2017 Rural Health Clinic Conference All general sessions take place in the Chicago room • Subject to change • Current as of 9.12.17 NRHA is authorized to award six hours of pre-approved ACHE Qualified Education credit for the Rural Health Clinic Conference toward advancement or recertification in the American College of Healthcare Executives. Download an attendance certificate at the NRHA website, ruralhealthweb.org. Tuesday, Sept. 26 1 - 1:15 p.m. Welcome 1:15 - 2:30 p.m. Keynote Presentation Rural Health Clinic Billing and Cost Report Updates Brian Bertsch, Eide Bailly, Principal Ralph Llewellyn, Eide Bailly, Partner CMS continues to update Rural Health Clinic billing and cost reporting requirements as there is a continued focus on the shift from volume to value. Examine billing and coding changes for service offerings as well as new cost reporting requirements to assist providers in meeting compliance requirements. 2:30 - 3:30 p.m. The Magic of Engagement Brian Lee, Custom Learning Systems Group Ltd., Founder and CEO Fully engage, influence and empower front-line staff to successfully improve the patient experience. Accountability, with engagement, equals profitability. When everyone knows they are the patient experience, no matter what their function, connections are made at an accelerated level which differentiates you from the competition. 3:30 - 3:45 p.m. Break Ballroom Foyer 3:45 - 5 p.m. Concurrent Sessions A: Working with State Offices of Rural Health to Build Capacity at RHCs Van Horn AB Crystal Barter, Michigan Center for Rural Health, Performance Improvement Director Kassie Clarke, National Organization of State Offices of Rural Health, Technical Assistance Director

Tammy Norville, North Carolina, Office of Rural Health, Rural Health Operations Specialist State Offices of Rural Health are hubs of rural health information for each state and have programs in place or information to share to help RHCs increase their capacity to improve rural health care delivery systems. SORHs will share their experiences working with RHCs to improve quality and efficiencies. B: Reducing ED Visits and Readmissions Through a Care Driven PCMH Benton Kate Hill, The Compliance Team, Clinical Services Vice President Jennifer Moss, Kirby Medical Center, Chief Clinical Officer Sarah Wells, Kirby Medical Center, Clinic Director Learn about a simplified Patient Centered Medical Home model designed specifically for the clinic that focuses more on patient care than data. The model stresses follow-up with the chronic care population, resulting in a reduction in Emergency Department visits as well as readmissions. Wednesday, September 27 7 - 8 a.m. Continental Breakfast Ballroom Foyer 8 - 9:15 a.m. Concurrent Sessions C: Implementation of Weight Loss Programs in Rural Practice Van Horn AB Christie Befort, PhD, University of Kansas Medical Center, Department of Preventive Medicine and Public Health, Associate Professor K. Allen Greiner, MD, University of Kansas Medical Center, Department of Family Medicine, Professor and Vice Chair Jennifer McKenney, MD, Bacani/McKenney Clinic, Practicing Physician And Principal Implementation of systematic and intensive weight loss programs can be difficult. Study a successful multi-practice program that employs group or one-on-one counseling, and outline the necessary steps for launch and maintenance. Gain improved understanding of practice workflows and transformations needed to support such a program. D: RHC Federal Resources and Policy Update Benton Kerri Cornejo, Federal Office of Rural Health Policy, Analyst Patricia Meier, MD, Centers for Medicare and Medicaid Services, Chief Medical Officer, Region VII Michelle Velasquez, Centers for Medicare and Medicaid Services, Health Insurance Specialist

Speakers from the Centers for Medicare & Medicaid Services and the Federal Office of Rural Health Policy will share policy updates and proposals relevant to RHCs, including aspects of the Quality Payment Program, chronic care management, the Medicare Diabetes Prevention Program, emergency preparedness, new Medicare cards, and related resources. 9:15 - 9:30 a.m. Break Ballroom Foyer 9:30 - 10:45 a.m. Concurrent Sessions E: Embracing the Value of Your Rural Health Clinic Van Horn AB Jeff Bramschreiber, Wipfli LLP, Partner Tina Nazier, Wipfli LLP, Strategic Alignment Director Hospitals and rural health clinics have been key components of a strong rural health equation. The most successful systems have discovered how to transform these two components into a high-performing system. Learn key steps to transform these two entities into a combined powerhouse. F: Rural Health Clinic Billing and Coding Updates Benton Joanie Perkins, North Sunflower Medical Center, Chief Compliance Officer Review Medicare's Qualifying Visit Line, CG modifier and health care common procedure coding system requirements. Understand how to properly document and bill for the Welcome to Medicare Physical, Annual Wellness Exam and Chronic Care Management in the Rural Health Clinic setting. 10:45 - 11 a.m. Break Ballroom Foyer 11 - 11:45 a.m. Rural Health Clinic Quality Reporting and Improvement Programs John Gale, Maine Rural Health Research Center, Research Associate Rural health clinics face growing pressure to participate in quality reporting programs developed by Medicare, Accountable Care Organizations, and commercial payers. Discuss the challenges to RHC quality reporting and describe RHC quality reporting and improvement models to inform development of state and local programs for RHCs. 11:45 a.m. - 1 p.m. Lunch on your own

Critical Access Hospital Conference Begins; Rural Health Clinic Conference Continues

2017 Critical Access Hospital Conference Plenary sessions are held in the Chicago Room NRHA is authorized to award nine hours of pre-approved ACHE Qualified Education credit for the Critical Access Hospital Conference toward advancement or recertification in the American College of Healthcare Executives. Download an attendance certificate at the NRHA website, ruralhealthweb.org. 1 - 1:15 p.m. Welcome 1:15 - 2:30 p.m. Keynote Presentation The Transformational Health Care Revolution: The Rural Impact Kevin Fickenscher, MD, CREO Strategic Solutions, President and CEO The growth in health care costs is stressing the ability of government, private industry and the whole of society to allocate sufficient resources for other critical needs in a rapidly changing environment. The use of technology and the Information Revolution are causing dislocations massive dislocations in the fabric of society. Health care is not immune to these transformational changes. The impact on rural America will be significant and positive! But, the need for educating, training and preparing our health care professionals to effectively manage in the new era is essential. Dr. Fickenscher will explore these issues and offer thoughts on where the future lies. 2:30 - 3 p.m. Break Ballroom Foyer 3 – 4:15 p.m. National Legislative Update Maggie Elehwany, JD, NRHA Government Affairs and Policy Vice President Discover how the latest policy changes will affect you and your facility from this DC insider. 4:15 - 5 p.m. Payment/Care Delivery Reform for Safety Net Providers Mac McCullough, PhD, Arizona State University, National Safety Net Advancement Center, Deputy Director The National Safety Net Advancement Center partnered with 60 safety net organizations to overcome payment and care delivery reform challenges. Review lessons learned for rural safety net providers

related to six central challenges: care team transformation, clinical integration, financial planning, network structure, patient attribution, and risk management. 5 - 7 p.m. Networking Reception Atlanta/New York Rural Health Clinic Conference Adjourns Thursday, September 28 7 - 8 a.m. Continental Breakfast Ballroom Foyer 8 - 9 a.m. American Hospital Association Regulatory Update John Supplitt, American Hospital Association, Constituency Sections, Senior Director Explore the latest regulatory updates and learn how they’ll affect your hospital. 9 - 10:30 a.m. Break Atlanta/New York Room 9 – 9:45 a.m. Busting Rural Healthcare Myths - Legato Healthcare Marketing, Partner Featured Session Mike Milligan, Legato Healthcare Marketing, President/CEO Find out how to break down barriers and change perceptions of rural health care in your community to increase patient volumes and revenue. 9:45 – 10:30 a.m. My Hospital’s Experience with a Cloud-based EHR – athenahealth Partner Featured Session Sharon K. Cox, Rawlins County Health Center, CEO Experience a conversation with an athenahealth client, covering why the hospital decided to convert from traditional software to network-enabled services and the results they have experienced.

10:30 - 11:45 a.m. Concurrent Sessions

1A: A CINderella Story- Clinically Integrated Networks Can Help (APM track) Benton A John Barnas, Michigan Center for Rural Health, Executive Director Lynn Barr, National Rural ACO and Caravan Health, CEO Brian Bauer, JD, Hall, Render, Killian, Heath & Lyman, Attorney Clinically Integrated Networks (CINs) are an effective strategy for rural hospitals to adapt to changing reimbursement trends and move to value-based payments. CINs help formally align independent and employed physicians in regions. CIN Alliances can expand network offerings and services and effectively pool resources to build robust population health infrastructures. 1B: Develop Rational Pricing Strategies for Critical Access Hospitals (financial track) Benton B Todd Kenney, BKD, Partner Steve Parde, BKD, Managing Director It's difficult for CAHs to track and estimate the amount of reimbursement to expect from Medicare cost report settlements. Discuss the most common volume/expense drivers of change in cost reimbursement, key Medicare cost report analytics and relationships they have with changes in the Medicare settlement estimate. 1C: Transitioning Critical Access Hospitals to Value-Based Care (leadership track) Chouteau A Danielle Lloyd, Premier Inc., Vice President of Policy and Advocacy Brock Slabach, NRHA, Member Services Senior Vice President As new federal policies focus on delivery system reform, critical access hospitals serving patients in rural communities are increasingly falling behind. This session will highlight challenges rural providers face when trying to keep up with these innovations and share a proposed alternative payment model tailored to reward CAH participation. 1D: Benchmarking Your Rehab Department for Continuous Success (quality track) Chouteau B Tracy Milius, RehabVisions, Operations Director Utilizing industry standards to set benchmarking guidelines for rehabilitation departments is the first step to establishing rehab as a profit center. Innovation in therapy practices is also vital for success and keeping patients from traveling to nearby metro centers, ultimately impacting patient outcomes, financial and clinical goals. 1E: Skills Labs for Improved Patient Experience (Top 20 track) Van Horn A

James Heise, MD, Door County Medical Center, Chief Medical Officer Sandy Vandertie, Door County Medical Center, Emergency Dept/Urgent Care and Outpatient Manager Skills labs allow hospitals to break down the patient encounter from all aspects, and to focus on that "one thing" per professional that best enhances the patient experience. 1F: EMS Best Practices (general track) Van Horn B Christy Edwards, Federal Office of Rural Health Policy, Public Health Analyst Diana Fendya, EMS for Children Innovation and Improvement Center, Acute Care, Trauma, and EMS for Children State Partnership Specialist Stephanie Laws, Rural Health Innovation Collaborative, Executive Director Darcy Litzen, Avera eCARE, Client Development Officer Ken Reed, Heart of America Medical Center, Director of EMS & Disaster Services Learn about integrating EMS into local systems of care, pediatric readiness at critical access hospital emergency departments and success stories of evidence-based tele-emergency grant programs. 11:45 a.m. - 2 p.m. Networking Lunch Atlanta/New York 12 – 12:45 p.m. Partnering with your EMR – Cerner Corporation Partner Featured Session Adam Willmann, Goodall-Witcher Hospital Authority, President/CEO Understand the process of building a successful and collaborative partnership with your EMR team to make your partnership work for you. 1 – 1:45 p.m. - The Change from Bedside Care to Care Cycle - CPSI Partner Featured Session

Ruth Ann Perr, Evident, Physician Experience Nurse Practitioner

This interactive session will explore making patients and family members of the care team, utilizing team member’s broadest scope of practice to maximize quality care. 2 - 3:15 p.m. Concurrent Sessions 2A: Integrating Behavioral Health Services into Primary Care (APM track) Benton A Maeve McClellan, National Rural ACO and Caravan Health, Practice Improvement Director Inadequate behavioral health services significantly impact Critical Access Hospitals, as resource intensive patients often suffer co-morbidities that include behavioral health conditions. Learn how primary care

practices can adopt accountable care strategies that include integrated behavioral health services that improve access to services and result in better outcomes. 2B: Maximizing Insurance Payment Agreements (financial track) Benton B Kerry Goff, Impact Healthcare Solutions, Chief Development Officer Landon Tooke, Impact Healthcare Solutions, Chief Operating Officer Many hospitals desperate for cash have never asked for an increase -- literally giving money to insurance companies who are making billions. Explore reasons and ideas to maximize insurance payer agreements. This problem is rampant in rural hospitals. 2C: 340B Operations and Compliance Trends: Lessons Learned (leadership track) Chouteau A Sondra Donald, PharmD, Boone County Hospital, Pharmacy Director Reid Horning, PharmD, New Ulm Medical Center, Pharmacy Director Steven Miller, 340B Health, Pharmacy Services Director Learn about trends in 340B operations and compliance and unique considerations for critical access hospitals. Examine cover inventory management, contract pharmacy, orphan drugs, and government audits. Discuss possible threats to 340B hospitals, including legislative or administrative changes that could limit hospital use of 340B. 2D: Telemedicine Impact on Rural Cardiac and Stroke Patients (quality track) Chouteau B Shelly Boden, Kansas Heart and Stroke Collaborative, Quality Assurance/Quality Improvement Director Darcy Litzen, Avera eCARE, Client Development Officer A joint effort with the Kansas Heart and Stroke Collaborative and Avera eCARE strives to improve stroke outcomes and impact heart health. Evidence based guidelines aided in developing protocols appropriate for rural hospitals. Through educational training and support of Avera eEmergency, hospitals provided thrombolytic stroke treatment for the first time. 2E: Prompt Recognition and Timely Intervention—Curtailing Disabilities and Deficits (Top 20 track) Van Horn A Doug Sutcliffe, Aspirus Ironwood Hospital and Clinics, Trauma/Stroke Coordinator Study the recognition/communication/intervention and the relationship to time. Methods will be covered that improve communications between EMS and hospital staff that directly increase the likelihood of timely administration of a thrombolytic in stroke patients and inversely improve the mortality and morbidity of trauma patients. 2F: Creating a High-Performing Network of Care for Rural Veterans (general track)

Van Horn B Thomas Klobucar, PhD, Office of Rural Health, Director Learn about the VA's efforts to collaborate with community providers to deliver integrated care to rural Veterans. Explore HHS/VA partnership, updates on Veterans Choice Program, free training, and Rural Promising Practices. 3:15 - 3:30 p.m. Break Ballroom Foyer 3:30 – 4:15 p.m. Trustee Perceptions of Factors Important for Physician Recruitment Ed Baker, PhD, Center for Health Policy, Boise State University, Professor and Director David Schmitz, MD, Univ. of North Dakota School of Medicine and Health Sciences, Family and Community Medicine, Professor and Chair The Critical Access Hospital Community Apgar Questionnaire was expanded to include trustee participation in Iowa. Examine how Iowa critical access hospital trustee perceptions of their community's strengths and challenges related to physician recruitment. Trustee perceptions on factors important to physician recruitment are contrasted with administrators and physicians. 4:15 – 5:15 p.m. Project CLEAN – Opioid Abuse Prevention Program; Addressing Substance Use Problems: How Can Hospitals Help? Emily Dilley, Columbus Community Hospital, Marketing Director John Gale, Maine Rural Health Research Center, Research Associate Critical access hospitals can play an important role in addressing substance use problems by implementing evidence-based prescribing quidelines, developing “oxy-free” emergency departments, implementing treatment programs based on local needs, and participating in collaborative community-based prevention, harm reduction, and recovery programs. Project C.L.E.A.N. (Communities Eliminating the Abuse of Narcotics) is a partnership between local rural leaders to enhance awareness and understanding of opioid abuse. Friday, September 29 8 - 8:30 a.m. Breakfast 8:30 - 9:15 a.m. Top 20 awards presentation Brock Slabach, National Rural Health Association, Member Services Vice President

Michael Topchik, iVantage Health Analytics, Senior Vice President Review a comprehensive set of rural health care delivery system findings based on publicly available and proprietary data sets. The insights gleaned are based on an evaluation of rural vs. urban payments and hospital performance (overall, quality, patient satisfaction) in the context of health care reform. 9:15 – 9:30 a.m. Break 9:30 - 10:45 a.m. Concurrent sessions 3A: Lessons Learned from Participants in Accountable Care Organizations (APM track) Benton A Brian Bertsch, Eide Bailly LLP, Principal Ralph Llewellyn, Eide Bailly LLP, Partner An increasing number of critical access hospitals have joined accountable care organizations. These rural providers have come together to learn about and to develop the structures and programming necessary to improve the value they provide. Survey lessons learned along the way. 3B: Five Changes to Chronic Care Management That Will Impact Implementation in 2017 (financial track) Benton B Marla Dumm, BKD, Managing Consultant Medicare Physician Fee Schedule Rule for CY 2017 provided updates to requirements for implementing a chronic care management program. It enhances coordination and quality of care for chronically ill patients in a rural facility or clinic setting. Advanced Care Planning, another quality of care service, encourages open discussion with patients. 3C: CEO Turnover: Root Causes and Practical Guidance (leadership track) Chouteau A Mark O'Neil, Yaffe & Company, Inc., Senior Consultant Larry Unroe, Yaffe & Company, Inc., Senior Consultant CEO turnover can be disruptive to an organization. Yaffe & Company in conjunction with The Kansas Hospital Education and Research Foundation studied the issue of CEO turnover and uncovered many of the root causes. Gain practical guidance on how to prepare for and deal with the contributing factors. 3D: Key Strategies for Successful Rural Antibiotic Stewardship Programs (quality track) Chouteau B James M. Keegan, MD, PYA, Infectious Disease Physician

A highly successful antibiotic stewardship program decreases resistant bacteria, clostridium difficile risk and preserves antibiotics for future generations. Critical access hospitals and rural communities are well positioned to improve the safety for both hospitalized and non-hospitalized community members. Investigate the science and practical application of successful strategies. 3E: Journey to a Top 20 Critical Access Hospital (Top 20 track) Van Horn A Kent Culbertson, First National Bank, Vice President Vickie Gibbs, Phillips County Health Systems, Chief Nursing Officer Stan Kats, Phillips County Health Systems, Board Chairman Tara Overmiller, Phillips County Health Systems, Marketing and Public Relations Director Rex Walk, Phillips County Health Systems, CEO There is talent and market growth available if nurtured and encouraged. Learn how a facility went from having a dismal community reputation to being ranked as a Top 20 Critical Access Hospital through several initiatives and personnel developments. 3F: Resources for Vulnerable Rural Hospitals and Communities (general track)

Van Horn B Sally Buck, National Rural Health Resource Center & Rural Health Innovations, CEO Kassie Clarke, National Organization of State Offices of Rural Health, Technical Assistance Director Michael Coyle, Coteau des Prairies Health Care System, CEO Sarah Young, Federal Office of Rural Health Policy, Flex Program Coordinator Learn about resources available to rural hospitals and rural communities struggling with changing health care delivery. Free resources highlighted in this session will include the Roadmap for Working with Vulnerable Hospitals and Communities, the Rural Hospital Value-Based Strategic Planning Guide, and the report After Hospital Closure: Pursuing High Performance Rural Health Systems without Inpatient Care. Presenters will discuss funding sources including the Small Rural Hospital Transition (SRHT) Project and the Rural Health Network Development Planning Program which have helped rural hospitals and communities address their health care challenges. 10:45 a.m. Critical Access Hospital Conference adjourns 11 a.m. 340B Workshop Registration with Complimentary Lunch 11 a.m. – 2:30 p.m. 340B Workshop (separate registration required)

Sondra Donald, PharmD, Boone County Hospital, Director of Pharmacy Steven Miller, 340B Health, Pharmacy Services Director

Engage in a meaningful conversation about how we can work together to safeguard 340B. Hospitals nationwide continue to face major threats. Influential lawmakers at a July 18 hearing on 340B oversight raised questions about how hospitals are using their 340B savings and whether there is sufficient oversight over the program. This is on the heels of a proposed rule issued by the Centers for Medicare & Medicaid Services to sharply reduce reimbursement to 340B hospitals. Legislation to restrict 340B has been drafted and may be introduced soon. At the same time, the President's budget request has called upon Congress to give the administration broad authority to regulate 340B.Never has it been so important to learn about key developments and the steps all 340B hospitals need to take now to protect the program.