The Wisconsin Office of Rural Health works to improve
the access to, and quality of, rural health care.

The Wisconsin Office of Rural Health (WI-ORH) was established in 1975 by the U.W. Center for Health Sciences Vice Chancellor Robert Cooke, M.D. The original mission of the Office was to address shortages of health services in rural Wisconsin by developing rural clinical sites, using University resources. During the first 18 months of operation, the Office was involved in a variety of activities to identify areas of shortage, organize programs to address the unique requirements of each area, and enlist University resources to implement the programs.

The WI-ORH, working closely with the Department of Family Medicine and the School of Nursing, helped establish two nurse practitioner clinics with physician participation, one located in Tigerton.

As the WI-ORH matured, it became clear that the emphasis for rural health at the University was located in the Department of Family Medicine (DFM). Consequently, it was relocated to DFM offices in September 1979, where it stayed until early 1986. During this period the Office of Rural Health became closely associated with family medicine and many of its activities were developed to support the rural practice of family medicine.

During the late 1970s and early 1980s the Office became more involved in federal programs such as the National Health Service Corps (NHSC) and Community Health Centers (CHCs). Much of its activity was focused on ways to bring services to underserved areas of the state. The Office sponsored a conference to identify potential NHSC sites in the state and helped to create new practices using these programs.

One of the most visible roles of the WI-ORH was its development of a physician recruitment and retention program, called New Physicians for Wisconsin (NPW). This program began operating in 1979 and has developed into a nationally recognized resource, which has placed more than 500 physicians in community practices throughout the state. NPW provides a full range of services including practice and community profile development; a reference library of community resource materials; finding qualified candidates, matching them with appropriate practice opportunities, and promoting those opportunities; development of pertinent personal background information on candidates; newsletter articles and other materials on recruitment and retention; and consultation on issues, trends, and available resources in the recruitment marketplace. NPW's primary source of financial support is through fee-for-service contract arrangements with communities, clinics, and hospitals.

By being close in touch with rural communities, the Office of Rural Health has been able to identify issues that rural physicians and clinics encounter. This dimension is useful in guiding young physicians in selecting practice opportunities and in assisting rural practices function more effectively. Because of this experience, Office of Rural Health staff have also been involved in medical practice management, community survey and market analysis projects, and community clinic development activities.

In 2005, in partnership with the Wisconsin Primary Health Care Association (WPHCA), a Dentist Placement Program was created, focusing on clinics serving underserved populations around the state. To date, the DPP has placed over 90 dentists at 30 locations in the state, a majority in the federally qualified community health centers that are the safety net for the large number of people in Wisconsin without dental insurance.

The WI-ORH helped formulate legislation that created the Wisconsin Health Professions Loan Assistance Program (HPLAP). This initiative provides educational loan repayment to primary care physicians, psychiatrists, nurse practitioners, physician assistants, and certified nurse midwives who agree to practice in medical shortage areas of Wisconsin. Dentists and Dental Hygienists were added to the program in 2001.  The WI-ORH has actively advised legislators and the Governor's office regarding health issues and has been closely associated with the development of WisconCare, National Health Service Corps legislation, furthering the concept of community-oriented primary care, Indian and migrant health, and health care delivery to underserved areas of the inner city of Milwaukee.

The Medicare Rural Hospital Flexibility Program (Flex Program) was created by the Balanced Budget Act of 1997 and is intended to strengthen rural health care by encouraging states to take a holistic approach.  The federal Flex legislation created the Critical Access Hospital (CAH) designation.  CAH designation allows the hospital to be reimbursed on a reasonable cost basis for inpatient and outpatient services provided to Medicare patients.  In 1999, the WI-ORH applied for and was successful in starting the Wisconsin Flex Program.  We have assisted 59 small rural hospitals in achieving CAH designation, with Ministry Eagle River Memorial Hospital being the first to designate in October 1999.  The last hospital to receive CAH designation was Memorial Medical Center in Ashland in October 2007.

Each year, the WI-ORH applies for Flex Program funding from the Health Resources and Services Administration (HRSA) to provide continued support and assistance to Wisconsin's Critical Access Hospitals, Rural Health Clinics and rural emergency service providers.  Now that CAH designation in Wisconsin is complete, Flex grant dollars are utilized to assist with quality and performance improvement initiatives, encourage the development of rural health networks, and improve rural emergency medical services, all in an effort to enhance and ensure health care access to rural Americans.

Throughout its history, the WI-ORH has continued to be engaged in a number of activities focused on sharing of information and resources with rural health providers, administrators, and policymakers. They include the research and publication of rural health news and events, legislative and regulatory updates, public policy developments, funding opportunities, and the maintenance and promotion of an online resources library.

The underlying thrust of Office of Rural Health programs is to support rural health care delivery by providing education, resources and services which enable these communities to function effectively in a competitive and rapidly changing environment. By working closely with individual communities the WI-ORH attempts to develop a very personal and responsive approach and, at times, serve as an advocate for rural health and rural society.
 

Dr. Byron Crouse, Associate Dean for Rural and Community Programs, oversees the WI-ORH for the UW School of Medicine and Public Health, along with similar programs like the Wisconsin Area Health Education Center (AHEC) System, the Wisconsin Academy of Rural Medicine (WARM) and the Wisconsin Rural Physician Residency Assistance Program (WRPRAP).  He is a faculty member in the Department of Family Medicine, and sees patients in a small rural community in Southern Wisconsin.