Posted: Oct 23 2015

TUCSON, AZ (Tucson News Now) - By Craig Reck

The potential closure of a nursing home in Willcox is the latest example of ongoing struggles for health care providers to remain open and above the red in rural areas of southern Arizona.

Administrators at Northern Cochise Community Hospital met with the community Thursday morning to hear concerns and address any questions.

The event had a good turnout, according to Dan Douglas of Charles William Leighton Jr. Hospice. He said he is worried that closing the hospital’s nursing home would hurt his business and negatively impact families in the area.

Jared Wilhelm, Director of Community Relations for the hospital, said the hospital has always operated on a very thin budget. He said the administration learned about severe losses after a line-by-line breakdown of the services offered at the hospital.

Preliminary numbers were complete by late September and the hospital’s board learned in early October that NCCH was losing close to $2 million a year, according to Wilhelm.

He said closing the nursing home would save almost $750,000 annually, so departments would have to cut their budgets in order to make up the remaining $1.25 million.

Part of the problem, according to Wilhelm, is the drop in collections. The hospital used to collect 51 percent of its money owed, but he said that number has dropped to 37 percent, causing the administration to miss out on approximately $6 million.

The hospital’s district board will make a decision Wednesday, Oct. 28 on the nursing home’s future. It could be part of the solution to keep NCCH from closing like other critical access hospitals before it in southern Arizona.

“We don’t want to be the next one,” Wilhelm said.

Tubac Regional Health Center closed its doors earlier this year, but a new facility opened up farther away in Sierra Vista. Cochise Regional Hospital shut down less than three months ago, but there is now an urgent care in operation with plans to open an emergency room as well. All of these closures are on the radar of the Arizona Center for Rural Health, according to Executive Director Dr. Daniel Derksen.

Posted: Sep 18 2015

Do you have a healthcare provider in your state that exemplifies a "Real Doc Hollywood"? NOSORH would like to use National Rural Health Day to honor "Real Doc Hollywoods" or other healers  who have made a positive impact on their local community, brought services that may not have been there before, has shown local leadership, or has been a dependable partner that has helped made a change for the better. We welcome you to showcase that individual and help NOSORH promote all of the amazing Real Doc Hollywoods and other Healers around the nation. Please take the time to fill out to provide the following information, showing what makes your choice.  You may enter as many individuals as you would like, this is not limited to one submission per person. If all goes well we'll work on media stories and a publication to honor their work. To make your submission, click here.

Posted: Sep 1 2015

By  Mark Brodie | Aug. 28, 2015


This week’s ruling by a Maricopa County Superior Court judge that the assessment used to pay for part of Arizona’s Medicaid expansion is constitutional has set the stage for an appeal to the state Court of Appeals.


It also brought at least temporary sighs of relief from expansion supporters, including Dan Derksen. He’s director of the Center for Rural Health at the University of Arizona. Derksen said small towns face big health care challenges.


Listen to full audio broadcast at link below:



Posted: Aug 28 2015

- Report credits accountable care organizations with more care coordination

by Shannon Firth
Contributing Writer


WASHINGTON -- Medicare Accountable Care Organizations (ACOs) continue to improve care quality and to lower costs, according to a new report from the Centers for Medicare & Medicaid Services (CMS).

"Many of these ACOs are demonstrating that they can deliver a higher level of coordinated care that leads to healthier people and smarter spending," said CMS Acting Administrator Andy Slavitt, MBA, in a press release that accompanied the detailed report on ACO performance in 2014.

Medicare ACOs comprise hospitals, physicians groups, and other clinicians working in collaboration to coordinate care for all patients. Since the Affordable Care Act was passed, 420 Medicare ACOs have been established, caring for around 7.8 million people in the U.S., according to CMS.

Pioneer ACOs, "the early adopters of coordinated care," met their targets for 28 of 33 quality benchmarks -- a 3.6% improvement, according to the agency. Shared Saving programs, which are a risk-averse model in comparison with Pioneer, achieved 27 of 33 quality measures in 2013 and 2014, the release stated.

In 2014, 20 Pioneer ACOs and 333 Shared Savings Program ACOs produced an estimated $411 million in savings, "which includes all ACOs savings and losses," the agency reported.

The report also noted that "97 ACOs qualified for shared savings payments of more than $422 million by meeting quality standards and their savings threshold."

- continued at link below


Posted: Aug 18 2015

Eligibility is open to medical students (allopathic or osteopathic) in their final year of a U.S. accredited school who are planning to pursue a career in primary care, and are committed to working in underserved communities with limited access to care.

Students to Service loan repayment award recipients receive up to $120,000 (tax free) for three years of full-time service or six years of half-time service. Upon completion of residency, recipients serve as primary care providers in an NHSC-approved site in a Health Professional Shortage Area (HPSA) of greatest need. The 2016 Students to Service application cycle closes on October 22, 2015 at 7:30 pm, ET. 

There are two Students to Service infographics that help explain the benefits of this program. One shows how the award can greatly reduce a medical school student’s debt by more than 45 percent, and the other shows overall benefits of the award, such as training and financial support.

The program is expected to be competitive. Please note that applicants who have federally-serviced loans will need to create a FSA ID before beginning the application process.  The FSA ID replaced the Federal Student Aid PIN on May 10, 2015.  Additional instructions can be found in the 2016 NHSC Students to Service Application and Program Guidance.  

Also, please encourage applicants to join us on Thursday, September 17 from 7:00 pm – 8:30 pm ET for the Students to Service Technical Assistance Webinar, to get questions answered about the application process, program eligibility, and service commitment. The login information is below:  

Access link:
Dial-In Number: 1-888-566-6151 
Participant Passcode: 4221465

Thank you for your continued support in helping us spread the word about the opening of the Students to Service Loan Repayment Program.

National Health Service Corps

Posted: Aug 7 2015

HRSA Awards $2.7 Million to Improve Rural Health

The Health Resources and Services Administration (HRSA) announced $2.7 million in grants for two pilot programs to increase access to and improve health care in rural communities.  These 3-year grants will provide rural communities an opportunity to collaborate in training allied health professionals and expanding health insurance coverage.   

The Rural Network Allied Health Training Program, funded at $1,994,150, will support 10 awards for budget requests up to $200,000 in each of eight states to develop networks for improving rural health care through the recruitment, clinical training, and retention of allied health professionals.  Emphasis is on integrated rural health networks that can partner with local community colleges and other accredited educational institutions to develop formal clinical training programs for allied health professional students.   The program is in response to the Administration’s Job-Driven Training Initiative, which calls for effectively placing ready-to-work Americans in jobs that are available now, or training them in the skills needed for better jobs.   

“The strength of this program is its collaborative approach to training allied health professionals,” said HRSA Acting Administrator Jim Macrae.  “This program builds on HRSA’s efforts to help those living in rural communities have access to the comprehensive care they need.”

The Rural Outreach Benefits Counseling Program is funded at $749,915 to support 10 projects in nine states with budget requests up to $75,000 each.  The program is designed to expand health insurance outreach, education and enrollment efforts to eligible uninsured individuals and families; help educate the newly-insured about their benefits; and connect these individuals to primary and preventive services to which they now have access.  Both programs are managed by the Federal Office of Rural Health Policy (FORHP) at HRSA. 

“With the large number of uninsured individuals living in rural areas, this program addresses a critical need,” said Tom Morris, FORHP director.  “It will help us identify the creative and effective models that are reaching the rural underserved.”

Posted: Jul 29 2015

Dr. Derksen is professor of public health policy and management and director of the Center for Rural Health at the UA Mel and Enid Zuckerman College of Public Health.

Dan Derksen, MD, professor of public health policy and management and director of the Center for Rural Health at the University of Arizona Mel and Enid Zuckerman College of Public Health, spoke today before the U.S. House of Representatives, Committee on Ways and Means, Subcommittee on Health, in Washington, D.C. Oral testimony at this hearing was from invited witnesses only.

Dr. Derksen provided expert testimony on “Rural Health Care Disparities Created by Medicare Regulations and Payment.”

A video of the hearing is available at; Dr. Derksen’s testimony begins at approximately 57:00.

Dr. Derksen’s statement is available at

Posted: Jun 26 2015 | The Arizona Daily Star | June 26, 2015

By Stephanie Innes


After the U.S. Supreme Court’s decision on the Affordable Care Act Thursday, Tucson insurance broker Raymond E. Magnuson had one reaction — a huge sigh of relief.

“Everything continues on as is,” said Magnuson, the owner of Magnuson & Associates. “There was so much anxiety going on. We were prepared for a deluge if the ruling was against the subsidies.”

Thursday’s ruling, which affirmed the Affordable Care Act’s health insurance subsidies to middle- and low-income Americans, means that the 126,506 Arizonans currently receiving the subsidies will continue to get them.

The average subsidy is $158 a month, and a ruling against the White House could have more than doubled some Arizonans’ monthly health insurance payments. Some health experts predicted that many of those people who currently have subsidies would have ended up going without health insurance altogether had their subsidies been cut.

“For those that would have been impacted, it could have been devastating,” Magnuson said.

The 6-3 decision applied to 34 states, including Arizona, that use the federal health exchanges set up via President Obama’s Affordable Care Act (ACA).

Other states, including California, Washington and Colorado, set up their own state exchanges and would not have been directly affected by the King v. Burwell case.

The plaintiffs had argued that the Affordable Care Act’s language specifies that health exchanges must be created by states and that the federal subsidies are allowable only in state-based marketplaces.

Had the justices ruled for the King side, Arizona faced some hurdles in setting up a state exchange.

The Arizona Legislature in the most recent session passed House Bill 2643, which makes it illegal for the state to use any personnel or financial resources to “administer, enforce or cooperate” with the ACA. The bill, which was signed into law by Gov. Doug Ducey, also says state money cannot be used for Arizona to create its own health exchange.

Responding to the high court’s ruling Thursday, Ducey spokesman Daniel Scarpinato wrote in an email that “the court has spoken.”

And while many health experts are hailing the King v. Burwell decision as a signal for the country to move on from divisiveness over the federal health law, Scarpinato wrote that Ducey maintains his long-held opinion that the ACA is “a rolling disaster.”

“It isn’t the right plan for Arizona or for America, and it should be replaced,” Scarpinato wrote.

Federal numbers show 205,000 Arizonans purchased insurance on the federal exchange in the most recent open enrollment, and that 126,506 of them, including 23,000 children, received subsidies in the form of tax credits paid directly to the insurance company by the federal government.

Families USA, a national nonprofit group, found that a total of 6.4 million Americans could have lost financial assistance with their monthly health insurance premiums.

In a study of individual congressional districts, Families USA found that 14,000 people in Rep. Raúl Grijalva’s 3rd Arizona Congressional District could have lost their health insurance subsidies, as could have 14,000 in Rep. Martha McSally’s 2nd District. Both districts include parts of Southern Arizona.

“I hope that with this decision, the Republican Party in Arizona and across the country recognizes the will of the American people to see this law stand,” Grijalva said in a prepared statement.

“The political decision of state lawmakers in Arizona to snub President Obama and this health-care law with House Bill 2643 threatened that right for too many Arizonans.”

McSally reacted with criticism of the ACA.

“While today’s ruling keeps intact subsidies under the law, the fact remains that the Affordable Care Act is fundamentally broken and hurting families across our country,” her statement says. “Southern Arizonans deserve a better answer to our broken health-care system, one that will put them first, and I’ll continue to work with my colleagues to give that to them.”

Tucson-based health policy expert Dr. Daniel Dersken said the decision will allow Arizona to move forward in encouraging more participation in ACA insurance.

Arizonans receiving subsidies through the marketplace represent just 38 percent of those estimated to be eligible, he said. By comparision, for example, Florida’s participation rate is 80 percent.

“We want to make sure people get covered.” said Derksen, a professor at the University of Arizona’s Mel and Enid Zuckerman College of Public Health. “Come Nov. 1 we have an opportunity to get well above 50 percent. Maybe we could draw on what Florida is doing.”

Derksen called the decision “great news for Arizona.” A ruling against the administration would have affected not only people with subsidies, but health care across the U.S., he said.

“I’m not going to come in on a parachute and say ‘mission accomplished,” Derksen said. “The partisan politics and litigation has continued — this (ACA) was signed in 2010 and here we are in 2015.”

Thursday’s decision represents what many experts say is the last major challenge to the federal law.

However, a pending lawsuit in Maricopa County, filed by a group of Republican Arizona lawmakers in 2013, could still affect health care in Arizona. The lawsuit seeks to overturn Medicaid expansion.

When Arizona expanded Medicaid in 2014, it not only raised the income limit to qualify, but also restored childless adults to the program, which is a government health insurance program for low-income people.

In Arizona the program is called the Arizona Health Care Cost Containment System (AHCCCS). Since December 2013, AHCCCS enrollment has increased by 365,129 Arizonans. People added to AHCCCS through Medicaid expansion could lose their coverage if the lawsuit is successful.

In a statement after the decision was announced, U.S. Health and Human Services Secretary Sylvia Burwell said she hopes the ruling will help “focus on the substance and turn to building on the progress we have made.”

The goal has always been to provide more Americans with affordable access to quality health coverage and create a system that improves the quality of care and spends dollars more wisely, she said.


Posted: Jun 26 2015

By Associated Press | June 25, 2015

The U.S. Supreme Court on Thursday upheld the nationwide tax subsidies under President Barack Obama's health care overhaul, in a ruling that preserves health insurance for millions of Americans.

The justices said in a 6-3 ruling that the subsidies that 8.7 million people currently receive to make insurance affordable do not depend on where they live, under the 2010 health care law.

The decision means the 126,000 Arizonans receiving  tax subsidies won’t have to find another means of paying for health insurance.

The outcome is the second major victory for Obama in politically charged Supreme Court tests of his most significant domestic achievement.

Dan Derksen, director of the Arizona Center for Rural Health at the University of Arizona, said this will likely be the last time the ACA will be challenged in the Supreme Court.

"I think at this point we’ll be seeing efforts to try to fine tune the patient protection and affordable care act there may be efforts to try to change the way it’s financed and budgeted certain portions," Derksen said.

Earlier this year, lawmakers in Arizona passed a law barring the state from setting up it’s own exchange. Arizona is one of 34 states that don't run their own marketplace for health insurance.

Chief Justice John Roberts again voted with his liberal colleagues in support of the law. Roberts also was the key vote to uphold the law in 2012. Justice Anthony Kennedy, a dissenter in 2012, was part of the majority on Thursday.

"Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them," Roberts wrote in the majority opinion.

Nationally, 10.2 million people have signed up for health insurance under the Obama health overhaul. That includes the 8.7 million people who are receiving an average subsidy of $272 a month to help pay their insurance premiums.

Of those receiving subsidies, 6.4 million people were at risk of losing that aid because they live in states that did not set up their own health insurance exchanges.

The challenge devised by die-hard opponents of the law, often derided by critics as "Obamacare," relied on four words — established by the state — in the more than 900-page law.

The law's opponents argued that the vast majority of people who now get help paying for their insurance premiums are ineligible for their federal tax credits. That is because roughly three dozen states opted against creating their own health insurance marketplaces, or exchanges, and instead rely on the federal to help people find coverage if they don't get insurance through their jobs or the government.

In the challengers' view, the phrase "established by the state" demonstrated that subsidies were to be available only available to people in states that set up their own exchanges. Those words cannot refer to exchanges established by the Health and Human Services Department, which oversees, the opponents argued.

The administration, congressional Democrats and 22 states responded that it would make no sense to construct the law the way its opponents suggested. The idea behind the law's structure was to decrease the number of uninsured. The law prevents insurers from denying coverage because of "pre-existing" health conditions. It requires almost everyone to be insured and provides financial help to consumers who otherwise would spend too much of their paycheck on their premiums.

The point of the last piece, the subsidies, is to keep enough people in the pool of insured to avoid triggering a so-called death spiral of declining enrollment, a growing proportion of less healthy people and premium increases by insurers.

Several portions of the law indicate that consumers can claim tax credits no matter where they live. No member of Congress said that subsidies would be limited, and several states said in a separate brief to the court that they had no inkling they had to set up their own exchange for their residents to get tax credits.

The 2012 case took place in the midst of Obama's re-election campaign, when he touted the largest expansion of the social safety net since the advent of Medicare nearly a half-century earlier. But at the time, the benefits of the Affordable Care Act were mostly in the future. Many of its provisions had yet to take effect.

In 2015, the landscape has changed, although the partisan and ideological divisions remain for a law that passed Congress in 2010 with no Republican votes.

The case is King v. Burwell, 14-114.

KJZZ's Carrie Jung contributed to this report.

Updated 6/25/205 at 10:30 a.m.


Posted: Jun 25 2015

Cochise Regional Hospital wins Corporate Turnaround of the Year in a Small Market, awarded on June 23, 2015 at the Turnaround Atlas Award Gala & Dinner in Chicago, IL.

TURNAROUND ATLAS AWARDS honoring the best value-generating transactions, outstanding firms, teams and influential leaders, worldwide.

Posted: Jun 15 2015 | Arizona Daily Star June 15, 2015 By Stephanie Innes


Rural hospitals across the country are closing, but a newly formed organization in Southern Arizona is looking to buck that trend.

Tucson Medical Center is expected to announce Monday that it is the hub and founding member of the fledgling not-for-profit Southern Arizona Hospital Alliance, which includes four rural hospitals.

Combined, those rural hospitals serve more than 70,000 people — Benson Hospital in Benson; Mount Graham Regional Medical Center in Safford; Northern Cochise Community Hospital in Willcox and Copper Queen Community Hospital in Bisbee.

Like TMC, rural hospitals in the new partnership want to remain independent, nonprofit and locally governed, a desire that is becoming increasingly difficult as health-care costs rise and larger health systems acquire smaller hospitals, clinics and physician practices.

“We think local health care is best determined by those living in it,” said Jim Dickson, CEO of Copper Queen Community Hospital.

That’s not always possible for smaller hospitals. But by banding together, hospitals in the Southern Arizona Hospital Alliance hope to leverage resources and gain advantages in purchasing, grant-writing and physician recruitment, as well as improved patient access to specialty care and more coordinated clinical care.

“This is a very promising sign that these communities are looking to keep an important part of their community identity while taking advantage of partnering,” said Dr. Daniel Derksen, director of the Arizona Center for Rural Health, which is housed at the University of Arizona’s Mel and Enid Zuckerman College of Public Health. “There is a lot of this going on, and it makes sense.”

Monday’s announcement falls on the same day as a scheduled rally at the U.S. Capitol aimed at preventing more rural hospitals from closing. The National Rural Health Association says that since January 2013, more rural hospitals have closed than in the previous 10 years combined.

“We have the same expenses, but not the same number of patients as a larger institution will have. So volume is the number one thing for rural hospitals that strains us financially,” said Roland Knox, CEO of Northern Cochise Community Hospital.

While there’s no money being exchanged between the hospitals, the hope is that the alliance will bolster the fiscal strength of all the hospitals by improving their operational efficiency. Forming a separate nonprofit organization allows the alliance to apply for grants as one entity, and also do group purchasing.

“We work closely with Tucson Medical Center and the other hospitals in this alliance already, with patient care, staff training and other resources that we all need,” Knox said. “It made sense to formalize those informal agreements. This is an enhancement of relationships we already have.”

Northern Cochise Community Hospital, which serves an area with a population density of 7.5 people per square mile, has been independent since its founding in 1966. Knox says it’s essential for the hospital to have a local board of directors in order ensure the health-care needs of the community it serves are the top priority.

“There’s a lot of pressure, as TMC has experienced. A lot of hospitals have had folks knocking on their door who say, ‘Hey, why don’t you become owned by us?’” said Susan Willis, a TMC executive who is president of the new Southern Arizona Hospital Alliance. “I would say that the independence you see at TMC is even stronger in the rural communities. It’s really important for them to remain independent.”

Benson Hospital CEO Richard Polheber, whose 22-bed hospital is about 48 miles southeast of downtown Tucson, hopes the partnership with TMC will help bring more primary care and specialty doctors to Benson.

“The real challenge we have is recruiting primary care physicians. TMC has a recruiter, and we’re talking to them about helping us,” Polheber said. “Right now people have to go to Tucson or Sierra Vista to see a primary care doctor. The doctors who are here have full practices.”

Polheber said Benson has five primary care physicians, but needs at least four more. The community includes about 12,500 people year-round, but swells to more than 16,000 with winter visitors.

“Getting more cardiology and pulmonology and OB-GYN physicians — we don’t have any OB-GYN,” he said. “I’ve been in rural health care for about 20 years now. People cherish the community they live in, but you struggle to bring in as many of the services as possible.”

The alliance is not intended to freeze out or exclude people from other rural hospitals, Willis stressed.

“We just felt we had to be true to the overall mission, the things we had in common. And that nonprofit and locally governed piece was super strong,” she said.

Posted: Jun 10 2015


A bipartisan grassroots movement to petition Congress, state legislatures, and Governors to pass measures to ensure the sustainability of rural hospitals in America. The Walk will begin on June 1, 2015 in Belhaven, North Carolina and end on June 15, 2015 on the US Senate lawn in Washington, DC. This is a 14 day, 283 mile walk, each mile representing the 283 rural hospital in danger of closure, from Belhaven, North Carolina to Washington, DC. The Walk will be led by Civic Rights Legend Bob Zellner and Belhaven Mayor Adam O’Neal.

Posted: Jun 1 2015

By Stephanie Innes

With the number of local deaths from drug overdoses now outpacing that of motor vehicle crashes, there’s a growing concern both in Tucson and nationally about prescription pain medications.

Arizona ranks sixth highest in the nation for individuals misusing and abusing prescription drugs, says Alyssa Padilla, a special projects coordinator at the University of Arizona’s Mel and Enid Zuckerman College of Public Health.

The Pima County Medical Examiner in 2013 handled 327 deaths due to overdoses, with the vast majority occurring because of opiate drugs, including oxycodone, morphine, heroin and hydrocodone.

By comparison, the office completed 197 autopsies on people who had died due to a motor vehicle accident in 2013, the most recent year for which complete data was available.

Posted: May 26 2015


MultiPlan, Inc. today announced the recipients of its 2015 Rural Health Outreach Grant. 

(PRWEB) May 26, 2015 

This year’s four grant recipients represent a diverse array of programs focused on improving the well being of people living in rural areas. Grant recipients will each receive $7,500 to help them introduce or expand services, education, screenings and other endeavors that support the healthcare needs of people in their communities. These four awards bring the total amount awarded since the program’s inception in 1995 to $490,000. 

The recipients of the 2015 MultiPlan Rural Health Outreach Grant are:

Penn Highlands Brookville Hospital in Brookville, Pennsylvania. This hospital is a member of Penn Highlands Healthcare and is designated as a Critical Access Hospital. Penn Highlands Brookville will use the grant money to establish a new primary health care “Q-Care Clinic,” to provide routine comprehensive primary care services in the town of Punxsutawney, Pennsylvania.

Howard Memorial Hospital in Nashville, Arkansas. Howard Memorial is a non-profit Critical Access Hospital in Southwest Arkansas, 25-bed count facility. The money granted to Howard Memorial will go toward funding its new facility which will provide therapy and treat the behavioral health needs of the elderly. 

North Texas Medical Center in Gainesville, Texas. North Texas Medical Center is a 60-bed acute-care hospital. The hospital serves a community in which 25% of the patient population under the age of 18 is considered to be living in poverty. The hospital will use the grant funds to support its new Pediatric Therapy Program.

Northern Cochise Community Hospital in Willcox, Arizona. This 24-bed inpatient Critical Access Hospital is seeking Pediatric Prepared Emergency Care Certification, making it the only hospital within a 40-mile radius to hold such credentials. The hospital will be using the grant money to purchase equipment for its pediatric facility. 

For more information about the MultiPlan Rural Health Outreach Grant and other programs that help support MultiPlan participating hospitals and the patients they serve, visit

About MultiPlan 
MultiPlan, Inc. is the industry’s most comprehensive provider of healthcare cost management solutions. The company provides a single gateway to a host of network- and analytics-based solutions for managing the financial risks associated with healthcare claims as well as products that fight waste, abuse and fraud before payments are made. Clients include insurers, health plans, third party administrators, self-funded employers, HMOs and other entities that pay medical bills in the commercial healthcare, government, workers compensation and auto medical markets. MultiPlan is owned by an investment group led by Starr Investment Holdings and Partners Group.


Posted: May 12 2015

TUBA CITY, Ariz. - The American College of Surgeons (ACS) in March designated Tuba City Regional Health Care Corporation as a level III trauma center enabling the hospital to see and take care of more critically injured patients.

ACS has only verified one other Native American Level III trauma center. That one is located in Anchorage, Alaska.. The designation moves TCRHCC up a ranking.

Four and a half years ago when Dr. Ralph Zane Kelley, a trauma surgeon and also the chief of surgery and trauma medical director at TCRHCC, arrived he said the hospital was designated by the state of Arizona as a level IV trauma center. The designation by ACS is a national ranking.

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for surgical patients. ACS is dedicated to the ethical and competent practice of surgery, according to its website.

In a recent statement, ACS emphasized that the allocation of trauma centers should be based on the needs of the population, rather than the needs of individual health care organizations or hospital groups. And, at their core, trauma systems are developed to achieve care that is optimal for injured patients.

In the state of Arizona there were only 11 verified Level III ACS trauma centers. Tuba City is now number 12 on that list. By comparison, Flagstaff Medical Center is a Level I.

"The others are ... big names that you don't normally see Tuba City on that list with," Kelley said.

He said the designation is a big deal across Indian country because of the amount of trauma on reservations, which has been verified by studies.

"I'm Native American and I was trained in Las Vegas in trauma on the agreement that I would come out here because they have such a need for trauma surgeons on the reservation," Kelley said, adding that four of the five trauma surgeons in Tuba City are Native American. The hospital employs a Native American hand surgeon and an ER doctor as well.

In trauma terms, Tuba City sees everything from car crashes, ATV accidents, assault, gunshot and knife stab wounds, patients who were bucked off a horse, gored by a bull and elderly patients falling.

"We even see a number of trauma's that are from international tourists at Monument Valley or Grand Canyon," Kelley said. "The majority are native traumas."

Shannon Johnson, RN director of trauma program services, and Kelley worked the last few years for the current Level III designation with an initial visit by ACS in 2013 and the final visit coming a year and a half later. ACS specifically looks at the trauma patients an emergency department cares for - whether they are cared for or operated on at the hospital or whether they are shipped somewhere else. The organization also looks at how the ER department tracks care of patients, how they do peer reviews of all trauma patients, how the surgeons receive trauma credentials, and the equipment and infrastructure each hospital has.

Even with the new designation, TCRHCC still has limitations on head and spine injuries - those patients are still treated in Flagstaff or Phoenix.

In addition to providing a higher quality of care, trauma surgeons and orthopedic surgeons are on call 24-7, the trauma process is tracked so it is up to the standard that ACS sets for trauma centers.

"It definitely increases the quality and competency of care that trauma patients receive here," Kelley said. "Tuba City is probably the only place on the rez that has ER residency trained board certified ER physicians. Also we have general surgeons who are advanced trauma trained."

Johnson said, in addition, the hospital has trauma nurse core curriculum certified nurses and emergency pediatric certified nurses as well.

One of the biggest things that Johnson and Kelley want people in the region to know is that the designation means something because it is one of a limited number in the state and only the second Native American hospital to be designated.

"We're accredited by a national organization and we do care for a high level of patients and definitely care for and have a higher acuity of care than the majority of other reservation facilities," Kelly said. "Tuba is constantly adding new services and new specialties to keep patients on the reservation rather than having to ship them to Flagstaff or Phoenix where it is an inconvenience for themselves but also their families."