Building on years of collaboration, the Oregon Office of Rural Health (ORH) and the Oregon Rural Practice-based Research Network (ORPRN) began planning in late 2023 to conduct listening sessions with rural and remote health facilities, public health, coordinated care organizations (CCOs) and community-based organizations (CBOs) to discuss and brainstorm solutions related to what each organization perceived as the most significant challenges to providing and receiving health care in rural Oregon. Session agendas were co-developed with input from facilities, agencies and organizations and tailored to each region’s priorities. The 2024 ORH/ORPRN Listening Session Report presents an overview of the common issues heard during the 2024 Listening Sessions. 

The 2024 Rural Listening Sessions included 96 participants from 50 rural health care organizations, public health departments, Coordinated Care Organizations and community-based organizations, including:

• 13 community-based organizations;
• 12 Critical Access Hospitals;
• 10 rural clinics;
• 2 Type B Hospitals;
• 8 public health departments;
• 4 Coordinated Care Organizations; and
• 1 county government.

Overview of identified challenges:

• Health care workforce recruitment and retention
• Access to care
• Patient supports and social drivers of health
• Health care facility finances

In early 2020, ORH began planning and outreach for the 2020 Rural Health Clinic (RHC) Listening Tour. Amid COVID-19, these efforts were put on hold and then redirected. In lieu of visits to RHCs, ORH has awarded several scholarships for continuing education and professional development to support clinics. These scholarships were based on feedback from RHCs on their most critical support needs. Below is a list of the scholarship awardees.

Evergreen Family Medicine was awarded a partial scholarship to attend the American Association of Professional Coders (AAPC).

Warner Mountain Medical Clinic received a partial scholarship to attend Oregon State University’s Community Health Worker course.

The following RHCs attended the National Association of Rural Health Clinic’s Fall Institute:

• Family Health Associates
• Madras Medical Group
• Orchid Health
• Providence Seaside
• Woodburn Pediatric Clinic

The following RHCs are attending the National Association of Rural Health Clinics Certified RHC Professional Course:

• CHI St. Anthony
• Columbia Memorial
• Evergreen Family Medicine
• Lake Health
• Malheur Memorial
• Morrow County Health District (Irrigon Medical & Ione Community)
• Orchid Health
• Providence Seaside
• Samaritan Medical Group-Newport, Depoe Bay, Toledo, Waldport
• Snake River Pediatrics
• Salem Health Medical Clinic—Woodburn

2018 Follow-up Year

During the 2017 Rural & Frontier Listening Tour (RFLT), health care facilities across Oregon identified workforce challenges as a major issue. One of the workforce challenges identified was with regard to recruiting and retaining bedside nurses. In the subsequent years ORH partnered with the Oregon Center for Nursing (OCN) to explore the feasibility of implementing a nurse mentoring program at Oregon’s Critical Access Hospitals (CAHs). The purpose of this study was to assess Oregon CAHs’ interest in a nurse mentoring program, their capacity to support a mentoring program, the type of program desired, and an estimate on the cost to hospitals and other entities of implementing such a program. As a result of this study, ORH partnered with the University of Iowa’s Online Nurse Residency to provide nurse mentoring for interested Oregon CAHs.

2019 Follow-up Year

Scholarship opportunities for the University of Iowa’s Online Nurse Residency Program (IONRP) were offered to all Oregon Critical Access Hospitals (CAHs) for their recently graduated, newly hired nurses. A total of eight CAHs expressed interest. ORH covered the cost of tuition for 19 nurses from these CAHs. Nurse residents will complete the IONRP course as well as a quality improvement/evidence-based final project. The year-long program takes place online with one-on-one check-ins between the nurse resident and the program mentor.  Education topics cover: Transition from Student to Professional Nurse; Communication; Responsibilities of the Professional Nurse; and Decision-Making at the Point of Care.

2017 Rural & Frontier Listening Tour (RFLT)

The 2017 report aimed to objectively address one of the challenges consistently raised during the RFLT—the lack of available information and clarity on the roles, responsibilities and authority of the various behavioral health providers (e.g. Local Mental Health Authority, County Mental Health Provider, Coordinated Care Organization, Hospital, Clinic).

The 2017 RFLT included 56 rural and frontier health care facilities:

• 28 Rural Health Clinics
• 11 Rural Clinics
• 10 Critical Access Hospitals
• 2 Type B Hospitals
• 2 Type C Hospitals
• 2 Federally Qualified Rural Health Clinics
• 1 Jail Clinic

Twenty-five partnering stakeholders joined the tour by area of scope:

• Coordinated Care Organizations (CCOs)
  • Regional CCOs; OHA Transformation Center
• Health Policy
  • Representatives from the governor’s, senators; and state representatives’ offices; OHA Health Policy and Analytics
• Oregon Workforce
  • Oregon Center for Nursing (OCN); Oregon State Board of Nursing (OSBN)
• Advocacy, Research and Technology
  • Oregon Association of Hospitals and Health Systems (OAHHS); OHA Health Information Technology; Oregon Rural Practice-Based Research Network (ORPRN)

Overview of identified challenges:

• Practice sustainability
  • CAHs at risk of designation loss
  • Current population-based funding formulas are not sufficient or equitable in rural and frontier areas
  • Viability of the small, independent practice 
• Available and affordable housing
• Workforce challenges
  • Provider recruitment
  • Provider and leadership retention
• Behavioral health
  • Authority, responsibility and coordination
  • Access and integration barriers
  • Funding model and reimbursement

2016 Rural & Frontier Listening Tour (RFLT)

In 2016, the RFLT included rural and frontier health facilities throughout Oregon. The 2016 report details identified challenges as well as associated Oregon statistics.

Forty-five facilities hosted listening sessions:

• 23 Rural Health Clinics
• 14 Critical Access Hospitals
• 4 Federally Qualified Health Centers
• 2 Type C Rural Hospitals
• 1 Rural Clinic
• 1 Tribal Clinic

Thirty-six partnering stakeholders joined the tour by area of scope:

• Coordinated Care Organizations (CCOs)
  • Regional CCOs; Oregon Health Authority Divisions: Transformation Center and External Relations
• Health Policy
  • Representatives from the governor’s, senators; and state representatives’ offices; Oregon Health Authority Divisions: Health Policy and Analytics; External Relations; Director’s Office (Tribal Liaison)
• Oregon Workforce
  • Oregon Center for Nursing (OCN); Oregon Health Authority, Provider Services Division; Oregon Medical Board
• Advocacy, Research and Technology
  • Oregon Association of Hospitals and Health Systems (OAHHS); Oregon Rural Practice-Based Network (ORPRN); Oregon Health Authority, Office of Health Information Technology;
• Social determinants of health
  • Housing Authority

Overview of identified challenges:

• Workforce
  • Provider recruitment and retention
  • Administration and leadership
  • Availability and affordability of housing
  • Nursing
  • Credentialed Medical Assistants
  • Health information and technology
• Access
  • Specialist and Primary Care Providers
  • Lack of acute care placements
  • New models of care

2014 Oregon Rural Hospital Listening Tour

2014 marked ORH’s first listening tour, which brought together state partners that work closely with Oregon's rural hospitals to hear from hospitals about important and challenging issues during a period of health reform. The 2014 report is available here. Tour partner stakeholders included Kelly Ballas, then Chief Financial Officer of the Oregon Health Authority, the Oregon Association of Hospitals and Health Systems and ORH.

Twenty-seven rural and frontier hospitals participated:

• 21 Critical Access Hospitals (CAHs)
• 3 Type B non-CAH rural hospitals
• 3 Type C non-CAH rural hospitals

Overview of identified challenges:

• Availability of mental health services
• Sustainability of health reform
• Availability of long-term care
• Improving access and quality of care
• Workforce challenges