2006 News Archive

FCC Pilot Program - Rural Health Care
December 19, 2006
Federal Trade Commission Announces New Nationwide Broadband Pilot Program
The Federal Communications Commission (FCC) - new Rural Pilot Program to facilitate the creation of a nationwide broadband network that will support dedicated to health care, connecting public and private non-profit health care providers in rural and urban locations. Applicants are encouraged to form statewide or regional consortia that may include academic health centers. In awarding funds, the FCC will consider how the applicant plans to:

• Aggregate (pool) the specific needs of health care providers, including providers that serve rural areas, within a state or region.
• Leverage (utilize) existing technology to adopt the most efficient and cost effective means of connecting those providers.
• Fully utilize a newly created dedicated broadband network to provide health care services.
• In addition, the FCC will consider:
• Whether the applicant has a successful track record in developing, coordinating, and implementing a successful telehealth/telemedicine program within their state or region.
• The number of health care providers that would be included in the proposed network, with considerable weight to be given to applications that propose to connect the rural health care providers in a given state or region. A proposal that connects only a de minimis (insignificant) number of rural health care providers will not be accepted.

What is the Rural Health Care pilot program?

The pilot program is an enhanced funding initiative intended to help public and non-profit health care providers construct state- and region-wide broadband networks to provide telehealth and telemedicine services throughout the nation. The program will fund up to 85% of the costs of constructing those networks, as well as the costs of advanced telecommunications and information services that will ride over these networks. If selected, up to 85% of the cost of connecting to Internet2, a dedicated nationwide backbone, may also be funded by the pilot program. Connection to Internet 2 is not required, but may be requested by the applicants.

What are the benefits of this pilot program?

• A broadband network that connects multiple health care providers will bring the benefits of innovative telehealth and, in particular, telemedicine services to those areas of the country where the need for those benefits is most acute.
• Linking statewide and regional networks to a nationwide backbone will connect a number of government research institutions, as well as academic, public, and private health care institutions that are important sources of medical expertise and information.
• Health care providers will gain increased access to advanced applications in continuing education and research.
• A ubiquitous nationwide broadband network dedicated to health care will enhance the health care community’s ability to provide a rapid and coordinated response in the event of a national crisis.

Who is eligible to receive funding under this program?

Public and not-for-profit health care providers are eligible to receive funding. For purposes of the pilot program, the definition of “Health Care Provider” is the same as that of Section 254(h)(7)(B) of the Communications Act and the FCC’s rules for the existing Rural Health Care program. Eligible health care providers include:

• Post-secondary educational institutions offering health care instruction, teaching hospitals, or medical schools;
• Community health centers or health centers providing health care to migrants;
• Local health departments or agencies including dedicated emergency departments of rural for-profit hospitals;
• Community mental health centers;
• Not-for-profit hospitals;
• Rural health clinics, including mobile clinics;
• Consortia of health care providers consisting of one or more of the above entities; and
• Part-time eligible entities located in otherwise ineligible facilities.

Non-eligible health care providers include any for-profit institutions (except as noted above), or any health care provider types not listed above. Examples of non-eligible providers include:

• Private physician offices or clinics;
• Nursing homes or other long-term care facilities (e.g. assisted living facilities);
• Residential substance abuse treatment facilities;
• Hospices;
• Emergency medical service facilities (e.g., rescue squads, ambulance services);
• For-profit hospitals;
• Home health agencies;
• Blood banks;
• Social service agencies; and
• Community centers, vocational rehabilitation centers, youth centers.

Will for-profit health care providers be allowed to connect to the network?

Yes. Applicants may include for-profit health care providers in their proposals as network participants. However, for-profit health care providers will be required to pay for their own costs of connecting to the network. In fact, one of the criteria specified in the order is that applicants describe how for-profit network participants will pay their fair share of the network costs.

New from MedPAC
December 19, 2006
Medicare Payment Advisory Commission (MedPAC) Releases Rural Payment Report

MedPAC announces the release of its December 2006 Report to the Congress: Rural Payment Provisions in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. You may go to our website at http://www.medpac.gov to view the report, or follow the direct link below.

(Note: Files are in Adobe PDF format and require Adobe Acrobat Reader 6 or later for viewing.)

Direct Link

[CYFAR] Kids Count Data on Children in Poverty
December 19, 2006
Recent data from the U.S. Census Bureau’s American Community Survey shows that in 2005, nearly 29 million U.S. children lived in low-income families. The majority of these children, or nearly 15 million, had at least one parent who worked regularly (see definition of low-income working families). These families are living on the economic edge­despite regular employment­and struggling to make ends meet. Access the full report at:
http://www.aecf.org/kidscount/sld/snapshot_working.jsp

Final Action on Health Legislation for the 109th Congress
December 19, 2007
Final Action on Health Legislation for the 109th Congress
Congress will wrap up its lame duck session this week and adjourn the 109th Congress. Final votes are expected in the House on Friday, December 8, while voting in the Senate may last through the weekend.

MEDICARE LEGISLATION
House and Senate negotiators agreed earlier this week on a Medicare package that will avert a scheduled 5.0 percent payment cut to physicians, and make other changes to Medicare. The House passed the Tax Relief and Health Care Act of 2007 (H.R. 6408) earlier today, while a Senate vote is expected before the Senate adjourns sometime this weekend. Thanks to the hard work of so many NRHA members, the package does extend some expiring provisions for rural providers. The bill includes the following key health components:

• Provides a zero percent update for physicians for 2007. Starting July 1, 2007, eligible professionals who report quality measures, as identified under the CMS Physician Voluntary Reporting System, will receive a bonus payment of 1.5 percent.
• Extends the floor on the work component of the physician geographic adjustor through 2007. The extension of this provision is an important victory for rural providers in the fight for payment equity, as it continues a hard-fought provision that helps to level the playing field for rural physician payments.
• Extends cost-based reimbursement for lab tests furnished in small rural hospitals (under 50 beds) in low density population rural areas through cost reports beginning before July 1, 2007.
• Continues direct billing for the technical component for pathology services by independent laboratories through 2007.
• Provides for a technical correction to the rural Program of All-Inclusive Care for the Elderly (PACE) provider grant program that allows the program to retain funds provided for outlier payments through 2010. The NRHA was a major sponsor of the rural PACE program’s inception.
• Extends the Section 508 wage index reclassifications for six months, through September 30, 2007.
• Other provisions include: a 2 percent reduction in payments for outpatient services provided by hospitals and ambulatory surgical centers that do not report certain quality measures, starting in 2009; a 1.6 percent update to End State Renal Disease facilities for 2007; payments to providers for administering Part D vaccines in 2007 and subsequent years; an extension through 2007 of an exception allowing additional reimbursement of outpatient therapy services not performed in a hospital; and setting a maximum Medicaid provider tax of 5.5 percent, to name a few.

Additional information on the Tax Relief and Health Care Act of 2007 can be seen at: http://waysandmeans.house.gov/ResourceKits.asp?section=2544

ERS/USDA Pubs: Rural America at a Glance
December 19, 2006
The Economic Research Service (ERS) is a primary source of economic information and research in the U.S. Department of Agriculture. ERS conducts a research program to inform public and private decision making on economic and policy issues involving food, farming, natural resources, and rural development. Access the link to see chart books on rural America, rural poverty, and rural children. http://www.ers.usda.gov/Emphases/Rural/ataglance.htm

Take Action on Possible Rural Medicare Extenders
December 19, 2006
Contact Your Members of Congress Now!

Key congressional staff are currently trying to negotiate a short-term fix for Medicare physician payments, with the hope of bringing a package up for a vote in the House and Senate this week. CQ reported yesterday that this bill may include "a package of provisions for rural providers valued at $2 billion." While it is unclear if the negotiations will succeed, this potential package of Medicare legislation is the best and only chance for any rural Medicare-related legislation during the remainder of this Congress. Absent Congressional action, physicians will face a 5.0 percent cut in Medicare payments starting January 1, 2007.

While NRHA’s rural agenda is extensive, there is limited opportunity here to attach additional provisions. NRHA is asking for an extension of important rural Medicare provisions from the Medicare Modernization Act (MMA) that are scheduled to expire at the end of this year or next. The MMA provisions were critical in putting payments to rural providers on more of a level playing field and helping to address provider shortages and we do not want to lose any of the hard-fought ground in our pursuit of payment equity.

NRHA members with Representatives and Senators on key congressional committees ( House Ways and Means Committee, http://capwiz.com/nrha/callalert/index.tt?alertid=9185031&type=TA, and the Senate Finance Committee), have received an action alert last week. Please take action as directed in those alerts.

For the rest of the NRHA membership, please ask your Representative and Senators to tell leadership and chair and incoming chairs of committees with jurisdiction over Medicare (the House Ways and Means Committee, the House Energy and Commerce Committee, and the Senate Finance Committee) to make sure any final package includes rural extenders.

New Joint Publication from the North Carolina Center and the RUPRI Center: "The Experience of Sole Community Rural Independent Pharmacies with Medicare Part D: Reports From the Field"
December 19, 2006
A new joint publication is available from the North Carolina Rural Health Research & Policy Analysis Center and the RUPRI Center for Rural Health Policy Analysis:

The Experience of Sole Community Rural Independent Pharmacies with Medicare Part D: Reports From the Field
The implementation of the new Medicare Part D benefit during 2006 created new experiences for both rural beneficiaries and the providers that serve them. Many rural beneficiaries gained important financial access to medications they previously struggled to afford. The effects on an important group of rural providers, local independent pharmacies, have been less positive. This study reports results from interviews conducted in the spring of 2006 of 12 rural independent pharmacists located at least 10 miles from the next closest pharmacy. The pharmacists interviewed are experiencing decreases in payment, increases in administrative burden, and changes in their interaction with patients as a result of the shift of patients from Medicaid or non-covered cash into new private-sector prescription drug plans.

Please click on one of the following links to download this document:

http://www.rupri.org/healthpolicy/Pubs/P2006-3.pdf

http://www.shepscenter.unc.edu/research_programs/rural_program/WP87.pdf

Medicare Drug Plans Troubling for Rural Pharmacies
December 19, 2006
(Washington, D.C.) - Medicare Part D Plans could have a negative effect on the finances of rural pharmacies across the nation, according to the National Rural Health Association (NRHA) after reviewing a newly released study. The study, The Experience of Sole Community Rural Independent Pharmacies with Medicare Part D: Reports from the Field, was released this week by The North Carolina Rural Health Research and Policy Analysis Center and The RUPRI Center for Rural Health Policy Analysis.

This study gathered first-hand reports from 12 rural independent pharmacists located at least 10 miles from the next nearest pharmacy. Some important findings from the study are that at the time of the interviews (summer, 2006):

• Payment per prescription was lower from Medicare PDPs than from either Medicaid or cash amounts paid by individuals who previously lacked drug coverage. In some instances payment from PDPs was less than the combined cost of stocking the medications and dispensing them. The time from service to receipt of payment was longer when PDPs were involved, as compared to Medicaid and most commercial plans. Pharmacies had few opportunities to negotiate payment rates with PDPs. Pharmacists had difficulty communicating with Medicare PDP representatives, with problems including excessive amounts of time on hold and an inability to reach someone knowledgeable about the problem.

NRHA president-elect, Paul Moore, D.Ph., President, Pharmacy & Consulting Management Company and Pharmacist/Owner, Roy's Discount Pharmacy, Wilburton, Oklahoma, said, "We are concerned about the financial effect Medicare Prescription Drug Plans are having on rural pharmacies, We must work to ensure a fair reimbursement system and continued access to these local pharmacies that cater to the needs of more than 20 million rural residents." If the financial stress on sole community pharmacies observed in the study is representative of conditions facing other pharmacies across the country, protections for these providers will need to be put in place in order to realize the full benefit of the Part D program.

The study's recommendations include creating a category of safety-net rural pharmacies that receive reimbursement at a level that equals or slightly exceeds their costs, developing a grant program to provide financial assistance to small independent pharmacies that need to implement new information systems, and other steps designed to decrease administrative burden and ease interactions between pharmacies and PDPs.

The Study may be accessed at www.NRHArural.org/opporty/sub/research.html

New Findings Brief from the Flex Monitoring Team
December 19, 2006
http://flexmonitoring.org/documents/CAHFindingsBrief1.pdf

The Flex Monitoring Team has released a new Findings Brief discussing how the financial performance and condition of Critical Access Hospitals changed as a result of converting to CAH status. Researchers at the University of North Carolina-Chapel Hill have developed 20 financial ratios, seven of which are analyzed in this Findings Brief.

The authors of this Findings Brief conclude that overall, financial performance and condition improved after hospitals converted to CAH status.

Findings include the following:

• Most CAHs had higher profitability post conversion
• About half of CAHs had higher liquidity post conversion
• Most CAHs had greater ability to meet debt obligations post conversion
• CAHs providing long-term care were less likely to improve their profitability than CAHs not providing long-term care

The authors of this Findings Brief are Mark Holmes, PhD, George H. Pink, PhD, and Rebecca T. Slifkin, PhD of the University of North Carolina at Chapel Hill

Help End Hunger in Pennsylvania!
December 19, 2006
The Governor's Inter-Agency Council on Food and Nutrition is initiating a process to create, a blueprint to end hunger in Pennsylvania. The Council, which includes the secretaries of the departments of Agriculture, Aging, Community and Economic Development, Education, Health and Public Welfare, wants your advice. Based on your experience, what do you think are the most important actions state government should take to end hunger in Pennsylvania?

You are invited to give your answer to this question on Thursday, January 18th, at a public hearing convened by the Governor's Council in the VIP Room at the Farm Show Complex, Harrisburg, PA.

You will be given five minutes in which to speak; written testimony also will be accepted. The summit will run from 9 a.m. to approximately 3 p.m.

The day's event will also include breakout sessions designed to address specific issues related to hunger and food security.

If you would like to attend this event, please RSVP to Ann Kier of the Interagency Council on Food and Nutrition by December 15th at akier@state.pa.us, or by calling 717-772-2694.

NRHA Observes World Aids Day
December 19, 2006
(Washington, D.C.) - As we observe World AIDS Day 2006 today, December 1st, an estimated 38.6 million people are living with HIV worldwide. In 2005, 4.1 million people became infected with HIV. World AIDS Day is an opportunity for us to learn more about the impact of HIV/AIDS throughout the world and within our own rural communities (1).

In the United States, an estimated 1,185,000 Americans are living with HIV, with approximately 40,000 new infections every year. HIV/AIDS continues to infect and affect members of our rural communities. Over the years, 5-8% of HIV cases in the U.S. have been in rural areas. I want to share some alarming facts about HIV in our rural communities1 :

• 68% of all AIDS cases among rural populations are in Southern states. In some rural areas, HIV/AIDS diagnosis rates are almost as high as those in urban areas. African Americans represent 50% of rural AIDS cases, followed by Whites (37%), Latinos (9%), and American Indian/Alaska Natives (2%). While 75 % of rural AIDS cases are among men, rates among rural women, particularly among African American women, are increasing. Most women are becoming infected with HIV through heterosexual contact. Among rural men, men who have sex with men (MSM) comprise approximately 60% of rural AIDS cases and injecting drug users (IDUs) about 20%. In 2000, in the rural South, 28.5% of men were infected through heterosexual contact.

(1) Adapted from "What are rural HIV prevention needs?" CAPS Fact Sheet, 5/06, prepared by UCSF Center for AIDS Prevention Studies. Available at http://www.caps.ucsf.edu/pubs/FS/revrural.php

To help address the needs of our rural communities, the National Rural Health Association, with support from the Department of Health and Human Services, Office of HIV/AIDS Policy, have developed the following resources: Rural HIV/AIDS Care: Resources for Providers presents web-based resources on delivery of HIV care to help minimize "digging" for online help. Specific resources for rural settings include provider training venues and ways to co-manage a client with an HIV expert. More general HIV care resources, such as treatment guidelines, are also provided. Best Practices in Rural HIV/AIDS Care provides insights on delivery of services in rural settings based upon interviews with rural HIV care programs around the nation.

• Transportation and Provider Training will be released on World AIDS Day. Future best practices will cover such topics as co-managing clients, techniques for delivering clinical care to rural clients, and addressing HIV/AIDS stigma.

In honor of World AIDS Day, I encourage all of you to learn more about HIV/AIDS and the new rural health provider resources we have developed. Although World AIDS Day is just one day, it serves as a reminder to all of us that we must continue to increase HIV/AIDS prevention, testing, and treatment in our rural communities and beyond.

For additional information please visit or call the following: National Rural Health Association: www.NRHArural.org World AIDS Day Resources: www.omhrc.gov/hivaidsobservances/world/index.html HIV Testing Locations: www.hivtest.org Centers for Disease Control and Prevention's National AIDS Hotline at 1-800-342-AIDS

GAO report on J-1 visa waivers issued today
December 19, 2006
The National Health Policy Forum announces the availability of Issue Brief 819 EPSDT: Medicaid's Critical But Controversial Benefits Program for Children. Click on the paper title to download a copy or visit NHPF's Web site.

The Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program under Medicaid provides the most comprehensive set of health benefits for children and adolescents in the public or private sector. A cornerstone of early childhood preventive and treatment services in the nation's health care "safety net," the EPSDT program serves nearly 30 million low-income children, including children with disabilities and special needs. Over the years, states have expressed frustration with the administrative burdens of EPSDT requirements. Rising Medicaid costs have put all Medicaid benefits, including the EPSDT program, in the budgetary crosshairs. This issue brief reviews the fundamental characteristics of the EPSDT program and highlights some of the challenges it has faced over the years. This paper also describes some of the changes proposed to preserve access to comprehensive care while controlling costs and encouraging administrative simplification and flexibility.

This issue brief provides background for a December 8, 2006, NHPF meeting on children with special health care needs and EPSDT. For more information about the meeting and how to register, click here.

GAO report on J-1 visa waivers issued today
December 19, 2006
The GAO report, "FOREIGN PHYSICIANS: Data on Use of J-1 Visa Waivers Needed to Better Address Physician Shortages," was issued today.

The report can be found on the GAO web site at the following links:

Full report - http://www.gao.gov/cgi-bin/getrpt?GAO-07-52

Highlights - http://www.gao.gov/highlights/d0752high.pdf

New Rural Health Chartbook
December 19, 2006
The Health and Well-Being of Children in Rural Areas: A Portrait of the Nation 2005,

A new HRSA data report indicates that children in urban and rural areas are equally healthy, with about 84 percent in both groups reported in excellent or very good health. But children living outside urban areas are less likely to be breastfed and more likely to live in households with a smoker, the report says.

SC Rural Health Research Center
December 9, 2006
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 findings brief. The publication, entitled Rural Hospitals and Spanish Speaking Patients with Limited English Proficiency, is authored by Myriam E.Torres, PhD, MSPH; Deborah Parra-Medina, PhD, MPH; Amy Brock Martin, DrPH; Andrew O. Johnson, MPH; Jessica D. Bellinger, MPH and Janice C. Probst, PhD.

** The Fact Sheet is attached.

** The following is a link to the Executive Summary http://rhr.sph.sc.edu/report/SCRHRC_LimitedEnglishProficiency_Exec_Sum.pdf.

** The full report is available through our Online Report Request System at http://rhr.sph.sc.edu . You may elect to receive a paper or electronic copy of the full report. The requested report will be sent to you via postal mail (paper copy) or email (electronic copy) within 7~10 days.

The Implementation of Pay-For Performance in Rural Hospitals: Lessons from the Hospital Quality Incentive Demonstration Project
December 9, 2006
A recently completed study reveals that the conditions for successful participation in pay-for-performance initiatives affect rural health care providers differently than urban providers. The study calls for future initiatives to include technical assistance for participating rural hospitals and also ensure that clinical areas that are tied to payment are relevant to the type of services delivered by small rural hospitals. The Policy Brief is available at http://www.uppermidwestrhrc.org/pdf/policybrief_p4p.pdf The full report is available at http://www.uppermidwestrhrc.org/pdf/pay_for_performance.pdf

These findings are part of a report just released by the Upper Midwest Rural Health Research Center (UMRHRC), a partnership between the University of Minnesota and the University of North Dakota, in collaboration with Premier, Inc.

FCC LAUNCHES "RURAL HEALTH CARE PILOT PROGRAM" WEBSITE
December 9, 2006
The FCC has launched a website (http://www.fcc.gov/cgb/rural/rhcp.html) that provides a consolidated source of information about the FCC's recently announced Rural Health Care Pilot Program. The FCC's pilot program is an innovative, enhanced funding initiative intended to help public and non-profit health care providers construct state- and region-wide broadband networks to provide telehealth and telemedicine services throughout the nation. For further information go to http://hraunfoss.fcc.gov/edocs_public/attachmatch/DOC-268591A1.doc

New Supplies of Flu Vaccine Now Available
December 9, 2006
The Centers for Disease Control and Prevention (CDC) announced the designation of the week after Thanksgiving (Nov. 27 ­ Dec. 3, 2006) as National Influenza Vaccination Week. This event is designed to raise awareness of the importance of continuing influenza vaccination, as well as foster greater use of flu vaccine through the months of November, December and beyond. CDC is recommending that people take this opportunity to be vaccinated and is hopeful that flu vaccine providers will use this time to enhance flu vaccine availability by scheduling additional clinics and extending clinic hours.An estimated 800,000 doses of Fluarix (Inactivated Adult Flu Vaccine) have been made available for order through the 340B Prime Vendor (PVP) based on the pharmaceutical manufacturer’s (GlaxoSmithKline (GSK)) production schedule. This vaccine offer is for late season doses and is intended to address participants unanticipated or unmet flu vaccine needs and is not intended to replace pre-committed orders that you may have in place.

As a reminder, Prime Vendor participants can place Fluarix orders direct with GlaxoSmithKline on a first-come, first-served basis. For more information, call GSK at (866) 475-8222 or to join the Prime Vendor call (888) 340-2787.

Spending Bills Will Not Be Completed During the 109th Congress
December 9, 2006
Lawmakers will not finish the remainder of the fiscal 2007 spending bills before adjourning this session. Instead, Congress will enact a short-term continuing resolution, or stopgap spending measure, that will last through January. This action will take place when Congress returns to Washington the week of December 4th.

This continuing resolution has the effect of pushing the unfinished fiscal 2007 spending bills into the next Congress, when Democrats will be in charge. Democrats will face the challenge of finishing the prior year’s work and preparing an expected supplemental spending bill for the war while simultaneously preparing for the President’s fiscal year 2008 budget, which will be submitted to Congress at the beginning of February.

Under the current continuing resolution, programs that are a part of the Rural Health Safety Net are funded at the FY 2006 level. For a full chart of FY 2006 funding levels, go to http://www.nrharural.org/advocacy/sub/07appropriations.html

Because the appropriations bills were the primary agenda item for lawmakers to consider in December, they will likely recess by December 8th, before the current continuing resolution expires.

New Flex Monitoring Team Paper Offers States Abundance of Ideas to Consider
December 9, 2006

(Washington, D.C.) A new paper released this week by the Flex Monitoring Team compiled an in-depth description of the proposed 2005 Flex Program grant applications on quality and performance improvement activities. The National Rural Health Association (NRHA) commends the Flex Team on the usefulness of this paper and encourages all CAH facilities to review it for ideas on how to further quality improvement in their own facilities and communities.

"The grant making capacity of the Flex Program has supported a wide range of local initiatives to improve the quality of patient care and hospital operations of Critical Access Hospitals. These initiatives have included projects on balanced scorecards, health information technology, patient safety and satisfaction, as well as participation in national quality improvement efforts, renewed relationships with state Quality Improvement Organizations, and efforts to ensure the efficiency of their business operations. The Flex Program goes well beyond ensuring the financial stability of Critical Access Hospitals - it is promoting a new level of hospital functioning", said Jennifer Lenardson, MHS, research analyst, University of Southern Maine, and lead author of the study.

This briefing paper examines quality improvement activities proposed by 45 states during fiscal year 2005 Flex Program grant applications to the federal Office of Rural Health Policy. The paper describes projects and activities that were requested in the most recent grant cycle. Some of the activities were a continuation of existing activities, while others were new. The paper organizes the activities by categories: improving clinical, operational, and financial performance; financial and organizational performance; promoting a culture of quality improvement; participating in national quality efforts; implementing HIT systems; and addressing patient safety and satisfaction issues. Together these proposals represented 30 percent of the total $7.7 million funding requested by the 45 states eligible for Flex Program grants.

A link to the paper is available on the NRHA web site at: http://www.nrharural.org/opporty/sub/research.html

Emerging Leaders in Public Health Fellowship
December 9, 2006
Managing in Turbulent Times: Emerging Leaders in Public Health

FYI

The Emerging Leaders in Public Health Fellowship is now accepting applications. All interested individuals should visit our website at www.publichealthleaders.org < http://www.publichealthleaders.org> to fill out an application before December 16th, 2006.

*Target Audience*

The Emerging Leaders in Public Health fellowship is designed to prepare the next generation of public health leaders by identifying and training those individuals with the talent to serve in significant leadership capacities to address health disparities, diversity, and crisis management in the next decade.

The Emerging Leaders in Public Health curriculum offers its fellows the essential skills necessary for leading and managing in a turbulent public health environment:

• Dealing with crises in finances, human resources, and communications
• 360 degree assessments
• One-on-one executive coaching
• Individual development planning
• Action learning teams
• Complex case study project

All interested individuals can visit the Emerging Leaders website at www.publichealthleaders.org or contact Mekeisha Williams, Director of Emerging Leaders for Public Health at 919-843-8541 or mpwillia@email.unc.edu

GOVERNOR RENDELL SIGNS HISTORIC 'COVER ALL KIDS' LEGISLATION
November 20, 2006
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 findings brief.

The publication, entitled Rural Hospitals and Spanish Speaking Patients with Limited English Proficiency, is authored by Myriam E. Torres, PhD, MSPH; Deborah Parra-Medina, PhD, MPH; Amy Brock Martin, DrPH; Andrew O. Johnson, MPH; Jessica D. Bellinger, MPH and Janice C. Probst, PhD.

The Fact Sheet is attached, and the full report is available through our Online Report Request System at http://rhr.sph.sc.edu. You may elect to receive a paper or electronic copy. The requested report will be sent to you via postal mail (paper copy) or email (electronic copy) within 7~10 days.

GOVERNOR RENDELL SIGNS HISTORIC 'COVER ALL KIDS' LEGISLATION
November 20, 2006
PITTSBURGH ­ Governor Edward G. Rendell today signed into law his Cover All Kids initiative, making Pennsylvania one of six states to make sure that every child has health care coverage.

“Living in the world’s most affluent society, it shocks the conscience that any child should be forced to live without access to basic medical care,” Governor Rendell said. “With Cover All Kids, Pennsylvania parents will no longer need to make the impossible choice between paying the rent and taking their child to see a doctor.

“Cover All Kids will provide peace of mind to parents because it offers a brighter, healthier future for our commonwealth’s most treasured resource: our children,” Governor Rendell added. “I thank the General Assembly for honoring its commitment to Pennsylvania families by passing this significant bill.”

Under Cover All Kids, parents will be able to afford to insure their children because the monthly premiums will be based on family income. Currently, the Childrens’ Health Insurance Program –known as CHIP – is free for children from families with annual incomes under $40,000 (family of four – 200 percent of the federal poverty level) and available at a reduced cost for children from families with incomes up to $47,000 (family of four - 200 percent - 235 percent of FPL).

Under Cover All Kids, 100 percent of the parents who currently cannot afford to insure their children will get assistance from the state to ensure that the cost of health insurance for their children is reasonable.

Under the new law, the approximate monthly cost for parents is based on a sliding scale:

• $36 a month per child for a family earning 200 percent – 250 percent of FPL (under $50,000 for a family of four)
• $50 a month per child for a family earning 250 percent -275 percent of FPL ($50,000- $55,000 for a family of four)
• $57 a month per child for a family earning 275 percent - 300 percent of FPL ($55,000-$60,000 for a family of four)
• Families that cannot find or afford private health insurance for their children who are earning above 300 percent of the FPL ($60,000 a year for a family of four) can purchase the coverage at the state cost, based on certain eligibility requirements. These families must show that coverage was denied due to a pre-existing condition, or that the cost of private coverage totals more than 10 percent of the family’s annual income, or that the cost of private insurance is one and a half times (150 percent) more than the state monthly per child cost for Cover All Kids.

If parents can buy employer-sponsored coverage for their children but cannot afford the full premium, the state will help the family to pay the premiums for private insurance, rather than enrolling the child in CHIP – if the cost of private coverage is lower.

To discourage parents from canceling private coverage to take advantage of the state subsidy, Cover All Kids has a waiting period that requires families show that their child has not had coverage for the last six months, unless the child is two years of age or less. The so-called “go bare” period is not required for infants, for children who have lost coverage because a parent lost a job or for kids who are moving from another public insurance program.

The 2006-07 state budget includes $4.5 million for Cover All Kids, which will be used to draw down additional federal funds. The bill the Governor signed today allows the state to step up outreach for existing programs for children, such as CHIP and Medicaid (MA), to ensure every qualified child is enrolled.

Pennsylvania’s CHIP program is one of the most successful children’s health insurance programs in the nation, covering a record 148,355 children during October. CHIP was created under legislation signed in late 1992 by Governor Robert P. Casey. The program served as a model for a federal CHIP program enacted by President Bill Clinton in 1997.

More information on the CHIP program can be found at www.chipcoverspakids.com or by calling 1-800-986-KIDS.

USDA Report on State Differences in Food Security
November 20, 2006
WHAT FACTORS ACCOUNT FOR STATE-TO-STATE DIFFERENCES IN FOOD SECURITY?

States differ in the extent to which their residents are food secure­meaning that they have consistent access to enough food for active, healthy living. The prevalence of food security in a State depends not only on the characteristics of households in the State, such as their income, employment, and household structure, but also on State-level characteristics, such as average wages, cost of housing, levels of participation in food assistance programs, and tax policies. Taken together, an identified set of household-level and State-level factors account for most of the State-to-State differences in food security. Some State-level factors point to specific policies that are likely to improve food security, such as policies that increase the supply of affordable housing, promote the use of Federal food assistance programs, or reduce the total tax burden on low-income households.

Released Wednesday, November 15, 2006

See http://www.ers.usda.gov/Publications/EIB20/

National Influenza Vaccination Week, November 27-December 3
November 20, 2006
The U.S. Department of Health and Human Services is holding National Influenza Vaccination Week on November 27-December 3. This event is designed to urge people to get flu shots and to encourage providers to make a greater effort to increase the availability of the vaccine. Free posters, flyers, educational handouts, and other materials are available for easy printing at http://www.cdc.gov/flu.

Available Now! Conference Materials from HIT: A Rural Provider's Roadmap to Quality!
November 20, 2006
Roadmap available here! http://www.raconline.org/HIT_Conf2006/

Families in Pennsylvania Resource Web Site Announced
November 20, 2006
Harrisburg (November 16, 2006). According to a report released yesterday by the U.S. Department of Agriculture (USDA), 481,000 Pennsylvania households struggled to keep themselves fed last year. Most avoided hunger through a variety of coping strategies such as smaller portions, less variety in the diet or help from local food pantries. But in 142,300 Pennsylvania households, those efforts failed and at least one individual in the household experienced hunger because of the inability to secure food.

Each year, the Census Bureau measures food security in the United States by interviewing a sample of nearly 150,000 households about their ability to obtain enough food for an active, healthy life for all household members. Since 1996, the USDA has annually reported the data to the public. This year’s report, Household Food Security in the United States, 2005, is posted on the web at .

Nationally, last year 35 million individuals lived in households that were at risk of hunger, down from the 2004 record high of 38 million. This improvement in food security – measured as a decline in the rate of food insecurity from 11.9 percent in 2004 to 11.0 percent in 2005 – was the first since 1999.

To report state data, the USDA uses 3-year averages that compensate for limited sample sizes and give a better estimate of the number of households at risk. The Pennsylvania data shows modest improvement in food security with the portion of households at risk falling from 10.2 percent in 2002-2004 to 9.8 percent in 2003-05. This is the first such improvement in four years.

“After three consecutive reports from the USDA showing Pennsylvania losing ground in the effort to end hunger, this is good news,” said Berry Friesen, executive director of the Pennsylvania Hunger Action Center. “On this vital indicator our state has gone from being a national leader to being mediocre. This slide has taken a toll on families and on the public in lost productivity, health and learning. Maybe this latest report indicates we’ve stopped the bleeding. I hope and pray that’s true.”

According to a second report published by the USDA, a variety of state-level factors account for differences in food security among the states. In rough order of importance these factors include wage levels, rental costs, participation levels among children in publicly-funded summer meal programs, unemployment levels, residential stability, participation levels in the Food Stamp Program, and the state and local tax burden.

In Pennsylvania, the portion of households that experienced more severe food insecurity - with hunger affecting at least one family member - remained unchanged at 2.9 percent. Approximately 336,000 individuals live in these households. The historic low for this indicator was in 1999-2001 when hunger affected 2.2 percent of households.

Nutrition policy will be front and center as the 110th Congress convenes in January. High on the agenda will be reauthorization of the Farm Bill, the legislation that governs the Food Stamp Program. “It will be a test of our nation’s resolve,” said Friesen. “Are we willing to do what it takes to end the scourge of hunger?”

Additional opportunities to learn about food insecurity and hunger in Pennsylvania are available by calling the Pennsylvania Hunger Action Center at 717-233-6705 or by visiting www.pahunger.org .

Families in Pennsylvania Resource Web Site Announced
November 20, 2006
Penn State Cooperative Extension announces the Families in Pennsylvania Web Site! This resource is intended as a resource for anyone who wants information about child, youth, and family related issues in Pennsylvania. Check out the most popular feature of the site, the Informational Maps link that has information on family poverty levels, public assistance usage, population change, and educational attainment levels for every county and school district in Pennsylvania. It also includes recently developed fact sheets from the Penn State Rural Youth Education Project, and lots of PowerPoint presentations related to youth risk taking behaviors, teen pregnancy and child bearing, and a host of other Children, Youth, and Family topics.

New Briefing Paper on Quality Improvement Activities of State Flex Programs
November 20, 2006
In this newly released briefing paper from the Flex Monitoring Team, the authors provide an in-depth description of quality and performance improvement activities proposed by states during the 2005 grant year, representing 30 percent of requested funding. This briefing paper provides Flex administrators and other stakeholders ideas to consider as they address their own state issues.

Categories of quality improvement activities included improving clinical, operational, and financial performance; financial and organizational performance; promoting a culture of quality improvement; participating in national quality efforts; implementing health information technology (HIT) systems; and addressing patient safety and satisfaction issues.

State activities acknowledge the different quality measurement needs of rural hospitals through the development of benchmarks and transfer protocols specific to CAHs and other small, rural hospitals. Some state programs proposed activities to build in-state knowledge and capacity and to assess current conditions, particularly in the areas of balanced scorecards, HIT, and patient safety.

Daily Health Policy Report
November 20, 2006
Pennsylvania on Tuesday became the first state to report publicly the number of patients who acquired infections in hospitals in 2005, a move that might "boost efforts for public reporting of hospital quality data nationwide," USA Today reports (Appleby, USA Today, 11/15). The report, released by the Pennsylvania Health Care Cost Containment Council, examined 1.6 million patients in 168 hospitals in the state in 2005. For the report, PHC4 grouped hospitals to account for differences in the severity and complexity of their cases and excluded certain patients with conditions that placed them at high risk for infection (Goldstein, Philadelphia Inquirer, 11/15). State law requires hospitals to report four broad forms of infections: surgical site, urinary tract, pneumonia and blood stream. According to the report, 19,154 patients acquired infections in 2005. An average of 12.2 per 1,000 patients acquired infections, and those who acquired infections cost private heath insurers an average of $59,915 for hospital care, compared with $8,311 for those who did not acquire infections, according to the report (USA Today, 11/15). The report also found that:

• Patients who acquired infections spent almost 400,000 additional days in hospitals at an estimated cost of $1 billion (Philadelphia Inquirer, 11/15);
• The average cost of hospital care for patients who acquired infections was $185,260, compared with $31,389 for those who did not acquire infections;
• The average length of hospital stays for patients who acquired infections was about 23 days, compared with about five days for those who did not acquire infections (Fahy, Pittsburgh Post-Gazette, 11/15);
• 2,478 patients who acquired infections died during their hospital stays, although PHC4 did not determine whether the infections caused their deaths; and
• The mortality rate for patients who acquired infections was 12.9%, compared with 2.3% for those who did not acquire infections (Philadelphia Inquirer, 11/15).

Comments
Marc Volavka, executive director of PHC4, said, "This first hospital-specific report demonstrates Pennsylvania's robust commitment to reducing these serious, costly and largely preventable infections" (Pittsburgh Post-Gazette, 11/15). He said that such infections result from "flawed processes" of care and hygiene, not from the treatment of sicker patients (Philadelphia Inquirer, 11/15). Roger Mecum, executive vice president of the Pennsylvania Medical Society, said, "There are too many infections, which are increasing mortality and hospital lengths of stay while adding billions of dollars in hospital charges." Lisa McGiffert, director of the "Stop Hospital Infections" campaign at Consumers Union, said, "This is really the first report of its kind in the U.S., where hospitals have actually identified infections and reported them to a state agency" (Pittsburgh Post-Gazette, 11/15). Health care quality experts said that the report might prompt additional efforts by hospitals to prevent infections. However, "controversy dogs efforts to report infection rates on a national level, with debate about what should be reported and how" and whether reports "should ... be hospitalwide or just in selected areas," among other issues, according to USA Today (USA Today, 11/15).

Broadcast Coverage

ABCNews' "World News" on Tuesday reported on the study. The segment includes comments from McGiffert; Volavka; Charles Wagner, chief medical officer and senior vice president of Holy Redeemer Hospital and Medical Center; and the families of patients who acquired infections in hospitals (Stark, "World News," ABCNews, 11/14). A related ABCNews story and expanded ABCNews coverage are available online.

PND News Briefs - Central & Northeastern PA Edition
November 20, 2006
Jersey Shore Hospital received a $1 million state grant for its expansion project.

The grant is part of the Redevelopment Assistance Capital Program, which provides funding for the acquisition and construction of regional economic, cultural, civic and historical improvement projects, reported the Williamsport Sun-Gazette. The hospital’s $18 million project is divided into two phases: construction of a 45,000-square-foot addition, which will take about 15 months, and renovation of the existing facility, which is expected to take six to eight months, the Sun-Gazette added. Williamsport Sun-Gazette, November 13, 2006
Read on...

The Bush administration said that it would strenuously oppose one of the Democrats’ top priorities for the new Congress: legislation authorizing the government to negotiate with drug companies to secure lower drug prices for Medicare beneficiaries.

Michael O. Leavitt, the secretary of health and human services, said that federal price negotiations would unravel the whole structure of the Medicare drug benefit, which relies on competing private plans, and that government could not do a better job than an efficient market, reported the New York Times. The 2003 Medicare law explicitly prohibits the federal government from negotiating drug prices or establishing a list of preferred drugs, while Rep. Nancy Pelosi, the California Democrat who is in line to become the House speaker, has said the House will take up legislation to repeal that ban in its first 100 hours under Democratic control, and Senate Democrats have expressed a similar desire, the Times added. New York Times, November 13, 2006
Read on...

Hundreds of hospitals around the country are joining a project to give faster emergency room care to people having major heart attacks.

Fewer than one-third of such patients now get their blocked arteries reopened within 90 minutes of arrival, as guidelines recommend, while hospitals participating in a new project designed by the American College of Cardiology pledge a "door-to-balloon" time of 90 minutes for angioplasty, reported the Associated Press. The campaign involves making internal procedural changes such as prompting early action to call in staff and activate the cath lab, and having hospitals act on paramedics’ pre-hospital electrocardiograms, the Associated Press added. Associated Press, November 13, 2006
Read on...

Common Threads from the RTC: Rural
November 20, 2006
Rural Independent Living and Physical Therapy: Exploring Collaborations

Centers for Independent Living provide skills training to individuals with disabilities that helps them to increase their community participation. However, most centers do not have the staff or facilities to help individuals increase their physical capacity. In rural areas, collaboration between physical therapists and Centers for Independent Living promises to increase the availability of physical activity for people with disabilities.

To explore that possible solution, RTC: Rural researchers interviewed rural physical therapists about their knowledge and beliefs regarding service delivery. We then examined their responses for compatibility with independent living philosophy. To learn more about our findings, please visit Rural Disability and Rehabilitation Research Progress Report #33: Rural Independent Living and Physical Therapy: Exploring Collaborations at http://rtc.ruralinstitute.umt.edu/health/PT.htm (Please note: some e-mail programs will not allow links to open from messages - if you experience this, please copy the URL and paste it into the address window of your web browser) Message distributed to Area Health Education Centers, Association of Programs for Rural Independent Living members, and Health Interest Group, by:

Diana Spas, Information Coordinator
Research and Training Center on Disability in Rural Communities
The University of Montana Rural Institute
52 Corbin Hall, Missoula, MT 59812-7056
(888) 268-2743 (RTC office)
(406) 243-5760 (my office) (406) 243-2349 fax
dspas@ruralinstitute.umt.edu
http://rtc.ruralinstitute.umt.edu
http://mtdh.ruralinstitute.umt.edu

Update from the New York Center for Health Workforce Studies
November 20, 2006
Five Articles on the Health Workforce in the United States
The World Health Report of 2006 provided an expert assessment of the current crises in the global health workforce, with attention to the impacts of health worker migration on the health status of poor countries. The World Health Assembly requested that "Human Resources for Health" become a priority program area for the World Health Organization in the next decade. In recognition of growing international interest in the health workforce, The Centre de Sociologie et de Demographie Medicales (CDSM), a workforce research center in Paris, France, focused its quarterly journal to spotlight health workforce research around the world. The Center for Health Workforce Studies was invited to represent the U.S. and publish its work in the bilingual CDSM journal that was released in June 2006. The five papers prepared by the Center that appeared in the journal are:

• U.S. Physician Workforce Forecasting: A Tale of Two States
• Trends in Foreign-Trained Registered Nurses in the United States
• Characteristics and Employment Patterns of Licensed Social Workers in the United States
• The Impact of the Aging Population on the Health Workforce in the United States
• Excerpts from the United States Health Workforce Profile.

The NIH LRP Deadline is approaching!
November 20, 2006
The National Institutes of Health (NIH) is now accepting applications for its five Loan Repayment Programs (LRPs) for Fiscal Year 2007, but only until December 1, 2006.

Did you know that the success rate for new applicants was 40% last year and may be even better this year?

The five LRPs offered by the NIH include the Clinical Research LRP, Clinical Research LRP for Individuals from Disadvantaged Backgrounds, Contraception and Infertility Research LRP, Health Disparities Research LRP, and Pediatric Research LRP. Through these programs, the NIH offers to repay up to $35,000 annually of the qualified educational debt of health professionals pursuing careers in biomedical and behavioral research. The programs also provide payment for Federal and tax liabilities.

To qualify, applicants must possess a doctoral-level degree, devote 50% or more of their time (for an average of 20 hours per week during each contract quarter) to research funded by a domestic non-profit organization or government entity (Federal, state, or local), and have educational loan debt equal to or exceeding 20% of their institutional base salary. Applicants must also be U.S. citizens, permanent residents, or U.S. nationals to be eligible.

Please share this e-mail with the researchers and other individuals in your organization who may benefit from LRP participation. All applications for 2007 awards must be submitted online by 8:00 p.m. EST, December 1, 2006.

For an online application, program information, or other assistance, visit the LRP Web site at www.lrp.nih.gov, telephone the Help desk at 866-849-4047, or send email inquiries to lrp@nih.gov.

Best regards,

NIH Division of Loan Repayment
www.LRP.nih.gov

Dr. Susan Mowatt Returns Home To Practice
November 5, 2006
(Honesdale, October 18, 2006)…Born at Wayne Memorial Hospital, raised in Hawley, Susan Simpson Mowatt, MD, is back home and excited about opening her Family Medicine practice in her hometown.

“Both my husband and I are from this area and our children’s grandparents—both sides—are here,” said Dr. Mowatt, “and I’m just thrilled to be back. I can’t wait to get to work!”

And working now she is—officially. Dr. Mowatt opened “Keystone Family Practice” and began seeing patients this week out of her new office on Main Avenue in Hawley (formerly occupied by Dr. Marilyn Pardine).

Dr. Mowatt received a Bachelor of Science degree from Georgetown University in Washington, DC, and later earned her Doctor of Medicine (MD) degree from Penn State College of Medicine in Hershey. She began her professional career in Williamsport, finishing up a Family Practice residency program and then joining a private practice affiliated with Susquehanna Health System. Dr. Mowatt was Medical Director of Loyalsock Family Practice before she decided to return home to Hawley.

A recipient of many honors and awards, Dr. Mowatt received her board certification in Family Practice in 2001. She joined the staff of Wayne Memorial Hospital this month.

“We welcome Dr. Mowatt to Wayne Memorial and the community,” said David Hoff, Chief Executive Officer of Wayne Memorial Health System. “It is especially gratifying to see a local resident come back to share her knowledge and skill with her hometown community. It is a reflection of respect on both sides, and we at Wayne Memorial are very pleased to benefit.”

Dr. Mowatt will have office hours from 9am – 6pm Monday through Friday, with some evening hours yet to be decided. Her address is 227 Main Avenue, Hawley and her phone number is (570) 226-6077.

Viral Hepatitus Conference
November 5, 2006
It's my pleasure to share this invitation to our First Ever Hepatitis (HIV/Substance abuse) annual Conference in Pennsylvania. The conference is packed with interesting topics/speakers, has sessions for dialogue about 'what works and how', and opportunities for peer/program exchange. This is the only statewide opportunity in Pennsylvania, apart from the AASLD 2006 Liver meeting, for program managers, clinicians, policy makers, legal entities, human services workers, public health workers, funding agencies, drug manufacturers and the general public to share concerns and resources about increasing access to testing, treatment and prevention of viral hepatitis with its co occurring conditions such as substance abuse and HIV. This conference should allow us to translate emerging scientific findings and policy advances into action. Learn about model programs and funding resources from national experts.

A State-by-State Approach to High Performance
October 17, 2006
Anyone who has traveled around the United States is keenly aware that regional differences, from cooking to music, still exist. While some of these differences should be preserved, other variations, such as those affecting the quality of people's health care, must be eliminated. In a new column, titled The Role of States in Achieving a High Performance Health System, Commonwealth Fund president Karen Davis maintains that no matter which state they call home, all Americans deserve high-quality and efficient care.

While every state has room to improve its health care system, it is especially critical that low-performing states learn from the innovative strategies being tested in higher performing states. States can look to Rhode Island, for example, where the Office of the Health Insurance Commissioner is implementing a plan to promote affordable coverage, and where the Department of Health and the Rhode Island Quality Institute are collaborating on an initiative to promote access to electronic health information data across the state.

"By observing these states' creative strategies in action," Davis says, "every state can develop initiatives tailored to its health care needs and unique circumstances."

Visit Chart Cart to review selected slides from Karen Davis's Oct. 16 keynote presentation, on the role of states in a high performance health system, at the National Academy for State Health Policy annual conference.

WMH Receives USDA Grant
October 17, 2006
Honesdale, October 16, 2006)…Congressman Don Sherwood (R) and officials from the Rural Development Office of the U.S. Department of Agriculture (USDA) presented Wayne Memorial Hospital with a ceremonial check today for $155,213. The monies, under the Distance Learning and Telemedicine Grant Program, will be used to help Home Health patients, Maternity patients and physicians, and patients who visit the new Waymart Medical Center due to open in early 2007.

“We are extremely grateful to receive this money,” said Virginia Fries, RN, Director of Patient Care Services. “Because of this funding, we will be able to help many chronically ill patients, who often require a lot of intervention, as well as mothers and fetuses experiencing difficulties as birth approaches.”

“This is exciting,” added WMH Home Health Manager Mary Lou Hoffner, RN. She explained how her department will use the grant money to buy tele-monitors for 40 patients. “These monitors will help keep conditions more stable for our patients and help avoid repeat hospitalizations and complications.”

Patients who use the monitors will have a cuff to take their blood pressures, a scale to take their weights and a pulse oximeter for oxygen readings. Once the measurements are taken, the patients press a button and the information is tele-transmitted to WMH Home Health.

The grant will also fund expansion of the Perinatal Monitoring program in New Beginnings to monitor laboring mothers and fetuses in the hospital. This program helps nurses in New Beginnings attend directly to patients and provides real-time telemetry to obstetrician/gynecological healthcare providers at their offices in the community.

Congressman Sherwood praised Wayne Memorial for “embracing the new technology and stepping up to today’s healthcare challenges.

“Change is tough, and access to healthcare in a rural area can also be tough,” Sherwood said, “A Home Health nurse might have to visit a patient in Masthope (Pike County) and then turn around to attend to a patient in Starrucca (in northern Wayne County). Tele-medicine technology makes it easier to deal with situations in rural areas.”

“We are very appreciative of this aid from the U-S-D-A,” said David Hoff, Chief Executive Officer of Wayne Memorial Health System. “Wayne Memorial is committed to growing with the community and the federal government’s help is affirmation of this commitment.”

Gary Groves, Pa State Director of the USDA’s Rural Development program, noted that only 100 grants of this kind were distributed nationwide at this time and “Pennsylvania received six of them, including this one at Wayne Memorial.”

Curtis Anderson, Deputy Administrator of Utilities for the USDA, said the Bush Administration is committed to “hooking up rural America” by making loans and grants available to provide broadband facilities to rural schools, hospitals and medical clinics. He also applauded Congressman Sherwood, who is on the House Appropriations Committee for helping to provide the funding.

Other Significant Grants Announced:

Wayne Memorial Hospital qualified for a $44,499.05 grant from the Hospital Quality Care Investment Grant Program/Department of Public Welfare out of Harrisburg. The funds are linked to the Hospital’s Medication and Patient Safety Initiative. They are to be used for Medical Assistance programs and must be used within 12 months.

The Blue Ribbon Foundation of Blue Cross of Northeastern Pennsylvania also recently awarded $20,000 to Wayne Memorial Health System for its Waymart Medical Center project. This is a new primary-care center being built in Waymart, adjacent to Wayne Woodlands Manor, Wayne Memorial Long Term Care’s skilled nursing facility on South Street. The building will also house an office of Pediatric Practices, as well as WMHS x-ray and lab services.

In just over a year, Wayne Memorial has received more than $1 million in public and private grants. Grants and Development Manager Jack Dennis said the aid is “essential for the future of healthcare access for the community and access to the latest technologies for the hospital and providers in an area of high growth such as ours.”

AgrAbility Press Release
October 17, 2006
Attached and below, please find a press release from AgrAbility for Pennsylvanians. Today we are announcing speaking engagements for a riveting and resourceful producer who has survived paralyzation by bullet and a house fire to become a successful farmer, disability advocate, and entrepreneur. Please share this story with your readers. As always, we are grateful for your help in telling the public about the resources of AgrAbility for Pennsylvanians.

click to open press release here

Application Materials for Barbara Jordan Health Policy Scholars Program Now Available
October 17, 2006
Applications will be accepted Oct. 15, 2006 through Dec. 15, 2006 for the summer 2007 session

Washington, D.C. - The Henry J. Kaiser Family Foundation has begun accepting applications for participation in the 2007 Barbara Jordan Health Policy Scholars Program. Operated in partnership with Howard University, the Scholars Program brings talented African American, Latino, American Indian/Alaska Native, and Asian/Pacific Islander college seniors and recent graduates to Washington, D.C., for placement in congressional offices to learn about health policy.

The application deadline for the Barbara Jordan Health Policy Scholars Program is 5:00pm ET on December 15, 2006.

Through the nine-week program (May 21- August 3, 2007), Scholars gain knowledge about federal legislative procedure and health policy issues, while further developing their critical thinking and leadership skills. In addition to gaining experience in a congressional office, Scholars participate in seminars and site visits to augment their knowledge of health care issues, and write and present a health policy research paper.

The Henry J. Kaiser Family Foundation established the Barbara Jordan Health Policy Scholars Program at Howard University to honor the legacy of former Foundation Trustee and Congresswoman Barbara Jordan and to expand the pool of students of color interested in the field of health policy. As a member of the United States Congress and the Texas State Legislature, Barbara Jordan's distinguished career was exemplified by her tireless advocacy on behalf of vulnerable populations. She brought this passion to her work, inspiring others to become involved in addressing challenging health policy issues.

"The Barbara Jordan Health Policy Scholars Program is an exceptional opportunity for these talented students to gain firsthand experience on Capitol Hill, learn about critical policy issues and undertake in-depth policy analysis projects," Foundation President and CEO Drew E. Altman said. "I encourage all qualified students to apply to be a part of this exceptional congresswoman's legacy as they prepare to take on leadership roles in the health policy arena."

Eligible candidates must be U.S. citizens who will be seniors or recent graduates of an accredited U.S. college or university in the fall of 2007. Currently enrolled law, medical, and graduate students are not eligible for participation in the program. Candidates are selected based on academic performance, demonstrated leadership potential, and interest in health policy. Scholars receive approximately $7,500 in support, which includes a stipend, a daily expense allowance, airfare, and lodging during their time in Washington.

Application materials are available online at: www.bjscholars.org . If you have questions about the application process, please contact the Barbara Jordan Health Policy Scholars Program Manager, Jomo Kassaye at (202) 238-2385 or jzkassaye@howard.edu . If you need more information about the administration of the program or have other questions that are not directly related to the completion of application materials, please contact the Program Director, Cara V. James, Ph.D., at (202) 347-5270 or cjames@kff.org.

The Henry J. Kaiser Family Foundation is an independent, national health philanthropy dedicated to providing information and analysis on health issues to policymakers, the media and the general public.The Foundation is not associated with Kaiser Permanente or Kaiser Industries.

New PHC4 Hospital Performance Report; Hospital Mortality Rates Decline at PA Hospitals; Readmission Rates Rise
October 17, 2006
The Pennsylvania Health Care Cost Containment Council (PHC4) is pleased to announce the release of its latest Hospital Performance Report.

The PHC4 Hospital Performance Report includes risk-adjusted mortality rates, lengths of hospitalization (stay) and hospital charges for patients admitted to 178 Pennsylvania hospitals from October 1, 2004 through September 30, 2005. The new report evaluates hospital performance across 49 common medical procedures and treatments.

To view and/or download the report, visit us on the web by clicking the following link: Hospital Performance Report 2005

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

New PBS Series: Remaking American Medicine
October 17, 2006
http://www.remakingamericanmedicine.org/airdates.html

REMAKING AMERICAN MEDICINE is a four-part television series for PBS that follows pioneering individuals struggling to fix our broken health care system.

PROGRAM 1 - SILENT KILLER profiles individuals who are committed to fixing a health care system that is estimated to kill up to 98,000 people a year.

PROGRAM 2 - FIRST DO NO HARM focuses on efforts to eliminate hospital-acquired infections and medication errors.

PROGRAM 3 - THE STEALTH EPIDEMIC looks at groundbreaking efforts to create effective chronic disease management programs.

PROGRAM 4 - HAND IN HAND shows how a unique partnership between patients, families and providers is transforming a teaching hospital.

New from the RUPRI Center: "Medicare Physician Payment: Impacts of Changes on Rural Physicians"
October 17, 2006
A new policy brief is available from the RUPRI Center:

Medicare Physician Payment: Impacts of Changes on Rural Physicians In this policy brief, we present the effects of the MMA on physician payment rates in rural areas. Specifically, we examine the impact of creating a floor of 1.00 in the geographic practice cost index for work expense. We also show the effects of the Medicare incentive payment for providing services in shortage areas and of the bonus for practicing in a physician scarcity area.

Please click on the following link to download this brief:
http://www.rupri.org/healthpolicy/Pubs/pb2006-2.pdf

This policy brief completes a series of RUPRI Center analyses of the rural issues embedded in physician payment policy. To download the other briefs in the series, please click on the links below:

Medicare Physician Payment
http://www.rupri.org/healthpolicy/Pubs/PB2003-2.pdf

Medicare Physician Payment: Practice Expense
http://www.rupri.org/healthpolicy/Pubs/PB2003-9.pdf

The Pennsylvania Commission for WomenTurns State Fountains Pink to Kick-Off Breast Cancer Awareness Month
October 2, 2006
Monday, October 2, 2006 Noon
State Capitol Fountain, Harrisburg

Please Join:
Leslie Stiles, Executive Director,
PA Commission for Women

and

Lieutenant Governor Catherine Baker Knoll
Secretary James Creedon, Department of General Services
Pat Halpin Murphy, President and Founder,
PA Breast Cancer Coalition

Tuesday, October 3, 2006 9 AM
Point State Park Fountain, Pittsburgh

Please Join
Leslie Stiles, Executive Director,
PA Commission for Women

and

Mary Robb Jackson, Reporter, KDKA-

Elsie Hillman

Holly L. Lorenz, RN, MSN,
COO and Vice President of Clinical Services,
UPMC Cancer Centers

Lou Ann Weil, Director,
Statewide Cancer Programs, Adagio Health

Jo Ann Meier, Executive Director,
Pittsburgh Komen Affiliate

Penn State Extension Proram Honored by National 4-H
October 2, 2006
UNIVERSITY PARK, Pa. -- A multi-level alcohol and drug-prevention program that brings together representatives from Penn State Cooperative Extension, local school districts and community service agencies with parents, youth and other community members has been cited as a Program of Distinction by the National 4-H Headquarters.

The PROSPER (Promoting School-Community-University Partnerships to Enhance Resilience) program, a collaborative, community-based initiative, has been inducted into the National 4-H Programs of Distinction database (http://www.national4-hheadquarters.gov/about/pod.htm), a searchable Web-based resource containing descriptions of high-quality youth development programs in communities across the United States.

"We're happy that National 4-H has added PROSPER to its national database," says Claudia Mincemoyer, associate professor in Penn State's agricultural and extension education department and co-investigator on the PROSPER research team. "This added exposure will help communities and their families become aware of this quality youth prevention program.

"The PROSPER project underscores the potential of the community-university partnership model," says Daniel Perkins, Penn State professor of agricultural and extension education and PROSPER co-investigator, who says PROSPER's status as a Program of Distinction also demonstrates the value of the work of Pennsylvania program teams.

The program uses the partnership model to reduce rates of youth substance use and other problem behaviors, as well as to foster positive youth development, according to Perkins. These goals are accomplished through teaching skills that foster improved family life and parent-child communication, along with providing students with skills for planning, problem-solving and peer resistance against problem behaviors.

Statewide, PROSPER reaches about 6,000 youths in seven school districts: Bradford, West Perry, Littlestown, Carbondale, Jim Thorpe, Salisbury and Wyoming Valley West. In each location, a local community team led by an extension educator oversees project activities to assure that programs are well-received within schools and communities and implemented with the highest quality to assure maximum positive impact.

Studies show PROSPER participants are less prone than their peers to youthful experimenting with drugs, tobacco or alcohol and less likely to have used marijuana or inhalants in the last year compared to nonparticipants. Recent economic studies also show that this type prevention program is cost-effective to communities.

"Because there is less need for the use of the court system and drug and alcohol rehabilitation services, PROSPER communities are saving money," says Mark Greenberg, distinguished professor and prevention scientist at Penn State and co-principal investigator for the project. "For every dollar the community spends on prevention programming, they are potentially saving $9.60 in related services." He estimates that the partnership prevents between five and six future cases of alcohol abuse for every 100 participating students.

"Schools do not have to deal with these issues alone; evidence-based programming and technical support come from the local PROSPER team," says Greenberg, who notes that PROSPER is reaching its goal of reducing rates of youth substance use and problem behavior, fostering positive youth development and improving family communication.

Early results from the PROSPER study indicate that youth who participated in the programs report their parents are using improved child management techniques (e.g., effective discipline), as compared to youth not in the program. In addition, youth reported stronger skills, such as refusing to use substances, greater intention to avoid substance use and improved problem solving.

PROSPER is funded by the National Institute on Drug Abuse and the National Institutes of Health and is being conducted in collaboration with Iowa State University. For more information, visit the PROSPER project Web site (http://www.prosper.ppsi.iastate.edu) or contact Perkins at (814) 865-6988 or Mincemoyer at (814) 863-7851.

NIH Loan Repayment Online Applications Available Today
September 25, 2006
The National Institutes of Health (NIH) is now accepting online applications for its five Loan Repayment Programs (LRPs).

The five LRPs offered by the NIH include the Clinical Research LRP, Clinical Research LRP for Individuals from Disadvantaged Backgrounds, Contraception and Infertility Research LRP, Health Disparities LRP, and Pediatric Research LRP.

Through these programs, the NIH offers to repay up to $35,000 annually of the qualified educational debt of health professionals pursuing careers in biomedical and behavioral research. The programs also provide coverage for Federal and state tax liabilities.

To qualify, applicants must possess a doctoral-level degree, devote 50% or more of their time (20 hours per week based on a 40-hour work week) to research funded by a domestic non-profit organization or government entity (Federal, state, or local), and have educational loan debt equal to or exceeding 20% of their institutional base salary. Applicants must also be U.S. citizens, permanent residents, or U.S. nationals to be eligible.

Please share this e-mail with the researchers and other individuals in your organization who may benefit from LRP participation.

All applications for 2007 awards must be submitted online by 8:00 p.m. EST, December 1, 2006.

For an online application, program information, or other assistance, visit the LRP Web site at www.lrp.nih.gov, telephone the Help desk at 866-849-4047, or send email inquiries to lrp@nih.gov.

Health Care Access and Rural Equity Act of 2006 Unveiled
September 25, 2006
(Washington, D.C.) Today, the National Rural Health Association (NRHA) joined the Honorable Greg Walden (R-OR) and the Honorable Earl Pomeroy (D-ND), and many of their colleagues from the House Rural Health Coalition, to unveil a new rural health care bill designed to increase equity and improve access to high quality care in rural America.

The Health Care Access and Rural Equity Act of 2006 (H-CARE) contains many important rural health provisions, including fair rural representation on the Medicare Payment Advisory Commission (MedPAC). Despite an existing requirement for balance between rural and urban representation, MedPAC currently has only one rural health commissioner, out of the 17 appointed, to represent the nearly 27 percent of Medicare beneficiaries that live in rural America. H-Care would ensure proportional representation of rural health interests on MedPAC.

The bill also furthers the Institute of Medicine's (IOM) recommendation to implement demonstration projects in rural communities that test innovative ways to improve health care quality. "We know from experience that collaboration within and among communities is key to high quality care, and that change in small communities and organizations can often be more readily accomplished than at larger facilities," said Hilda R. Heady. Heady spoke on behalf of the NRHA and is the immediate past president of the National Rural Health Association, and associate vice president for rural health at West Virginia University. She continued, "We strongly believe that rural health care providers can not only achieve high performance standards, but can be leaders in the national quality movement. H-CARE gives us the resources to continue these efforts, and to pave the way to higher quality care in rural America and across our land."

The new H-CARE bill incorporates all of the provisions of the The Rural Hospital and Provide Equity Act (S. 3500, HoPE Act) and contains many important rural health provisions including:

The creation of a Rural Community Hospital (RCH) program, providing the option of Medicare cost-based reimbursement for inpatient and outpatient services for hospitals with 50 or fewer beds. The requirement that Medicare Advantage plans pay Critical Access Hospitals at least as much as they would receive under the traditional Medicare program. The authorization of $140 million over five years for grants to rural providers to help with the cost of implementing health information technology. The mandate of prompt payment to rural pharmacies by Medicare prescription drug plans. The re-authorization of Rural Outreach and Network grants. These important programs provide capital investments so that rural communities can plan and launch innovative projects that build networks across providers, increase access to care, and are specifically designed to become self-sufficient.

WMH Press Release - Foundation Welcomes New Members
September 25, 2006
(Honesdale, PA, September 7, 2006)— Margaretta Niles (Maggie), Joseph Harcum and Kate Carmody are the newest members of the Wayne Memorial Health Foundation Board. All three bring experience, dedication to service and a sense of community to their work on the Board.

Maggie Niles, who resides in Pike County with her husband Nick, is a member of the Vestry of Grace Episcopal Church in Honesdale and Secretary of the Peters Valley Craft Center Board. Niles was born in Carbondale, but grew up in Virginia and spent most of her married life in Darien, Connecticut, where she worked with several human service organizations such as the area’s Children and Services Board and the Southwestern Connecticut Regional Health Board. A graduate of Smith College and Columbia University, Maggie has a degree in English Literature. She and Nick have two grown children, Jennifer and David. Joseph Harcum is not a native, but there is no doubt he loves northeastern Pennsylvania. Born in Virginia, he and his wife Nancy discovered Wayne County in 1985 when they bought 230 acres at Duck Harbor Pond. More land purchases followed and today, Harcum is the President and Chief Executive Officer of the Duck Harbor Company, a major real estate developer in the Upper Dealaware region. Harcum’s “former” life included stints with Lehman Brothers, Donaldson, Lufkin and Jenrette and the top post—CEO—at Fleet Securities.

“I joined the Wayne Memorial Health Foundation Board because I believe it’s important to have a good healthcare system in this area. Because I want a good hospital to be there for me and my family,” Harcum says. “I guess you could say I joined because I’m selfish, really.” He smiles. “I want the best for myself and my family.”

The Harcums have four children. The oldest son, Jay, is involved with his dad in the family business.

Many area residents know Kate Frisch Carmody by name—she’s a Honesdale native—and by face! Kate graciously agreed to be on a billboard for Wayne Memorial’s Operation Vital Signs campaign after successfully battling breast cancer, with the help of several WMH physicians, including Dr. George Tietjen and Dr. Paula Bennett.

Kate, one of five children, currently owns her own hair salon, Kate’s Creative Hair Design, and has one school-age daughter.

“On the billboard, I’m quoted as saying ‘Wayne Memorial doctors saved my life,’” says Kate, “and it’s true. That’s how I feel. I hope my work on the Foundation Board will help save other lives, too—even if it’s only one person that I can help, that’s good enough.”

The Foundation Board, chaired by Henry Skier, is composed totally of volunteers. It now has 18 members.

Medicaid Too Important to Fail
September 25, 2006
(Washington, D.C.) "Medicaid is an essential lifeline for the most vulnerable Americans in rural communities and too important to fail," said Alan Morgan, CEO of the National Rural Health Association (NRHA). Morgan provided comments to the Medicaid Commission today on the important role that Medicaid plays as a safety net for millions of low-income working families, disabled and elderly, - particularly those residing in rural areas. The NRHA is a member of the Partnership for Medicaid, a non-partisan, nationwide effort led by safety net providers and other key organizations to preserve and improve the Medicaid program, the largest single source of funding for long-term care in the United States.

Morgan's comments to the Medicaid Commission focused on the long-term care needs of rural elderly. He expressed strong support for the PACE program (Programs of All-inclusive Care for the Elderly). PACE is centered around the belief that it is better for the well-being of seniors with chronic care needs and their families to be served in the community whenever possible. The Deficit Reduction Act authorized a rural PACE pilot project to adapt PACE so that it can be successfully implemented in rural areas, and the NRHA strongly supports its continued expansion.

While PACE provides an opportunity for the frail elderly to stay at home, Morgan pointed out that nursing homes will continue to play a critical role in the continuum of long-term care, in particular, for rural elderly and the very old (over age 85). The higher rate of nursing home beds per capita, narrower range of available home and community based services and geographical barriers to accessing care make nursing homes a necessary alternative for many individuals in rural communities.

Other members of the Partnership for Medicaid joined Morgan to present the Partnership's recommendations, including representatives from the National Association of Community Health Centers, National Association of Children's Hospitals, American Academy of Pediatrics, American Academy of Family Physicians, and the Association for Community Affiliated Health Plans. They recommended steps to improve health care quality, enhance prevention efforts, encourage disease management, and control pharmaceutical costs. Specific recommendations mentioned were extension of the 340B drug discount to Critical Access Hospitals and assistance with health information technology costs for safety net providers.

The Partnership for Medicaid recognizes the following core principles that should be used when analyzing Medicaid policy initiatives:

• Reform efforts should preserve federal coverage guarantees.
• Policymakers should reject proposals to replace the current financing of Medicaid with an upper limit or cap on federal spending for Medicaid.
• Medicaid should provide fair and adequate compensation to providers.
• Policies should be developed that recognize the linkages between primary, acute and long-term care services.
• Medicaid must continue to play a critical role in supporting vital public health services.

The full report from the Medicaid Partnership as well as comments from the National Rural Health Association can be viewed at www.NRHArural.org and following the link in the green "hot items" box.

Study Examines Differences in Care for Medicaid Beneficiaries in Rural, Urban Areas
September 25, 2006
"The Health Care Experiences of Rural Medicaid Beneficiaries," Journal of Health Care for the Poor and Underserved: For the study, Sharon Long, principal research associate at the Urban Institute; Teresa Coughlin, also a principal research associate at the institute; and Jennifer King, research associate at the institute, examine the differences in access to care and use of health services between Medicaid beneficiaries in rural and urban areas, as well as differences between those enrolled in Medicaid and low-income adults who are members of a private health plan. According to the study, those with Medicaid coverage in both rural and urban areas have worse access to care than those with private insurance. However, Medicaid beneficiaries have more consistent access to care than low-income individuals with private insurance (Long et al., Journal of Health Care for the Poor and Underserved, August 2006).

Elizondo Named as NRHA Vice President of Program Services
September 25, 2006
(Alexandria, VA) - Today, the National Rural Health Association (NRHA) announced that Amy Elizondo has joined the Association staff as Vice President of Program Services.

"NRHA is thrilled that Ms. Elizondo has joined our team," said Alan Morgan, NRHA CEO. "With Ms. Elizondo's strong foundation in rural health care, we believe her expertise puts our rural programs in extremely good hands. She will be instrumental in leading the way for the continued growth of our State Associations as well as overseeing the important grant programs currently in place."

Ms. Elizondo comes to the NRHA after having served as the primary analyst for rural health care and post-acute care issues for the Centers for Medicare & Medicaid Services' (CMS) Office of Legislation in Washington, DC. She previously worked as a special assistant to the Director of the Medicare Outreach Office at the CMS. In this capacity, she worked with stakeholder groups on various outreach activities to promote current initiatives within the Agency, in particular, the Medicare Prescription Drug Benefit. Rural health care has always been a special interest of Ms. Elizondo's as she also worked at the Health Resources & Services Administration's Office of Rural Health Policy and Project HOPE's Walsh Center for Rural Health Analysis. A native of South Texas, Ms. Elizondo holds a Master of Public Health from the Texas A&M Health Science Center, School of Rural Public Health.

"I am very excited to be joining the NRHA team in this new role," said Ms. Elizondo. "It is my intent to build on the NRHA tradition of working to improve the health care of rural Americans and I plan to do this by making sure the programs we have matter."

PENN STATE EXTENSION PROGRAM HONORED BY NATIONAL 4-H
September 25, 2006

UNIVERSITY PARK, Pa. -- A multi-level alcohol and drug-prevention program that brings together representatives from Penn State Cooperative Extension, local school districts and community service agencies with parents, youth and other community members has been cited as a Program of Distinction by the National 4-H Headquarters.

The PROSPER (Promoting School-Community-University Partnerships to Enhance Resilience) program, a collaborative, community-based initiative, has been inducted into the National 4-H Programs of Distinction database (http://www.national4-hheadquarters.gov/about/pod.htm), a searchable Web-based resource containing descriptions of high-quality youth development programs in communities across the United States.

"We're happy that National 4-H has added PROSPER to its national database," says Claudia Mincemoyer, associate professor in Penn State's agricultural and extension education department and co-investigator on the PROSPER research team. "This added exposure will help communities and their families become aware of this quality youth prevention program.

"The PROSPER project underscores the potential of the community-university partnership model," says Daniel Perkins, Penn State professor of agricultural and extension education and PROSPER co-investigator, who says PROSPER's status as a Program of Distinction also demonstrates the value of the work of Pennsylvania program teams.

The program uses the partnership model to reduce rates of youth substance use and other problem behaviors, as well as to foster positive youth development, according to Perkins. These goals are accomplished through teaching skills that foster improved family life and parent-child communication, along with providing students with skills for planning, problem-solving and peer resistance against problem behaviors.

Statewide, PROSPER reaches about 6,000 youths in seven school districts: Bradford, West Perry, Littlestown, Carbondale, Jim Thorpe, Salisbury and Wyoming Valley West. In each location, a local community team led by an extension educator oversees project activities to assure that programs are well-received within schools and communities and implemented with the highest quality to assure maximum positive impact.

Studies show PROSPER participants are less prone than their peers o youthful experimenting with drugs, tobacco or alcohol and less likely to have used marijuana or inhalants in the last year compared to >nonparticipants. Recent economic studies also show that this type revention program is cost-effective to communities.

"Because there is less need for the use of the court system and drug and alcohol rehabilitation services, PROSPER communities are saving money," says Mark Greenberg, distinguished professor and prevention scientist at Penn State and co-principal investigator for the project. "For every dollar the community spends on prevention programming, they are potentially saving $9.60 in related services." He estimates that the partnership prevents between five and six future cases of alcohol abuse for every 100 participating students.

"Schools do not have to deal with these issues alone; evidence-based programming and technical support come from the local PROSPER team," says Greenberg, who notes that PROSPER is reaching its goal of reducing rates of youth substance use and problem behavior, fostering positive youth development and improving family communication.

Early results from the PROSPER study indicate that youth who participated in the programs report their parents are using improved child management techniques (e.g., effective discipline), as compared to youth not in the program. In addition, youth reported stronger skills, such as refusing to use substances, greater intention to avoid substance use and improved problem solving.

PROSPER is funded by the National Institute on Drug Abuse and the National Institutes of Health and is being conducted in collaboration with Iowa State University. For more information, visit the PROSPER project Web site (http://www.prosper.ppsi.iastate.edu) or contact Perkins at (814) 865-6988 or Mincemoyer at (814) 863-7851.

Rural Information Technology: Information Technology Challenges in the Heartland
September 5, 2006
Hospital and Health Networks, sponsored by the American Hospital Association, just released an article on rural Health Information Technology (HIT) that includes segments on unique challenges, rural connectivity, and funding/capital. The piece can be found at:

http://www.hhnmag.com/hhnmag/jsp/articledisplay.jsp?dcrpath=HHNMAG/PubsNewsArticle/data/2006August/0608HHN_FEA_RuralIT&domain=HHNMAG

Coverage & Access | Record 46.6M U.S. Residents Lack Health Insurance in 2005, Fewer Receive Coverage Through Employers, Census Figures Show
September 5, 2006
The number of U.S. residents without health insurance increased by 1.3 million in 2005 to a record 46.6 million individuals, or 15.9% of the U.S. population, compared with 45.3 million individuals, or 15.6% of the population, in 2004, according to figures from the U.S. Census Current Population Survey released on Tuesday, the San Francisco Chronicle reports. The data show that almost one in six U.S. residents was uninsured in 2005 (Colliver, San Francisco Chronicle, 8/30). The number of U.S. residents with health insurance increased by 1.4 million to 247.3 million in 2005, according to the report (Benjamin/Young, Bloomberg/Philadelphia Inquirer, 8/30). In addition, the report finds that the percentage of U.S. residents with employer-sponsored health coverage decreased from 59.8% in 2004 to 59.5% in 2005, the lowest percentage since 1993 (Appleby, USA Today, 8/30). By comparison, in 2001, 14.6% of U.S. residents were uninsured, and 62.6% had employer-sponsored coverage (San Francisco Chronicle, 8/30).

To view what else the report found visit this website http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=39531

Child Poverty in Rural America
September 5, 2006
Rural children continue to live in poverty Carsey Institute (Durham, NH), Aug. 30, 2006 Rural children continue to live in poverty

A new study by the University of New Hampshire's Carsey Institute has found that a higher percentage of rural children in forty-one states live in poverty today than they did five years ago. "Many of the headlines are saying that poverty levels have not increased, but unfortunately trends are worse for rural children," Cynthia M. Duncan, Director of the Carsey Institute, said. "Clearly many rural families, especially in the South, are struggling to support their families and rural children are paying the price, growing up in poverty with bleak futures." To download the full report in PDF format go to: http://www.carseyinstitute.unh.edu/documents/rural_child_poverty_fact_sheet.pdf

USDA/RCDI
September 5, 2006

Congress initially created the Rural Community Development Initiative (RCDI) in FY 2000 to develop the capacity and ability of nonprofit organizations, low-income rural communities, or federally recognized tribes to undertake projects related to housing, community facilities, or community and economic development in rural areas. Grants will be made to qualified intermediary organizations that will provide financial and technical assistance to recipient organizations to develop their capacity and ability to undertake projects related to housing, community facilities, or community and economic development.

DEADLINE: Applications are due by October 10, 2006 AWARD AMOUNT: Congress appropriated approximately $6 million in FY 2006 for the RCDI. The intermediary will be required to provide matching funds in an amount at least equal to the RCDI grant. The respective minimum and maximum grant amount per intermediary is $50,000 and $300,000.

CONTACT: William Kenney at (202) 720-1506 or william.kenney@wdc.usda.gov For details, click on: http://www.grants.gov/search/search.do?mode=VIEW&oppId=10294

Cover All Kids Flyer and Postcard
August 30, 2006
Children Health Insurance Prorgam Releases New Materials Please see below for CHIP's new Cover All Kids flyer and postcard.

Click for postcard here

Click for flyer here

Something to keep our eyes on
August 30, 2006
One-third of rural pharmacists consider closing under new Medicare plan

A survey of more than 500 community pharmacists revealed that nearly nine out of 10 (89 percent) are getting less money and a third are considering shutting down since the new Medicare Part D prescription drug plan went into effect Jan. 1.

"The survey found that more than half (55 percent) of respondents said they have had to obtain outside loans or financing to supplement their pharmacy’s cash flow because of slow reimbursement by health care plans," according to the National Community Pharmacists Association. "More than two-thirds (67 percent) of those surveyed said their pharmacy was located in an area with a population of less than 50,000 persons, and most (68 percent) said they had been in business for at least 20 years."

“Community pharmacists have been the backbone of the Part D program and are frequently the most accessible—and sometimes the only—health care provider in the community,” said NCPA Executive Vice President and CEO Bruce Roberts. “We need to address the serious problems of low and slow reimbursement in the Medicare Part D program to ensure that these communities will continue to be served by their pharmacists.” (Read more)

A May 8 item in The Rural Blog referenced a study that shows rural residents are paying more for drugs than urbanites under Medicare Part D prescription drug plan. The study by the Center for Rural Health Policy Analysis of the Rural Policy Research Institute reported that average monthly premiums for Medicare Advantage prescription drug plans vary from $6 in urban New Hampshire to $53 in rural Hawaii. Click here for the archived item and click here for the study.

Greater Pittsburgh Community Food Bank report now available online
August 30, 2006
Could walk-in retail clinics help slow rising health costs?
Updated 8/24/2006 6:34 PM ET

By Julie Schmit, USA TODAY

Retail clinics are spreading nationwide as more than a dozen clinic operators plan to open thousands in stores such as CVS, Wal-Mart, Walgreens and Kerr Drug. The clinics, about 150 nationwide, provide convenient but limited service at a low cost. They treat common ailments only ­ such as strep throat, ear infections and allergies ­ and offer an alternative to packed doctors' offices and pricey emergency rooms. The clinics save even more if they keep patients out of emergency rooms, which can cost hundreds of dollars per visit, and which frequently treat the uninsured.

Full Story at:
http://www.usatoday.com/money/industries/health/2006-08-24-walk-in-clinic-usat_x.htm

Greater Pittsburgh Community Food Bank report now available online
August 30, 2006
“Hunger and Food Insecurity in Southwestern Pennsylvania” was released on July 27, 2006 by Greater Pittsburgh Community Food Bank as part of the ongoing effort to raise awareness and encourage action to end hunger in our region. Drawing from an array of authoritative sources and case studies of families and individuals who rely on the food assistance network, the report provides both the “facts and faces” of hunger.

It describes the Food Bank, our member agencies and our clients. It outlines the foundation and building blocks of a hunger-free community­the public and private food assistance programs operating in southwestern Pennsylvania. The report also provides recommendations for strengthening the government programs and the private sector efforts that can help our neighbors in need and ultimately end hunger in our region.

“Hunger and Food Insecurity in Southwestern Pennsylvania” serves as an introduction to hunger and food insecurity for people not yet aware of the problem. It can also be used as a valuable reference and resource for those already involved in building a hunger-free southwestern Pennsylvania.

The full report is available through the Greater Pittsburgh Community Food Bank website by clicking on: http://www.pittsburghfoodbank.org/store/products_details.cfm?id=74&catid=5

Rural Assistance Center Announces New State Information Resource
August 30, 2006
RURAL ASSISTANCE CENTER ANNOUNCES NEW STATE INFORMATION RESOURCE

GRAND FORKS, N.D. -- The Rural Assistance Center (RAC), a national resource for rural health and human services information, has launched State Resources on its Web site allowing easy access to continuously updated demographics and statistics, documents and resources, contacts and success stories for all 50 states.

"People using our services are often looking for state-level contacts, resources or information that can help them to maintain and improve services in their local communities," said Kristine Sande, RAC's director. "The new part of the RAC Web site has been developed in response to these information needs."

The new State Resources, located at http://www.raconline.org/states, feature an overview of each state and its rural health and human services environment. In addition, the pages include:

• State-level contacts and organizations relevant to rural health and human services;
• Tools, such as web sites with demographic and statistical information for the state;
• Possible funding sources for rural health and human service projects;
• Documents, articles and journals written about the state;
• Success Stories from the state that can serve as model projects in rural communities; and
• News and upcoming events from the rural community.

"The new State Resources help rural communities find information and resources that can assist them in important activities such as locating and competing for funding opportunities and networking within their state," said Sande. "We are working with state-level partners, such as the State Offices of Rural Health, to ensure that these pages remain current and feature the best information available for each state."

"In small towns, health care providers and human services representatives juggle many responsibilities," explained Mary Wakefield, director of the Center for Rural Health which houses the Rural Assistance Center. "The federally-funded Rural Assistance Center's State Resources is a one stop shop to help these individuals quickly find local resources and information. It's about helping them to do their jobs more efficiently and serve their rural communities even better."

About RAC
The Rural Assistance Center (RAC) serves asa rural health and human services information portal which helps rural communities access the full range of available programs, funding, and research that can enable them to provide quality health and human services. RAC is a collaboration of the University of North Dakota Center for Rural Health and the Rural Policy Research Institute (RUPRI). It is funded through HRSA's Office of Rural Health Policy.

Since its launch in December 2002, RAC's web site has received over 680,000 visits, with over 335,000 of those visits coming in the last year. In addition, RAC has responded to nearly 3,600 customized assistance requests from people in all 50 states, Puerto Rico and several foreign countries.

RAC's other web-based services, available at www.raconline.org, include an online clearinghouse of news, documents, maps and success stories; a calendar of events; a directory of rural contacts and organizations; 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 subscribersabreast of new happenings and resources available. RAC also provides free customized assistance on topics related to rural health or human services. Contact RAC at 1-800-270-1898 or info@raconline.org to request customized assistance from RAC's information specialists.

Strategic Planning for Tobacco Use Prevention and Cessation in Pennsylvania
August 30, 2006
The Pennsylvania Department of Health and Temple University's Institute for Public Affairs invite individuals and organizations working to prevent and control tobacco use to help guide the development of a strategic plan to direct the Commonwealth's efforts in the area.

At stakeholder meetings earlier this year, participants attended breakout sessions organized around the four goals, as outlined by the U.S. Centers for Disease Control and Prevention, of a comprehensive tobacco control program. The participants suggested and discussed objectives and strategies for reaching each goal in Pennsylvania.

We invite you now, whether or not you attended one of those meetings, to review and react to the preliminary lists of objectives and strategies compiled from those discussions. To participate in a survey soliciting your input, please click on or direct your web browser to:

http://www.keysurvey.com/survey/117571/f952/

Walsh Center Report released on Emergency Preparedness Activities by State Offices
August 13, 2006
To view report click here

For information on this report, contact:
Curt Mueller, Ph.D.
Director, Walsh Center
202-887-2356
Mueller-curt@norc.org

Resource Launched to Assist in Purchasing Prescriptions
August 13, 2006
Together RX Access has been announced as a resource for eligible persons who need assistance in paying for prescriptions. Eligible persons are those who have no prescription drug coverage, are not eligible for Medicare, and who are a legal resident of the United States or Puerto Rico. For more information, access http://www.togetherrxaccess.com/home.html.

High Performance Health System
August 13, 2006
This Framework for a High Performance Health System for the US is brief and well worth the read.

From The Commonwealth Fund Commission on a High Performance Health System

Click to view brief here

A new policy paper is available from the RUPRI Center for Rural Health Policy Analysis
August 13, 2006
Elements of Successful Rural Diabetes Management Programs

In this paper, we report findings from a study about local innovations implemented by rural chronic disease management programs. Using diabetes as a proxy for all chronic diseases, we explored how local innovations overcame challenges of the rural setting to provide effective and efficient disease management. Please click on the following link to download this document: http://www.rupri.org/healthpolicy/Pubs/p2006-2.pdf

The Annie E. Casey Foundation recently released the 2006 Kids Count Book
August 13, 2006
It reports that national trends in child well-being are no longer improving in the steady way they did in the late 1990s with more than 13 million children living in poverty in 2004; an increase of 1 million over four years. It shows that 3 out of the 10 child well-being indicators have worsened since 2000. For more information and to read the data book online please visit http://www.aecf.org/kidscount/sld/databook.jsp

PA Healthy Kids - Pennsylvania's Strategy for Balancing Nutrition and Exercise in Kids
August 1, 2006
The Governor's Cabinet on Children and Families would like to share with you and your organization PA Healthy Kids - Pennsylvania's Strategy for Balancing Nutrition and Exercise in Kids, which provides an overview of the Commonwealth's activities to prevent childhood obesity. This compendium outlines a number of state initiatives directed at increasing physical activity and improving nutrition in the states youth, and offers a multitude of resources available to inspire organizations to create their own programs. Eating right and being physically active is key to a healthy lifestyle. With healthful habits, children, their families and their communities can work together to reduce the risk of many chronic diseases associated with childhood obesity and assist in increasing the chance of a longer and more virbrant life.

HIT Funds Available for Rural Physicians: NRHA Celebrates at 1st Annual Clinical Conference
August 1, 2006
(Patton, PA) AgrAbility for Pennsylvanians will be hosting a number of free health screenings at the upcoming Penn State Ag Progress Days (APD), held at Rock Springs on August 15-17. Please note the following screenings and times:

• Blood Pressure Readings, Stroke Risk Assessments, and Blood Oxygenation Level Readings will be conducted by Centre Home Care on Tuesday, Wednesday, and Thursday from 10 AM - 3 PM.
• The PA Department of Health will provide free Tetanus Shots on Tuesday and Thursday from 9 a.m. to 3 p.m. One hundred (100) vaccinations will be available; first come, first served.
• A Vision Evaluation, including screening for glaucoma, will be conducted by the North Central Sight Services on Tuesday and Wednesday, only, from 9 a.m. – 4 p.m.
• The Diabetes Education Awareness Project of Penn State Cooperative Extension, Cambria County, will provide information on the Diagnosis and Care of Diabetes on Wednesday from 9 a.m. to 3 p.m.
• Ergonomic displays will focus on simple ways to reduce strain and stress on your body while completing tasks in the shop, garden, or dairy barn. These displays will be available throughout the entire week.

For more information regarding AgrAbility services, call toll free within PA to 1-866-238-4434 or visit the following website: http://AgExtEd.cas.psu.edu/agrab/.

HIT Funds Available for Rural Physicians: NRHA Celebrates at 1st Annual Clinical Conference
August 1, 2006
(Alexandria, VA) . . . The National Rural Health Association celebrated with clinicians today the passage of the House bill that would provide $5 million in grants during 2007 and 2008 for small physician practices located in rural or medically underserved areas for the purchase and support of health information technology (HIT).

HIT advancement is a critical component for access, equity and quality of care in rural and frontier areas. It opens the door to treatment by experts in specialized care who are typically located in only the largest metropolitan cities. HIT has the potential to offer cutting edge treatment options to the 20 percent of Americans that live in rural and frontier areas, and could make obsolete arduous and often times hazardous travel for health care. It also allows for other important treatment advancement such as electronic medical records.

"This new grant program is very important for those who practice in rural locations. By providing grants for these areas, we continue to bring equity in care practices to all Americans. We are glad that Congress is attuned to the needs of rural physicians and their patients," said Alan Morgan, NRHA CEO.

The news today was greeted with hearty approval by clinicians kicking off the NRHA's First Annual Clinical Conference in Denver, Colorado, July 28-29. Dr. Tom Dean, a practicing physician in Wessington Springs, South Dakota, extended his heartfelt thanks to the NRHA for their continuing work on the Hill. "We appreciate the work of the NRHA in their vigil to make rural health care one of the many priorities of our nation's leaders. For many small practices, a grant such as this can make the difference between reality and a dream in their ability to purchase and support health information technology."

WMH Awarded $375,000 for Medication Safety Project: Only PA Hospital to Receive Award
August 1, 2006
(Honesdale, July 25, 2006)…Wayne Memorial’s patient safety efforts have received another significant boost from the federal government. The Health Resources Services Administration (HRSA, part of US Health & Human Services Department) has awarded the Hospital a Rural Health Care Outreach grant of $375,000 over three years for its IMAPS project.

IMAPS—or Improving Medication and Patient Safety—is a $2.5 million project that involves emerging technologies, telehealth and extraordinary communication between pharmacists and healthcare providers to ensure against medication errors. Specifically, IMAPS entails setting up a secured Internet web portal for Wayne Memorial Hospital (WMH) and physician/practitioners to share vital patient medication information. IMAPS will also use advanced barcoding/labeling technology to reconcile patient identities with medications ordered for them before, during and after their discharge; in other words, to make sure the patient getting the medication is the right patient receiving the right dose at the right time.

“Wayne Memorial has a statistically low record of medication errors compared to other hospitals,” states WMH Chief Pharmacist Len O’Hara, “but medication errors are a national problem.” And most are due to human error. According to a report released July 21 by the Institute of Medicine, at least 1.5 million Americans are sickened, injured or killed each year by avoidable errors in prescribing, dispensing and taking medications.

“This grant and the technology it’s supporting at Wayne Memorial will certainly help us keep our numbers low and hopefully bring them down even more,” adds O’Hara, pictured here with Pharmacy staffer Julie Alvarez.

“Patient safety is and has always been a priority at Wayne Memorial,” notes David Hoff, WMH Chief Executive Officer. “Our goal with IMAPS is to cut down our medication errors by 50% in our inpatient units, operating rooms and emergency services.”

Wayne Memorial Hospital is the only hospital in Pennsylvania to receive a Rural Health Care Outreach grant this go-round, according to Jack Dennis, WMH Manager of Grants and Development. “We were very fortunate, and it will be our honor to pass the benefit on to our patients.”

The project will involve a consortium, managed by WMH, which includes Wayne Memorial Health System Community Health Concern physicians and 15 private physician practices.

WMH’s patient safety initiatives have already received grants from Blue Cross of NEPA ($300,000) for the IMAPS project and a “telehealth” grant from HRSA for $196,000. The balance of funds needed for the IMAPS project is expected to come from the Hospital budget process.

New report from the IOM on medication errors
August 1, 2006
A major report by the Institute of Medicine (IOM) on medication errors suggests that, despite all the progress in patient safety since To Err is Human, medication errors remain extremely common, and the health care system can do much more to prevent them. Among the startling statistics from this report: more than 1.5 million Americans are injured every year in American hospitals, and the average hospitalized patient experiences at least one medication error each day. The report emphasizes actions that health care systems, providers, funders, and regulators can take to improve medication safety. These actions include having all US prescriptions written and dispensed electronically by 2010, more widespread use of medication reconciliation, and additional research on drug errors and how to prevent them. Importantly, the report also emphasizes actions that patients can take to prevent medication errors, such as maintaining active medication lists and bringing their medications to appointments. Support for the IOM report came from the Centers for Medicare & Medicaid Services.

Influenza Information from the Pennsylvania Department of Health
August 1, 2006
The PA Department of Health is preparing for the eminent flu season that is steadily approaching. We would like to share the latest information on influenza as well as routine vaccinations. We hope you will find the attachments beneficial to your organizations.

Here are the articles

• Paycheck stuffer formatted flu 06
• Healthcare worker immunization recommendations
• 2006 Influenza update

PAC3 Members: Deadline extended for CURE Program written testimony on the 2007-08 health research priorities
July 27, 2006
Pennsylvania Department of Health Invites Comments on Injury and Death

The Pennsylvania Department of Health is inviting the public to submit written testimony to recommend health research priorities for the CURE Program for state fiscal year 2007-2008. Of particular interest to the Department is testimony on the need for research to prevent the incidence of violent injuries and deaths. Please use the attached form to prepare and submit your recommendations regarding the research priorities. Recommendations should be submitted no later than July 31, 2006 to ra-healthresearch@state.pa.us. Questions? Contact: Cathy Becker, Kristen Weitzel or John Koch at 717-783-2548.

Background: Act 2001-77, the Tobacco Settlement Act, authorized the Pennsylvania Department of Health to establish the Health Research Program, known as the Commonwealth Universal Research Enhancement (CURE) Program. Each year, CURE awards two types of health research grants: (1) health research formula grants, which are awarded only to hospitals, universities and non-profit organizations that have received three consecutive years of funding from the National Institutes of Health; and (2) nonformula grants, which are awarded competitively in response to a Request for Application (RFA) that is issued once a year. Any person or organization in Pennsylvania is eligible to apply for the nonformula health research grants in response to the RFA.

The nonformula health research grants fund biomedical, clinical and health services research projects that are consistent with specific research priorities. Once a year, the research priorities for both formula and nonformula grants are reviewed and revised as needed. The research priorities are established by the Department in conjunction with a Health Research Advisory Committee, which is chaired by the Secretary of Health.

Prior to establishing the research priorities, the public is invited to provide testimony on research needs. After the research priorities are established for the year, an RFA is issued to solicit research projects that address the priorities. Typically, the RFA is issued during late summer or early fall.

The research priorities for the competitive nonformula health research grants have changed each year. They were: bioinformatics related to cancer or infectious diseases (2001-02); reducing disparities in cardiovascular disease and four types of mental disorders (2002-03); reducing disparities in lung disease and pregnancy outcomes (2003-04); reducing disparities in neurodegenerative disease and tobacco use and cessation (2004-05); reducing disparities related to obesity (2005-06); and reducing disparities related to vaccine development and gene-environment interactions (2006-07). Current and past state fiscal year priorities for both formula-funded and nonformula-funded health research are posted on the Department of Health's CURE website ( http://www.health.state.pa.us/cure; see CURE Health Research Priorities for a complete description of the priorities).

WMH Press Releast - WMH Honors Dedicated Employees
July 27, 2006
(Honesdale, July 17, 2006)...“When I came to Wayne Memorial—in 1961—the lab was only one room and I took home only $300 a month. But then, my rent was only $68 a month!” Wayne Memorial Lab Technician Ernie Becker and Freda Avery, RN, both reminisced about their early days at Wayne Memorial during the Hospital’s annual Employee Service Awards ceremony on June 15th. The two were honored for 45 years of service. “Our employees are the heart of what we do at Wayne Memorial,” said Liz McDonald, Director of HR. “We are happy to be able to offer our appreciation tonight.” The ceremony at Lukan’s Farm Resort in Hawley spotlighted 86 employees at five-year intervals of service—5 years, 10 years, 15, 20, 25, 30, 35 and 45. Their stories are the Hospital’s story. “We used to have to wash diapers by hand,” said Freda Avery, RN, of her early years in Maternity. “We don’t do that any more. But more importantly, babies today have a whole lot better chance of survival than they did back when I started.” “I had to reinvent myself when I came to Wayne Memorial,” noted Kathy Faubel, RN, who was honored for 15 years of service. “I was a pediatric nurse at a big hospital in Philadelphia. At Wayne Memorial, I had to find a new niche—chemotherapy— and become more of an independent thinker, because we didn’t have the layers upon layers of doctors, fellows, administrators. I’ve really grown a lot at Wayne Memorial. It’s made me more versatile and more of an asset I hope to our patients.” Many of those honored at the Awards ceremony said it was the “people” who made all the difference at Wayne Memorial over the years. “I’ve made really good friends here,” said Jennifer Aronica, Respiratory Therapist (10 years).

“I enjoy working with the staff. I’ve worked with a lot of good people,” said Kathy Firmstone, Radiology Department (35 years). Sharon Bryant started in Housekeeping 25 years ago. She was encouraged to pursue a career in the nursing arena—and she did. Bryant has been working in the Hospital Operating Room for five years. “When I first went to the OR,” she mused, “We saw a lot more trauma, mostly due to drinking-and-driving accidents. I think the anti-drunk driving campaign has worked to some degree, at least from my perspective. And that’s good.” WMHS Chief Executive David Hoff and Chairman of the Board Peter Rodgers both thanked employees for their dedication over the years. “You are the engine that drives our success,” Rodgers told the gathering. Ernie Becker, who plans to retire this year, remembers his rent and his salary in 1961. A video presentation also reminded him of the price of gas back then-- .31 cents a gallon.

PHC4's Annual Report
July 8, 2006
I am pleased to let you know that the Pennsylvania Health Care Cost Containment Council's Annual Report for 2005 is now posted on the PHC4 Web site - www.phc4.org PHC4's commitment to data transparency translated into several initiatives last year. Pennsylvania made national headlines, becoming the first state in the nation to collect and publicly report about hospital-acquired infections. PHC4 also broke new ground with its total hip and knee replacement surgery report, and continued its efforts to collect third party insurance data. We continued our traditional reporting on hospital performance and finances and Medicare managed care plans. As the report demonstrates, PHC4 has strengthened its position as a national leader among health data organizations and in 2005 continued its delivery of timely accurate useful health care information to its stakeholders. If you have any questions please contact Joe Martin, Director of Communications and Education Department at 717-232-6787 or by email jmartin@phc4.org.

NRHA Helps People Without Coverage Obtain Savings at the Pharmacy
July 8, 2006
Alexandria, VA - The National Rural Health Association (NRHA) is making it easy for those who lack prescription drug coverage in rural America to enroll in the Together Rx AccessT Program and receive meaningful savings on a wide range of brand-name and generic prescription products. The program offers a free savings card to help uninsured Americans gain access to prescription products.

"The National Rural Health Association supports this major effort to ensure that uninsured people living in rural America obtain the medicines they need, and we're proud to be doing our part to help," said Alan Morgan, CEO, National Rural Health Association. "Through the NRHA's more than 10,000 members, we have the network to provide rural residents with information about the Together Rx Access program and help make enrollment as easy as possible for them."

The NRHA is working on a number of Together Rx Access educational initiatives that include direct mailings, web-based information and grass roots community outreach aimed at its membership comprised of health care professionals, health clinics and community-based groups. These initiatives are designed to provide members with the necessary tools to help educate their patients and constituents about the features of the program including its broad eligibility requirements and simple enrollment process.

"We are pleased that the National Rural Health Association recognizes the importance of educating the nearly one-fourth of Americans who live in rural communities about the Together Rx Access Card," said Roba Whiteley, Executive Director of the Together Rx Access Program. "Rural residents are less likely to have prescription drug coverage so it's critical at this time when the nation's uninsured population is on the rise that we help eligible people lead healthier lives by offering them meaningful savings on their prescriptions."

Lota and Steve Riley of Pleasant Shade, Tennessee never thought that they would have to worry about being able to afford their prescription medicines. But when Steve, a trucking industry veteran, lost his job and was later hired by a small company that did not offer health insurance, the couple became deeply concerned. "Even though our insurance went away, our ailments did not," said Lota, who has type II diabetes. Fortunately, the Rileys discovered the Together Rx Access Program.

"We looked far and wide for help and this was the only program for which we were eligible," said Lota. "We gained savings right away for our brand-name and generic prescription medications. Now we can put the money that we save from the Together Rx Access Card to help pay down our credit card bill - every little bit helps." About Together Rx Access

Together Rx Access was created by 10 pharmaceutical companies to help hardworking Americans and their families gain access to meaningful savings on prescriptions right at the pharmacy counter. Most cardholders save 25 percent to 40 percent* on brand-name prescription products, including medicines to treat high cholesterol, diabetes, asthma, and many other conditions. Over 300 brand-name prescription products are included in the program. Savings are also available on a range of generic products. The Card is accepted at the majority of pharmacies nationwide and in Puerto Rico.

*Each cardholder's savings depend on such factors as the particular drug purchased, amount purchased, and the pharmacy where purchased. Participating companies independently set the level of savings offered and the products included in the program. These decisions are subject to change.

Broad Eligibility

To qualify for the Together Rx Access Card, applicants cannot be eligible for Medicare or have public or private prescription drug coverage. They cannot have a household income of more than $30,000 for a single person or $60,000 for a family of four (income eligibility is adjusted for family size). And they must be a legal resident of the United States or Puerto Rico. Families of six or more and residents of Alaska and Hawaii should contact Together Rx Access at 1-800-444-4106 for household income information.

How to Enroll

• The program is easy to enroll in and easy to use. There is one simple enrollment form. A quick start savings card is also available which gives cardholders speedy access to savings on the brand name products and generic drugs in the program. The card is active within two hours if the eligible enrollee calls a toll-free number within call center business hours, and two business days at all other times.
• Individuals who meet eligibility requirements can use their Together Rx Access Card at the majority of pharmacies nationwide and in Puerto Rico. Individuals can get information about the program and enroll at TogetherRxAccess.com or by calling 1-800-250-2839 The Together Rx Access Program also directs individuals to the Partnership for Prescription Assistance (PPA), a clearinghouse for over 475 public and private assistance programs, including participating companies' existing Patient Assistance Programs.

Totally Deserved
July 8, 2006
Robert Wood Johnson Community Health Leadership Award Goes to Rural Leader

Kristy Nichols, Director of the Bureau of Primary Care and Rural Health in Baton Rouge, LA and a leader in the NRHA, received one of ten awards recognizing "ingenuity, perseverance and social commitment that is moving the needle to improve the health and well-being of people in their communities and giving a voice to those who may need help in raising their own." The winners receive $120,000 each ($105,000 for their program and a $15,000 personal award) for their work in solving some of the most complex health and social service problems of our day. They were chosen from more than 300 nominations submitted nationwide.

Kristy Nichols' leadership summary read that she "grew up in the south around people she saw struggling financially and without access to adequate health care. This experience inspired Nichols to make her life's work that of enabling those most vulnerable to act on their own behalf. As head of the Bureau of Primary Care and Rural Health, she has improved the health status of rural residents. After Katrina hit, Nichols worked with other state officials to get medicines, supplies, doctors and nurses to hundreds of Louisiana clinics and shelters. At the same time, she helped local residents create detailed recovery plans so that scarce federal resources get to the state's hardest hit parishes."

House Approps Earmarks
July 8, 2006
House Report 109-515 - DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATIONS BILL, 2007

Click to download report here

SC Rural Health Research Center
July 8, 2006
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 findings brief.

The publication entitled, Trends in Uninsurance among Rural Minority Children is authored by Amy Martin, DrPH; Janice C. Probst, PhD; Charity G. Moore, PhD; Daniel Patterson, PhD; and Keith T. Elder, PhD.

The Fact Sheet is attached(click here to open), and the full report is available through our Online Report Request System at http://rhr.sph.sc.edu . You may elect to receive a paper or electronic copy. The requested report will be sent to you via postal mail (paper copy) or email (electronic copy) within 7~10 days.

New Surgeon General Report Focuses on Effects of Secondhand Smoke
July 8, 2006
New Surgeon General's Report Focuses on the Effects of Secondhand Smoke

U.S. Surgeon General Richard H. Carmona today issued a comprehensive scientific report which concludes that there is no risk-free level of exposure to secondhand smoke. Nonsmokers exposed to secondhand smoke at home or work increase their risk of developing heart disease by 25 to 30 percent and lung cancer by 20 to 30 percent. The finding is of major public health concern due to the fact that nearly half of all nonsmoking Americans are still regularly exposed to secondhand smoke.

The report, The Health Consequences of Involuntary Exposure to Tobacco Smoke, finds that even brief secondhand smoke exposure can cause immediate harm. The report says the only way to protect nonsmokers from the dangerous chemicals in secondhand smoke is to eliminate smoking indoors.

"The report is a crucial warning sign to nonsmokers and smokers alike," HHS Secretary Michael Leavitt said. "Smoking can sicken and kill, and even people who do not smoke can be harmed by smoke from those who do."

Secondhand smoke exposure can cause heart disease and lung cancer in nonsmoking adults and is a known cause of sudden infant death syndrome (SIDS), respiratory problems, ear infections, and asthma attacks in infants and children, the report finds.

"The health effects of secondhand smoke exposure are more pervasive than we previously thought," said Surgeon General Carmona, vice admiral of the U.S. Public Health Service. "The scientific evidence is now indisputable: secondhand smoke is not a mere annoyance. It is a serious health hazard that can lead to disease and premature death in children and nonsmoking adults." Secondhand smoke contains more than 50 cancer-causing chemicals, and is itself a known human carcinogen. Nonsmokers who are exposed to secondhand smoke inhale many of the same toxins as smokers. Even brief exposure to secondhand smoke has immediate adverse effects on the cardiovascular system and increases risk for heart disease and lung cancer, the report says. In addition, the report notes that because the bodies of infants and children are still developing, they are especially vulnerable to the poisons in secondhand smoke.

"The good news is that, unlike some public health hazards, secondhand smoke exposure is easily prevented," Surgeon General Carmona said. "Smoke-free indoor environments are proven, simple approaches that prevent exposure and harm." The report finds that even the most sophisticated ventilation systems cannot completely eliminate secondhand smoke exposure and that only smoke-free environments afford full protection.

Surgeon General Carmona noted that levels of cotinine -- a biological marker for secondhand smoke exposure -- measured in nonsmokers have fallen by 70 percent since the late 1980s, and the proportion of nonsmokers with detectable cotinine levels has been halved from 88 percent in 1988-91 to 43 percent in 2001-02.

"Our progress over the past 20 years in clearing the air of tobacco smoke is a major public health success story," Surgeon General Carmona said. "We have averted many thousands of cases of disease and early death and saved millions of dollars in health care costs." He emphasized, however, that sustained efforts are required to protect the more than 126 million Americans who continue to be regularly exposed to secondhand smoke in the home, at work, and in enclosed public spaces.

To help communicate the report findings as widely as possible, the Surgeon General unveiled an easy-to-read guide with practical information on the dangers of secondhand smoke and steps people can take to protect themselves.

Copies of The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General and related materials are available on the Surgeon General's Web site at: http://www.surgeongeneral.gov/library/secondhandsmoke/report/

Kids Count
July 8, 2006
KIDS COUNT, a project of the Annie E. Casey Foundation, is a national and state-by-state effort to track the status of children in the U.S. By providing policymakers and citizens with benchmarks of child well-being, KIDS COUNT seeks to enrich local, state, and national discussions concerning ways to secure better futures for all children.

Website located at http://www.aecf.org/kidscount/sld/errata/update10.jsp

Reminder: 2007 Annual Conference Session Submissions due July 1st, 2006!
July 8, 2006
The National Rural Health Association (NRHA) invites individuals with an interest in rural health to submit concurrent session ideas for presentation during the NRHA's 30th Annual Conference to be held May 14-18, 2007, in Anchorage, AK. Final determination for Annual Conference Concurrent Sessions will be made by the NRHA Annual Conference Planning Committee by mid-September.

This submission offers the opportunity for NRHA members and others to present relevant and timely information at its Annual Conference on innovative rural health care programs, service delivery models, policy issues, educational programs, clinical concerns for rural practitioners, and leadership development and skills training. These sessions may be didactic, hands-on interactive workshops, or roundtable discussions. Presentations should relate to issues that affect rural populations, providers or programs.

To submit online, visit: http://www.nrharural.org/conferences/sub/AnnConf.html before July 1st!

In addition, those interested in submitting academic abstracts or student papers should also visit http://www.nrharural.org/conferences/sub/AnnConf.html for information regarding the fall deadlines for these exciting programs during next year's Annual Conference.

Calico Leadership Award Nomination Form
June 20, 2006
The Calico Leadership Award is presented by the Rural Health Resource Center’s Technical Assistance and Services Center (TASC) to an outstanding rural health leader each year. The Calico Award was created to honor our former project officer and long-time rural health leader, Dr. Forrest Calico for his life-long commitment to improving the quality of rural health. This year’s award, which will be selected by a special task force, will be presented to an individual who has demonstrated outstanding leadership in the area of health information technology (HIT). Nominations may be submitted by any State Office of Rural Health or Flex Program. The award will be presented during the National Conference of State Flex Programs in St. Paul, Minnesota, August 14-16, 2006. We will also showcase all nominees on our web site and elsewhere in order to share their success stories with others around the country. Nominations must be received by June 30th. Please see the attached nomination form for more details. Nominations may be emailed to enicholson@ruralcenter.org , faxed to (218) 727-9392, or mailed to the address below. If you have any questions, please let me know!

Click for nomination form Here

Funds for Community Health Leaders
June 20, 2006
The Robert Wood Johnson Community Health Leadership Program (CHLP) honors outstanding individuals who overcome daunting odds to expand access to health care and social services to underserved and isolated populations in communities across the United States.

CHLP honors ten outstanding individuals each year for their work in creating or enhancing healthcare programs serving communities whose needs have been ignored and unmet. Candidates should be working at the grassroots level, have received no significant national recognition and be in "mid-career", with no less than five and no more than fifteen years of community health experience. Each leader receives $120,000 to be used for personal and program enhancement over a period of up to three years.

The Letter Of Intent (LOI) deadline is September 22, 2006. Nominators of candidates meeting the program's criteria will receive full nomination packages which will be due to the program office November 9, 2006.

More information at: http://www.communityhealthleaders.org/index.asp?Type=B_BASIC&SEC={DF43CE A9-3679-40B5-9026-73EDC2F99D78}

Funding Opportunity
June 13, 2006
Rural Domestic Violence Pilot Program

The U.S. Department of Justice's Office on Violence Against Women (OVW), via the Rural Domestic Violence and Child Victimization Enforcement Grants, has recently launched a new pilot program specifically targeting the unique needs of rural communities. The Faith and Community Technical Support (FACTS) program announces the availability of approximately $2.2 million to fund a number of faith-based and community organizations (from September2006 through August 2007) with the ability to serve rural victims of domestic violence. Funds are available particularly for those grassroots faith-based or community organizations that have not previously received funds from the U. S. Department of Justice. Applicants must have a staff of less than 10 full-time employees and an annual domestic violence program budget of less than $100,000 (and an overall budget less than $350,000).

Sub-award applications meeting the minimum eligibility requirements will be accepted from all organizations and all states, rural or non-rural. For further information or to view the solicitation, click on the following link: http://www.factsdv.org/

Deadline to apply: August 2, 2006.

New Publication Available
June 13, 2006
The Comparison of the Rural Health Clinic and Federally Qualified Health Center Programs, Revised June 2006, is online at

http://www.ask.hrsa.gov/downloads/fqhc-rhccomparison.pdf

Auditor General Jack Wagner Calls on PennDOT to Make Rural Transportation for Persons with Disabilities Available Statewide
June 13, 2006
Auditor General Jack Wagner said today that the Pennsylvania Department of Transportation must take immediate steps to expand its Rural Transportation for Persons with Disabilities Program statewide. Currently, PennDOT does not offer the same discounted transportation program in 30 counties that it offers in 35 other rural counties, thereby shutting out about 50 percent of eligible persons with disabilities.

Wagner said PennDOT should ensure that all Pennsylvanians with disabilities receive the same opportunity no matter what their county of residence. He called for PennDOT to make the discretionary program a separate line item in its budget so there is more certainty about the program's status.

"The Rural Transportation for Persons with Disabilities Program would have more prominence and commitment if PennDOT budgets for it by name," said Wagner. "For years, persons with disabilities have asked to have the same opportunities in all counties, and PennDOT must finish the job it has started."

The Rural Transportation for Persons with Disabilities Program was established by PennDOT in 2001 as a program of last resort to provide transportation to persons with physical and mental disabilities between the ages of 18 and 64 who reside in rural counties and are not eligible to receive discounted transportation from other programs. (PWD is not offered in the urban Philadelphia and Allegheny counties.)

Wagner's special performance audit covered 4 1/2 years, from Jan. 1, 2001, to June 30, 2005. During the last year of the audit, 138,660 rides were provided to Pennsylvanians living in rural areas of 28 counties, and each rider benefited from an average taxpayer-funded subsidy of $10.81 per ride. In May, the program began in Bedford, Fulton, and Huntingdon counties; later this year, it will begin in Adams, Berks, Monroe, and Pike counties.

Wagner added, "PennDOT has done well to expand the program from 8 counties in 2001 to 35 counties later this year. But we can't forget that persons with disabilities who need the program live in other counties also."

Wagner's audit said it was unclear how many eligible riders reside in the counties where the program is not available because no state agency, including PennDOT, compiles precise statistics. Based on estimates from transportation advocates, nearly 60,000 people in the 30 counties are likely eligible for this program, although actual participation rates could be far less. Expanding service to the remaining counties would cost an additional $5 million in the first year and about $2.5 million per year in subsequent years. Wagner noted that the program requires just a fraction of PennDOT's $6.3 billion annual budget.

The audit also identified several issues in PennDOT's day-to-day administration of the program that should be addressed. For example, PennDOT should communicate its plans more clearly to the public, including persons with disabilities, and should perform periodic audits of transportation providers.

Wagner said the Department of the Auditor General would consult with the Department of Transportation and follow up within the next 24 months to measure progress. Wagner's report, with PennDOT's response, is available at http://www.auditorgen.state.pa.us.

Auditor General Jack Wagner is responsible for ensuring that all state money is spent legally and properly. He is the Commonwealth's elected independent fiscal watchdog, conducting financial audits, performance audits and special investigations. The Department of the Auditor General conducts more than 5,000 audits per year. To learn more about the Department of the Auditor General, taxpayers are encouraged to visit the department's website at http://www.auditorgen.state.pa.us

Announcing the 2007 NCHS/AcademyHealth Health Policy Fellowship Call for Applications
June 12, 2006
Deadline for Call for Applications: January 8, 2007

This program brings visiting scholars in health services research-related disciplines to the NCHS to collaborate on studies of interest to policymakers and the health services research community using NCHS data systems. Fellows can access the data resources provided by CDC and participate in developmental and health policy activities related to the design and content of future NCHS surveys.

Applicants must:

• Demonstrate training or experience in health services research
• Be at any stage in their careers from doctoral students to senior investigators
• Doctoral students must have completed course work and be at the dissertation phase
• Be U.S. citizens, permanent residents, or able to acquire a valid work authorization

Fellows will reside in Hyattsville, MD for a duration of 13-24 months beginning September 2007.

For more information or to apply visit www.academyhealth.org/nchs.

Rural Assistance Center (RAC) Seeks Rural Success Stories
June 9, 2006
Do you have a success to share? RAC has a database of successful rural projects at: http://www.raconline.org/success/. For rural leaders and future grant applicants, the success stories may serve as examples for new approaches to organizing, financing, and delivering rural services.

Please add a success story to the RAC web site at: http://www.raconline.org/success/success_suggestion.php. We appreciate you helping us identify success stories that will be useful to our users.

FDA Licenses New Vaccine for Prevention of Cervical Cancer and Other Diseases in Females Caused by Human Papillomavirus
June 8, 2006
The Food and Drug Administration (FDA) today announced the approval of Gardasil, the first vaccine developed to prevent cervical cancer, precancerous genital lesions and genital warts due to human papillomavirus (HPV) types 6, 11, 16 and 18. The vaccine is approved for use in females 9-26 years of age. Gardasil was evaluated and approved in six months under FDA's priority review process-a process for products with potential to provide significant health benefits.

"Today is an important day for public health and for women's health, and for our continued fight against serious life-threatening diseases like cervical cancer," said Alex Azar, Deputy Secretary, U.S. Department of Health and Human Services (HHS). "HHS is committed to advancing critical health measures such as the development of new and promising vaccines to protect and advance the health of all Americans."

HPV is the most common sexually-transmitted infection in the United States. The Centers for Disease Control and Prevention estimates that about 6.2 million Americans become infected with genital HPV each year and that over half of all sexually active men and women become infected at some time in their lives. On average, there are 9,710 new cases of cervical cancer and 3,700 deaths attributed to it in the United States each year. Worldwide, cervical cancer is the second most common cancer in women; and is estimated to cause over 470,000 new cases and 233,000 deaths each year.

For most women, the body's own defense system will clear the virus and infected women do not develop related health problems. However, some HPV types can cause abnormal cells on the lining of the cervix that years later can turn into cancer. Other HPV types can cause genital warts. The vaccine is effective against HPV types 16 and 18, which cause approximately 70 percent of cervical cancers and against HPV types 6 and 11, which cause approximately 90 percent of genital warts.

"This vaccine is a significant advance in the protection of women's health in that it strikes at the infections that are the root cause of many cervical cancers," said Andrew C. von Eschenbach, MD, Acting Commissioner of Food and Drugs. "The development of this vaccine is a product of extraordinary work by scientists as well as by FDA's review teams to help facilitate the development of very novel vaccines to address unmet medical needs. This work has resulted in the approval of a number of new products recently, including Gardasil, which address significant public health needs."

Gardasil is a recombinant vaccine (contains no live virus) that is given as three injections over a six-month period. Immunization with Gardasil is expected to prevent most cases of cervical cancer due to HPV types included in the vaccine. However, females are not protected if they have been infected with that HPV type(s) prior to vaccination, indicating the importance of immunization before potential exposure to the virus. Also, Gardasil does not protect against less common HPV types not included in the vaccine, thus routine and regular pap screening remain critically important to detect precancerous changes in the cervix to allow treatment before cervical cancer develops.

"This is the first vaccine licensed specifically to prevent cervical cancer. Its rapid approval underscores FDA's commitment to help make safe and effective vaccines available as quickly as possible. Not only have vaccines dramatically reduced the toll of diseases in infants and children, like polio and measles, but they are playing an increasing role protecting and improving the lives of adolescents and adults," said Jesse Goodman, MD, MPH, Director of FDA's Center for Biologics Evaluation and Research.

Four studies, one in the United States and three multinational, were conducted in 21,000 women to show how well Gardasil worked in women between the ages of 16 and 26 by giving them either the vaccine or placebo. The results showed that in women who had not already been infected, Gardasil was nearly 100 percent effective in preventing precancerous cervical lesions, precancerous vaginal and vulvar lesions, and genital warts caused by infection with the HPV types against which the vaccine is directed. While the study period was not long enough for cervical cancer to develop, the prevention of these cervical precancerous lesions is believed highly likely to result in the prevention of those cancers.

The studies also evaluated whether the vaccine can protect women already infected with some HPV types included in the vaccine from developing diseases related to those viruses. The results show that the vaccine is only effective when given prior to infection.

Two studies were also performed to measure the immune response to the vaccine among younger females aged 9-15 years. Their immune response was as good as that found in 16-26 year olds, indicating that the vaccine should have similar effectiveness when used in the 9-15 year age group.

The safety of the vaccine was evaluated in approximately 11,000 individuals. Most adverse experiences in study participants who received Gardasil included mild or moderate local reactions, such as pain or tenderness at the site of injection.

The manufacturer has agreed to conduct several studies following licensure, including additional studies to further evaluate general safety and long-term effectiveness. The manufacturer will also monitor the pregnancy outcomes of women who receive Gardasil while unknowingly pregnant. Also, the manufacturer has an ongoing study to evaluate the safety and effectiveness of Gardasil in males.

Gardasil is manufactured by Merck & Co., Inc., of Whitehouse Station, NJ.

For more information, see: http://www.fda.gov/cber/products/hpvmer060806.htm.
http://www.fda.gov/womens/getthefacts/hpv.html

Citizens' Health Care Working Group
June 6, 2006

Citizens' Health Care Working Group Announces Interim Recommendations As part of the Medicare Prescription Drug, Improvement, and Modernization Act Of 2003, the U.S. Congress created the Citizens' Health Care Working Group.

The Citizens' Health Care Working Group has developed Interim Recommendations based on input received from participants in community meetings, respondents to our Web polls, citizens who wrote in to tell us their views, and presenters at public hearings. These recommendations outline a vision and a plan for achieving broad-based change in health care in America.

Interim Recommendations

June 1, 2006

• Recommendation 1: It should be public policy that all Americans have affordable health care
• Recommendation 2: Define a "core" benefit package for all Americans
• Recommendation 3: Guarantee financial protection against very high health care costs
• Recommendation 4: Support integrated community health networks
• Recommendation 5: Promote efforts to improve quality of care and efficiency
• Recommendation 6: Fundamentally restructure the way that palliative care, hospice care and other end-of-life services are financed and provided, so that people living with advanced incurable conditions have increased access to these services in the environment they choose

http://www.citizenshealthcare.gov/recommendations/recsover.php

CAH Replacement
June 6, 2006

House Rural Health Care Coalition urges CMS to reconsider new CAH relocation restrictions

Sixty members of the House Rural Health Care Coalition urged the Centers for Medicare & Medicaid Services Friday to reconsider interpretative guidelines issued last year that make it more difficult for Critical Access Hospitals to maintain their CAH designation if they choose to relocate. In a letter to CMS Administrator Mark McClellan, the representatives urged CMS to reconsider the overly restrictive requirements, especially for hospitals moving only a short distance, and establish reasonable criteria to ensure that the hospitals can continue to serve patients in their service area. They note that many CAHs are more than 40 years old and well past their useful service life. These facilities no longer meet modern health care code and service requirements and the hospital structure is often not suitable for major remodeling to correct the deficiencies, they said. Relocation proves to be the most appropriate and sometimes the only alternative.

Physician election period extended for Medicare Part B Drug CAP 2006
June 6, 2006

On June 1, 2006, CMS announced an extension to the physician election period for the Medicare Part B Drug Competitive Acquisition Program (CAP). The CAP is a voluntary program that offers physicians an option to acquire many drugs they use in their practice from approved CAP vendors. Rather than purchasing these drugs from distributors and being reimbursed by Medicare, the physician would order the drug from an approved vendor and administer it to the beneficiary, but the vendor would be responsible for billing Medicare for the drug and collecting the coinsurance from the beneficiary.

The CAP physician election period's extension will begin on June 3, 2006 and continue through June 30, 2006. Physicians must return their completed election forms to their local carrier by mail. Physicians whose completed physician election forms are postmarked on or after June 3, but no later than June 30, 2006, will begin participation in the CAP starting on August 1, 2006.

Initial CAP implementation is still scheduled for July 1, 2006. Physicians whose completed CAP election forms are postmarked on or before June 2, 2006 will begin participation in the CAP starting on July 1, 2006.

Please see the Medicare Part B Drug CAP Websites Information for Physicians page (http://www.cms.hhs.gov/CompetitiveAcquisforBios/02_infophys.asp#TopOfPage) for additional information about CAP physician election. The physician election form may be downloaded from this page. Completed forms must be returned by mail to the physician's local carrier.

Please note that participation in the CAP is voluntary and that no action is required from physicians who do not wish to participate.

CMS anticipates holding another Ask the Contractor call for physicians before the conclusion of the extended physician election period. We will post details on the CAP Information for Physicians page

(http://www.cms.hhs.gov/CompetitiveAcquisforBios/02_infophys.asp#TopOfPage ) as they become available.

Important Medicare Hospital Information
June 6, 2006

MEDICARE POSTS HOSPITAL PAYMENT INFORMATION Important Step Toward Transparency in Health Care Costs and Quality to help consumers, providers, and payers make more informed health care decisions, the Department of Health and Human Services through its Centers for Medicare & Medicaid Services (CMS) today posted information on what Medicare pays for 30 common elective procedures and other hospital admissions. President Bush directed the data be made publicly available to all Americans as part of the Administration's commitment to make health care more affordable and accessible. The new information posted by CMS at http://www.cms.hhs.gov/HealthCareConInit/01_Overview.asp#TopOfPage shows the range of payments by county and the number of cases treated at each hospital for a variety of treatments provided to seniors and people with disabilities in fiscal year 2005. These include 30 common elective procedures including heart operations and implanting cardiac defibrillators, hip and knee replacements, kidney and urinary tract operations, gallbladder operations and back and neck operations, and for common non-surgical admissions. Please click the following link to read more from the HHS Press Release http://www.hhs.gov/news/press/2006pres/20060601a.html Click on the CMS Fact Sheet at a http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1872

Also, you can read more helpful information on the CMS webpage for Health Care Consumer Initiatives located at http://www.cms.hhs.gov/HealthCareConInit/01_Overview.asp#TopOfPage

Stakeholder Meetings for PA Tobacco Strategic Plan Announced
June 2, 2006
Dear Steering Committee, The dates for Stakeholder Meetings have now been set:

Philadelphia: Wednesday, June 7
Pittsburgh: Thursday, June 15
Harrisburg: Tuesday, June 20
I hope you all will be able to attend at least one. Please let us know your plans as soon as you can.

Please also distribute the attached announcement to individuals and organizations working to prevent and control tobacco use in Pennsylvania. The Temple Institute for Public Affairs website (www.temple.edu/ipa) now includes links to a page devoted to strategic planning process, which includes this announcement, a brief agenda for the stakeholder meetings, directions to the meetings, and the pre- registration form we ask all who plan to attend a meeting to complete. The page also links to tobacco control plans in other states and other Pennsylvania plans that address tobacco control.

We ask that you let us know, via e-mail to patobaccoplan@temple.edu, about the lists of individuals and organizations to which you relay the invitation to the meetings, so that we can estimate the numbers of people likely to attend each meeting and ensure that all the various stakeholder communities are represented.

We will be distributing more materials for your review prior to the meetings just as soon as they are available.

Thank you very much for your time and energy in helping to guide the Commonwealth's efforts to prevent and control tobacco use.

Welcome to RURAL REALITIES
June 2, 2006

It is with great pleasure that we share with you the inaugural issue of Rural Realities, a quarterly publication sponsored by the Rural Sociological Society. The primary intent of Rural Realities is to offer a social sciences lens to the host of critical issues impacting rural people and places in the U.S. and beyond. The aim, however, is to share insights on key issues through the use of sound, social sciences-based research. In other words, Rural Realities is not intended to advocate, but rather serve as a vehicle for sharing quality information on policy options in a format that can prove most useful to policymakers/policy analysts, to foundations, nonprofit organizations, and to others who have an interest in rural issues.

This first issue addresses the problem of poverty in rural America, making note of the set of options that might offer hope in tackling this difficult issue. Leif Jensen, a researcher who has studied and written scores of articles on this issue, is the author of this important piece. Jensen is a member of the Penn State University faculty.

We have some exciting articles on the horizon. These include:

• A demographic assessment of how nonmetro areas of the South were impacted by Hurricane Katrina – an analysis that finally brings to light the fact that devastation associated with this natural disaster was not only confined to the large metropolitan areas of Louisiana, Mississippi and Alabama.
• An innovative piece that explores the role that “Community Emergency Response Teams” (CERTs) can play, not only as first responders in times of disasters, but also as a strong voice of the citizenry that could be mobilized to help tackle the variety of important community development needs existing in their localities.
• The current trends regarding the state of methamphetamine production and use in rural America, and the options that might be considered to address this critical problem in rural communities across the U.S.

Our Board of Editors, comprised of representatives from academia, foundations, government agencies, nonprofit organizations, etc. are constantly on the search for sound social sciences research that can offer insight on current and emerging issues in rural America and across the world. If you have any recommendations for topics, or would like to submit an abstract for consideration for Rural Realities, please feel free to contact me by email.

Look forward to hearing from you!!

Sincerely,

Bo Beaulieu, Editor, Rural Realities

ljb@srdc.msstate.edu

click for publication here

HRSA New Cultural Competence Web Page
June 2, 2006

Dear Colleagues:

I am pleased to unveil HRSA's new Web page on cultural competence (www.hrsa.gov/culturalcompetence). This user-friendly site highlights approximately 40 HRSA-supported projects on the critical subject of cross-cultural health care. HRSA has provided exceptional leadership in helping health care providers enhance their clinical and organizational skills in cultural competence. As a result, the quality of cultural and linguistically appropriate services that HRSA provides to its diverse constituents has vastly improved.

This page is special for several reasons:

• It serves as a one-stop-shop for health care providers wishing to learn about HRSA's progress in improving culturally competent health care.
• It profiles the diverse approaches taken by HRSA-funded activities and programs in areas such as assessment, culture and language, specific diseases, health professions, research, special populations, technical assistance, training, and web-based learning.
• HRSA's Office of Minority Health and Health Disparities (OMHHD) developed the page with important input from the HRSA Cultural Competence Committee. This Committee consists of representatives from HRSA bureaus and offices that help ensure that HRSA programs integrate cultural competence into health services and health professions education.

I applaud the collaborative effort that produced this excellent resource, hope you will utilize it often, and share it with your grantees and colleagues. If you need assistance, please contact Leonard G. Epstein, M.S.W., Senior Advisor, Clinical Quality & Culture, OMHHD at 301-594-3803 or lepstein@hrsa.gov.

HRSA is committed to a health care system that provides the highest quality health services for our Nation's increasingly diverse patients.

William A. Robinson, MD, MPH, Director, Office of Minority Health and Health Disparities, Chief Medical Officer

NRHA Urges "Close Eye" on Changes to Medicaid in Rural Areas
June 2, 2006

(Alexandria, VA) - A new issue brief released by the Rural Policy Research Institute (RUPRI) highlights the importance of Medicaid to the rural health care safety net. The National Rural Health Association, a non-profit association that has been advocating for rural health issues for nearly 30 years, has long been aware that rural areas experience higher rates of poverty, fewer employer insurance programs and proportionately larger elderly populations. This issue brief provides new evidence underscoring the point that rural areas have a higher level of dependence on Medicaid funding. It serves as a stark reminder that rural communities must closely monitor any changes to Medicaid because of the critical role Medicaid plays in ensuring access to care. This is of utmost importance as states consider new options available to them under the Deficit Reduction Act, which the President signed into law on February 8, 2006.

The RUPRI issue brief, "Medicaid and Its Importance to Rural Health" can be viewed on-line at www.rupri.org in the updates section. In short, the RUPRI issue brief reports the following:

• Individuals in rural communities are more likely to rely on Medicaid for their health coverage than their urban counterparts, with 14.2 percent of rural residents enrolled in Medicaid as compared to only 11.2 percent of urban residents. The reasons for this higher enrollment are numerous: rural communities have higher rates of disability, a higher proportion of elderly residents, higher poverty levels, and lower availability of employer-sponsored insurance.
• Physicians in rural communities are more affected by Medicaid payments where it counts for 20 percent of their revenue base, as compared to urban doctors where Medicaid is only 15 percent of their revenues.
• Medicaid plays an important role in rural economic development because its funding helps to keep health professionals in the community and contributes to the economy through the revenue and jobs it generates.

"Given the overall demographics of rural America, the importance of Medicaid payments cannot be overstated. In many areas there are fewer physicians treating higher numbers of the uninsured, poverty stricken and the elderly, and often Medicaid payments make the difference in having access to local healthcare or not," said Bill Sexton, president of the National Rural Health Association. "We need to continue to keep a close eye on Medicaid changes in order to make sure that there are no adverse effects on the health coverage currently in place for rural Americans."

The NRHA calls on its members, state and local government officials and other concerned citizens to closely monitor changes to the Medicaid program in order to ensure that it continues to serve as an important source of health coverage in rural areas.

"We are working closely with a coalition of safety net providers to raise awareness about the importance of Medicaid, and NRHA recently convened a policy meeting with advocates and experts in rural health and Medicaid as the kick-off to our new Medicaid issue group," said Alan Morgan, NRHA CEO. "Preserving and improving Medicaid for rural communities will continue to be a top priority for NRHA."

The NRHA is a national nonprofit organization, with approximately 10,000 members that provides leadership on rural health issues. The Association's mission is to improve the health and well-being of rural Americans and to provide leadership on rural health issues through advocacy, communications, education, and research. The NRHA membership is made up of a diverse collection of individuals and organizations, all of whom share the common bond of an interest in rural health.

Chronic Disease Management Systems (Registries) in Rural Health Care
June 2, 2006

A new policy brief is available from the RUPRI Center for Rural Health Policy Analysis:

Chronic Disease Management Systems (Registries) in Rural Health Care

This brief discusses the different types of chronic disease management systems (registries) used by a sample of 14 state organizations and 19 local rural clinics in 6 states, with a focus on the management of diabetes.

Please click on the following link to download this document:

http://www.rupri.org/ruralPolicy/publications/PB2006-1.pdf

Brothers Walk Tall on the Farm Despite Genetic Bone Disorder
June 2, 2006

(Chambersburg) Imagine spending your entire life growing no taller than the average 8-year-old. Combine this challenge with a lifelong dream to farm, and you may have some idea what it’s like for brothers Tim and Colby Lehman.

The Lehmans, ages 17 and 19 respectively, are the sons of Lester and Tina Lehman who operate a dairy farm outside of Chambersburg, PA. Both young men reached their full heights of 48”and 46” as the result of a genetic bone disorder called Dyggve-Melchoir-Clausen Syndrome.

“We began to suspect there was a problem when Colby’s growth slowed around 18 months,” explains Tina Lehman. “He was 2-years-old before he was diagnosed, and by that time I was expecting again. Tim was just a 1 year old when doctors confirmed that he was affected by the syndrome as well.”

Throughout Colby and Tim’s childhood, Mr. & Mrs. Lehman pondered about the lifetime care and productivity of the boys. Prior to 2003, the family rented a dairy farm. Because of this, the boys had limited involvement, but had hopes of being fully involved in the day-to-day farm operation at some time. In June 2003, Lester and Tina were able to fulfill their dream of purchasing their own 119 acre dairy. Immediately, Colby and Tim began to take a more active role in farm chores. Milking quickly became a favorite job that required creativity in participation.

“My brother and I used stools to reach the cows in our Double-Ten Parallel Pit Parlor,” explains Colby. “It was necessary to climb on and off the stool for each task at each cow. Even though we don’t have too much pain in our hips, knees and other joints now, the doctors worry about arthritis and other problems in the future which are common with our condition.”

Tim adds, “Milking is my favorite job on the farm. I really enjoy working in the parlor with my Dad and brother. Now that we have the glide, it’s even more fun, plus it’s much easier and a lot less painful.”

Tim is referring to the automatic glide, or trolley, created and installed by Life Essentials. There is a trolley located along the floor of each side of the pit parlor. Equipped with controls for forward and backward motion, as well as storage areas for teat dip, towels, and other essentials, the young men are now able to move along the parlor with ease. They experience reduced strain on their joints, and take a greater responsibility with the milking. In addition to the trolley system, automatic take-offs for the milkers, as well as, power operated steps with a handrail into the pit parlor, were installed in the milking area.

“We are so grateful to AgrAbility for Pennsylvanians’ involvement in helping us identify equipment and modifications that make a huge difference for the boys,” says Tina Lehman. “And the Office for Vocational Rehabilitation has been supportive by helping us acquire the necessary equipment through their grant resources.”

AgrAbility for Pennsylvanians helps farmers and farm family members who are coping with many different kinds of physical challenges, including arthritis, stroke, knee and back problems, amputations, vision and hearing disabilities, and many others. The project is funded by the United States Department of Agriculture and is a partnership of Penn State Cooperative Extension, Easter Seals Central Pennsylvania, and the PA Assistive Technology Foundation.

In addition to their farm chores of milking, taking care of calves, and cleaning the barn with the skid steer, Colby and Tim also enjoy hunting, fishing, and swimming. Both boys also enjoy helping their Dad in the shop, whether it be on farm equipment or small engines.

“We really feel that the more involved the boys can be, the more it raises their self-esteem,” notes Lester Lehman. “We wanted to provide a career opportunity for them so that as they mature, they will have a place to use their time and talents. We feel truly blessed to have this farm, and blessed to watch our sons become men.”

For more information about AgrAbility for Pennsylvanians, or to find out how AgrAbility can help you or someone you know, telephone toll free in PA to 1-866-238-4434. The project may also be found on the web at http://AgExtEd.cas.psu.edu/agrab/.

New Tool to Aid State Flex Programs
June 2, 2006

Creating Program Logic Models: A Toolkit for State Flex Programs

A logic modeling toolkit recently developed by the Flex Monitoring Team is now available for use by state Medicare Rural Hospital Flexibility Programs (Flex Programs) in planning for and managing their Flex programs.

The use of the Program Logic Model (PLM) Toolkit will provide states with a tool to assist in:

Planning, managing, reporting on, and assessing their Flex Program goals, activities, and accomplishments; Developing buy-in among key Flex Program stakeholders; Clarifying the underlying program assumptions; Identifying and defining measurable outcomes; Linking state-level Flex Program strategies and activities to specific and measurable outcomes; and Reporting program results to both internal and external stakeholders.

The PLM Toolkit is organized according to the steps in the PLM development process and guides the user through each section. Included in the Toolkit is an overview of PLMs, their component parts, and the application of the PLM framework to the planning, implementation, and evaluation of the Flex Program. The bulk of the Toolkit provides a step-by-step approach to developing a Program Logic Model. The final section of the Toolkit lists resources for additional information on PLMs.

For more information or to provide feedback on the PLM Toolkit,

please contact John Gale at 207-228-8246 or jgale@usm.maine.edu

To view or download the PLM Toolkit, visit the Flex Monitoring website at:

http://flexmonitoring.org/documents/PLMToolkit.pdf

New Briefing Paper from the Flex Monitoring Team in collaboration with the Technical Assistance and Services Center examines Health Information Technology Use in Critical Access Hospitals
June 2, 2006

The Current Status of Health Information Technology Use in Critical Access Hospitals

This briefing paper examines the use of Health Information Technology (HIT) in Critical Access Hospitals (CAHs), based on a national survey of 333 CAHs. The survey found that CAHs have relatively high use rates for many administrative and financial HIT applications, but much lower use rates for a number of clinical applications. These results indicate that adoption of HIT is a priority for CAHs and suggest that Medicare cost-based reimbursement has permitted many CAHs to make some initial investments in HIT infrastructure. However, CAH use rates for several technologies are lower than the overall rates for hospitals reported by the American Hospital Association and others. To realize HITs potential for improving access to care and the quality of care in rural areas as envisioned by the Institute of Medicine and the National Advisory Committee on Rural Health and Human Services, continued public and private efforts are essential. These efforts need to focus on increasing the use of HIT clinical applications in CAHs and increasing interconnectivity of CAHs and other health care providers.

The authors of this report are Michelle Casey, Jill Klingner, Walt Gregg, and Ira Moscovice of the University of Minnesota Rural Health Research Center; and Emily Nicholson, Tami Lichtenberg, and Terry Hill of the Technical Assistance and Services Center.

The full report may be viewed or downloaded from the Flex Monitoring Team website at:

http://flexmonitoring.org/documents/BriefingPaper11_HIT.pdf

To request a hard copy of this report, please contact Michelle Casey at

mcasey@umn.edu or 612-626-6252

Safety-net centers call for health IT help
June 1, 2006

The National Association of Community Health Centers is calling on Congress to subsidize the cost of installing and using e-medical records at health clinics that serve uninsured, low-income and homeless patients.

At a briefing on Capitol Hill last week, association leaders released early findings of a national survey showing that although 18 percent of physicians with private office practices use e-medical records (EMRs), only 8 percent of federally funded health centers do so.

Even before the briefing, the health centers had found a supporter in the departing national health IT coordinator. Dr. David Brailer told reporters during a press conference after announcing his resignation from the federal government that so-called safety net health providers might need some extra help if they are to meet President Bush’s goal of EMRs for most Americans.

In an interview with Government Health IT, Brailer said that although he believes most of the health care industry will invest in health IT eventually, about 15 percent of doctors, particularly in rural areas and poorer neighborhoods, won’t be able to acquire systems on their own. They lack both capital and technical resources, he said.

“We can’t get 85 percent of the way and stop there,” Brailer said. “We have to take it as a national obligation to make sure that this is not a technology that haves have and have-nots don’t.”

The association’s survey found that capital shortages, the need to integrate an EMR system with existing billing or claims systems, and transition costs were the chief obstacles to the adoption of EMRs at the clinics and health centers. Sixty percent have plans to install EMR systems, according to an association fact sheet.

The health centers “run the risk of ending up on the wrong side of health care’s digital divide,” Dan Hawkins, policy director for the association, said in a statement.

Congressional refusal to provide extra help for clinical information technology “could well doom health centers and other safety-net providers to a permanent second-class status within our already flawed health care system,” Hawkins said. “…Congress has a real opportunity to assist them.”

Kevin Kearns, chief executive officer of the Health Choice network of health centers, said he often hears that those who pay for health care – mostly insurance companies, employers, government agencies and patients – should pay for technology. But more than half the 400,000 patients at his organization’s centers lack insurance, he said, so there is no payer to foot the bill for EMRs.

“Where does that leave us?” Kearns asked. He said patients such as those at Health Choice centers can benefit the most from health IT.

Dr. Neal Calman, president of the Institute for Urban Family Health in New York City, said the institute spent about $30 per patient for its EMR system and has found that it greatly improves patients’ health. It also will reduce costs in the long run, he said.

Rural AIDS/STDs Fact Sheets
June 1, 2006
RCAP has developed two new fact sheets. Fact sheet #18, "Rural Methamphetamine Use and HIV/STD Risk," was prepared by Susan Dreisbach, RCAP co-director. Fact sheet #17, "Older Adults and HIV/AIDS," was prepared by April Winningham, University of Arkansas at Little Rock.

PDF copies of both fact sheets are avaiable on the RCAP website ( www.indiana.edu/~aids). Click on the "fact sheet" tab on the first page to go to the listing of all RCAP fact sheets.

Copies of the printed fact sheets are avaliable free upon request to RCAP (aids@indiana.edu). We can provide multiple copies within reason.

HSRA Grants
June 1, 2006

HRSA Awards Over $38 Million to Promote and Improve Safety-Net Services

HHS’ Health Resources and Services Administration recently announced the award of over $38 million to primary care associations and offices across the nation to improve and expand health care services offered by America’s safety-net providers and to increase local residents’ access to them.

“PCAs and PCOs play an important role in helping to extend quality medical care to individuals across the nation,” said HHS Secretary Mike Leavitt. “These organizations help their local communities assess health care needs and obtain health center funding.” HRSA is an HHS agency that oversees the nation’s health center program.

Over $28.5 million was awarded to 50 state and regional Primary Care Associations (PCAs), which are private, non-profit organizations whose members represent HRSA-supported health centers and other safety-net providers. PCAs' core activities include providing training and technical assistance to health centers and other safety-net providers, planning for the growth of health centers in their state, and enhancing the quality of care provided by health centers.

More than $9.8 million went to 53 state and territory Primary Care Offices (PCOs), state and territorial government offices that work to meet the needs of the medically underserved. PCOs' core activities include assessing the need for health care and for primary care providers in their state; applying to have parts of the state designated as health professional shortage areas; and recruiting and retaining providers to work in underserved areas.

Along with these core activities, PCAs and PCOs also use the funds to reach out to residents with information about their eligibility for low- or no-cost health care at health centers and other safety-net facilities.

Creating new or expanding health centers in underserved communities is a key component of the Bush Administration’s strategy for increasing access to health care for uninsured and underinsured populations in America. Health centers deliver preventive and primary care to patients regardless of their ability to pay. Typically, 40 percent of the patients treated at health centers have no insurance coverage, and others have inadequate coverage. Charges for health care services are set according to income.

For more information, visit the web site of HRSA’s Division of State and Community Assistance. Lists of FY 2006 grant recipients are attached below: (click for full article)

USDA Rural Development (RD) Toolkit
June 1, 2006
USDA Rural Development (RD) is committed to helping faith and community organizations learn about and access programs that can enhance their capacity to serve their community. RD's new toolkit offers a one-stop shop for organizations interested in applying for RD programs and includes supplemental resources, legal guidance for faith and community groups, and contact information for the Faith-Based and Community Initiative Office and liaisons at USDA.

To use the new toolkit, click on: http://www.rurdev.usda.gov/rd/fbci/fbci_toolkit.html

RUPRI - The Price of Rural Health Care
May 10, 2006
As Thomas Jefferson once said, "The price of freedom is eternal vigilance." So, apparently, is the price of rural health care.

In a depressing but not surprising rerun of last year's budgetary drama, President Bush has once again cut programs that provide health care to millions of rural Americans-this time by 83 percent. Among the programs on the chopping block are those that help hospitals, clinics and other providers work together to reach underserved people and provide higher quality care to all.

I say "drama," because last year it took an eleventh-hour effort by a handful of House members to restore (albeit only partially) funds for rural health. Indeed, the move by six Republicans, against the party line, halted the multi-billion dollar appropriations bill for the Departments of Health and Human Services and of Labor -all in the name of preserving rural health. One Washington insider described the bold feat as "pretty freaking amazing."

The question now is how much drama we'll have this year? Will Congress stand up early for rural Americans? Will it once again wait until the last minute and rely on a brave few? Or will it allow the cuts to go through and rural Americans to suffer?

The Senate has already voted in its budget resolution to fully fund all rural health programs. The plotline in the House isn't so straightforward. Though not yet passed, the House budget resolution toes the President's hard fiscal line. What really counts, however, are the spending bills that will come later this year (appropriations subcommittees start work this week). That's when we'll know whether and by how much funding that ensures that rural Americans have access to affordable, quality health care will be cut or restored.

The other big question in all of this is why? Why the cuts to rural health care? Cuts that go way beyond the across-the-board belt tightening we've come to expect in order to pay for two wars and big tax breaks. Cuts that last year brought howls of protest from the rural health crowd, something my Washington insider described as "rural finally playing hardball." Why would Congress and the White House again risk such chastening? In an election year no less?

The administration's stated rationale is that increases to Medicare back in 2003 more than make up for the cuts. But according to National Rural Health Association CEO Alan Morgan, that's apples and oranges. The Medicare increases, he says, reimburse providers to ensure that existing care continues to be available in rural areas. The programs being cut now are about increasing the reach and improving the quality of care.

"That basic concept," he told me, "is not catching hold with this administration."

On top of that-and the faulty logic of equating unequal things aside-many of the Medicare increases are set to expire soon. How will they help then?

In cutting other programs, the Administration has cited poor performance as measured by the Office of Management and Budget's Program Assessment and Rating Tool, PART for short. The problem here is that the rural health programs are, in fact, judged to be performing adequately.

So, not only do we have drama, we also have mystery.

Fortunately, the story's ending is not yet written. Rural advocates can-as last year--influence the outcome. Doing so, however, will require staying abreast of developments as bills move through Congress and letting the story's legislative authors know what we think and want. As with freedom, the price of programs we believe in, is vigilance.

This and previous columns can be found at http://www.rupri.org/editorial

NRHA Urges "Close Eye" on Changes to Medicaid in Rural Areas
May 10, 2006
(Alexandria, VA) - A new issue brief released by the Rural Policy Research Institute (RUPRI) highlights the importance of Medicaid to the rural health care safety net. The National Rural Health Association, a non-profit association that has been advocating for rural health issues for nearly 30 years, has long been aware that rural areas experience higher rates of poverty, fewer employer insurance programs and proportionately larger elderly populations. This issue brief provides new evidence underscoring the point that rural areas have a higher level of dependence on Medicaid funding. It serves as a stark reminder that rural communities must closely monitor any changes to Medicaid because of the critical role Medicaid plays in ensuring access to care. This is of utmost importance as states consider new options available to them under the Deficit Reduction Act, which the President signed into law on February 8, 2006.

The RUPRI issue brief, "Medicaid and Its Importance to Rural Health" can be viewed on-line at www.rupri.org in the updates section. In short, the RUPRI issue brief reports the following:

• Individuals in rural communities are more likely to rely on Medicaid for their health coverage than their urban counterparts, with 14.2 percent of rural residents enrolled in Medicaid as compared to only 11.2 percent of urban residents. The reasons for this higher enrollment are numerous: rural communities have higher rates of disability, a higher proportion of elderly residents, higher poverty levels, and lower availability of employer-sponsored insurance.
• Physicians in rural communities rely more heavily on Medicaid to keep their doors open, with Medicaid counting for 20 percent of their revenue base, as compared to urban doctors where Medicaid is only 15 percent of their revenues.
• Medicaid plays an important role in rural economic development because its funding helps to keep health professionals in the community and contributes to the economy through the revenue and jobs it generates.

"Given the overall demographics of rural America, the importance of Medicaid payments cannot be overstated. In many areas there are fewer physicians treating higher numbers of the uninsured, poverty stricken and the elderly, and often Medicaid payments make the difference in having access to local healthcare or not," said Bill Sexton, president of the National Rural Health Association. "We need to continue to keep a close eye on Medicaid changes in order to make sure that there are no adverse effects on the health coverage currently in place for rural Americans."

The NRHA calls on its members, state and local government officials and other concerned citizens to closely monitor changes to the Medicaid program in order to ensure that it continues to serve as an important source of health coverage in rural areas.

"We are working closely with a coalition of safety net providers to raise awareness about the importance of Medicaid, and NRHA recently convened a policy meeting with advocates and experts in rural health and Medicaid as the kick-off to our new Medicaid issue group," said Alan Morgan, NRHA CEO. "Preserving and improving Medicaid for rural communities will continue to be a top priority for NRHA."

The NRHA is a national nonprofit organization, with approximately 10,000 members that provides leadership on rural health issues. The Association's mission is to improve the health and well-being of rural Americans and to provide leadership on rural health issues through advocacy, communications, education, and research. The NRHA membership is made up of a diverse collection of individuals and organizations, all of whom share the common bond of an interest in rural health.

NRHA e-News; Vol. 7; No. 6
May 10, 2006
Visit the NRHA website for the newest volume of e-news: http://www.NRHArural.org

New AHA Quality Center
May 10, 2006
The new AHA Quality Center will guide CEOs who are looking for answers to questions about quality, safety and affordability.

While most hospital board members are not clinically trained, as consumers they understand the notion of "value for the money." The calls for publicly reported data, greater transparency and increased accountability are all tied to "value"--to patients, communities and payers. As a result, trustees are well aware that they must support initiatives regarding quality of care, patient safety and affordability of services. Click here for full story. http://www.hhnmag.com/hhnmag/jsp/articledisplay.jsp?dcrpath=HHNMAG/PubsNewsArticle/data/2006May/060509HHN_Online_Mayfield&domain=HHNMAG

New MedPAC Appointees
May 10, 2006
Download the .pdf document: www.gao.gov/medpac/medpac06.pdf

New from the RUPRI Center: "Medicare Part D: Early Findings on Enrollment and Choices for Rural Beneficiaries"
May 10, 2006
Medicare Part D: Early Findings on Enrollment and Choices for Rural Beneficiaries This policy brief gives a first snapshot of Medicare Part D enrollment in rural and urban areas across the United States and outlines the early findings from an analysis of plans available to rural persons under Medicare's Part D program. The data in this brief will be updated as new data are available from the Centers for Medicare & Medicaid Services.

Please click on the following link to download this document: http://www.rupri.org/ruralPolicy/publications/Medicare%20Part%20D%20brief.pdf

New from the RUPRI Rural Health Panel: "Medicaid and Its Importance to Rural Health"
May 10, 2006
Download the .pdf document: http://www.rupri.org/ruralPolicy/publications/IssueBrief.pdf

HRSA Awards Over $38 Million to Promote and Improve Safety-Net Services
May 7, 2006
HHS' Health Resources and Services Administration recently announced the award of over $38 million to primary care associations and offices across the nation to improve and expand health care services offered by America's safety-net providers and to increase local residents' access to them.

"PCAs and PCOs play an important role in helping to extend quality medical care to individuals across the nation," said HHS Secretary Mike Leavitt. "These organizations help their local communities assess health care needs and obtain health center funding." HRSA is an HHS agency that oversees the nation's health center program.

Over $28.5 million was awarded to 50 state and regional Primary Care Associations (PCAs), which are private, non-profit organizations whose members represent HRSA-supported health centers and other safety-net providers. PCAs' core activities include providing training and technical assistance to health centers and other safety-net providers, planning for the growth of health centers in their state, and enhancing the quality of care provided by health centers.

More than $9.8 million went to 53 state and territory Primary Care Offices (PCOs), state and territorial government offices that work to meet the needs of the medically underserved. PCOs' core activities include assessing the need for health care and for primary care providers in their state; applying to have parts of the state designated as health professional shortage areas; and recruiting and retaining providers to work in underserved areas.

Along with these core activities, PCAs and PCOs also use the funds to reach out to residents with information about their eligibility for low- or no-cost health care at health centers and other safety-net facilities.

Creating new or expanding health centers in underserved communities is a key component of the Bush Administration's strategy for increasing access to health care for uninsured and underinsured populations in America.

Health centers deliver preventive and primary care to patients regardless of their ability to pay. Typically, 40 percent of the patients treated at health centers have no insurance coverage, and others have inadequate coverage. Charges for health care services are set according to income.

For more information, visit the web site of HRSA's Division of State and Community Assistance http://bphc.hrsa.gov/osnp/pcapco.htm

America's Health Rankings
May 7, 2006
On behalf of United Health Foundation, the American Public Health Association, and Partnership for Prevention(tm), we are pleased to present the 2005 edition of America's Health Rankings(tm): A Call to Action for People and Their Communities. Improving the health of the American people is critical to our society and, therefore, this comprehensive annual assessment of the relative healthiness of our nation is important to our organizations. It is our hope that this report will be translated into meaningful actions by individuals, families, communities, government officials and elected representatives. We urge our audience to carefully examine the relevant data in this year's rankings and use it to drive solutions that promote health and prevent disease.

State Rankings at: http://www.unitedhealthfoundation.org/shr2005/Findings.html#Table4

Rural, Low Income Mothers
May 7, 2006
A fact sheet from Rural Families Speak Project lends further support to maintaining physical, oral and mental health of rural mothers in order to prevent further poverty. The three-page Fact Sheet "Health: Essential to Rural, Low-Income Mothers' Economic Well Being" is available at: http://fsos.che.umn.edu/img/assets/16501/March_Health_FactSheet.pdf

Impact of Welfare Reform on Health Insurance Coverage in Rural Areas
May 7, 2006
A new RUPRI report "The Impact of Welfare Reform on Health Insurance Coverage in Rural Areas" shows that while welfare reform has been hailed for decreasing dependence on welfare and for moving former welfare recipients into jobs, less attention has been paid to the quality of those jobs and whether those jobs come with health insurance, and especially whether there is a difference between urban and rural conditions. This eight-page report is available at: http://www.rupri.org/healthpolicy/Pubs/PB2005-6.pdf

Governor Rendell Announces New Web Site for Children's Health Insurance Program
May 7, 2006
PITTSBURGH – At the direction of Governor Edward G. Rendell, Pennsylvania today launched an interactive Web site designed to help parents quickly learn whether their children qualify for free, or low-cost, medical insurance coverage under the state’s groundbreaking Children’s Health Insurance Program, or CHIP.

“Our new CHIP Web site a great new tool to help parents learn about the benefits of CHIP and help them determine in a matter of minutes whether or not their children are eligible for coverage,” Governor Rendell said. “This new outreach tool is an important part of my ongoing effort to ensure that all Pennsylvania children have access to health insurance coverage.

“Healthy children are happy children who pay better attention in school, get better grades and are more productive at work after graduation.”

CHIP is the state’s nationally-recognized program that provides free, or low-cost, health insurance to children under 19 whose families earn too much money to qualify for Medicaid, but not enough to purchase private health insurance. In April, CHIP reported its highest enrollment ever at 140,260.

Deputy Insurance Commissioner George Hoover unveiled the new Web site at Carnegie Library of Pittsburgh’s Main Branch in conjunction with a national awareness campaign called “Cover the Uninsured Week.” The Internet address is http://www.chipcoverspakids.com/.

“Libraries have a rich tradition as being a great resource of information in a fun and inviting atmosphere,” Hoover said. “So what better place to unveil our new Web site than in a place that not only offers free online access, but whose sole purpose is to inform and educate parents and children?”

In his budget address earlier this year, Governor Rendell introduced a new initiative to expand CHIP. Called “Cover All Kids,” the initiative would guarantee affordable, comprehensive health care coverage and make sure all of Pennsylvania’s children are insured and getting the services they need to grow up healthy.

Under CHIP, children of families earning up to 200 percent of the federal income poverty guidelines – or $40,000 gross income for a family of four – may be eligible for free health insurance. Low-cost insurance is available for children of families earning up to 235 percent of the federal poverty guidelines, or $47,000 gross income for a family of four.

Children enrolled in CHIP are eligible for numerous benefits, including prescription drugs; routine checkups; immunizations; diagnostic testing; emergency care; dental, vision and hearing services; mental-health benefits; inpatient hospitalization up to 90 days per year; durable medical equipment, such as wheelchairs and walkers; rehabilitation therapy (speech, occupational, physical and respiratory); drug- and alcohol-abuse treatment; hearing aids; home health care, such as nursing services and post-operative care; and partial hospitalization for mental-health services.

Families are encouraged to log onto the CHIP Web site at http://www.chipcoverspakids.com or call the toll-free helpline at 1-800-986-KIDS to get more information about benefits and to find out if their children qualify for free, or low-cost, health insurance. All calls and inquiries are confidential.