Happy National Rural Health Day! In celebration of National Rural Health Day, we thought we would share a radio interview and op-ed from our own Dr. Tom Dean, long-time rural physician at Horizon Health Care from Wessington Springs, South Dakota. His stories and perspective wonderfully capture the experience of a rural health care provider in the midst of a pandemic.

The pandemic has shined a light the value and importance of rural health care. Rural providers have been the last and only source of COVID-19 testing in many communities. They have supported local nursing homes and schools as they have developed infection control and testing protocols. As hospital capacity reaches a breaking point, they are developing protocols for supporting and monitoring patients in their homes, including administering oxygen and checking in on patients regularly.

Rural health care providers have stepped in to play critical public health roles through the pandemic. As Dr. Dean describes, he has taken it upon himself to start sharing educational information about COVID-19 in the local newspaper. Rural providers are an important source of accurate information with patients, neighbors, local schools boards, church councils and others. They are often the first to know about emerging hotspots, including their source. For example, providers at Horizon Health Care were some of the first to recognize an emerging COVID-19 cluster early in the pandemic at a local meat packing plant. They communicated with the state health department and other local providers and they ultimately organized and staffed emergency testing events designed slow the spread of the disease in the plant and in the community. Community-facing testing events are being hosted across the Dakotas by rural community health centers including Coal Country Community Health Center and Northland Community Health Centers.

While rural health providers have been a critical line of defense against the spread of COVID-19, they have also absorbed an incredible emotional and spiritual toll. As Dr. Dean states, the individuals receiving care care aren’t just patients, but also friends, neighbors, colleagues and family. Those who are dying are loved ones and community elders. In many communities, there are no back-up providers when health care workers need time away to care for their own families or attend to their own emotional and spiritual health.

So, National Rural Health Day is a great opportunity to express our heartfelt thanks and appreciation to rural health care providers including primary care teams of medical assistants, nurses, advanced practice providers, and physicians, behavioral health providers, dental teams, front office staff, health IT professionals, administrators and others who are literally saving lives every day even when it takes a heavy personal toll. You are all real live health care heroes!

CHCs in the News!
Darrold Bertsch, CEO of Coal Country Community Health Center, is quoted in Politico about staffing shortages due to COVID-19 exposure, close contacts, and quarantines.
The Yankton Daily Press & Dakotan highlighted Horizon Health Foundation’s annual giving campaign.
The Direct Relief blog shared the story of Spectra Health and their efforts to provide care during the pandemic. Since the start of the pandemic in January, Direct Relief has provided Spectra Health with nearly $81,000 worth of requested medical aid. For more information on Direct Relief and the services and supplies they offer, contact Carmen Toft at CHAD.
Top Counties and Trends in the Dakotas
As of Wednesday, November 18, North Dakota and South Dakota remain ranked 1 and 2 in total new cases per population over the last seven days, according to the New York Times COVID-19 database.

The emerging hot spots in the two states with the most cases in the last seven days per population are:

In South Dakota, the positivity rate over the last 14 days is 19.6%, holding steady since the previous two week period. In North Dakota, the 14-day rolling average positivity rate is 15.9%. North Dakota’s positivity rate has been climbing since late June, when it was less than one percent.

Hospitalization capacity and trends tend to be difficult to track with staffed bed numbers constantly in flux. South Dakota has 593 people currently hospitalized, a number that has nearly doubled in the last month. North Dakota reports 276 currently hospitalized, up over 120 in the past month.

Here are some trusted websites that show data, trends, hospitalization rates, hot spots, etc.
North Dakota Governor Issues New Statewide Mandates
On Friday, November 13, Governor Doug Burgum issued several new mandates to slow the spread of COVID-19 in North Dakota. The mitigation efforts are being put in place to avoid further overwhelming hospital capacity and to keep schools open. The measures include:
  • A statewide mask mandate with a $1,000 fine for a failure to comply;
  • All bars and restaurants are limited to fifty percent capacity and must be closed for indoor dining from 10:00 pm to 4:00 am;
  • All banquet, ballroom, and event venues are limited to twenty-five percent capacity; and,
  • All K-12 extracurricular activities are paused for four weeks.

You can read more about the new mitigation efforts
South Dakota COVID-19 Response Update
The South Dakota Department of Health (SDDOH) recently announced a campaign to place SARS-CoV-2 antigen testing equipment and supplies throughout South Dakota. A short form needs to be completed by organizations interested in receiving SARS-CoV-2 antigen testing resources. The SDDOH says that the placement of resources is not guaranteed, and the timeline for placement must remain flexible. 

On Wednesday, November 18, Governor Noem granted an interview with South Dakota Public Broadcasting and held a press conference to discuss the state’s COVID-19 response. She continued with her standard message, saying the safest things people can do to protect themselves against the virus are good hand hygiene, be outside, and take care of our elderly neighbors. It should be noted that in sharing links to the Governor’s public statements we are not vouching for their accuracy. In fact, we believe that the information she shares about the effectiveness of masks and the potential of certain public policy interventions to slow the spread of COVID-19 are untrue.

Several municipalities in South Dakota have implemented mask legislation independently. Both Huron and Sioux Falls have passed resolutions or ordinances related to community masking this week, and Rapid City will take up the issue on Thursday.
Use of Cloth Masks to Control the Spread of COVID-19
On November 10, the Centers for Disease Control and Prevention (CDC) published a brief titled "Scientific Brief: Community Use of Cloth Masks to Control the Spread of SARS-CoV-2," showing that studies have confirmed the benefit of universal masking in communities. The combination of an infected person, especially those infected and asymptomatic (around 50% of transmissions), wearing a mask, and the healthy person wearing a mask (personal protection for the mask wearer) reduces the spread of SARS-CoV-2. According to the brief, "An economic analysis using U.S. data found that, given these effects, increasing universal masking by 15% could prevent the need for lockdowns and reduce associated losses of up to $1 trillion or about 5% of gross domestic product."

To read more about the mask studies and details on their ability to filter fine particles, please visit the CDC webpage.  
National Health Service Corps Loan Repayment Program Update
In October, the U.S. Department of Health and Human Services’ (HHS) Health Resources and Services Administration (HRSA) announced nearly $500 million in awards to support, recruit, and retain qualified health professionals and students through the National Health Service Corps (NHSC), Nurse Corps, and other workforce development programs.

In 2020, 40 clinicians received NHSC loan repayment or SUD loan repayment in North Dakota. This is an 11% increase from 2019. Two of those clinicians were placed in health centers. In South Dakota, 76 clinicians were awarded NHSC loan repayment and SUD loan repayment, an increase of 41% from 2019.

With recent changes to auto HPSA scoring, CHAD has closely followed the scores that health centers received and advocated for their eligibility to participate in the NHSC loan repayment program. We were pleased to see that additional positions in our states were funded in spite of early concerns about changes to the HPSA scoring methodology. We understand from conversations with the Bureau of Health Professions that they were able to apply additional resources to the program, which enabled them to serve more providers than they originally expected. We have reached out to BHP to learn more about the HPSA scores they were able to fund and how health centers faired overall given the new scoring methodology. As a reminder, CHAD also recently shared comments about the HPSA scoring approach, which you can review here.

New CPT Codes Released for COVID-19 Vaccination Reimbursement
On November 10, the American Medical Association (AMA) issued a press release announcing the publication of an update to the procedure code set known as the current procedural terminology (CPT) that includes new vaccine-specific codes to report immunizations for SARS-CoV-2. The CPT editorial panel worked with the Centers for Disease Control and Prevention (CDC) to approve two unique codes for each of the vaccines on track to be approved for use during the public health emergency.

The new CPT codes clinically distinguish each coronavirus vaccine for better tracking, reporting, and analysis that supports data-driven planning and allocation. Importantly, these CPT codes are available prior to the vaccines’ public availability to facilitate updating of health care electronic systems across the U.S.

For quick reference, the new CPT codes for the vaccine products are:
  • 91300   Pfizer-BioNTech COVID-19 vaccine; and,
  • 91301   Moderna COVID-19 vaccine.

The CPT editorial panel also worked with the Centers for Medicare & Medicaid Services (CMS) to create new vaccine administration codes that are distinct to each coronavirus vaccine and the specific dose in the required schedule. This specificity level is a first for vaccine CPT codes, and these CPT codes report the actual work of administering the vaccine, in addition to all necessary counseling provided to patients or caregivers and updating the electronic record.

For quick reference, the new vaccine administration CPT codes are:
  • 0001A     Pfizer-BioNTech COVID-19 vaccine, first dose;
  • 0002A     Pfizer-BioNTech COVID-19 vaccine, second dose;
  • 0011A     Moderna COVID-19 vaccine, first dose; and,
  • 0012A     Moderna COVID-19 vaccine, second dose.

All of the new vaccine-specific CPT codes published in the recent update will be available for use and effective upon each new coronavirus vaccine receiving emergency use authorization (EUA) or approval from the Food and Drug Administration. Additional detail, including the long, short, and medium descriptors for the new codes, can be accessed on the AMA website, along with several other recent modifications to the CPT code set that have helped streamline the public health response to the SAR-CoV-2 virus and the COVID-19 disease. In addition to the release of CPT codes, CMS has also released a payment allowance schedule for the procedures.
National AIDS Memorial to Honor Anthony S. Fauci, M.D. and David D. Ho, M.D. on World AIDS Day
The Community Health Center of the Black Hills is a proud community sponsor of World AIDS Day 2020 – A National Conversation. As part of their sponsorship, they are hosting a virtual viewing of the AIDS memorial quilt. Check for more details.

The National AIDS Memorial will bring together influential voices from the AIDS and COVID-19 pandemics on World AIDS Day, December 1, for an inspiring discussion about health justice, social activism, remembrance, and hope. World AIDS Day 2020 –A National Conversation will spotlight both pandemics’ interconnectedness -- the lives lost, the survivors, the activism, and the heroes. Through a distinguished list of guest speakers, video storytelling, and musical tributes, the topics and conversations will help answer the questions about how a nation responds, how it heals, and what lessons must be learned for the future.

During the event, the National AIDS Memorial will honor Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases, and David D. Ho, M.D., director of the Aaron Diamond AIDS Research Center at Columbia University, with its National Recognition Leadership Award. As renowned health experts on the frontlines of both the AIDS and COVID-19 pandemics, Dr. Fauci and Dr. Ho will be recognized for their lifelong commitment, work, and the profound impact they have had over the span of 40 years and two pandemics in advancing science, treatments, and education around both diseases. The event will be presented virtually at beginning at 11:00 am MT/ 12:00 pm CT on December 1 and is free to the public.
GP11 Network News
The Great Plains Health Data Network (GPHDN) would like to introduce the GP11 Network News! Each CHAD newsletter will contain a GP11 Network News section highlighting different health information technology initiatives happening in the network. Topics may include educational opportunities, program updates, or upcoming events. Please contact Becky Wahlor Kyle Mertens to include any noteworthy news that should be shared with other health centers.

One of the Great Plains Health Data Network (GPHDN) objectives is to build a centralized data warehouse for storing patient-level data, which will be siloed by health center. The warehouse is called the data aggregation and analytics system or the DAAS. The DAAS infrastructure will be built on a population health management (PHM) system, which can integrate data from external resources like electronic health records (EHR), payers, and health information exchanges (HIE) along with the analytic tools health centers can use to assist with care planning, risk stratification, quality measure reporting, and visit planning.

To select the PHM system, the GPHDN created a workgroup consisting of representatives from each of the 11 health centers. The DAAS workgroup is comprised of a diverse group of members that include staff from the c-suite, clinical/quality, data analytics, finance, and IT. This workgroup met weekly over the last few months to review a select number of vendors. The workgroup’s end goal is to review all the qualifications to select a single vendor, which then will be recommended to the GPHDN leadership board before going to the CHAD board of directors.

The pandemic definitely impacted the schedule, but the group is still planning select a PHM system by the end of the year. To keep the project on track, GPHDN will set up meetings that health centers can join to help inform and ask questions. It is vital to have participation from all health centers because this is a significant decision and a large investment. The following is the upcoming schedule:

  • All health center staff education session on the value of the DAAS and the leading vendor: Wednesday, December 9, 10:00 am MT/ 11:00 am CT
    • 15-minute vendor demo
    • Review workgroup information and Q&A
  • GPHDN leadership meeting: Thursday, December 17, 10:00 am MT/ 11:00 am CT
  • CHAD board of directors meeting: Friday, December 18, 10:00 am MT/ 11:00 am CT

Additional information, including the project charter, request for proposal, and schedule, can be found under the Work Groups section on the
GPHDN website. For additional information, reach out to the leadership committee representative at your health center or contact Kyle Mertens at CHAD.

CHAD Chat with Dr. Robin Landwehr
Health center leaders have shared with CHAD some of the questions, concerns, and fears that have been raised by staff as they continue to work within the pandemic response. There are so many reasons health center staff could be feeling increased stress and anxiety, including concerns about safety, the health of one’s family, and all of the other life issues that are amplified due to the impact of COVID-19 on our families and communities.

In an effort to respond to the potential needs of health center staff, CHAD’s behavioral health and substance use disorder program manager, Dr. Robin Landwehr, is available to offer health center providers and staff free telephone or video-based informal conversations as an additional support resource. Discussions can be about anything that would be helpful during this difficult time, such as work, health, family, and relationships. While not considered therapy, these conversations will be kept confidential.Health centers can make this informational flyer available to employees.

Robin has both day and evening times available. She can be reached through emailor by leaving a confidential voicemail at (407) 252-0898. Read more about Robin and her work at CHADhere.
National Influenza Vaccination Week is December 1-7
Community health centers in the Dakotas have been busy promoting flu vaccinations and holding flu shot clinics. While flu vaccination is recommended before the end of October, getting vaccinated later can still be beneficial for people who have put it off. Previous flu vaccination coverage data has shown that few people get vaccinated against influenza after the end of November. The Centers for Disease Control and Prevention (CDC) and its partners chose December for National Influenza Vaccination Week (NIVW) to remind people that even though the holiday season has begun, it is not too late to get a flu vaccine. 
Webinars & Meetings
Find these and other events on the CHAD website.

South Dakota Department of Health COVID-19 Update

The South Dakota Department of Health hosts a weekly COVID-19 webinar for health care facilities, medical providers, laboratorians, long-term care facilities, EMS providers, and other health professionals.

Thursdays in November (reoccurring)
10:00 am MT/ 11:00 am CT
For weekly call-in information, please join the listserv here. Find archived calls and slides here.

South Dakota Department of Health COVID-19 Mass Vaccination Planning

The South Dakota Department of Health hosts a weekly COVID-19 vaccination planning webinar for health care facilities, medical providers, laboratorians, long-term care facilities, EMS providers, and other health professionals.
Tuesdays (reoccurring thru March 2021)
12:00 pm MT/ 1:00 pm CT
Meeting link or call (669) 900 9128
Meeting ID: 845 2763 1820
Passcode: 719500
COVID-19 in North Dakota: Mental Health and Public Health

Presented by the North Dakota Rural Health Association, this webinar will look at the pandemic’s effect on mental health and public health in North Dakota and the resources available. Click here for more information.

Thursday, November 19
11:00 am MT/ 12:00 pm CT
Link to join. No registration is required.

Organizations Values, Culture, and Measurement: Impact on the Bottom Line

Presented by the North Dakota Rural Health Association, this presentation will provide both concepts, models, and case studies to show how rural leaders can answer the call to action to optimize primary care in rural markets. With declining reimbursement and increased competition, independent hospitals, health care systems, and independent practices must leverage available opportunities to improve financial performance. Rural providers and other stakeholders should consider their organizational values and how those are put in action to ensure their advantages can be strategically positioned using an abundance mindset to ensure a measurable impact on primary and specialty care practice alignment within the health care system.

Thursday, November 19
12:00 pm MT/ 1:00 pm CT
Link to join
. No registration is required.
Surviving & Thriving – The Power of Rural is 100% Community

On National Rural Health Day, Katherine Ortega Courtney, Ph.D., and Dominic Cappello, authors of 100% Community: Ensuring 10 Vital Services for Surviving and Thriving, will discuss their groundbreaking research and the roadmap they have created to help rural counties press reset and learn how to work together in new ways to create local systems of health, safety, education, and economic stability.

Thursday, November 19
12:00 – 1:15 pm MT/ 1:00-2:15 pm CT
Register here.

CHAD Network Team Meetings

Friday, November 20 at 11:00 am MT/ 12:00 pm CT – Behavioral Health Work Group
Tuesday, November 24 at 12:00 pm MT/ 1:00 pm CT – O & E Network Team
Tuesday, December 1 at 9:00 am MT/ 10:00 am CT – CHAD Board of Directors Meeting
Tuesday, December 8 at 1:00 pm MT/ 2:00 pm CT – Communications/Marketing Network Team Meeting

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