the CRH role as

a primary information source to inform health workforce policy

for rural Arizona. At: http://crh.arizona.edu/publications/studies-

reports .

Len Kirschner.

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Arizona Rural Hospital Flexibility Program (AzFlex) – In 1999, the Center for Rural Health initiated the AzFlex Program, with

funding from HRSA’s Medicare Rural Hospital Flexibility Program

that began after the Balanced Budget Act of 1997. Today, 15 rural Ar-

izona hospitals have Critical Access Hospital (CAH) federal desig-

nation. CAHs are located in a rural area, have less than 25 inpatient

beds, are 35 miles or more from another facility, staff a 24-hour

Emergency Department, and maintain acute care status by aver-

aging less than 96 hours for an inpatient stay. Medicare reimburs-

es CAHs on a reasonable cost basis for inpatient and outpatient

services. Enhanced reimbursement through Medicare and state

funding (such as the Arizona CAH Pool), help sustain these crucial

safety net services in rural communities. In the last year, AzFlex

completed 18 site visits to 11 of the 15 Arizona CAHs.

AzFlex offers support and technical assistance to Arizona CAHs in

the following four core areas:

Performance and Quality Improvement - Quality and Perfor-mance Improvement projects include helping CAHs use tools like

the Hospital Consumer Assessment of Healthcare Providers (10

of 15 Arizona CAHs use HCAHPS), report on outcome measures in

Hospital Compare (11 of 15 reported on at least one measure), and

because the admission and discharge data for a specific diagnosis

can be too small for the purposes of comparison – 14 of Arizona’s

15 CAHs participate in data collecting and reporting through the

Medicare Beneficiary Quality Improvement Project (MBQIP). CAHs

are working on projects to improve the patient experience includ-

ing “Quiet at Night,” “Pain Management,” and “Physician Commu-

nication.” AzFlex convened Directors of Nursing and Quality from

12 CAHs in its Quality Network, used Team STEPPS methodology

(an evidence-based teamwork system to improve communication

among health professionals), to provide technical assistance for

Quality Directors, and participated in the Arizona Department

of Health Services quality committee on Healthcare Associated

Infections. Thirteen of the 15 Arizona CAHs attended both the 2013

and 2014 Performance Improvement Summits, with 100% of the

evaluations ranking the meeting from good to excellent, and many

written comments supporting the decision to hold it in conjunc-

tion as a separate track with the Annual Rural Health Conference.

Operational & Financial Improvement - AzFlex supports efforts to improve CAH operational and financial performance improvement.

One key sponsored event is the Western Region Flex Conference held

yearly. AzFlex supports leadership staff and board members from

AzCAHs to attend this conference and gain important information to

improve operational and performance strategies. AzFlex also hosts an

annual Performance Improvement Summit. This year the summit was

held in conjunction with the 41st Arizona Rural Health Conference.

Jendean Sartain, Board Member Cobre Valley

Regional Medical Center and Neal Jensen, CEO

presented on the Center’s community health

needs assessment and plan.

Cochise Regional Hospital, Douglas – LIFELINE

Air Ambulance, at Cochise Regional Hospital in

Douglas, Arizona, transporting a local resident

to a Tucson tertiary center.

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SANTA CRUZ

COCHISEPIMA

YUMA

PINALGRAHAM

GREENLEE

MARICOPA

LA PAZ

GILA

YAVAPAI APACHE

MOHAVE

COCONINO

NAVAJO

NewMexico

ColoradoUtah

ARIZONA

Nevada

California

Mexico

Zuni Reservation

Ramah Navajo Reser

Ute MountainReservation

Ft ApacheReser

Navajo Reservation

HopiReservation

Camp VerdeReser

YavapaiReser

San Carlos Reser

Salt RiverReser

Gila RiverReser

Ft McDowell Reser

Tohono O'odham Reservation

San XavierReservation

Maricopa ReserGila Bend

Reser

Ft YumaReser

Cocopah Reser

HavasupaiReservation

HualapaiReservation

Ft MojaveReser

ColoradoRiver Reser

Chemehuevi Reser

PaiuteReser

Kaibab Reser

MoapaRiver Reser

Phoenix

Sierra Vista Southeast

Sierra Vista

Tucson

Yuma

Mesa

Goodyear

Buckeye

Scottsdale

Peoria

Parks

Kaibab

Oljato-Monument Valley

h

Blythe

Needles

Nogales

Rio Rico Southwest

Rio Rico Northwest

Rio Rico Northeast

ElginSonoita

Green Valley

East SahuaritaBenson

SahuaritaVail

Three Points

Drexel HeightsTucson Estates

Tanque Verde

Catalina FoothillsCasas AdobesPicture Rocks

AjoAvra Valley

Oro Valley

Marana

CatalinaSan Luis

San Manuel

Fortuna FoothillsEloy

Gila Bend

Casa GrandeClifton

Buckeye Queen Creek

ChandlerGilbert Gold Camp

Cibola GlobeApache JunctionTempeAvondale

Paradise Valley

Ehrenberg

Fountain HillsSun City

Glendale

Quartzsite

Surprise

SalomeWenden Cave Creek

Tonto BasinWhiteriverNew River

ParkerBlack Canyon City

Young

Congress

Show LowPayson

Peeples Valley

Wilhoit

Pine

Mayer

TaylorSnowflake

Dewey-HumboldtLake Havasu City Camp Verde

Prescott ValleyLake Montezuma

Prescott

CornvilleWilliamson

Chino Valley

Sedona HolbrookPaulden

Munds Park

Mohave Valley

Winslow

Bullhead City

Flagstaff

Golden Valley

Kingman

Houck

Williams

New Kingman-ButlerLeupp

Dilkon

Dolan Springs

Second Mesa

Cameron

Kykotsmovi Village

Hotevilla-Bacavi

Tusayan

Grand Canyon Village

Chinle

Rough Rock Lukachukai

Round RockChilchinbito

Kaibito

Kayenta

Rock Point

Page

Lechee

Teec Nos Pos

Red Mesa

Beclabito

Big River

DouglasBisbee

Tubac

AmadoWhetstone Tombstone

St. DavidSells

Summit

Valencia West

WillcoxSanta Rosa

Tortolita

Oracle

Arizona City

SaffordDudleyville

Ak-Chin Village

Maricopa

Florence

Santan

Queen CreekQueen Valley Peridot

San Carlos

Tolleson

El Mirage

Sun City West

Rio Verde

Carefree

BouseWickenburg

Cibecue

McNaryEagar

SpringervilleYarnell Sun Valley

Parker StripCordes Lakes

Spring Valley

Strawberry

St. JohnsDesert HillsBagdad

Cottonwood

Clarkdale

Big Park

Mountainaire

Seligman

GreasewoodPeach Springs

Window RockGanado

Burnside Fort DefianceJedditoKeams Canyon

First Mesa

SawmillNazlini

PinonTuba City

TsaileTonalea

Many Farms

Shonto

Bitter Springs

Dennehotso

Colorado CityFredonia

Naco

Flowing Wells

Stanfield

Litchfield Park

Canyon Day

St. Michaels

Hildale

Tse Bonito

Pirtleville

Patagonia

Huachuca City

Pisinemo

South Tucson

GadsdenSomerton

Wellton

Tacna MammothChuichu

Duncan

Pima

Hayden

MorenciKearny

Sacaton

Superior

Miami

Claypool

Youngtown

East Fork

Poston

Gisela

Bluewater

Willow Valley

Kachina Village

Ash Fork

Steamboat

Shongopovi

Moenkopi

Supai

Guadalupe

Winterhaven

Palo Verde

East Blythe

Littletown

Winkelman

Jerome

Winslow West

Heber

Overgaard

Gul f o f Ca l i fo rn ia

North Country HealthCare, Williams

Northern CochiseCommunity HospitalWillcox

White Mountain Regional Medical CenterSpringerville

Benson HospitalBenson

Cobre Valley Regional Medical CenterGlobe

Little Colorado Medical CenterWinslow

La Paz Regional HospitalParker

Parker Indian Health Center

Banner HealthHospitalPage

WickenburgCommunity HospitalWickenburg

Hu Hu Kam Memorial HospitalSacaton

Sage MemorialHospitalGanado

Hopi Health Care CenterPolacca

CarondeletHoly Cross HospitalNogales

Cochise RegionalHospital

Critical Access Hospitals

Copper QueenCommunity HospitalBisbee

Bouse MedicalClinic, Bouse

Parker Medical Center, Parker

La Paz Medical Services, Quartzsite

Tri-Valley MedicalCenter, Salome

Community HospitalClinic, Congress

Little Colorado Physicians O�ceWinslow

Community Hospital ClinicWickenburg

Kearny ClinicKearny

Sonoran FamilyPractica, Coolidge

Superior ClinicSuperior

Hereford Rural Health ClinicPalominas

Mt. Graham RegionalMedical Center Rural Health Clinic, Sa�ord

Sulphur Springs Medical CenterWillco x

Sunsites MedicalClinic, Pearce

GreasewoodClinic, Ganado

Sage Outpatient Clinic, Ganado

Copper Queen Medical AssociatesBisbee

Copper Queen Medical AssociatesDouglas

Rural Health Clinics

Pleasant Valley Community Medical Center, Young

Summit Healthcare Heber-Overgaard Community ClinicOvergaard

San Luis Walk-in Clinic - Family & Adult CenterSan Luis

North Country HealthCareKingmanNorth Country

HealthCareBullhead City

Adelante HealthcareWickenburg

Adelante HealthcarePeoria

Canyonlands Healthcare, Globe

Mountain Health & Wellness, Kearny Outpatient

Sun Life Maricopa Family Healthcare

Adelante HeathcareGila Bend

Desert Senita Community Health Center & Dental CenterAjo

Sunset CommunityHealth CenterWellton

Sunset CommunityHealth CenterYuma

Sunset CommunityHealth CenterSan Luis

Sunset CommunityHealth CenterSomerton

Canyonlands HealthcareDuncan

North Country HealthCareRound Valley

North CountryHealthCareShow Low

North CountryHealthCareSt. Johns

North CountryHealthCareHolbrook

North Country HealthCare, Winslow

Canyonlands HealthcareSa�ordSun Life San Manuel

Family Healthcare

Sun Life Oracle Family Healthcare

United Community Health Center at Old Vail Middle School

Sun Life Casa Grande Family Healthcare & Center for Children

Sun Life Eloy Family Healthcare

Sun Life Coolidge Family Healthcare

Canyonlands HealthcareUrgent Care & Lake PowellPage

Canyonlands HealthcareFredonia

Canyonlands HealthcareBeaver DamLittle�eld

Tuba City RegionalHealth Care Corporation

North Country HealthCare, Grand Canyon

Canyonlands HealthcareChilchinbeto

North Country HealthCare, Flagsta�

North Country HealthCare, Ash Fork

North Country HealthCareSeligman

Community Health Center of YavapaiPrescott

Community Health Center of YavapaiPrescott Valley

Community Health Center of YavapaiCottonwood

North Country HealthCare, Payson

Chiricahua Community Health CentersBisbee Clinic

ChiricahuaCommunity Health CentersSierra Vista

Chiricahua Community Health Centers: Jennifer 'Ginger' Ryan Clinic & 15th Street Pediatric Center of Excellence, Douglas

Chiricahua CommunityHealth CentersCli� Whetten Clinic, Elfrida

Mariposa Community Health Center Nogales

Federally Quali�ed Health Centersin rural areas

Mariposa Community Health Center Patagonia

Mariposa Community Health CenterRio Rico

United Community Health Center, Arivaca

United Community Health CenterAmado

United Community Health CenterGreen Valley

North Country HealthCareLake Havasu City

Arizona’s Critical Access Hospitals, Associated Rural Health Clinics and Federally Qualified Health Centers in Rural Areas

9

Health System Development and Community Engagement - AzFlex supports the AzCAHs in developing collaborative regional

or local systems of care, addressing community needs, and inte-

grating EMS in these systems of care. As an example, in collabo-

ration with the Arizona Department of Health Services, Bureau of

EMS, a statewide Trauma Performance Improvement Plan is being

developed. Best practices are shared among the states’ Trauma

Centers to ensure quality outcomes.

Tribal Health Initiative - The Center for Rural Health staff col-laborates with Arizona’s sovereign tribal nations and rural com-

munity non-profit organizations to improve health outcomes and

the well-being of these communities by conducting regional grant

writing training, strengthening the American Indian health profes-

sional pipeline, capacity building assistance on health promotion/

disease prevention interventions, and training health educators

and community outreach workers on multi-media health commu-

nication methods and health literacy.

Strengthening Rural Health Care Delivery Systems – HRSA/ORHP has funded the Small Rural Hospital Improvement Program

(SHIP) at the CRH since 2002. AzSORH helps eligible hospitals (

10

Critical Access Hospital Economic Impact – Arizona’s Crit-ical Access Hospitals play crucial roles in assuring access to

quality health care, improving health outcomes, and contrib-

uting to their community’s overall economic health. AZ CAH

fiscal margins improved over the last year. Medicaid (AHCCCS)

and the Marketplace covered more uninsured in 2014, and

hospital uncompensated care decreased from the levels seen

during the great recession, that pushed CAH margins to the

brink of bankruptcy in many communities.

However, new threats to Arizona CAH fiscal viability include:

addressing a $0.5 to $1 billion estimated 2015 state budget

deficit – that could erode CAH and Rural Hospital Payment

Program funding by AHCCCS, facing possible cuts in state

Medicaid (AHCCCS) payment for CAH hospital and their Rural

Health Clinic outpatient services, diminishing Dispropor-

tionate Share (DSH) payments, eliminating state funding that

helped cover uncompensated care, changing rural county

and CAH designations that affect payment rates, and strictly

enforcing CAH designation criteria as proposed by the Federal

Office of the Inspector General (OIG). Figures 1 and 2 illustrate

the precarious fiscal position of Arizona CAHs over the last

10 years. Any of the threats above could shift the CAH bottom

line from a positive fiscal position to deficit.

Northern Cochise Community Hospital, Willcox Roland Knox, CEO • 2013 l Excellence in Outcomes,

iVantage Health Analytics • 2013 l Excellence in Efficiency,

iVantage Health Analytics

Little Colorado Medical Center, Winslow Jack Dempsey, CEO • 2012/2014 l Excellence in Outcomes,

iVantage Health Analytics

Wickenburg Community Hospital, Wickenburg James Tavary, CEO • 2012/2013 l Excellence in Outcomes,

iVantage Health Analytics

Copper Queen Community Hospital, Bisbee James Dickson, CEO • 2011 l James Dickson, CEO, winner of the American Hospital Association’s (AHA) Shirley Ann Munroe

Leadership Award. (Recognizes the accomplishments of rural leaders who have improved health care delivery through innovative and progressive efforts).

• 2012 l Excellence in Patient Satisfaction, iVantage Health Analytics

• 2013 l CQCH awarded the Healthcare Financial Management Association’s (HFMA) MAP (measure, apply, and perform) for High Performance in Revenue Cycle.

• 2013 l James Dickson CEO, named to the “50 Rural Hospital CEOs to Know” by Becker's Hospital Review • 2013 l Excellence in Outcomes

iVantage Health Analytics

Carondelet Holy Cross Hospital, Nogales Debra Knapheide, Site Administrator, CNO • 2012 l “Top Performer on Key Quality Measures” named by The Joint Commission • 2013 l ZERO Award, ZERO reportable adverse events for :Brachial Plexus injury l Falls with Serious

Injury l Latrogenic Pneumothoraxl Post-op Respiratory Failure l Post-op PE or DVT l Pressure Ulcer Without Stage 1, Ascension Health

• 2013 l Excellence in Quality, iVantage Health Analytics

Cobre Valley Regional Medical Center, Globe Neal Jensen, CEO • 2013 l Top 100 out of 1,300 CAHs,

iVantage Health Analytics • 2013 l Excellence in Outcomes,

iVantage Health Analytics

Banner Health Page Hospital, Page Sandy Haryasz, CEO • 2012 l Excellence in Quality, Excellence in Efficiency, Excellence in

Patient Satisfaction, iVantage Health Analytics

• 2013 l Excellence in leadership and innovation in quality patient care National Rural Health Resource Center

• 2013 l Excellence in Quality, iVantage Health Analytics

• 2014 l Top 100 out of 1,300 CAHs, iVantage Health Analytics

Sage Memorial Hospital, Ganado Christi El-Meligi, CEO • 2012/2014 l Excellence in Outcomes,

iVantage Health Analytics • 2014 l "Gold Seal of Approval," of Razaghi Healthcare, The Joint Commission

Benson Hospital, Benson Richard Polheber, CEO • 2013 l Excellence in Outcomes

iVantage Health Analytics • 2013 l Excellence in Efficiency

iVantage Health Analytics

14 11

4

7

15

9

1

3

12

Funding is from the HRSA Office of Rural Health Policy to the Arizona Rural Hospital Flexibility Program at the University of Arizona, Mel and Enid Zuckerman College of Public Health, Center for Rural Health.

-2.0

-1.0

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

201220112010200920082007200620052004

YEAR

U.S. Median CAH AZ Median CAH

Tota

l Mar

gin

(Per

cent

)

Figure 2: Arizona and U.S. CAH Total Margin Trend2004-2012

6.7

1.92.6

3.6 3.7

2.41.9 1.9

2.3 2.6

3.9

7.4 7.4

5.9

0.1

-1.4

6.86.1

Source: Cecil G. Sheps Center CAH Financial Indicators Reports

2004

Numberof CAHs

Source – Arizona Dept. of Health Services: Hospital Cost Reports (2004-2013)

CAH# (+ Pro�tability) CAH# (- Pro�tability)

2005 2006 2007 2008 2009 2010 2011 2012 2013

Figure 1: Arizona CAHs’ Pro�tablility Summary2004-2013

0

2

4

6

8

10

12

5 5

2

6

3

9

1

7

4

7

4

4

7

8

3

8

3

6

5

0

YEAR

11

n Howard Eng, DrPH was honored at a White House ceremony as a “Champion of Change” in April 2014 for his work educating uninsured

Asian Americans and Pacific Islanders in Pima County, and helping

them select a plan on the Arizona Marketplace.

n Beginning January 2015, Joyce Hospodar will serve as the new Re-gion D Representative to the National Organization of State Offices of

Rural Health (NOSORH) Board.

n Jill Guernsey de Zapien, Associate Dean for Community Programs at the Zuckerman College of Public Health, received the 2014 Vision Award for Excellence in Health Planning from the American Public

Health Association (APHA). Winston Tseng, PhD, Chair of the APHA Community Health Planning and Policy Development Section recog-

nized Jill’s “exceptional leadership for more than 20 years advancing

health planning and policy development in partnership with under-

served populations through bi-national, community-based work in

the U.S.-Mexico Border Region.” 

n After 27 years working for the betterment of Arizona’s rural com-munities, Lynda Bergsma, PhD, retired in June of 2014. Her work covered state and national efforts around oral health, media literacy,

smoking cessation, and behavioral health. The Arizona Rural Health

Association recognized Lynda with an Exceptional Rural Health Pro-

fessional service award at the 41st Annual Rural Health Conference in

August of 2014.

n Kevin Driesen, PhD, retired in June of 2014 from the University of Arizona where he served as the Director of the Arizona Rural Hospital

Flexibility Program in the Center for Rural Health. Kevin contribut-

ed in numerous capacities on grants and initiatives focused on rural

areas including Area Health Education Centers (AHEC), Community

Access Program (CAP), Health Careers Opportunities Program (HCOP),

Border Volunteer Corps, and Border Vision Fronteriza. He was award-

ed a National Rural Health Association Fellowship in 2013.

The recipients for the Arizona Rural Health Service Awards present-ed at the 41st Annual Arizona Rural Health Conference were:

n Senator Steve Pierce | Distinguished Martha Ortiz Volunteer

n !Vida! Educational Series, Promoting Good Health | Inspiring Rural Health Program

RECOGNITION, AWARDS AND APPOINTMENTS

New York City

Boston

Portland, ME

Philadelphia

Did you know that Arizona’s land area of

113,594 sq. miles would encompass the state of

New York, the six New England states (CT, ME,

MA, NH, RI, VT) and have enough room left

over to include D.C. and Delaware?

For more information about our programs and projects, please visit our web site: http://crh.arizona.edu.Design/layout: Paul Akmajian • Cover photo: Ken Miller

CENTER FOR RURAL HEALTH STAFF

Daniel DerksenWalter H. Pearce Endowed Chair & Professor; Community, Environment & Policy Department; Director Arizona Center for Rural HealthPhone: 520.626.3085Email: dderksen@email.arizona.edu

Howard EngAssistant Professor Phone: 520.626.5840Email: hjeng@email.arizona.edu

Jennifer PetersSenior Program Coordinator Phone: 520.626-2254Email: jspeters@email.arizona.eduProgram: AZ SORH

Rebecca RuizSenior Program Coordinator Phone: 520.626.2243Email: raruiz@email.arizona.edu

Sharon Van SkiverSenior Program Coordinator Phone: 520.626.5823Email: sharonv@email.arizona.edu

Joseph TaborAssistant Professor | Data and Evaluation Management Phone: 520.626.0795Email: jatabor@email.arizona.eduPrograms: AZ Flex | AZ SORH

Joyce HospodarManager Health System Development Phone: 520.626.2432Email: hospodar@email.arizona.eduPrograms: AZ SHIP | AZ SORH | AZ Flex

Martha Moore-MonroyProgram ManagerPhone: 520-626-8036Email: mmonroy@email.arizona.eduProgram: AZ SORH

Sonia NievesAdministrative Associate Phone: 520-626-0721Email: soniam@email.arizona.eduProgram: AZ Flex

Alyssa PadillaCoordinator Special Projects Phone: 520.626-4439Email: alydilla@email.arizona.edu

Jill Guernsey de ZapienAssociate Dean Community ProgramsPhone: 520.626.3978Email: dezapien@email.arizona.eduProgram: Rural Service Learning

Paul AkmajianManager Marketing and Outreach Phone: 520.626.5837Email: pakmajian@email.arizona.edu

Agnes AttakaiDirector Health Disparities Outreach & Prevention Phone: 520.626.4272Email: agnesa@email.arizona.eduProgram: AZ SORH

Jill BullockRural Health Services Coordinator Phone: 520.626.3722Email: bullock1@email.arizona.eduProgram: AZ Flex