Rural Health Delivery
A QUARTERLY UPDATE FROM MONTANA AHEC / OFFICE OF RURAL HEALTH 
In This Issue
AHEC Personnel
Osler's Evenings
HOSA
Outreach Coordinator
AHEC Overview
Quick Links

Montana AHEC Regions
AHEC Map
 
 Issue: #2                                                                December 2009
Greetings!

Welcome to the 2nd Edition of
the Montana AHEC (Area Health Education Center) 
and Office of Rural Health (ORH) E-Newsletter
Rural Health Delivery!
 
This E-Newsletter is being sent to you by Montana AHEC / ORH in hope of opening a dialogue about healthcare in rural and underserved areas of Montana. Through this newsletter we hope to tell you a little more about what we are doing for healthcare in this great state we call home!
 
If you work in healthcare, you know that acronyms are endless...and this issue doesn't disappoint - TRUST, SHIP, HOSA, and MFMR are just a few you will learn about. Enjoy! 
AHEC - Personnel Changes 
Montana AHECAs the Montana AHEC System continues to grow and expand, we are delighted to have new staff members join us on this journey.
 
The South Central MT AHEC, based in Dillon, welcomes Casey Palmer. Casey is the Program Assistant and assists the Director and Program Coordinator with recruitment and pipeline activities. She also updates information on our MSHHRA website, coordinates the MSHHRA newsletter, and provides administrative support. 
 
The Western MT AHEC, based in Missoula, welcomes Ilsa Seib, the new Administrative Associate. Ilsa is well-versed in campus office operations as she had worked on the University of Montana campus for several years before joining the AHEC staff in November. Ilsa has taken on the financial and grant management responsibilities for the Western office, and is working to improve and maintain the WMT-AHEC website. 
 
The Eastern MT AHEC has been under the leadership of Susan Barton at RiverStone Health in Billings since October 2007. While staying with RiverStone Health, Susan will be leaving the AHEC position to manage the Health Improvement Program for a five county region. This program will assist Medicaid patients navigate the healthcare system in a compassionate and cost effective manner.
 
The new Program Manager for the EMTAHEC, beginning on January 18, 2010 will be Lisa Browning former Vice President for Enrollment Services at Rocky Mountain College and a Montana native. Lisa is looking forward to the challenges and joys of developing and implementing programs that will help to increase the healthcare workforce in Montana. Welcome Lisa!
Program Office Update - MSU Bozeman

TRUST (Targeted Rural and Underserved Track)  

                                                                         
The goal of the TRUST Program of the Montana WWAMI Medical School at Montana State University is to increase the number of Montana WWAMI students choosing to enter primary care, or other needed specialties, - and - following residency training, return to practice medicine in rural communities, or in clinics providing care to low income/underserved patients.  Medical students selected for the TRUST Program are required to do a two-week pre-matriculation clinical rotation in a community and with a physician selected by the WWAMI Program in consultation with the students.  A second long week-end (3 day) clinical/community rotation is required during the first semester of medical school.  In the summer following the first year of medical school, the TRUST students return to the same rural community for a one month rotation through the Rural/Underserved Opportunities Program (R/UOP).  During the third and fourth years of medical school, the TRUST students are given priority for clerkships and other clinical education program opportunities in Montana. 
 
This model TRUST Program developed by the Montana WWAMI Medical School has been accepted by the University of Washington School of Medicine.  It is now part of the underserved pathway in the Department of Family Medicine. In addition, the TRUST Program has been adopted by the first year WWAMI Program in Spokane, Washington.  Another "spin-off" of the TRUST Program is an increased interest in bringing information about rural health to the attention of second year medical students at the University of Washington.  This includes the development of a new rural health course which is offered as a selective for these students.  As part of TRUST at Montana State University, the WWAMI Program initiated a new course entitled Rural Health Care Delivery Systems.  All TRUST students are required to take the course, but it is open to all of the medical students.  During the current semester (Fall 2009), nineteen of the twenty WWAMI students chose to take the course.
In the summer of 2008, a grant was submitted to Blue Cross Blue Shield Foundation of Montana to obtain funding to assist with expenses of the TRUST Program.  In September 2009, a three year grant in the amount of $35,000 per year was awarded to the WWAMI Program at Montana State University.  The Montana Office of Rural Health and the Montana Area Health Education Centers are directly involved in the TRUST Program in the following activities: (1) arranging for community-based clinical rotations with physicians, (2) paying for travel costs, (3) teaching the rural health course, (4) providing student memberships in the National Rural Health Association, (5) liaison with the Director of the Montana Clinical Education Programs (Jay Erickson, M.D.) and (6) collaboration with the Department of Family Medicine at the University of Washington School of Medicine. 

The names, community assignments and physician preceptors of the 2009 TRUST students are as follows:
 
Brooke Christiaens: Helena (CHC): Will Snider, D.O.
Hans Hurt: Libby: Greg Rice, M.D.
Abby Kelly: Lewistown: Laura Bennett, M.D.
Talya Lorenz: Wolf Point: Mark Zilkowski, M.D.
Andrea Prasch: Hardin: Kristen Morissette, M.D
 
For more information, please contact Frank Newman, MORH/AHEC, [email protected]
Small Rural Hospital Improvement Grant Program (SHIP) 
 
The Montana Office of Rural Health (MORH) administers the Small Rural Hospital Improvement Program (SHIP).  Funding for SHIP is provided through the federal Office of Rural Health Policy (ORHP).  Each year, the MORH prepares a comprehensive application which is submitted to the (ORHP).  This SHIP grant is based on applications sent to the MORH by each of the forty-seven (47) Critical Access Hospitals (CAHs) located in small rural communities throughout Montana.  For the current year (September 1, 2009 through August 31, 2010), the amount of funding received by the MORH at Montana State University was $427,729.  Each of the CAHs received an equal amount ($8,650).  Allocations to the CAHs are provided through subawards made by the Office of Sponsored Programs at Montana State University.  Thirty-one (31) subawards were made directly to small rural hospitals (CAHs) and one (1) to the Montana Health Network (MHN) located in Miles City.  The MHN sends the funding to each of the sixteen (16) CAHs involved in the network - and - assists the hospitals in the development of programs and activities consistent with the goals and objectives designated by the federal SHIP guidelines.  Activities approved for the current year are: (1) purchase of software and hardware to be used for quality improvement, performance improvement and patient safety, (2) education and training of staff on computer information systems which improve patient outcomes and (3) costs related to implementation of Prospective Payment Systems (PPS) such as updating chargemasters and providing training on billing and coding.
 
In February of 2010, the MORH will send grant applications to each of the forty-seven SHIP hospitals in preparation for the submission of a new SHIP grant for the period of September 1, 2010 through August 31, 2011.  The MORH conducts the following SHIP activities throughout the year: (1) notification of CAHs about SHIP funding potential and sending applications to each facility administrator, (2) reviewing applications and preparing a comprehensive grant to the ORHP, (3) processing payments to individual CAHs and to the MHN, Inc., (4) requesting progress reports from each hospital on utilization of funding providing through subawards, (5) preparing a comprehensive progress report to the ORHP, (6) providing technical assistance to hospitals as requested and (7) visiting CAHs during the grant year. 
 
  SHIP map MT
 
For more information, please contact Frank Newman, MORH/AHEC, [email protected]
South Central MT AHEC Update - Dillon
Osler's Evenings
 
After hearing from various WWAMI students that they have been discouraged about going into primary care or rural practice, based on such reasons as "they are too smart to go into primary care" or "rural practices leave no time for a quality of life", Jay Erickson, MD, WWAMI Clinical Coordinator, and Lisa Benzel, Director of South Central Montana AHEC decided to address the issue head on - by asking rural, primary care practitioners that love what they do and where they do it, to speak to the students.  South Central Montana AHEC is sponsoring the costs associated with Osler's Evening sessions and Dr. Erickson is arranging the speakers.  Short presentations are made by the evening's presenters that highlight their journeys into and through medicine, why they've made the choices they've made, their reasons for choosing rural primary care, why they love what they are doing and how their spouse and/or family fit into the decision.  Ample time is provided for discussions and questions.  The presenters have been individual practitioners, couples or a panel and, later in the year, will feature presentations by both the Billings and Missoula WWAMI Tracks.  The presentations will occur seven times throughout year and the invited guests are the first year WWAMI med students, located on the MSU campus.
 
The name Osler's Evening is named after Sir William Osler, often considered the father of modern medicine and the physician who is credited with creating clinical clerkships for students and for bringing residency training from Germany to the US.  He hoped his tombstone would read: He brought medical students into the ward for bedside teaching.    
 
For more information, please contact Lisa Benzel, Director of the South Central MT AHEC: [email protected] 
HOSA Integration 
 
HOSA (Health Occupations Students of America) is a national student organization whose mission is to promote career opportunities in healthcare and to enhance the delivery of quality healthcare to all people. HOSA logo 

HOSA provides a unique program of leadership development, motivation, and recognition exclusively for high school and post-secondary students. Since its inception in 1976, HOSA has grown steadily reaching nearly 100,000 members through 47 charted HOSA State Associations.
 
Currently in Montana we have high school level HOSA Chapters located in the following schools/communities:
     - Kalispell          - CMR Great Falls
     - Missoula         - Great Falls High 
     - Helena High    - Capital High Helena
     - Billings           - Augusta
 
As of November 2009, Bergen Morehouse, Program Coordinator for the South Central MT AHEC, took over the role of State HOSA Advisor. This transition came as a result of the strong AHEC partnership with the Office of Public Instruction (OPI) and specifically with Renee Harris, Health Science Education Specialist at OPI. Bergen's primary duties for AHEC include work on "pipeline programs" for K-12 students to generate an interest in healthcare careers. These responsibilities tie nicely into the mission of HOSA and the two positions fold well into each other. We are excited to now have an official partnership between Montana HOSA and Montana AHEC!
 
For more information about HOSA, please contact Bergen Morehouse, State HOSA Advisor, 406.683.2790,
[email protected].
Eastern MT AHEC Update - Billings
AHEC Students  
 
Since July 2009, seventeen students from around the world have benefited from a stipend given by Eastern Montana AHEC. These stipends are offered to medical, physician assistant, nurse practitioner and dental students. The stipends help students pay for travel and living expenses so they can come to Montana to experience rural and frontier healthcare.
 
Montana has been proud to host students from 10 different states, the Caribbean, Israel, Ireland and Mongolia. These students have had the opportunity to work in Billings at RiverStone Health, Montana Rescue Mission, three rural clinics (Bridger, Worden and Joliet), the Montana Women's Prison, nursing homes, Billings Clinic and St. Vincent Healthcare. Four of the students also did rotations in Warm Springs, Lame Deer, Roundup and Columbus.
 
Sarah Metzger, a fourth year medical student from Northeastern Ohio Universities Colleges of Medicine and Pharmacy wrote: "While traveling out to Montana, I felt that I had extensive experience working with underserved populations in the Northern Ohio (which were) the uninsured in inner city Akron, Hispanic migrant workers, and Burmese refuges. I quickly found that rural Montana is nothing like rural Ohio. The Northern Cheyenne people forced me to look at healthcare from a different perspective. There was a pride in the Cheyenne people that I had never experienced before. I was impressed by their strength and passion, and overwhelmed by the kindness that was shown to me on a daily basis. Without the support of the Eastern Montana AHEC and the Northern Cheyenne Service Unit, I may not have been able to afford the trip to Montana. It's hard to justify and finance non-essential trips on a student budget, but it is trips like these that help to shape an effective, culturally-sensitive physician. Thank you so much."
 
For more information, please contact Mary Helgeson, Placement Coordinator, Eastern Montana AHEC - 406.247.3297, [email protected]
Outreach Coordinator
 
The Eastern MT AHEC will be hiring an Outreach Coordinator whose job will be to work with minorities and other underrepresented groups in Montana to encourage them to consider a profession in healthcare. In Montana, over 6% of the population is Native American and yet only 2% of the healthcare workforce is comprised of Native Americans.
 
The Outreach Coordinator will help implement a sustainable plan that encourages youngsters, as well as older adults seeking a new profession, to acquire the proper background education, information, experiences and motivation to pursue a career in healthcare. This will be done in conjunction with the three tribes in the Eastern region initially with a hope that the program will be replicable in the rest of the state. The job will be advertised in late winter with a hopeful start date of early spring 2010.
Western MT AHEC Update - Missoula
Under Discussion:  Family Medicine Residency in Missoula
 
It is a truism that "physicians practice where they last trained." But statistics from the Montana Family Medicine residency in Billings bear this out: fully 69% of residents trained in Billings between 1998 and 2008 are practicing in Montana today.
 
Medical ResidentMontana has fewer family medicine residency slots per capita than any other state. Yet these slots are highly sought after; unlike family medicine residencies in other regions of the country, the Montana residency turns away applicants every year. In fact, for six slots in Billings they review over 400 applications. Increasing the number of residency slots in the state is a key way to increase the likelihood that practitioners will choose to live and practice here when their training is complete.  
 
This fall, several meetings of the Missoula family practice community have taken place, facilitated by Western Montana AHEC, to discuss the potential for establishing a family medicine residency in Missoula. The discussions have included over twenty family physicians, representatives of Missoula's two hospitals, and consultants from the University of Washington's Family Medicine Residency Network. With the support of this group, and the formation of a Steering Committee, WMT-AHEC has begun a feasibility study, and Steering Committee discussions will continue monthly. 
 
Establishing a new residency program in Missoula will certainly require an immense and highly collaborative effort. However, the potential benefits to the state's healthcare workforce are tremendous and exciting. We will continue to keep you posted as this initiative progresses.
 
For more information, please contact Larry White, Director of the WMT AHEC, [email protected] 
Hundreds of Missoula Kids get their Hands on Health
Like many AHECs across the country, Montana's AHECs are developing "pipeline" programs for students in kindergarten through twelfth grade to inform, excite and inspire interest in health science and health careers.
 
Montana's vast distances present a special challenge in developing programming for students away from the larger towns - the very audience we would most like to reach. To address this challenge, Western Montana AHEC has partnered with spectrUM, a hands-on science exploratorium on the University of Montana campus, to create Hands on Health, an innovative, fun, and interactive exhibition all about health and health professions.
 
The exhibition, generously funded by Blue Cross and Blue Shield of Montana, features five hands-on stations, each of which highlights a particular type of health occupation.Swabbing the Giant Nose at Hands on Health
 
At the Surgery station, visitors "scrub in," don gowns, and explore a life-sized teaching torso with 25 removable parts, while others perform a virtual surgery on a large flat screen monitor.
 
At the Public Health and Medical Lab station, visitors swab a giant nose and use a microscope to diagnose the results; others discover the importance of thorough hand-washing through a simple black light "heart-germ" demonstration.
 
At the Health Assessment station, visitors measure their blood pressure, pulse oxygen, heart rate, and temperature before and after vigorous exercise (using Dance Dance Revolution.)
 
At the X-Ray station, visitors view and manipulate a complete x-ray body with broken and intact bones on a giant light table.
X-Ray Light Table at Hands on Health
 
At the I Choose Healthy Living station, visitors discover the hidden fat, salt, and sugar in a variety of foods and test their nutrition IQ, then feel the impact of extra pounds by performing a vertical jump test while wearing  a special "fat vest." Then, visitors add a drawing of their favorite way to be active to a community bulletin board. Finally, spectrUM educators lead visitors in guided Dissections of a heart, a set of lungs, or an eyeball.
 
Hands on Health has been experienced by almost 800 visitors since its Missoula opening in September 2009, but this is just the beginning. The exhibition was designed to be portable, and tours are in development, beginning in March 2010, to the far corners of the state to bring the excitement of careers in health to rural Montana students.
 
If you would like more information about Hands on Health or how you can help bring this exhibition to your area, contact Grace Decker, Western Montana AHEC, 406-243-4746 or [email protected]
AHEC - The Basics 
AHEC MapThe Montana AHEC mission is to improve the supply and distribution of healthcare professionals, with an emphasis on primary care, through community/academic educational partnerships, in order to increase access to quality healthcare. We work to connect students to healthcare careers, professionals to communities, and communities to better health.

To fulfill our mission, we focus on these key areas:
1) Programs and resources for K-12 students and teachers to generate interest in healthcare professions
 
2) Placement of health profession students in rural rotations throughout the state
 
3) Recruitment and retention of qualified healthcare professionals to Montana

4) Continuing Education programs for practicing healthcare professionals
 
Montana has 4 regional AHEC offices - Eastern, located in Billings- South Central, located in Dillon - Western, located in Missoula - and the North Central, opening soon.  
 
For more information, please visit:
Please contact us with your comments, ideas, questions or projects you'd like to see highlighted in future issues of this e-newsletter.
Thank you for the work you do every day to improve the healthcare industry and the health of all Montanans!!
 

Montana AHEC