Current News

CHCS Launches Online ROI Forecasting Calculator for Quality Initiatives in Medicaid
April 24, 2008
The Return on Investment Forecasting Calculator for Quality Initiatives is a new web-based tool designed to help Medicaid stakeholders identify programs with the potential to both improve health care quality and control costs. The Center for Health Care Strategies developed this practical tool with support from the Robert Wood Johnson Foundation (RWJF).

The ROI Calculator, available at www.chcsroi.org , is designed to help Medicaid stakeholders generate realistic return on investment (ROI) estimates for quality improvement initiatives. States and health plans can use this online tool for an array of purposes throughout the course of program development and implementation. In particular, the ROI Calculator can be used to support resource allocation, program design, program funding, and monitoring and evaluation of quality improvement initiatives.

CHCS will host a WebExchange on May 8 from 2-3:30 ET to provide a live demonstration on the ROI Calculator. This call will also share experiences in using the tool from three states that participated in the Return on Investment Purchasing Institute, a national learning collaborative funded by The Commonwealth Fund and the RWJF.

Hospital- Acquired Infections in Pennsylvania 2006
April 24, 2008
Pennsylvania Health Care Cost Containment Council

The Pennsylvania Health Care Cost Containment Council (PHC4) today released its second hospital-specific report on hospital-acquired infections. Hospitals reported that 30,237 patients hospitalized during 2006 contracted an infection during their hospitalization, a rate of 19.2 per 1,000 cases.

Hospital-acquired Infections in Pennsylvania includes information on approximately 1.6 million patients treated in 165 general acute care hospitals. Because not all hospitals treat the same types of patients, they were categorized by "peer groups" so that hospitals that offer similar types and complexity of services and treat a similar number of patients are displayed together. In addition to the number of cases and infection rate per 1,000 cases, information on mortality, mean and median length of stay, and mean and median charges are presented for each hospital.

To view and/or download the report, visit us on the web by clicking the following link:

Hospital-Acquired Infections in Pennsylvania 2006

Update from the New York Center for Health Workforce Studies
April 24, 2008
Residency Training Outcomes in New York, 2007
This report describes findings from the Center’s annual survey of physicians completing residency or fellowship training in New York. The survey inquires about residents’ demographic characteristics, practice plans, experiences in searching for a job, and impressions of the physician job market. New York retained about half of all new physicians in the state, although there were substantial differences by specialty. Unlike previous years, demand for primary care physicians (generalists) was comparable to demand for non-primary care physicians (specialists). Respondents planning to practice outside of New York were asked their reasons for leaving the state. The most commonly cited reasons were proximity to family (26 percent) and inadequate salary (21 percent). Thirteen percent (13 percent) of respondents indicated that they never intended to practice in New York. To view the full report go to: http://chws.albany.edu/index.php?nys_exit.

Podiatric Medicine Workforce Study
With support from the American Podiatric Medicine Association, the Center recently completed a study that estimated future supply of and demand for podiatric physicians in the U.S. The study found that the production of new podiatrists would have to expand dramatically to meet increasing demand for foot-related services created by the aging of the population and expected increases in the prevalence of obesity and diabetes. To view the report of this study, visit the Surveys page of the APMA Web site at: http://www.apma.org. Enumeration of the Public Health Workforce in New York
The Center, in collaboration with the NYS Department of Health and the NYS Association of County Health Officials, recently completed a study of local public health workers in an effort to gain a better understanding of this workforce’s size, composition, and responsibilities. The study found that the local public health workforce was older than average and not as diverse as the population it serves. Also, a large number of workers age 55 and older reported retirement plans in the next five years and about 20% of workers younger than age 35 reported plans to leave the field of public health. Download the report: http://chws.albany.edu/download.php?id=446561,343,2.

Health Careers Web Site
The Center continues to expand its Health Careers Web site, with extensive information on nearly 50 health careers in New York, including general descriptions of health occupations and specific education and licensure requirements; listings of and electronic links to all educational programs in the state; the current number of individuals in the health occupation in New York; and forecasts from the federal Bureau of Labor Statistics on future job growth. The Web site is designed to be a guide for students, guidance counselors, health workers, or anyone interested in a career in health care. To visit the health careers Web site, go to: http://www.healthcareersinfo.net.

CLARIFICATION

In an April 1 press release expressing gratitude to Governor Paterson and legislative leaders for including the Doctors Across New York initiative in the health budget for FY 2008-09, the Medical Society of the State of New York stated that according to data from the Center for Health Workforce Studies released in December 2006, there was a continuing downward spiral in New York in the number of practicing physicians in certain specialties, including Obstetrics/Gynecology, General Surgery, Orthopedic Surgery, Neurosurgery, Family Medicine, Thoracic Surgery, and Psychiatry.

A further analysis of these data comparing the supply of these specialties in 2001 to supply in 2005 reveals wide regional variation, with steep declines in some regions, offset by growth in supply in other regions. The most up-to-date information on physician supply and distribution in New York can be found in the 2007 edition of the Annual New York Physician Workforce Profile posted on the Center’s Web site at: http://chws.albany.edu/index.php?nyphysicians.

WORKS IN PROGRESS

New York RN Forecasting Study
The Center is currently conducting a study to forecast future registered nursing supply and demand gaps in New York. The RN forecasting model, developed by the federal Health Resources and Services Administration, has been adapted and applied to counties and county groups within New York, using 2005 as a base year and projecting through 2020. The goal of the study is to quantify RN supply and demand gaps in New York by locality over the 15-year period. A report of findings from this research will be released next month.

OTHER NEWS

Jean Moore, director of the Center, participated in an orientation seminar sponsored by the Pan American Health Organization in Bridgetown, Barbados last winter. The seminar was targeted to data research teams conducting health workforce studies in territories and countries of the Caribbean and Latin America. Ms. Moore’s presentation, "Monitoring the Health Workforce: Definitions, Sources, and Methods," focused on approaches to data collection, measures of supply and demand, and dissemination strategies.

AgrAbility Press Release
April 24, 2008
Below is a press release from AgrAbility for Pennsylvanians. AgrAbility staff members rely on a team of professionals in order to fully serve our farm family clients. Part of that team is an Occupational Therapist, and the important work they do helping to recognize ways in which modifications might assist clients through everyday tasks. April is recognized as OT Month; AgrAbility joins many others in saluting this worthwhile occupation.

Thank you for your support of farm families throughout PA through the publication of AgrAbility press releases. Best wishes.

AgrAbility Press Release

Measuring the Quality of Pennsylvania's Commercial HMOs
April 24, 2008
The third year of the Rural Hospital Replacement Facility Study, prepared by Stroudwater Associates and RED CAPITAL GROUP, identified measurable changes in the experiences of Critical Access Hospitals (CAH) engaged in the process of facility replacement. Notably, respondents reported improvement in tangible measures of hospital performance, such as faster patient discharge growth and improved operational efficiency. Respondents also reported greater success in physician and staff recruitment and improved customer and employee satisfaction. Other intangible benefits enjoyed by participating hospitals included community economic development, improved work culture and better quality of care.

CAH Replacement Study
CAH Replacement Study Exec Summary

Measuring the Quality of Pennsylvania's Commercial HMOs
April 24, 2008
The Pennsylvania Health Care Cost Containment Council (PHC4) is pleased to announce the release of its latest report – Measuring the Quality of Pennsylvania's Commercial HMOs.

This report includes data from Calendar Year 2006 and combines clinical results, preventive measures and member satisfaction information to give purchasers, policymakers and consumers a more complete picture of how well HMOs serve their members.

To view and/or download the report, visit us on the web by clicking the following link:

Measuring the Quality of Pennsylvania's Commercial HMOs

Copies of the report can also be ordered by calling PHC4 at (717) 232-6787.

SHIP Bulletin
April 24, 2008
SHIP Student Research Paper Competition
Submission deadline: May 30, 2008
Initiated in 2000, the SHIP Student Research Paper Competition recognizes graduate-level student research on community health improvement topics. The goals of the Competition are to promote student research in community health and to promote the awareness of SHIP in Pennsylvania. This is a statewide competition for graduate level students in health related fields including, but not limited to, public health, epidemiology, medicine, dentistry, nursing, sociology, social work, behavioral health and health administration. The paper must incorporate the concepts of State Health Improvement Plan (SHIP). Interdisciplinary student teams, as well as individual students, are encouraged to apply. First Place $1,000; Second Place $500; Third Place $250.

2006 Birth Data Tables
A large volume of all the latest available and historical annual and three or five-year state, county, and municipality data by age, sex, race/ethnicity, birth weight, trimester of entry into care, method of delivery, marital status, etc.

Hands Only CPR
When an adult has a sudden cardiac arrest, his or her survival depends greatly on immediately getting CPR from someone nearby. Unfortunately, less than 1/3 of those people who experience a cardiac arrest at home, work or in a public location get that help. Most bystanders are worried that they might do something wrong or make things worse. That’s why the AHA has simplified things.
 
Asian American Health Disparities
Going beyond national studies that often treat Asian Americans as a homogenous and relatively healthy group, a new analysis by the Kaiser Family Foundation and the Asian & Pacific Islander American Health Forum finds that certain subgroups of the nation’s Asian American, Native Hawaiian and Pacific Islander populations are doing much worse than other subgroups in terms of health insurance coverage and access to health care.
 
Demands on Nurses Grow as Hospital Quality Improvement Efforts Increase
Hospitals face growing tensions and trade-offs when allocating  nurses between the competing priorities of direct patient care  and quality improvement efforts, a new study from the Center for  Studying Health System Change finds.
 
Reported Health &Health-influencing Behaviors among Urban American Indians & Alaska Natives: The Urban Indian Health Institute
While data are difficult to gather, studies have found that urban AIAN suffer from significant health disparities compared with the general population. These disparities include higher rates of tobacco use, infant mortality, late prenatal care, interpersonal violence, attempted suicide, and deaths due to diabetes, accidents and chronic liver disease.3,4,5,6 Work currently taking place by the Urban Indian Health Institute and others is attempting to better understand health risks and strengths of this diffuse population.

Update from the American Heart Association
April 24, 2008
Hands-Only (Compression Only) Cardiopulmonary Resuscitation: A Call to Action for Bystander Response to Adults Who Experience Out of Hospital Sudden Cardiac Arrest

When you see an adult suddenly collapse, use Hands-Only CPR: that's CPR without mouth-to-mouth breaths. And it can help save lives.

Hands-Only CPR is CPR without mouth-to-mouth breaths. It is recommended for use by bystanders who see an adult suddenly collapse in the "out-of-hospital" setting. It consists of two steps:

1. Call 911 (or send someone to do that).
2. Begin providing high-quality chest compressions by pushing hard and fast in the center of the chest with minimal interruptions

The American Heart Association recommends conventional CPR (that is, CPR with a combination of breaths and compressions) for all infants and children, for adult victims who are found already unconscious and not breathing normally, and for any victims of drowning or collapse due to breathing problems.

Read the full Hands-Only CPR Advisory statement.

To learn more about Hands-Only CPR visit: www.americanheart.org/handsonlycpr

PA Gov Signs EO Creating HIE - PAeHI Named Advisory Partner
April 24, 2008
From HIMSS News

Governor Rendell Signs Executive Order Creating Pennsylvania HIE

Governor Edward G. Rendell signed an executive order creating the Pennsylvania Health Information Exchange (PHIX) on March 27th. The HIE is a framework that will give healthcare providers improved access to clinical data and lead to safer and more efficient patient-centered care. The initiative is part of the Governor's Prescription for Pennsylvania healthcare reform plan.

"This is consistent in what we are seeing in terms of a positive momentum that is occurring and the domino effect of state involvement in embracing the health information exchange (HIE) concept," said Mark Jacobs, [PAeHI Vice Chair and] chair of HIMSS HIE Steering Committee. "Still, more work is needed to translate the value and benefits of these HIEs and what they mean to the different verticals since everyone may not be interested in every aspect of what a HIE brings and potential global benefits can be undervalued if we look at HIEs from ten-thousand feet. Still, more work is also needed around the area of "alignment" as well as the largest category of electronic health record adoption, universal definitions and investment in terms of incentives to expand demand and use."

PHIX will provide the information technology architecture to support statewide interoperable electronic health records and electronic prescribing by sharing data that is captured at the point of care in a physician office or hospital. Most doctor's offices, hospitals, laboratories, and pharmacies now have their own separate information systems. With an information exchange, those entities will be able to share information with various healthcare providers and other authorized parties for treatment purposes. HIEs will help to provide clinicians with important medical details about the patients they treat.

The Governor's executive order also establishes an advisory council and provides for advisory organizations. The advisory council is made up of representatives from state agencies, legislators, insurers, physicians, hospital executives, pharmaceutical organizations and nurses who will advise on IT strategies and issues. The advisory organizations may provide research, analysis and recommendations relative to the unique needs of the state. The Pennsylvania eHealth Initiative (PAeHI) is recognized as an advisory organization to PHIX.

"We applaud Governor Rendell's [statewide HIE initiative] - clinical information-sharing will help [reduce medical errors,] increase the quality and lower the cost of healthcare for all Pennsylvanians," said Mark Stevens, a member of the Delaware Valley HIMSS Board of Directors and executive director of PAeHI. "PAeHI is also pleased to have been named a collaborator in this historic effort."

"By offering healthcare providers the ability to electronically share patient information, we will be able to improve patient care and safety and reduce healthcare costs that are a result of today's independent information technology systems," Governor Rendell said. "Giving clinicians access to data about their patients' care by other providers will result in fewer medical errors and better continuity of care. Less time will be wasted waiting for patient's charts and for processing referrals. And, reporting of vital statistics and diseases will be more efficient and complete."

The executive order, as well as more information on Governor Rendell's Prescription for Pennsylvania, can be found at http://www.rxforpa.com.

Health Industry Issues of the Coming Year
March 20, 2008
PricewaterhouseCoopers’ Health Research Institute’s predictions for the top eight health industry issues of the coming year:

Hospital coffers will feel the impact of a new Medicare reimbursement system that’s designed to better recognize the severity of patient illnesses. Specialty hospitals and others that see less acutely ill patients could see their revenues decline, while urban hospitals that treat sicker patients could benefit.

Increased oversight and authority by the U.S. Food and Drug Administration may boost the public’s trust in drug safety, but also could add to the regulatory burdens on pharmaceutical companies. The FDA now may require drug companies to conduct additional clinical trials to assess risks associated with a drug after it has been released to the public.

A surge in the number of retail health clinics, such as those in drug stores, will force states, payers and policymakers to think about the best ways to deliver primary care. Hospitals could benefit from retail clinics if they draw uninsured patients, while pharmaceutical companies may need to market more to the nurse practitioners who run the clinics.

The market for individual health insurance could get much broader if other states and the federal government follow the lead of Massachusetts, which requires that all residents have coverage. Individual coverage also could get a boost from Republican proposals for tax incentives to help consumers buy individual policies.

Retirees are playing a greater role in funding their health-care coverage, whether they like it or not. As the population ages and health-care costs increase, employers are shifting more responsibility for retiree coverage to the retirees. In a PricewatehouseCoopers survey of multinational company executives, 73 percent said they needed to reduce contributions to retiree health coverage and cap benefits.

Big pharmaceutical companies, groaning under the high price of drug development, will keep buying and collaborating with life-science companies to stock their product pipelines. But biogenerics ­ generic copies of biological drugs ­ could crimp drug company revenues.

New IRS rules will mandate that nonprofit hospitals uniformly disclose more details about the community benefits they provide, such as charity care. Hospitals also will have to be more forthcoming about executive salaries and benefits, because of pressure to justify their tax-exempt status.

Asia is poised to become the world’s largest pharmaceutical consumer and producer. American drug companies have increased their marketing and clinical trials in Asia because of the market’s size, increasing wealth and growing awareness of health-related issues. On the production side, much of Asia provides high-quality, inexpensive labor. But watch out: Several Asian drug companies aim to become worldwide pharmaceutical powerhouses, not just contract manufacturers.

Survey compares rural and urban/suburban physicians
March 20, 2008
The nation's current doctor shortage is most acute in rural America, and an aging U.S. population combined with an increased interest in "quality of life" issues will likely make the situation worse before it gets better, according to representatives from LocumTenens.com. The physician recruitment firm recently surveyed doctors to better understand their perceptions of practicing medicine in rural America versus practicing in areas with populations of 50,000 or more.
read on...

Use of Preventive Services Among Hispanic Sub-Groups: Does One Size Fit All?
March 20, 2008
The South Carolina Rural Health Research Center at the Arnold School of Public Health, University of South Carolina is pleased to announce the release of a new report. The publication, entitled "Use of Preventive Services Among Hispanic Sub-Groups: Does One Size Fit All?", is authored by Myriam E. Torres, PhD, MSPH; Jessica D. Bellinger, MPH; Janice C. Probst, PhD; Nusrat Harun, MSPH; and Andrew O. Johnson, PhD.

The Fact Sheet is can be accessed here.

The full report is available through our Online Report Request System at http://rhr.sph.sc.edu .

Organ Transplant Review
March 20, 2008
Patients living in small towns and rural areas stand a lower chance of getting an organ transplant if they need one, according to a study published in the Journal of the American Medical Association.

Based on a review of almost 175,000 patients who were on waiting lists for heart, kidney or liver transplants from 1999 to 2004, the study found that depending on the organ needed, residents of rural areas were 10 to 20 percent less likely to get a transplant, reported the New York Times. About 14 percent of the population lives outside major urban areas, and that very distance from cities, where transplant centers tend to be located, may explain why they end up with fewer organs, the Times added.
New York Times, January 15, 2008
Read on...

HRET Disparities Toolkit - Now Available Free of Charge
March 20, 2008
The updated HRET Disparities Toolkit gives hospitals, health systems, clinics, and health plans the information and resources needed for collecting race, ethnicity, and primary language data from patients. In order to make this invaluable Toolkit more accessible to all health care providers, the Toolkit is now available free of charge.

Disparities in processes and outcomes of patient care are well-documented. Collecting accurate data on patients race, ethnicity, and primary language is needed to track the prevalence and nature of disparities in care and to help focus efforts to eliminate disparities and improve quality of care.

HRET's Disparities Toolkit helps clinicians and administrators at all levels learn the why and how of collecting race, ethnicity, and primary language data from patients. The Toolkit is useful for educating and informing hospital staff about the importance of data collection, how to implement a framework to collect the data, and how to use these data to improve quality of care for all populations.

Go to www.hretdisparities.org to access the new Toolkit.

State Updates on Medicare Advantage Enrollment
March 20, 2008
These state-by-state reports compare MA enrollment in December 2005 to that in September 2007, including information on overall and rural enrollment in all MA plans. The reports also show the growth in enrollment in private fee-for-service plans over this period and discuss the policy implications of these enrollment changes.

Click here for reports

Tracking the Presidential Candidates on Health Care
March 20, 2008
With the Iowa caucus and New Hampshire primary completed and a string of primaries across the country coming up, health care remains a top domestic issue that the public wants to hear the presidential candidates talk about, second to Iraq for Democrats, Republicans, and Independents, according to Kaiser's latest poll on health and the campaign.

The Kaiser Family Foundation's health08.org website, http://www.health08.org, offers resources for following health care developments during campaign season. The website serves as a hub of information about health and the election, including original content produced by Kaiser and easy access to health-related resources from the campaigns, other organizations and news outlets.

Visit www.health08.org for:
An interactive tool for side-by-side comparisons of the candidates' health care proposals allowing users to compare up to four candidates' positions on health care coverage, cost containment, quality of care, and financing.

Regular Kaiser polls examining the public's views on health issues and perceptions of the presidential candidates on health care, as well as links to the latest polls by other organizations.

Syntheses of news coverage about health and the campaign, updated frequently.

Videos and podcasts from the campaign trail, including one-hour long presidential forums on health care, candidate speeches, interviews, and health-related highlights from forums and debates.

A calendar of events taking place around the country and links to studies and resources from other organizations.

Economic & Workforce Brief Reports Available
March 20, 2008
The Brief is a free one-page summary of the worth of 100 jobs in an industry in terms of total jobs created, compensation generated, and property taxes paid in a county or group of Pennsylvania counties.

You may order a Brief by completing a form linked to http://PSUBrief.notlong.com. Subscribers to this listserv have ordered a number of the Brief reports that are listed in the below document.

Click here for the brief

Updated Fact Sheets on Women’s Health Insurance Coverage
February 20, 2008
Health insurance is a key element in ensuring access to health care for women, as women with coverage are more likely to obtain preventive, primary, and specialty care services. However, many women face barriers to obtaining coverage because they have limited access to private insurance or do not qualify for public programs. Kaiser has released two updated fact sheets that provide the most current information and data on health insurance coverage for women ages 18-64. The fact sheet, Women’s Health Insurance Coverage, provides new statistics on health coverage and describes the major sources of health insurance for non-elderly adult women, including employer-sponsored coverage, Medicaid, individually purchased insurance, and Medicare. It also summarizes the major policy challenges facing women in obtaining health coverage, and provides data on the more than 17 million women who are uninsured. The second fact sheet, Health Insurance Coverage of Women by State, provides state-by-state data on the uninsured rate, as well as rates of private insurance and Medicaid coverage.

Update from Statehealthfacts.org
February 20, 2008
Statehealthfacts.org, from the Henry J. Kaiser Family Foundation, provides free, up-to-date, and easy-to-use health and health policy data on all 50 states. Statehealthfacts.org has data on more than 500 health topics including Medicaid and SCHIP, Medicare, health coverage and the uninsured, health costs and budgets, providers and service use, minority health, womens health, and HIV/AIDS

Statehealthfacts.org has recently added new and updated data on Medicaid, Health Status, Providers and Service Use, and HIV/AIDS. You can also view a list of all recent updates at http://cme.kff.org/Key=13630.Wm.C.C.VyrW.

Medicaid & SCHIP
Updated data on home and community based services (HCBS) waivers been added and include 2004 HCBS expenditure, participant, and waiting list data for all states and the nation. Based on analysis of The Centers for Medicare and Medicaid Services's (CMS) Form 372 conducted by the Kaiser Commission on Medicaid and the Uninsured (KCMU) and the University of California at San Francisco (UCSF), this update also includes information on home health and personal care services expenditures and participants.
http://cme.kff.org/Key=13630.Wm.D.C.Q1gz3

Federal Medical Assistance Percentage (FMAP)
The Federal Medical Assistance Percentage (FMAP), the rate at which the federal government matches each states Medicaid and SCHIP spending, is now available for FY 2009 for all states.
http://cme.kff.org/Key=13630.Wm.F.C.Tvcl9

Deaths
Updated data from the Centers for Disease Control and Prevention (CDC) on infant death rates by race/ethnicity for 2004 are now available for all states and the nation. Also available are data on deaths caused by heart disease and cerebrovascular disease for 2004.
http://cme.kff.org/Key=13630.Wm.G.C.V386x

Adult Overweight/Obesity Rate
Updated data from the CDC on the rate of obesity among adults for 2006 are now available by state.
http://cme.kff.org/Key=13630.Wm.H.C.77kPh

Adult Smoking Rate
Data from the CDC on smoking rates among adults for 2006 are also available for all states and the nation.
http://cme.kff.org/Key=13630.Wm.J.C.hcKFf

Federally Qualified Health Centers
Information from the National Association of Community Health Centers on the number of Federally Qualified Health Centers (FQHCs), total patients served by FQHCs, and total FQHC visits is now available for 2006 for all states and the nation.
http://cme.kff.org/Key=13630.Wm.K.C.ccPDC

Health Care Employment
Updated data from the Bureau of Labor Statistics on the population employed in the health care field are now available for 2006 for all states and the nation.
http://cme.kff.org/Key=13630.Wm.L.C.5V5thhttp://cme.kff.org/Key=13630.Wm.L.C.5V5th

Medical Malpractice
Data on medical malpractice claims and payments have been updated for 2007 using data from the National Practitioner Data Bank (NPDB). The total number of paid claims, total dollars in paid claims, and average claims payments are available for all states and the nation.
http://cme.kff.org/Key=13630.Wm.M.C.3cBBq

HIV Death Rate
Updated data from the Centers for Disease Control and Prevention (CDC) on the number of deaths caused by HIV disease and the age-adjusted death rate for 2004 are now available for all states and the nation.
http://cme.kff.org/Key=13630.Wm.N.C.Zc33X

CDC Health Advisory on the potential health effects associated with the Satellite Re-entry
February 20, 2008
The Centers for Disease Control and Prevention (CDC) is collaborating with federal partners to address potential health and safety threats associated with the reentry of an uncontrolled U.S. government satellite into the earths atmosphere within the next few weeks. Because the satellites fuel contains the toxic chemical hydrazine, it is possible that the reentry of the satellite could pose a public health threat if pieces of it fall into populated areas. The risk of health effects related to the satellite is considered to be low. However, CDC is encouraging health officials and clinicians to review information about the health effects related to hydrazine to prepare in case their communities are affected by satellite debris.

Hydrazine is a clear, colorless liquid with an ammonia-like odor. Hydrazine is highly reactive and easily catches fire. It can easily evaporate to the air and can dissolve in water. In soil, hydrazine may stick to particles. In each of these forms hydrazine breaks down quickly into less harmful compounds.

People can be exposed to hydrazine by breathing contaminated air, dermal contact, or ingestion. Breathing hydrazine may cause coughing and irritation of the throat and lungs, convulsions, tremors, or seizures. Dermal contact may cause redness, pain, and burns. Eating or drinking small amounts of hydrazine may cause nausea, vomiting, uncontrolled shaking, inflammation of the nerves, drowsiness, or coma.

Additional information about hydrazine can be found at http://emergency.cdc.gov/agent/hydrazine.

New Government Grant, Contract and Loan Website Debuts
February 20, 2008
The Office of Management and Budget has launched a new Web site that provides information on all major federal grants, loans and contracts. The new site, USASpending.gov, fulfills one of the key requirements of the 2006 Federal Funding Accountability and Transparency Act, which requires full disclosure on a Web site maintained by OMB of all organizations receiving more than $25,000 in federal funds. The new website will eventually provide a full searchable database of all federal grants, contracts, earmarks and loans.

http://www.usaspending.gov

Jefferson Medical College update
February 20, 2008

Jefferson Medical College is expanding its Physician Shortage Area Program (PSAP), which helps place medical school graduates in rural settings in need of doctors, into the state of Delaware. The expansion is being funded by a three-year, $450,000 grant that Thomas Jefferson University's department of family and community medicine secured from the U.S. Department of Health and Human Services, while the grant will also be used to expand the Center City medical school's family medicine curriculum in areas such as oral health, health literacy and domestic violence, reported the Business Journal. Launched in 1974, PSAP is geared toward medical school applicants who are committed to practicing family medicine in a rural area, and it includes an extensive mentorship component along with rural clinical educational experiences, the Business Journal added. The expansion of the PSAP into Delaware will focus on identifying and educating students to provide primary care in Sussex and Kent counties in the southern part of the state.
Philadelphia Business Journal, February 4, 2008
Read on...

New Research & Policy Brief from Maine Rural Health Research Ctr
January 28, 2008
Rural Inpatient Psychiatric Units Improve Access to Community-Based Mental Health Services, but Medicare Payment Policy a Barrier

Authors: Stephenie Loux, David Hartley & David Lambert

Inpatient Psychiatric Units (IPUs) may not only be an important source of care for rural residents, but may also assist in the development of community-based services and the recruitment of mental health professionals. This study investigates the typical characteristics and admission processes of IPUs in rural hospitals with less than 50 beds, as well as the community-based services available to them when discharging patients. Reasons for developing these IPUs as well as the barriers to opening and operating a rural IPU and factors that have led some to close are also explored.

To view or download this Research & Policy Brief, click on the link below:

http://muskie.usm.maine.edu/Publications/rural/pb36/IPU.pdf

This Research & Policy Brief is based on a longer study, which is being submitted for journal publication. For more information on this study, please contact Stephenie Loux at sloux@usm.maine.edu or 207-780-5774.

Reminder: Sign-up for the New Listserv of the Rural Health Research Gateway
January 28, 2008
Rural health research findings from eight national research centers, supported by the Federal Office of Rural Health Policy (ORHP), are now featured at one convenient location, the Rural Health Research Gateway Listserv. This initiative is designed to help move the most up-to-date findings of the Rural Health Research Centers to policy makers, health care providers and others as quickly and efficiently as possible.

New information is launched on the listserv and its corresponding web site ( www.ruralhealthresearch.org) to provide easy and timely access to projects, research, and findings of these national research centers. The web site has abstracts of both current and completed research projects addressing issues such as rural health quality and behavioral health, related publications, and information about the researchers and research centers.

If you would like to continue to receive the Rural Health Research Gateway postings, please sign-up at http://www.ruralhealthresearch.org/listserv.

Below is an example of a listserv posting.

Policy Brief Released

Spontaneous Evacuation Following a Dirty Bomb or Pandemic Influenza: Highlights from a National Survey of Urban Residents' Intended Behavior

This policy brief reports results of a national survey to assess the evacuation intentions of urban citizens following emergency scenarios. It includes information on how likely it would be for evacuees to go to a rural or urban area and discusses the potential impact of an urban evacuation on rural areas.

New Alliance Toolkit: Health Information Technology
January 28, 2008
The Alliance for Health Reform's latest toolkit will help understand how health information technology (IT) is slowly changing health care, and how analysts disagree about the value of some technologies. We offer an introduction to issues such as protecting patient privacy and the cost of new technologies. This resource also offers story ideas for reporters, selected experts with contact information, selected websites of interest and a glossary. Supported by the Robert Wood Johnson Foundation.

To download, click here. For a version suitable for viewing on a Blackberry or other handheld device, click here. This is the table of contents:

Key Facts

• Background
• Overview: Health IT
• Electronic Medical Records/Electronic Health Records
• Computerized Physician Order Entry
• Personal Health Records
• Health Information Exchange
• Health IT and Costs
• Health IT and Patient Privacy
• The Future of Health IT
• Story Ideas for Reporters
• Selected Experts
• Selected Websites
• Glossary on Health IT

The Alliance has compiled four other toolkits recently, also with the support of the Robert Wood Johnson Foundation. Each is also available in a version suitable for viewing on a Blackberry or other handheld device. To download any of them, click here. Topics are:

• the uninsured
• Medicaid
• child health coverage
• health care costs

Of special interest in the uninsured toolkit: links to websites tracking presidential candidates health plans and updates on state-level health reforms.

New from the RUPRI Center: Rural Hospital Charges Due to Ambulatory Care Sensitive
January 5, 2008
Two new policy briefs are available from the RUPRI Center:

(1) National Rural Hospital Charges Due to Ambulatory Care Sensitive
Conditions
(2) Regional Variation in Rural Hospital Charges Due to Ambulatory Care Sensitive Conditions

These policy briefs estimate and document the national and regional
magnitude of charges associated with hospitalizations due to ambulatory care sensitive conditions in rural hospitals. Findings from this research suggest that the potential national saving in rural hospital inpatient expenditure could be up to $9.5 billion if rural patients receive timely and effective primary health care and if charges closely mirror actual costs.

The findings also show that resource utilization for rural preventable hospitalizations varies by geographic region and ranges from about 14% of hospital charges for rural hospitals in the West region to more than 20% of hospital charges for rural hospitals in the South region, a pattern that reflects patients’ socioeconomic status and the supply of primary care physicians.

Please click on the following links to download these documents:

http://www.unmc.edu/ruprihealth/Pubs/PB2007-4_National_ACSC.pdf

http://www.unmc.edu/ruprihealth/Pubs/PB2007-5_Regional_ACSC.pdf

Federally Qualified Health Centers
January 5, 2007
Information from the National Association of Community Health Centers on the number of Federally Qualified Health Centers (FQHCs), total patients served by FQHCs, and total FQHC visits is now available for 2006 for all states and the nation. http://cme.kff.org/Key=13630.Wm.K.C.ccPDC

ANTI-HUNGER GROUP NAMES NEW EXECUTIVE Joseph Quattrocchi Will Begin in January
December 20, 2007
Harrisburg (December 20, 2007). The Board of Directors of the Pennsylvania Hunger Action Center, meeting December 17th in Harrisburg, appointed Joseph Quattrocchi as the organizations new Executive Director. Quattrocchi, a Mechanicsburg resident, will be the sixth executive to lead the 30-year old organization. He succeeds Berry Friesen, who has been the executive director since 1997.

Currently, Quattrocchi serves as Vice President for Community Impact with the United Way of Lancaster County. There he leads and manages the integration of several community change initiatives related to affordable housing, early care and education, high school completion and access to health care.

I'm energized and motivated by the opportunity to be part of making positive change, Quattrocchi told the Board. And I don't accept hunger in a country as prosperous as ours. That's why I have sought this position.

Janet Ney, who chaired the Boards search committee, said many strong applicants had expressed interest in the position. Joe's professionalism, experience, and passion for the cause made him a clear choice for us; we are expecting great things as he leads us into the future.

Apart from growing up in Bucks County and completing undergraduate and graduate degrees at Penn State University, Quattrocchi has lived and worked in central Pennsylvania. He began his career with the Governors Action Center during the Shapp Administration. Subsequent positions included management roles with Tri-County Catholic Social Services and the United Way of York County, as well as serving in an executive capacity for the Tri County Easter Seal Society and the PA Society of Association Executives. Quattrocchi also worked as a consultant, including a stint with the Central PA Food Bank.

Quattrocchi will begin his new duties as Executive Director on January 14th. He will lead a staff of seven.

The Pennsylvania Hunger Action Center works to end hunger and improve food security by promoting sound public policies, effective utilization of taxpayer-funded food programs, nutrition education and private engagement in the anti-hunger effort. Its advocacy and organizing efforts have contributed to the development of a range of food and nutrition programs including WIC, the Farmers Market Nutrition Program, the State Food Purchase Program and Food Stamp Nutrition Education. Its Board President is Timothy F. Whelan of Harrisburg.

New Synthesis Release: Pay-for-Performance
December 20, 2007
There is growing interest among private and public health care purchasers in using financial incentives to improve the quality of care delivered by physicians. The concept has gained traction as a way for purchasers to better align physician payment and quality of care delivered.

A new Synthesis report by Jon Christianson, Ph.D. and colleagues reviews the findings on pay-for-performance (P4P) initiatives undertaken by Medicare, Medicaid, private health insurers and the United Kingdom national health program.

The Synthesis report addresses the following questions:

* What explains the current widespread interest in physician P4P?
* How are current incentive programs structured and how prevalent are they?
* What performance measurement issues does physician P4P raise?
* How do physicians perceive quality incentive programs?
* What is the research evidence on the impact of P4P?

To read the findings, download the Synthesis Project reports from RWJF.org:
Policy Brief (PDF/195 KB)
Research Synthesis (PDF/430 KB)

AHRQ Releases Patient Safety Toolkits for Providers, Patients
December 20, 2007
The Agency for Healthcare Research and Quality (AHRQ) has released 17 toolkits to help health care providers and patients prevent medical errors. Developed through the agency's Partnerships in Implementing Patient Safety program, the toolkits focus on identifying high-risk practices and promote interventions to prevent errors and enhance communication among caregivers and with patients. Several of the patient toolkits address medication safety.

These toolkits can be found at:

http://www.ahrq.gov/qual/pips/

Announcing the New Listserv of the Rural Health Research Gateway
December 20, 2007
Rural health research findings from eight national research centers, supported by the Federal Office of Rural Health Policy (ORHP), are now featured at one convenient location, the Rural Health Research Gateway Listserv. This initiative is designed to help move the most up-to-date findings of the Rural Health Research Centers to policy makers, health care providers and others as quickly and efficiently as possible.

New information is launched on the listserv and its corresponding web site ( www.ruralhealthresearch.org) to provide easy and timely access to projects, research, and findings of these national research centers. The web site has abstracts of both current and completed research projects addressing issues such as rural health quality and behavioral health, related publications, and information about the researchers and research centers.

If you would like to continue to receive the Rural Health Research Gateway postings, please sign-up at http://www.ruralhealthresearch.org/listserv/subscribe.php.

Below is the first listserv posting.

New Policy Brief Released: Reliance on Independently Owned Pharmacies in Rural America

This policy brief provides researchers, policy makers, and stakeholders with the locations of independently owned pharmacies in rural American that are the sole sources of access to local pharmaceutical services. In over 2,000 rural communities, the only local pharmacy is independently owned, and in 1,044 of those communities, there is no other pharmacy within 10 miles. The information in this brief lays a foundation for analyzing vulnerability of pharmacy services in rural America and identifies the questions that research and policy activities should address. State maps showing the locations of communities with only one pharmacy, independently owned, can be found at http://www.unmc.edu/ruprihealth/Pubs/statepharms.html.

Kellogg Foundation Refines Its Mission
December 20, 2007
The W.K. Kellogg Foundation, which gave out nearly $335-million in grants during the 2006-7 fiscal year, announced today that it has refocused its mission to help vulnerable children succeed.

Officials said they would start an online public forum next year, on which people can discuss the foundations work and share ideas.

Kellogg's previous mission was to help people help themselves through the practical application of knowledge and resources to improve their quality of life and that of future generations.

The new mission statement reads: The W.K. Kellogg Foundation supports children, families, and communities as they strengthen and create conditions that propel vulnerable children to achieve success as individuals and as contributors to the larger community and society.

Other considerations that are expected to influence the foundations future work will be included in the foundations 2007 annual report, to be available online in January.

NEW! SHIP-Special Report on the Characteristics of the Physician and Physician Assistant Population in Pennsylvania
December 20, 2007
This report is one in a series of Special Reports on Pennsylvania’s Health Care Workforce and is released under the auspices of the State Health Improvement Plan (SHIP). It will provide lawmakers, researchers, academics, and state agencies with objective, factual data concerning the characteristics of various health professional populations in the Commonwealth. This report, along with previous reports on registered nurses, licensed practical nurses, nursing education programs, physicians, dentists and dental hygienists, can be accessed at www.health.state.pa.us/ship under the State Health Improvement Plan, SHIP Health Care Work Force Reports.

State reports on Medicare Advantage enrollment are available on the RUPRI Center Web site
December 20, 2007
As of September 2007, about 8.3 million Medicare beneficiaries in the United States were enrolled in a Medicare Advantage (MA) plan (a 42% increase since December 2005), and over 845,000 rural Medicare beneficiaries were enrolled in an MA plan (a 230% increase since December 2005). The RUPRI Center has prepared state-by-state reports that compare MA enrollment in December 2005 to that in September 2007, including information on overall and rural enrollment in all MA plans. The reports also show the growth in enrollment in private fee-for-service plans over this period and discuss the policy implications of these enrollment changes.

Click on the following link to download these reports: http://www.unmc.edu/ruprihealth/Pubs/statesheets.html This report is one in a series of Special Reports on Pennsylvania’s Health Care Workforce and is released under the auspices of the State Health Improvement Plan (SHIP). It will provide lawmakers, researchers, academics, and state agencies with objective, factual data concerning the characteristics of various health professional populations in the Commonwealth. This report, along with previous reports on registered nurses, licensed practical nurses, nursing education programs, physicians, dentists and dental hygienists, can be accessed at www.health.state.pa.us/ship under the State Health Improvement Plan, SHIP Health Care Work Force Reports.

Pennsylvania School Breakfast Report Card Released
December 20, 2007
Today Hunger Action released its annual Pennsylvania School Breakfast Report Card. It provides information about school district utilization of this important nutrition program.

To view all of the tables, including data about every school district in the state, go to www.pahunger.org. A link on the homepage will take you to the report.

This years release includes information about how lower-income schools (those with at least 20 percent low-income children) responded to Governor Rendells challenge that they all implement the School Breakfast Program. Of 239 lower-income public schools that did not have breakfast when the Governor issued his challenge, 87 have started breakfast and 152 have not.

To see particulars, click on the attached documents.

As compared to adjoining states, Pennsylvania continues to lag behind (6th out of 7th). The state in 7th place (New Jersey) will soon surpass us. All of these seven states have a legislated mandate except Delaware and Pennsylvania.

The effort to enact a partial mandate here in Pennsylvania failed during the final hours of the state budget crisis in July.

As compared to 2005-06, school breakfast participation in Pennsylvania schools did improve during 2006-07. Average daily participation (ADP) was 229,206 students, up 3.2 percent from the previous year when ADP was 222,013 students.

Rural Assistance Center Celebrates 5-Year Anniversary, 1.5 Million Visits with Release of New Home Page
December 10, 2007
GRAND FORKS, N.D. – In December 2002, the Rural Assistance Center (RAC) launched its fledgling web site and took its first information request by telephone. Five years and 1.5 million web visits later, RAC’s extensive web site is getting a facelift.

The Rural Assistance Center (RAC) is a national resource designed to meet the substantial rural health and human services information needs of rural communities. RAC provides rural communities with access to a full range of available programs, funding and research that can enable them to provide quality health and human services.

Dr. Elizabeth Duke, the top administrator of the Health Resources and Services Administration, and Alan Morgan, CEO of the National Rural Health Association, are joining RAC today in celebrating its 5th anniversary and launching its new home page.

“In five short years, the Rural Assistance Center has built a national reputation as a leader in both quality and timeliness of information,” said Kristine Sande, RAC project director. “The RAC web site has become a premiere site for access to current information on rural health and human services topics. Our new homepage will allow our users even easier access to the wealth of information available on our site.”

Since its launch in December 2002, RAC’s web site has received over 1.5 million visits, with more than half a million coming in the last year. In addition, RAC has responded to almost 5,000 customized assistance requests from people in all 50 states and over 20 foreign countries.

“The Health Resources and Services Administration is delighted to be celebrating a five-year partnership with the Rural Assistance Center, which provides a one-stop location for people seeking information about health and human services in rural America,” said Duke. “The RAC is a key part of HRSA’s efforts to improve the delivery of health and social services in rural areas.”

“The knowledgeable and committed staff, coupled with state-of-the-art technical resources, support and extend rural community access to information and resources needed to improve local health care and human services delivery systems,” said Dr. Mary Wakefield, director of the Center for Rural Health at the University of North Dakota. “This service saves countless hours for rural stakeholders throughout the nation and ensures they don’t miss important information or opportunities.”

Based at the University of North Dakota Center for Rural Health, RAC is a collaboration of the University of North Dakota and the Rural Policy Research Institute (RUPRI). It is funded through HRSA's Office of Rural Health Policy. RAC coordinates and streamlines information and makes it available through the use of a comprehensive web site, www.raconline.org, including an online clearinghouse of news, documents, maps and success stories; a calendar of events; a directory of rural contacts and organizations; state resource pages; and a searchable database of funding opportunities. Also available on the web site are Information Guides, which provide in-depth information focusing on rural aspects of an issue or topic. RAC’s electronic updates on rural health and human services keep more than 5,000 subscribers abreast of new information and resources. RAC also provides free customized assistance on topics related to rural health or human services.

New from the RUPRI Center: "Reliance on Independently Owned Pharmacies in Rural America
December 10, 2007
A new policy brief is available from the RUPRI Center:

Reliance on Independently Owned Pharmacies in Rural America This policy brief provides researchers, policy makers, and stakeholders with the locations of independently owned pharmacies in rural American that are the sole sources of access to local pharmaceutical services. In over 2,000 rural communities, the only local pharmacy is independently owned, and in 1,044 of those communities, there is no other pharmacy within 10 miles. The information in this brief lays a foundation for analyzing vulnerability of pharmacy services in rural America and identifies the questions that research and policy activities should address. State maps showing the locations of communities with only one pharmacy, independently owned, are also available.

Please click on the following links to download these documents:
http://www.unmc.edu/ruprihealth/Pubs/PB2007-6_PharmLocBrf_1127.pdf

http://www.unmc.edu/ruprihealth/Pubs/statepharms.html

GOVERNOR RENDELL OFFERS NEW FUNDING SOURCE FOR COVER ALL PENNSYLVANIANS
December 10, 2007
By Nate Collins

Governor Ed Rendell held a press conference to announce a new possible funding source for Cover all Pennsylvanians.
 
He offered that the legislature has been working with him on his goals to reform health care. He commented on two specific cost-containment measures that have become law, increasing the scope of practice for certain medical practitioners and health care-acquired infection legislation.
 
The governor then discussed his Cover All Pennsylvanians (CAP) proposal, noting that almost 767,000 citizens in the state do not have health care coverage. He explained that he originally proposed to fund the plan through a 10 cent per pack increase of the cigarette tax, taxing smokeless tobacco and cigars and a “fair share” assessment of 3% on employers.
 
It will be difficult to achieve a fair share tax, he stated, adding that if CAP is going to become a reality there is a necessity for a new funding source. He suggested that by using available surpluses in the state Health Care Provider Retention Account and combining them with the other CAP funding sources that he previously proposed, it will be enough to fund the program.
 
The governor explained that the Mcare Fund was created to stop the loss of doctors moving out of Pennsylvania. He explained that doctors in Pennsylvania are required to have $500,000 in private coverage and $500,000 under Mcare, which is abated by using the Mare Fund.
 
The Mcare Fund has paid out nearly $1 billion in abatement payments, Governor Rendell said. He added that for the last two years the largest medical malpractice insurers have not imposed any premium increases. The Mcare assessment is 50% of what it was in 2003, he noted, adding that the number of medical malpractice filings is down 38%.
 
He said the Health Care Provider Retention Account has a surplus of almost $400 million because payouts are decreasing. In his opinion, the best use of the funds in that account is to link it to health care for all Pennsylvanians.
 
He acknowledged that CAP can be funded by using the surplus in the Health Care Provider Retention Account and eliminating the Mcare abatement, but he believes that is a bad idea. The governor stated he favors using the Health Care Provider Retention Account surplus, the surplus from the 25 cent per pack cigarette tax to fund Mcare, a redirection of state-provided uncompensated care payments to health care institutions, a 10 cent tax increase on cigarettes and new taxes on cigars and smokeless tobacco.
 
This will allow the Mcare abatement to stay at the current level for the next 10 years, he explained. The governor concluded by stating that there is no way to provide health care for everyone without paying for it.
 
Rep. Mike Sturla (D-Lancaster), the sponsor of the CAP legislation ( HB 1870), said his legislation includes the 3% fair share tax but he realizes that it will probably be removed. He stated he doesn’t care how the program is paid for as long as it is funded.
 
Rep. Todd Eachus (D-Luzerne) noted that the House Insurance Committee will work on CAP legislation over the next few days. He reiterated that there is a surplus in the Health Care Provider Retention Account, explaining that House Democrats want to link Mcare abatement money to that fund. He said the committee will consider an amendment that will link Mcare and the Health Care Provider Retention Account to create the Medical Coverage Availability for Pennsylvanians (MCAP) Fund to guarantee the assessments for physicians and a level of funding to pay for CAP.
 
Governor Rendell then answered questions from the press.
 
Will the cost of CAP be the same as originally proposed?
The governor answered yes, adding that it will cost $1.5 billion when all 767,000 uninsured people are covered. He added that the program will be phased in over a number of years.
 
How much of the surplus would you use to fund CAP?
All of it, Governor Rendell said, adding that enough money will be left in Mcare to cover the abatement. He noted that all of the money in the Health Care Provider Retention Account would be used.
 
You have said that you don’t like trading one thing for another. Would you sign Mcare abatement without this proposal?
He said he is not trading one thing for another, adding that he could not sign Senator Don White’s Mcare abatement bill because the money in the fund has to be used for health care. He reiterated that he does not want to end the abatement but he would do it reluctantly to fund CAP if there is not an increase in the cigarette tax and a new tax on cigars and smokeless tobacco. “I would sign an abatement extension only when Cover All Pennsylvanians has been properly funded,” he said.
 
For clarification purposes, how much would you take from Mcare to pay for this proposal?
He explained that the proposal takes whatever is left in the Health Care Provider Retention Account at the end of this year and the surplus each year from the Mcare abatement. Budget Secretary Michael Masch explained that it is a small amount in the first few years but the amount goes up in the years going forward. He said this model is based on Mcare payouts growing and if they do not more money will be available than is projected.
 
Can you rely on the Mcare surplus in perpetuity?
Governor Rendell said he is looking at the next 10 years, adding that they are being very conservative with their estimates and he believes they will have more money than is necessary right away, which will be kept in reserve until needed as more Pennsylvanians sign up.
 
When would you apply the Mcare surplus to Cover All Pennsylvanians?
The governor replied that he hopes the legislature acts by the end of January and people can begin to be enrolled in October 2008.
 
Since there is a $400 million surplus, have you been overcharging doctors on their assessments?
Secretary Masch responded that doctors are charged what is set by statute. He explained that it is based on the prior year’s payouts from the Mcare Fund, the current year’s administrative costs and a 10% buffer. The amount the state has been charging has been going down every year because it is based on the prior year’s payouts, he offered. He commented that he does not believe anyone is being overcharged.
 
Are you still pushing for a statewide smoking ban?
The governor answered yes, but that is not tied to this proposal.
 
Republicans have said all along that they will not accept any new taxes this year. What is going to change on this proposal?
They can say no to taxes but they will also say no to health care for Pennsylvanians, he replied. He said it is a choice that they can make but if they do so they will have to explain to Pennsylvanians why they made that choice.
 
What can you do under an Executive Order to use the money in the Health Care Provider Retention Account?
Governor replied that he can’t use that money under Executive Order. He noted that the Insurance Commissioner could end Mcare and he could refuse to sign an extension of the abatement program, but those are negatives and he wants to work on this with the Legislature.
 
Aren’t you holding Mcare abatement hostage?
Governor Rendell said he doesn’t believe he is holding anything hostage, commenting that he needs the money for CAP. He stated that assuming the fair share tax is a nonstarter he needs to be able to tap into the Mcare surplus and the Health Care Provider Retention Account.
 
 
What is your frustration level with the lack of action on a smoking ban bill?
“I am continually frustrated,” the governor replied, but he said he would rather focus on the positive, like the passage of the scope of practice bill and health care-acquired infection legislation.

State Health Facts Released
December 10, 2007
Statehealthfacts.org Updates Data on SCHIP, Cost of Living, Medicare Payments, Mortality Rates, Cancer Incidence, Syringe Exchange, and More
Statehealthfacts.org has added new data from the Congressional Research Service (CRS) on potential FY2008 SCHIP funding shortfalls if Congress and the President do not increase SCHIP funding above current levels. Data are available for all states and include states' own projected FY2008 federal SCHIP spending, FY2008 allotment totals, and FY2008 shortfall amounts for the 21 states projected to exhaust available federal funding under current law. Also new on the site are data on the relative cost of living for a family of four at three times the national poverty level in selected urban markets in each state in 2007 based on analysis of the Council for Community and Economic Research's Cost of Living Index. The latest data from the Centers for Medicare and Medicaid Services (CMS) on Medicare payments for elective inpatient hospital procedures for FY2006 are also now available for all states. Updated mortality data from the Centers for Disease Control and Prevention (CDC) have been added and include overall mortality rates by gender and race/ethnicity for 2005 and cancer mortality rates and Alzheimer's Disease mortality rates for 2004. Data on cancer incidence rates for 2003, adult oral health status for 2006, and information on sterile syringe exchange programs for 2005 are also available from the CDC. Other updates include state-by-state data from the Annie E. Casey Foundation on child and teen death rates for 2004 and household employment status data based on analysis of the U.S. Census Bureau's March 2007 Current Population Survey (CPS) conducted by the Urban Institute and the Foundation’s Kaiser Commission on Medicaid and the Uninsured.

CARDINAL HEALTH FOUNDATION GRANTS $537,000 TO RURAL, PUBLIC HOSPITALS IN SUPPORT OF IHI’S 5 MILLION LIVES CAMPAIGN
December 10, 2007
DUBLIN, Ohio, Dec. 3, 2007 ­To increase the number of rural and public hospitals participating in the Institute for Healthcare Improvement’s (IHI) 5 Million Lives Campaign, the Cardinal Health Foundation announced today it is granting $537,000 to 37 hospitals that enroll and report their data to IHI. Hospitals will receive an average of $15,000 each to help deepen their commitment and ability to implement IHI initiatives, aimed at protecting patients from five million incidents of medical harm over two years (December 2006 – December 2008).

Cardinal Health worked with The National Rural Health Association (NRHA) and the National Association of Public Hospitals and Health Systems (NAPH) to oversee the application process and review grant applications. Both associations will administer the grants.

"The Cardinal Health Foundation has once again made a wonderful contribution to American hospitals in their efforts to improve the quality and safety of the health care they provide," said Joe McCannon, vice president and 5 Million Lives Campaign manager at the IHI. "This funding gives crucial energy and confidence to a new group of public and rural facilities, engaging them more deeply in their urgent work to reduce injury and connecting them to a vibrant network of hundreds – even thousands ­ of peer facilities across the nation."

"We believe it is vitally important to support health care initiatives and innovation aimed at improving patient safety and quality of care," said Jim Mazzola, vice president of Cardinal Health and the Cardinal Health Foundation. "The 5 Million Lives Campaign is an exemplary program with the noble mission of saving patient lives. We are proud to be one of its leading sponsors."

For a list of hospitals and more information click here

CALL FOR PANELISTS: Rural Public Health Agency Accreditation
December 10, 2007
The NORC Walsh Center for Rural Health Analysis, with funding from the National Network of Public Health Institutes and the Centers for Disease Control and Prevention, is seeking input from local health department leaders on their views regarding voluntary public health agency accreditation. They are requesting the participation of representatives and stakeholders from local health departments that serve rural areas for a one-day panel meeting to be convened in the Washington DC area, early in 2008. This panel will address:

• potential benefits of accreditation
• barriers to rural local health department accreditation
• potential strategies for rural LHDs seeking accreditation

If you are interested in participating in this panel or would like more information, please contact Michael Meit at meit-michael@norc.org or 301-951-5076. The organizers will cover all travel-related expenses and will also offer a modest honorarium to each participant. For more information on public health agency accreditation, please visit the Public Health Accreditation Board at http://www.exploringaccreditation.org.

New Briefing Paper on State Flex Grant Program Initiatives
November 26, 2007
The authors discuss each of these categories and provide specific examples of successful initiatives.  Consistent with the Flex Monitoring Team’s earlier observation that future CAH conversion activity is likely to be limited, the interviews revealed that State Flex Programs have shifted the focus of their activities to address hospitals’ and communities’ longstanding needs and to enhance the rural health care infrastructure.

 

The authors of this report are John Gale and Jennifer Lenardson of the Maine Rural Health Research Center, University of Southern Maine; Walt Gregg and Michelle Casey of the University of Minnesota Rural Health Research Center; and Indira Richardson, Stephen Rutledge, and Rebecca Slifkin of the University of North Carolina Rural Health Research and Policy Analysis Center. 

 

For more information, please contact John Gale at jgale@usm.maine.edu, 207-228-8246

 

FCC Chairman Announces Major Expansion of Broadband Telehealth Network Program
November 26, 2007
Yesterday at the annual American Health Information Community meeting in Chicago, Illinois, Federal Communications Commission (FCC) Chairman Kevin Martin delivered a presentation on the FCC’s plans to fund a $400 million, three year “Rural Health Care Pilot Program” designed to improve health care access in rural areas by developing broadband telehealth networks. Chairman Martin’s announcement that the program would be funded at $400 million was a surprise to many observers, because the FCC had previously announced that funding would be based on a mechanism that would set annual spending in the $55-60 million range.

Chairman Martin noted that the program will connect more than 6,000 health care providers by funding the construction of broadband networks in 42 states and 3 U.S. territories. Included in his presentation were several charts depicting maps of the United States with dots indicating “Non-rural facilities” and “Rural Facilities” scattered throughout 42 states, with eight states lacking dots. Many in the telehealth community are trying to determine if these charts provide any indication as to the identities of the grant award recipients, which are not scheduled to be announced publicly until the week of Nov. 18 th . The charts and the full text of Commissioner Martin’s presentation have been posted by the National Telehealth Resource Center here .

Medicare Advantage Going Wrong? They're Worried at MedPAC
November 13, 2007
By John Reichard, CQ HealthBeat Editor

November 9, 2007 -- Worries are growing at the Medicare Payment Advisory Commission over the direction of the Medicare Advantage program­the private health plan side of Medicare­and whether the nation is getting the value it should for the dollars it's spending.

"I fear we are going backwards," MedPAC Chairman Glenn Hackbarth said Friday at a commission meeting. Hackbarth was reacting to data showing spottier quality in newer plans, as well as the growing prominence of "private fee-for-service plans" in Medicare Advantage­known as "MA"­that don't really manage care.

"Evaluating various data sources, what we have found is the most recent data on quality in MA plans show a need for improvement," MedPAC staffer Carlos Zarabozo told commissioners. "They also show that there is substantial variability across plans in their performance, and performance in newer plans is generally poorer" than performance in older plans, he added.

Mohit Ghose, a spokesman for the managed care industry, said analysts should not draw the wrong conclusions from the data, noting that systems to manage and evaluate quality of care are largely missing in traditional Medicare. That means quality of care is largely unknown in the traditional program, and that, by contrast, even MA plans with spottier performance have benchmarks against which to make improvements, noted Ghose, a spokesman for America's Health Insurance Plans (AHIP).

His comments suggest that quality of care in traditional Medicare may be considerably worse.

Zarabozo focused on results from a Medicare survey designed to assess changes in "health outcomes" in MA plans, as well as recent findings from the National Committee on Quality Assurance (NCQA) on the performance of MA plans on specific measures of quality.

The "outcomes" survey questions beneficiaries in MA plans at the beginning of a two-year period and again at the end to get their individual assessments about whether their health had grown better or worse than they expected over the two years. Beneficiaries were asked about both their physical and mental health. The survey has examined two-year periods going back to 1998.

In the most recent assessment­from 2004 to 2006­beneficiaries in only five of the 151 plans surveyed rated their mental health as better than expected. In the 2003–2005 and the 2002–2004 periods, beneficiaries in considerably more plans reported better-than-expected mental health­18 plans and 27 plans, respectively. Beneficiaries in 13 of the plans reported that their physical health was worse than expected in the 2004–2006 study, compared with beneficiaries in zero plans in the 2003–2005 and 2002–2004 studies. Thirteen was the largest number of plans in the history of the two-year surveys in which beneficiaries rated their physical health as worse than expected.

Reviewing NCQA findings released in September on 2006 quality performance, Zarabozo said commercial and Medicaid managed care plans showed greater improvement on a larger number of quality performance measures than did Medicare Advantage plans. MA plans improved on 7 of 38 measures from 2005 to 2006, while commercial plans improved on 30 of 44 and Medicaid plans on 34 out of 43, according to Zarabozo. "For the 30 measures common to MA and commercial plans, commercial plans had better scores than Medicare on 16 measures," he said.

His presentation also looked specifically at one measure, whether diabetics receive routine eye exams to assess whether their vision is declining. Twenty-four percent of Medicare Advantage plans provided those exams for fewer than 50 percent of their diabetic enrollees, and about half provided them for fewer than 60 percent of their diabetic enrollees, according to the 2006 data. Older plans were far more likely to provide the exams than newer plans, a trend noted on almost all measures of quality performance, the MedPAC staffer noted. "New plans are smaller and are more likely to be PPOs, but these factors do not explain lower scores," he noted.

Zarabozo defined 119 MA plans in the analysis as "new," meaning they signed contracts with the Medicare Advantage program on or after June 1, 2004. The plans included HMOs and PPOs but not private fee-for-service plans, which are exempt from requirements to report data on the quality of care. The new plans account for about 15 percent of Medicare Advantage enrollment.

MedPAC Commissioner Jack C. Ebeler called the data "disappointing." Ebeler, the former head of the Alliance of Community Health Plans, an association representing older, more tightly managed HMOs, said "this is not what we are hoping for."

For his part, Hackbarth queried Zarabozo on where Medicare stood in providing data comparing quality in Medicare Advantage to that in traditional Medicare. The staffer said Medicare will be making data available comparing how often MA enrollees and enrollees in traditional Medicare get flu shots, and how they rate overall satisfaction with the care they are receiving.

But Hackbarth weighed in more strongly a few minutes later. "I'm struggling to get to 'disappointed,'" he said dryly, referring to Ebeler's reaction to the data on quality. "I'm more depressed."

Hackbarth's comment seemed as much, if not more, directed at the surging enrollment in private fee-for-service plans, which are paid much more than other MA plans but which do not have networks of providers that attempt to organize care more efficiently and are not measured on the care they do provide. Private fee-for-service plans, in addition to "Special Needs Plans," were added to the private health plan side of Medicare under the 2003 Medicare overhaul law (PL 108-173), and account for much of the surge in overall MA enrollment since then.

"A number of things are depressing about these results," Hackbarth said. "I think that one of them is that I fear that we are going backwards, that the policy changes that we made in this program are converting Medicare Advantage from a program that's leading edge where we reward organized systems that reduce costs and improve quality ... that we're going to private fee-for-service, that has little potential to do either. These results are just a reflection that we're not evolving, we're devolving."

Commissioner Nancy M. Kane noted that Harvard Pilgrim Health Care, a Massachusetts health plan with a reputation for tightly managing care, has switched its Medicare enrollees into a private fee-for-service plan. That not only means it gets paid more, it also isn't held to the higher quality standards that other Medicare Advantage plans must meet. Many more private fee-for-service plans have applied to enter the Medicare Advantage program next year, and could be highly attractive to Medicare beneficiaries. That's because as in traditional Medicare, they have the ability to choose which doctor or hospital they use­but they also may pay lower copayments and get better benefits.

Commissioners said MedPAC should state more forcefully its position that Medicare Advantage plans should be accountable for the care they provide and that they should be paid based on the quality of their performance. "We want not only reporting, but also performance," said commissioner Nicholas Wolter. "I think we should be very strong on this" in recommendations to Congress and the Medicare program.

The Friday meeting also examined special needs plans, or "SNPs," whose enrollment also is growing fast, whose payments are higher than those received by many MA plans and whose number is rapidly growing. In theory, the plans could significantly improve quality and lower costs by managing much more carefully the treatment received by the most chronically ill Medicare beneficiaries. But SNPs are not subject to requirements to ensure that they offer that type of specialized care, said MedPAC staffer Jennifer Podulka.

Podulka unveiled a package of eight draft recommendations to establish performance measures for the plans and to evaluate their performance within the next three years, among other provisions. MedPAC is scheduled to vote on the recommendations at its meeting in December, in a bid to influence Medicare legislation pending in Congress.

AHIP's Ghose emphasized that the data on quality performance presented at Friday's meeting must be placed in the proper context. It takes time to bring enrollees into managed systems and to improve the quality of their care, he said. As a result, it's hardly surprising that older MA plans would outperform newer ones, he added. But unlike providers in traditional Medicare, managed care plans in the Medicare Advantage program are organized to measure, manage, and improve care, he said. Improvements by Medicare Advantage plans on NCQA quality measures may have slowed because of the influx of new enrollees, according to Ghose, but because of a lack of data on quality of care in traditional Medicare, "we don't know whether people are doing better at all."

Health Literacy Tool for Professionals Who Serve Older Adults
November 13, 2007
$4.8 Million Awarded to Pittsburgh Center for Minority Health to Fund Health Disparities Research The Center for Minority Health (CMH) in the Graduate School of Public Health (GSPH) at the University of Pittsburgh has been awarded a five-year, $4.8 million grant to establish a Research Center of Excellence in Minority Health Disparities by the National Center on Minority Health and Health Disparities, a part of the National Institutes of Health (NIH). Dr. Stephen B. Thomas is the director of the CMH and the grant's principal investigator. The new multi-year grant positions CMH as a national center of excellence in translating evidence-based research into community-based interventions designed to prevent disease and promote health in Pittsburghs African-American community. "This NIH funding will help our efforts to improve the translation of scientific findings into interventions that contribute to the elimination of racial and ethnic health disparities," said Dr. Stephen Thomas. The Research Center of Excellence in Minority Health Disparities will embed rigorous scientific research within the Healthy Black Family Project, a health promotion and disease prevention program that has enrolled more than 6,000 participants in the Pittsburgh area in a lifestyle behavior-change intervention designed to increase physical activity, improve nutrition, reduce stress and provide access to a medical home. The Healthy Black Family Project is currently headquartered in East Liberty, with a satellite office in Wilkinsburg, and is expanding to the Hill District and North Side to bring program activities closer to where people live, work, play and worship. "Public health faces many challenges, but there is no greater challenge than the elimination of health disparities. Eliminating disparities is a daunting task that will require more than just good intentions. Excellent science, visionary leadership and a deep moral commitment are required to bring about change. This NIH award confirms that the CMH has the leadership needed to bring exactly these strengths to the GSPH, the university, the region at large and the nation," said Dean Donald S. Burke of GSPH and the Jonas Salk Chair in Global Health at the University of Pittsburgh. "The NIH was impressed with the inclusion of representatives from African-American organizations, local foundation leaders, the CMH Community Research Advisory Board and people from the community, as members of the leadership team in the new center," said Dr. Thomas. "We have demonstrated how community partnerships must be more than lip service in grant applications and that it is feasible to develop and sustain a true partnership which benefits the African-American community and the community of academic research scientists." As part of the new center, Dr. Charles Reynolds III, director of the Late Life Mood Disorders Center in the department of psychiatry at the University of Pittsburgh School of Medicine, will serve as principal investigator of a study designed to prevent depression through the use of problem solving therapy (PST). PST is a behavioral treatment that teaches problem-solving orientation and skills. It teaches people to accept problems as a normal part of life, enhances belief in ones ability to solve them, develops active coping skills and helps people plan daily pleasurable activities to combat worsening of mood and decreased activity. "The Healthy Black Family staff will be trained in the PST method to increase their capacity to identify and avert early signs of depression, a condition commonly associated with people who also suffer from diabetes and cardiovascular disease," said Dr. Reynolds. The mission of the National Center on Minority Health and Health Disparities is to promote minority health and to lead, coordinate, support and assist the NIH effort to reduce and ultimately eliminate health disparities. For more information, visit:

http://www.cmh.pitt.edu/
www.cmh.pitt.edu

Health Literacy Tool for Professionals Who Serve Older Adults
November 13, 2007
Health Literacy Tool for Professionals Who Serve Older Adults
As part of Health Literacy month, the U.S. Department of Health and Human Services released a new health literacy tool for people who serve older adults.  The Quick Guide to Health Literacy and Older Adults is designed to provide useful strategies and suggestions to professionals who work with older adults to help bridge the communication gap between professionals and older adults. In a national assessment of health literacy, only three percent of the older adults surveyed were found to be proficient in health literacy. Persons with limited health literacy have more adverse health outcomes including less frequent use of preventive services, higher hospitalization rates, and more emergency room visits. For older Americans, difficulties with health literacy can complicate already challenging health problems since as many as 80 percent of older Americans have at least one chronic disease. The tool can be accessed at the link above.
Funding Web page

Great American Smoke Out
November 13, 2007
Great American Smoke Out
November 15, 2007
The Great American Smokeout will celebrate its 31st anniversary on Thursday, November 15. The event challenges people not to smoke cigarettes for 24 hours, helping them to begin to make the shift away from smoking permanently. With exactly half of the United States now protected by smoke-free laws, and a variety of cessation resources available, there has never been a better time to quit smoking and enjoy the health benefits. For more information, resources, and tools you can use to promote the event, visit the link above.

HS Announces Project to Help 3.6 Million Consumers Reap Benefits of Electronic Health Records
November 13, 2007
Health and Human Services (HHS) Secretary Mike Leavitt has announced a five-year demonstration project that will encourage small to medium-sized physician practices to adopt electronic health records (EHRs).  Conducted by the Centers for Medicare & Medicaid Services (CMS), the demonstration would be open to participation by up to 1,200 physician practices beginning in the spring.  Over a five-year period, the program will provide financial incentives to physician groups using certified EHRs to meet certain clinical quality measures.  A bonus will be provided each year based on a physician group’s score on a standardized survey that assesses the specific EHR functions a group employs to support the delivery of care. The CMS demonstration also will help advance Secretary Leavitt’s efforts to shift health care in the U.S. toward a system based on value.  The Department is working to effect change through its Value-Driven Health Care initiative, which is based on Four Cornerstones: interoperable electronic health records, public reporting of provider quality information, public reporting of cost information, and incentives for value comparison.

Challenge Grants Press Release
November 13, 2007
Below is the link to open the Challenge Grants press release.

PRESS RELEASE

A new policy brief is available from the RUPRI Center
November 13, 2007
Update on Rural Enrollment in Medicare Advantage: Growth Continues Enrollment in Medicare Advantage (MA) plans in rural areas grew over 50% in the first three quarters of 2007 and has more than tripled since the inception of the MA program at the beginning of 2006. However, rural enrollment remains well below urban enrollment as a percentage of the eligible population. This brief updates early findings from analysis of the Medicare+Choice/MA program presented in previous RUPRI Center policy briefs.

Please click on the following links to download this brief and accompanying tables:

http://www.unmc.edu/ruprihealth/Pubs/PB2007-7%20110507.pdf
http://www.unmc.edu/ruprihealth/Pubs/PB2007-7%20Tables%20110507.pdf

Office Guide to Communicating with Limited English Proficient
November 13, 2007
Office Guide to Communicating with Limited English Proficient Patients
The American Medical Association's new edition of the brochure includes questions and answers, tips for working effectively with interpreters, resources, and a brief guide for when to use different interpretation resources. The guide is available at the link above. This guide provides information and resources that physicians and health care staff can use to provide better care to patients with limited English proficiency (LEP). With the LEP population rising in both rural and urban areas of the United States, language gaps between physicians and patients are increasing. This guide offers detailed information on the ways LEP can affect patient care and effective strategies to address the language needs of patients in a culturally, linguistically and ethically appropriate manner.

Research Tested Intervention Programs
November 13, 2007
Research Tested Intervention Programs
The website allows users to find research-tested intervention programs and products, review summary information and usefulness/integrity scores for each program, order or download materials to adapt for use in your own program, and obtain readability scores for products distributed to the public. Newly added programs include POOL COOL, to promote sun safety, and DINE Healthy: Diet Improvement Software. Information is also available on research tested intervention programs related to increasing cancer screening, diet and nutrition, physical activity, tobacco control, and sun safety. The site was developed by the National Cancer Institute and can be accessed at the link above.

2007 KIDS COUNT Data Book
November 13, 2007
2007 KIDS COUNT Data Book
From the Annie E. Casey Foundation, this resource is a national & state-by-state effort to track the health, academic, & economic status of children throughout the nation. It also includes a special section on children in immigrant families. KIDS COUNT also ranks states based on a combination of health, social, and economic indictors for youth on which data was collected for the 2002 through 2007 KIDS COUNT Data Books. Similar data may also be available for your county, municipality, or school district through another project of the foundation, CLIKS. In addition to accessing data and comparative rates for the state or nation, you can also create maps, lists of ranking based on a specific indicator, and graphs to show changes in an indicator over time. You can access the KIDS COUNT Data book at the link above.

Rural Health Bookmark
November 13, 2007
The Rural Health Bookmark, which offers Medicare providers, suppliers, and physicians information about rural educational resources, is now available in print format from the Centers for Medicare & Medicaid Services Medicare Learning Network. To place your order, visit http://cms.meridianksi.com/kc/main/kc_frame.asp?kc_ident=kc0001&loc=5 scroll down to the bottom of the page for the following rural health resources.

Rural Health

• Critical Access Hospital Program Fact Sheet (ICN# 6400)(Mar 2007) (Fact Sheet)
• Federally Qualified Health Center (ICN# 6397)(Mar 2007) (Fact Sheet)
• Medicare Billing Information for Rural Providers, Suppliers, and Physicians (ICN# 6762)(May 2007) (Informational Resource)
• Medicare Disproportionate Share Hospital Fact Sheet (ICN# 6741)(Mar 2007) (Fact Sheet)
• Medicare Guide to Rural Health Services Information for Providers, Suppliers, and Physicians (ICN# 6423)(Feb 2007) (Guide)
• Medicare Guide to Rural Health Services Information for Providers, Suppliers, and Physicians (ICN# 6735)(Feb 2007) (CD-Rom)
• Rural Health Bookmark (ICN# 6917)(Oct 2007) (Informational Resource)
• Rural Health Clinic Fact Sheet (ICN# 6398)(Mar 2007) (Fact Sheet)
• Rural Referral Center Fact Sheet (ICN# 6742)(Mar 2007) (Fact Sheet)
• Sole Community Hospital Fact Sheet (ICN# 6399)(Mar 2007) (Fact Sheet)

Announcement of MAC Contractor for Jurisdiction 12
November 13, 2007
CMS has completed the award of the Medicare Administrative Contract in Jurisdiction 12 for Part A and Part B claims processing. Attached please find the press release dated Friday, October 26, 2007 announcing that the contract was awarded to Highmark Medicare Services which is headquartered in Camp Hill, Pennsylvania. As you know, Jurisdiction 12 is comprised of the States of Pennsylvania, Maryland, New Jersey, Delaware and the District of Columbia.

To view the announcement click here

Pennsylvania's hospitals annually contribute nearly $77 billion to the state's economy, according to a report released by the Hospital & Healthsystem Association of Pennsylvania (HAP)
October 28, 2007
The report updates a 2006 study conducted by HAP, and incorporates data from the U.S. Department of Commerce, the Pennsylvania Department of Labor & Industry and member hospitals and health systems, reported the Business Journal. For the first time, the HAP report also attempts to quantify hospital community benefit, which encompasses programs and services that provide treatment or promote health and healing as a response to identified community needs - including the unreimbursed costs of providing care to patients who have little or no means to pay and community services that include free clinics, health screenings, prenatal/maternity programs, scholarships, and outreach, the Business Journal noted. Based on data compiled from hospitals across the state, HAP estimates the value of hospital community benefit to be $3.9 billion annually, the Business Journal added. Philadelphia Business Journal, October 24, 2007. Read On..

One Year In: Sole Community Rural Independent Pharmacies and Medicare Part D
October 28, 2007
A new Findings Brief from the North Carolina Rural Health Research & Policy Analysis Center at the University of North Carolina at Chapel Hill and the RUPRI Center for Rural Health Policy Analysis describes the experiences of 51 rural independently-owned pharmacies that are the sole providers of pharmacy services in their community.

The Findings Brief is available at

http://www.shepscenter.unc.edu/research_programs/rural_program/FB83.pdf

Three conclusions are apparent from the data collected:

• One year following implementation, dealing with Part D plans (PDPs) and working with patients during enrollment periods remains administratively burdensome;
• Areas of concern identified by pharmacists following program implementation in 2006, such as reimbursement levels, complexity of dealing with multiple plans, and timeliness of payments, continue to be cited as problem areas a year later; and
• Opportunities to generate additional revenue through Medication Therapy Management (MTM) may be more limited for sole community providers due to a variety of factors, including limited time available for pharmacists to spend on MTM, relatively small numbers of eligible patients, and program requirements perceived as barriers to participation.

Common Threads from the RTC
October 28, 2007
RTC: Rural's Living Well with a Disability is one of the few health promotion programs for people with disabilities who live in rural areas. The original Living Well program was designed to be delivered in-person to groups of participants by staff of Centers for Independent Living. For many rural people with disabilities, however, the distances and travel difficulties inherent in their environment make onsite group programs impractical or inaccessible. To overcome these rural barriers, RTC: Rural researchers are exploring ways to use the Internet to deliver the Living Well program. We asked, Will people with disabilities naturally adopt an Internet health promotion program.

To learn more, please read Tele-Health Promotion for Rural People with Disabilities: Toward a Technology Assisted Peer-Support Model at http://rtc.ruralinstitute.umt.edu/health/TeleHealth.htm

HRSA's Women's Health USA 2007 Reports Sharp Drop in HIV-Positive Newborns
October 28, 2007
The number of U.S. children born with HIV/AIDS has declined markedly since the mid-1990s in all demographic groups, according to the latest edition of HRSA's Women's Health USA.

From 1994 to 2005, the number of non-Hispanic black infants born with HIV/AIDS has declined by 65.6 percent. The drop among non-Hispanic white infants born with HIV/AIDS was more than 80 percent during the same time, while the decline among Hispanic infants born with HIV/AIDS was 40.6 percent.

Women's Health USA 2007 – the sixth annual report on the health status and service needs of America 's women – focuses on emerging issues and trends among women across the lifespan.

Other findings of Women's Health USA 2007 include:

• Up to 16 percent of women, usually beginning before age 25, are at risk for the gynecological disorder--vulvodynia. Hispanic women may be at greater risk for this disorder.
• Early prenatal care among racial and ethnic groups with historically low rates of utilization, including non-Hispanic Black, Hispanic, and American Indian/Alaska Native women, has increased by at least 20 percent since 1990.
• In 2004, 23.9 percent of women had untreated dental caries, with non-Hispanic Black and Hispanic women most likely to have untreated caries.
• Serious psychological distress occurs in almost 23 percent of women aged 18 to 25 years, compared to 9 percent of women over age 50.
• In 2005, 72.9 percent of mothers ever breastfed their infants, with Asian/Pacific Islanders most likely to breastfeed their infants (81.4 percent).
• In 2005, 71.8 percent of women aged 18 to 64 had private insurance, 14.6 had public insurance, and 17.8 percent were uninsured.

Women's Health USA 2007 is an easy-to-read snapshot of the most current women's health data available and include graphs and summaries of long-term trends. This publication is available on-line at Women's Health USA 2007.

Senate Passes Labor-HHS Appropriations Bill
October 28, 2007
On October 23, the Senate passed the fiscal year 2008 Labor-HHS Appropriations bill that funds the programs that make up the "rural health safety net" with a bipartisan vote of 75 to 19. The Senate numbers improve on past years, but are not as generous as the previously passed House bill for many of the programs for rural America.We anticipate the Congress working together in the coming weeks to combine the two bills before sending this funding bill to the President.

Despite the Senate passing the funding bill with a veto proof majority, the President reiterated his threat to veto.Disconcerting to advocates of these health care programs is that 40 Republican Senators voted for an amendment that would have limited funding to the level of the President's request, which would mean large cuts to the "rural health safety net." This amendment vote was seen as a potential predicator of any veto override vote in the Senate and while it failed, it proved that there may be enough Senators to sustain the veto.

The NRHA will be working with rural champions in both the House and Senate to create a strong combined funding bill and will be asking NRHA members to advocate as we get closer to final passage.

For more information about the fiscal year 2008 process, visit http://www.nrharural.org/advocacy/sub/approps.html.

New Interactive Map Tracks Comprehensive State Initiatives on Covering the Uninsured
October 28, 2007
New Interactive Map Tracks Comprehensive State Initiatives on Covering the Uninsured  
With the number of the uninsured continuing to grow, states have taken the lead in developing proposals to reform the health care system with the goal of increasing the number of people with health coverage and making coverage more affordable. Kaiser has created a new online interactive map and related summaries of plans to track which states have enacted or are planning comprehensive health initiatives .

Uninsured Primer and Fact Sheet Updated with 2006 Data
The Foundation's Kaiser Commission on Medicaid and the Uninsured (KCMU) has updated two of its key publications that provide basic information on health coverage in America and the uninsured policy problem.  The Uninsured: A Primer reviews the basic profile of the uninsured population, how they receive care, and what the options are for increasing coverage.  It includes many charts and tables of data.  The Uninsured and Their Access to Care fact sheet describes the characteristics of the uninsured population, the difference health insurance makes, and why there is a large uninsured population.

Report: State of Women's Health Poor Nationwide
October 28, 2007
The health of women in America is unsatisfactory, and compared with three years ago, it's growing worse, according to the latest "report card" on women's health released by the National Women's Law Center. Read more »

For the Latest on Health IT, Visit the AHRQ National Resource Center Web Site
October 15, 2007
The AHRQ National Resource Center (NRC) for Health Information Technology Web site is the go-to source for the latest, highest-quality information evidence and best practices in the health IT field. The site provides access to more than 7,000 resources on key issues, such as health information exchange (HIE), electronic health record (EHR) implementation, privacy, security, and interoperability standards. Plus, this site is the only source for real-time news and evidence from AHRQ-funded health IT research projects. The site also features the latest conference proceedings and materials from the AHRQ 2007 Annual Conference. If you are in the trenches, trying to make health IT work, then you must go to http://healthit.ahrq.gov.

The NRC Web site now features an RSS feed to help you stay on top of the latest news and information on health IT. Visit http://healthit.ahrq.gov/rssfeeds to access the feed and incorporate it into your blog or Web browser. For more information on how to use the RSS feed, please contact us at NRC-HealthIT@ahrq.hss.gov.

AHRQ-funded projects are transforming everyday clinical care through health IT. Find out more about the critical lessons learned from these projects at the AHRQ National Resource Center Web site--A unique and dynamic resource that keeps getting better! Visit http://healthit.ahrq.gov.

Web Site for Part D
October 15, 2007
CMS Unveils Updated Web Site To Help Medicare Beneficiaries Better Compare Price, Coverage, Quality of Prescription Drug Plans Palm Beach Post The site (www.medicare.gov) allows beneficiaries to sort plans in their communities by factors such as annual costs, the amount of premiums and what kind of coverage the plans provide once beneficiaries have reached the so-called "doughnut hole," when coverage is reduced.

HState-Specific Medicare Drug Plan Information Now Available
October 15, 2007
This week, Kaiser issued a new summary of the stand-alone Medicare Part D drug plans that will be available in each state in 2008. The two-page fact sheet shows the number of plans available in each state, as well as the number that offer some relief in the benefit's coverage gap and the number available at no cost to low-income beneficiaries who receive additional assistance. It also lists the range of premiums for plans in each state.

To view the fact sheet click here

Health Careers Opportunity Program­Closing Date February 22, 2008
October 15, 2007
The goal of the Health Careers Opportunity Program (HCOP) is to assist individuals from disadvantaged backgrounds to undertake education to enter a health profession. The HCOP program works to build diversity in the health fields by providing students from disadvantaged backgrounds an opportunity to develop the skills needed to successfully compete, enter and graduate from health professions schools.

The legislative purposes, from which HCOP funds maybe awarded are:

1) identifying, recruiting and selecting individuals from disadvantaged backgrounds for education and training in a health profession;

2) facilitating the entry of such individuals into such a school;

3) providing counseling, mentoring, or other services designed to assist such individuals to complete successfully their education at such a school;

4) providing, for a period prior to the entry of such individuals into the regular course of education at such a school, preliminary education and health research training designed to assist them to complete successfully such regular course education at such a school, or referring such individuals to institutions providing such preliminary education;

5) publicizing existing sources of financial aid available to students in the education program of such a school or who are undertaking training necessary to qualify them to enroll in such a program;

6) paying scholarships, such as the Secretary may determine, for such individuals for any period of health professions education at a health professions school;

7) paying stipends for such individuals for any period of education in student-enhancement programs (other than regular courses), except that such a stipend may not be provided to an individual for more than 12 months;

8) carrying out programs under which such individuals gain experience regarding a career in a field of primary health care through working at facilities of public or private nonprofit community-based providers of primary health services;

9) conducting activities to develop a larger and more competitive applicant pool through partnerships with institutions of higher education, school districts and other community-based entities.

For more details, click here.

Advocacy Groups Unite in Concerns for Rural Seniors’ Health Care
October 15, 2007
WASHINGTON – Today on Capitol Hill, the National Rural Health Association (NRHA) joined with the American Medical Association (AMA) and AARP to detail their respective concerns for rural Medicare beneficiaries who take part in Medicare Advantage plans.

In An Evaluation of Medicare Advantage in Rural America, leaders from the advocacy groups and academia briefed Congressional staff on findings that show in rural areas both Medicare patients and the physicians who care for them are often being ill-served by private Medicare plans that cost the government more money than traditional Medicare.

NRHA board member, Brock Slabach, told Congressional staff that certain rapidly growing Medicare plans actually impede access to health care in rural America. Slabach outlined the NRHA’s concerns for rural patients and providers alike over the growth of Medicare Advantage Private Fee-for-Service plans (PFFS) in rural America. Including concern that such plans often reimburse providers at rates far lower than under traditional Medicare, hampering the ability to access care in rural America.

Rural seniors deserve Medicare options that are equivalent to urban seniors...Medicare must continue to improve, but the fragility of our rural seniors and the rural health infrastructure demand something more than the Medicare Advantage plans of today, said Slabach. These plans have the ability to completely undo the reimbursement structure that Congress created a decade ago.

Slabach also testified that PFFS plans are often confusing to seniors, contain gaps in coverage and are sold with questionable marketing tactics. We can and must do better for our rural seniors, Slabach told the congressional staff.

Private Fee-For-Service has experienced enormous growth following Medicare Advantage payment increases made by the Medicare Modernization Act of 2003. In 2003, less than 26,000 beneficiaries were enrolled in PFFS plans, but by April 2007 that number had exploded to nearly 1.5 million – a growth of more than 5600 percent.

Private plans in Medicare were supposed to save Medicare money and expand choices for people in rural America, but after a few years in action some private plans have cost Medicare more and left beneficiaries at greater risk, said Brian McGuire, Associate Regional Director, AARP.

Slabach also detailed the NRHA’s recommendations and told Congressional staff that, as it works to modify the Medicare Advantage PFFS program, it must:

• Ensure that rural providers receive equitable reimbursements in amounts no less than they would be paid by traditional Medicare;
• Ensure that plans fully disclose to seniors gaps and limitations of benefit coverage and unscrupulous marketing tactics are eliminated; and
• Ensure that the federal government engages with rural health experts on how to enforce rural community access standards and how to assist providers to collaborate in the review of Medicare Advantage contracts.

While Medicare Advantage plans are being paid at a higher rate, patient premiums are increasing and Medicare physician payments are being cut.

A full 60 percent of physicians say that next year’s Medicare payment cut will force them to limit the number of new Medicare patients they can treat, and rural Medicare patients will be particularly hard hit, as additional payments to rural physicians also expire next year, said AMA Board Member Ardis Hoven, M.D. There needs to be a balance between payments to private insurance companies and payments to traditional Medicare. This is the path to preserving access to care for all Medicare patients.

Pennsylvania’s Health Care System in “Critical Condition”
October 15, 2007
A new government report released today by the Pennsylvania Health Care Cost Containment Council (PHC4) termed the state's health care system in "critical condition."

To view the press release click here

To view the report click here

HHS Awards C