Pennsylvania Office of Rural Health (PORH)

Enhancing the Health Status of Rural Pennsylvanians

The Pennsylvania Office of Rural Health (PORH) works with local state and federal partners to achieve equity in, and access to, quality health care for Pennsylvania's rural residents. We strive to be the premier rural health leadership organization in the state and one of the most effective State Offices of Rural Health in the nation.

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PORH Announces Spring 2015 Magazine

We are pleased to present our Spring 2015 Magazine for your review.

Magazine Cover

For Information Contact:
Lisa Davis Director and Outreach Associate Professor of Health Policy and Administration Pennsylvania Office of Rural Health 202 Beecher-Dock House University Park, PA 16802

Rural Women Delivering Babies in Non-Local Hospitals: Differences by Rurality and Insurance Status

This policy brief describes the extent to which rural pregnant women give birth in non-local hospitals, and to analyze current patterns of non-local delivery by rural women's health insurance status and residential rurality.

Key Findings:

  • In nine geographically-diverse states with substantial rural populations, 25.4% of rural pregnant women delivered their babies in non-local hospitals in 2010 and 2012.
  • Rural women living in more densely populated rural areas were less likely to give birth in a non-local hospital (19.5%) than those in less densely populated rural areas, either next to a metropolitan area (35.9%) or not (33.7%).
  • Privately-insured rural women were more likely to give birth in non-local hospitals than rural women who were covered by Medicaid (28.6% vs. 22.5%).
  • Rural women with Medicaid coverage were more likely than privately-insured women to deliver their babies in a hospital where more than half of all births were covered by Medicaid (63.8% vs. 36.7%).

Contact Information:

Katy Kozhimannil, PhD
University of Minnesota Rural Health Research Center
kbk@umn.edu

Dentist Supply, Dental Care Utilization, and Oral Health Among Rural and Urban U.S. Residents

Do adults in rural locations report lower dental care utilization or higher prevalence of dental disease or both compared with their urban counterparts? This analysis of data from the Behavioral Risk Factor Surveillance System (BRFSS) shows that residents of non-metropolitan counties were significantly less likely than residents of metropolitan counties to report having a dental visit or teeth cleaning in the past year and significantly more likely to report undergoing tooth extraction. These findings persisted even when controlling for demographic factors, income, insurance and health and smoking status. Policies aimed at increasing the supply of generalist dentists who will choose to work in rural areas may reduce these substantial rural/urban disparities in access to oral health care and dental outcomes.

Contact Information:

Eric Larson, PhD
WWAMI Rural Health Research Center
Phone: 206.616.9601
ehlarson@u.washington.edu

Characteristics of Rural Accountable Care Organizations (ACOs) - A Survey of Medicare ACOs with Rural Presence

In this policy brief, we present the findings of a survey of 27 rural ACOs focusing on characteristics important to their formation and operation. We find that a majority of responding ACOs were formed from pre-existing integrated delivery systems and had physician and hospital participants with prior risk-sharing and quality-based payment experience. In addition, physician groups played a leading role in the formation and management of the ACOs.

Contact Information:
Keith J. Mueller, PhD
RUPRI Center for Rural Health Policy Analysis
Phone: 319.384.3832
keith-mueller@uiowa.edu

Health Insurance Marketplaces: Early Findings on Changes in Plan Availability and Premiums in Rural Places, 2014-2015

Analysis of nationwide county-level Health Insurance Marketplace plan and premium data for 2014 and 2015 provides evidence that many low-density rating areas are gaining firms and that average premium growth is low in many rural areas. However, premium growth is somewhat higher in low-density rating areas, and a small minority of rural states have experienced large average premium increases. Thus there is no systematic pattern to rural experiences of HIMs, although some isolated places may be at risk for weak outcomes.

Click to download a copy: Health Insurance Marketplaces: Early Findings on Changes in Plan Availability and Premiums in Rural Places, 2014-2015

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RUPRI Center for Rural Health Policy Analysis
University of Iowa
College of Public Health
Department of Health Management and Policy
145 Riverside Drive, N200 - CPHB
Iowa City, IA 52242
Phone: (319) 384-3831
Fax: (319) 384-4371
Web site: www.public-health.uiowa.edu/rupri

A Rural Taxonomy of Population and Health-Resource Characteristics

This policy brief reports the newly developed taxonomy of rural places based on relevant population and health-resource characteristics; and discusses how this classification tool can be utilized by policy makers and rural communities. Using the most current data from multiple sources, we applied the cluster analysis to classify 10 distinct types of rural places based on characteristics related to both demand (population) and supply (health resources) sides of the health services market. In descending order, the most significant dimension in our classification was facility resources, followed by provider resources, economic resources, and age distribution. Each type of rural places was distinct from other types of places based on one or two defining dimensions.

Contact Information:

Keith J. Mueller, PhD
RUPRI Center for Rural Health Policy Analysis
Phone: 319.384.3832
keith-mueller@uiowa.edu

Developmental Strategies and Challenges of Rural Accountable Care Organizations

This Policy Brief shares insights into initial strategic decisions and challenges of four Accountable Care Organizations (ACOs) with a rural presence, one from each census region (West, Midwest, Northeast, and South). Semi-structured on-site interviews were conducted with ACO leaders and key stakeholder group representatives (e.g., board members, physicians). The four ACOs were formed as a step toward a value-driven rural delivery system, recognizing that ACO participation may not have a short term return on investment. Common value-enhancing strategies included care management, post-acute care redesign, medication management, and end-of-life care planning. The four ACOs also emphasized the importance of access to data for population health management, care management, and provider participation. While several challenges need to be addressed, these insights can inform development of other rural ACOs.

Contact Information:

Keith J. Mueller, PhD
RUPRI Center for Rural Health Policy Analysis
Phone: 319.384.3832
keith-mueller@uiowa.edu

Developmental Strategies and Challenges of Rural Accountable Care Organizations

This Policy Brief shares insights into initial strategic decisions and challenges of four Accountable Care Organizations (ACOs) with a rural presence, one from each census region (West, Midwest, Northeast, and South). Semi-structured on-site interviews were conducted with ACO leaders and key stakeholder group representatives (e.g., board members, physicians). The four ACOs were formed as a step toward a value-driven rural delivery system, recognizing that ACO participation may not have a short term return on investment. Common value-enhancing strategies included care management, post-acute care redesign, medication management, and end-of-life care planning. The four ACOs also emphasized the importance of access to data for population health management, care management, and provider participation. While several challenges need to be addressed, these insights can inform development of other rural ACOs.

Click to download a copy: Developmental Strategies and Challenges of Rural Accountable Care Organizations


RUPRI Center for Rural Health Policy Analysis
University of Iowa
College of Public Health
Department of Health Management and Policy
145 Riverside Drive, N200 - CPHB
Iowa City, IA 52242
Phone: (319) 384-3831
Fax: (319) 384-4371
Web site: www.public-health.uiowa.edu/rupri

Rural Health Clinic Readiness for Patient-Centered Medical Home Recognition

The patient-centered medical home (PCMH) model both reaffirms traditional primary care values such as continuity of care, connection with an identified personal clinician, provision of same day- and after-hours access and also prepares providers to succeed in the evolving health care system by focusing on accountability, continuous quality improvement, public reporting of quality data, data exchange, and patient satisfaction. However, little is known about the readiness of the over 4,000 Rural Health Clinics (RHCs) to meet the PCMH Recognition standards established by the National Council for Quality Assurance (NCQA). This policy brief reports findings from a survey of RHCs that examined their capacity to meet the NCQA PCMH requirements, and discusses the implications of the findings for efforts to support RHC capacity development.

Key Findings

  • Based on their performance on the “must pass” elements and related key factors, Rural Health Clinics (RHCs) are likely to have difficulties gaining National Center for Quality Assurance’s (NCQA) Patient-Centered Medical Home (PCMH) Recognition.
  • RHCs perform best on standards related to recording demographic information and managing clinical activities, particularly for those using an electronic health record.
  • RHCs perform less well on improving access to and continuity of services, supporting patient self-management skills and shared decision-making, implementing continuous quality improvement systems, and building practice teams.
  • RHCs are likely to need substantial technical assistance targeting clinical and operational performance to gain NCQA PCMH Recognition.

Contact Information:

John A. Gale, MS
Maine Rural Health Research Center
Phone: 207.228.8246
jgale@usm.maine.edu

Surgical Services in Critical Access Hospitals, 2011

This brief describes the types and volume of major surgical services provided in Critical Access Hospitals (CAHs) across four regionally representatives states in 2011. Of the surgery volume performed in CAHs, on average 77% was performed on an outpatient basis and 23% inpatient. Operations on the musculoskeletal system, the eye, and the digestive system accounted for 67% of all surgical procedures performed in CAHs. Most reports of surgery volume in CAHs focus on inpatient procedures, thus missing a significant portion of the surgery volume that CAHs perform. CAHs offering outpatient procedures that complement inpatient surgical capacity are providing the communities they serve significant and valuable services through access to both convenient and emergent surgical care services that lessen many of the health care burdens associated with travel for surgery and follow-up care.

Contact Information:

Keith J. Mueller, PhD
RUPRI Center for Rural Health Policy Analysis
Phone: 319.384.3832
keith-mueller@uiowa.edu

Use and Performance Variations in U.S. Rural Emergency Departments: Implications for Improving Care Quality and Reducing Costs

The purpose of this brief is to describe the geographic variation in the use of EDs for non- emergent health conditions across rural and urban areas as well as by U.S. Census Regions. Potential risk factors including patients’ socioeconomic characteristics, geographic location and level of primary care resources are identified. Quality of care indicators, limited to wait times and the length of the visit for rural and urban EDs, are also addressed.

Contact Information:

Yvonne Jonk, PhD
North Dakota and NORC Rural Health Reform Policy Research Center
Phone: 701-777-0871
yvonne.jonk@med.und.edu

HRSA releases Rural Health Care Coordination Network Partnership Program

The Health Resources and Services Administration (HRSA), Federal Office of Rural Health Policy (FORHP) is pleased to announce the release of the Rural Health Care Coordination Network Partnership Program (Care Coordination Program), a new, one-time funding opportunity created as one of the activities of the White House Rural Council.

Key attributes of the Care Coordination program:

  • Partnership: This grant program, which encourages new public-private partnerships in rural, will allow communities to have more support as they develop and implement their program. In addition to this FORHP funding opportunity announcement, 11 foundations have expressed interest in considering providing additional funding for care coordination activities by applicants in this program who are in their service areas. To find out further information on this opportunity, please visit: http://www.hrsa.gov/ruralhealth/philanthropy/carecoordination/index.html
  • Focus on Care Coordination: The main goal of care coordination is to meet patients’ needs and preferences in the delivery of high-quality, high-value health care. Care coordination in the primary care practice involves deliberately organizing patient care activities and sharing information among all of the participants concerned with a patient’s care to achieve safer and more effective care.
  • Attention to Chronic Illnesses: Grantees of the Care Coordination Program will focus on activities related to one or more for the following chronic conditions: 1) Type 2 Diabetes; 2) Congestive heart failure (CHF); and 3) Chronic obstructive pulmonary disease (COPD). The prevalence of these chronic diseases is increasing across the U.S. and is particularly problematic in rural areas. Applicants shall develop creative and innovative approaches to improve outcomes in one or more of the three pre-specified disease states and will track a minimum set of process and outcome measures.
  • Building the Evidence-base: A priority for FORHP grant programs is the identification of rural evidence-based, which puts the focus on project outcomes and allows FORHP to showcase model programs through the Rural Community Health Gateway, located on The Rural Assistance Center (RAC) website (http://www.raconline.org/communityhealth/). The Rural Community Health Gateway includes a variety of resources, including success program models and evidence-based toolkits, which can provide guidance and ideas to communities planning on developing similar programs. The information gathered through the Care Coordination program will help populate the Gateway.

Funding availability:

Applicants can request up to $200,000/year for three years. To download an application for the Rural Health Care Coordination Network Partnership Program (HRSA-15-123) please visithttp://www.grants.gov/web/grants/view-opportunity.html?oppId=273226 The deadline to apply is April 6th, 2015.

Program contact:

The program contact is Sara Afayee (SAfayee@hrsa.gov or 301-945-4169).

Federal office of Rural Health Policy announces Rural Network Allied Health Training Program

In response to the White House Job-Driven Training initiative, the Federal Office of Rural Health Policy (FORHP) is pleased to announce the release of the Rural Network Allied Health Training Program (Allied Health Training), a new one-time funding opportunity.

The Allied Health Training Program supports the President’s Rural Health Care Initiative by focusing on rural recruitment and retention activities and builds upon the accomplishments of the Rural Health Workforce Development (RHWD) pilot program, which ended in 2013. As a result of the RHWD Program, approximately 4,000 program participants completed their rural training/rotation, and of these, almost half said they plan on returning to practice in a rural area and a number of them have. Moreover, there was a significant economic impact of $19 million within rural America from FORHP’s $12 million investment via the RHWD Program.

The Allied Health Training Program will support the development of formal, mature rural health networks that focus on activities that achieve efficiencies, expand access to, coordinate and improve the quality of essential health care services, and strengthen the rural health care system as a whole. This purpose will be achieved through the recruitment, clinical training, and retention of allied health professionals.

This program will further support integrated rural health networks that can partner with local community colleges and other accredited educational institutions (such as vocational and technical colleges) to develop formal clinical training programs. These formal training programs will target enrolled rural allied health professional students, to include displaced workers and veterans, in completing a rural, community-based clinical training rotation and obtaining eventual employment with a rural health care provider.

FORHP will hold a technical assistance webinar on Wednesday, February 11, 2015 at2:00 PM Eastern Standard Time to assist applicants in preparing their applications. The toll-free call-in number (for audio) is 800-857-9638, and the passcode is ALLIEDHEALTH. The Adobe Connect webinar URL is https://hrsa.connectsolutions.com/ruralalliedhealth/.

Muncy Valley Hospital Receives Award for Quality Improvement in Rural Health

University Park, Pa. - Muncy Valley Hospital, in Muncy, Pennsylvania, part of the Williamsport, Pennsylvania-based Susquehanna Health received the 2014 Louis A. Ditzel Award for Quality Improvement in Rural Health from the Pennsylvania Office of Rural Health (PORH) at a ceremony at the hospital on Jan. 7, 2015. The award was accepted by Ronald Reynolds, hospital president, and C. Cynthia Whipple, director of nursing. Read more at the following link: 2014_Louis_Ditzel_Quality_Award_Muncy_Valley_Hospital_1-20-15.doc

2014: Rural Medicare Advantage Enrollment Update

Rural Medicare Advantage (MA) and other prepaid plan enrollment in March 2014 was nearly 1.95 million, or 20.3 percent of all rural Medicare beneficiaries, an increase of more than 216,000 from March 2013. Enrollment increased to 1.99 million (20.4 percent) in October 2014. MA enrollment increased in both rural and urban areas despite reductions in payment and the conclusion of the MA bonus payment demonstration at the end of 2014.

Some rural counties were reclassified, due to a change in population, and nearly 10 percent of the previously rural MA population is now considered urban; however, the percentage of the rural Medicare beneficiaries enrolled in MA did not change significantly. The majority of growth in rural MA enrollment was in Preferred Provider Organization plans, with over 56 percent of enrollment, while nearly a third of beneficiaries were enrolled in Health Maintenance Organization plans.

Contact Information:


Keith J. Mueller, PhD
RUPRI Center for Rural Health Policy Analysis
Phone: 319.384.3832
keith-mueller@uiowa.edu

Rep. Glenn Thompson (R-PA5) Applauds PORH and the 2014 Pennsylvania Rural Health Award Recipients

http://www.c-span.org/video/?c4521567/rep-glenn-thompson-rural-health

New Flex Monitoring Team Policy Brief Examines CAHs' Receipt of EHR Incentives

This policy brief describes current Critical Access Hospital (CAH) participation in the Medicare and Medicaid Electronic Health Record (EHR) incentive programs and compares CAH participation by state.

Monitoring CAH progress in achieving Meaningful Use (MU) is not the role of the Flex Program and Flex Program funds cannot be used to help CAHs achieve MU; however, Flex Programs can share the information in this policy brief with other state stakeholders to increase awareness of the need to help CAHs achieve MU, since CAHs will be subject to Medicare payment reductions if they do not successfully demonstrate meaningful use by 2015. Particular attention should be focused on smaller CAHs that may be facing greater challenges in achieving MU than their larger counterparts

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National Rural EMS Conference: Building Integration & Leadership for the Future
Cheyenne, Wyoming | May 5-6, 2015
Click here for more information

USDA Seeks Applications for Grants to Help Finance Rural Broadband

HARRISBURG, Pa, Dec. 22, 2014 – USDA Rural Development State Director Thomas Williams announced today that USDA is soliciting applications for Fiscal Year (FY) 2015 Community Connect Program grants. The program provides grants to establish essential broadband services in rural communities where it is currently not available.

“Many rural communities in Pennsylvania do not have access to broadband,” said Williams. “USDA’s Community Connect Grant Program ensures that rural residents have the ability to run businesses, get the most from their education, and benefit from the infinite services that fast, reliable broadband provides.”

The minimum amount of grants awarded will be $100,000; the maximum is $3,000,000. The deadline for applications to be submitted is February 17, 2015.

Last year, USDA announced new rules to better target Community Connect grants to areas where they are needed the most. To view the rules, go to: http://www.gpo.gov/fdsys/pkg/FR-2013-05-03/pdf/2013-10502.pdf

Since its inception, the Community Connect program has funded 237 projects with investments of $149 million. For more information, see page 75120 of the December 17, 2014 Federal Register.

Advancing the Transition to a High Performance Rural Health System

Despite decades of policy efforts to stabilize rural health systems through a range of policies and funding programs, accelerating rural hospital closures combined with rapid changes in private and public payment strategies have created widespread concern that these solutions are inadequate for addressing current rural health challenges. This paper presents strategies and options that rural health providers may use in creating a pathway to a transformed, high performing rural health system, which are then categorized into four distinct approaches. We elaborate each approach, and discuss a related set of public policy implications that should be considered when following each strategy. We follow the discussion of policy implications with four demonstration ideas that reflect the essential elements of each strategic approach in achieving the aims of a high performing rural health system.

Please click on the following link to download a copy:

RUPRI Health Panel Paper

RUPRI Health Panel Brief

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RUPRI Center for Rural Health Policy Analysis
University of Iowa
College of Public Health
Department of Health Management and Policy
145 Riverside Drive, N200 - CPHB
Iowa City, IA 52242
Phone: (319) 384-3831
Fax: (319) 384-4371
Web site: www.public-health.uiowa.edu/rupri

Characteristics, Utilization Patterns, and Expenditures of Rural Dual Eligible Medicare Beneficiaries

Dual eligible beneficiaries are known to have a higher disease burden: a higher proportion of dual eligible beneficiaries are disabled, have three or more chronic conditions, report being in fair or poor health or report difficulties with activities of daily living. As a result, Medicare per capita expenditures for dual eligible beneficiaries are nearly double those for other Medicare beneficiaries. The Affordable Care Act (ACA) includes several provisions aimed at improving care and reducing costs of care for dual eligible beneficiaries, including the creation of the Federal Coordinated Health Care Office (FCHCO) and the Center for Medicare and Medicaid Innovation. Located within the Centers for Medicare and Medicaid Services, the FCHCO is tasked with monitoring and improving benefit coordination, expenditures, access, and outcomes of dual eligible beneficiaries. The Center for Medicare and Medicaid Innovation is charged with examining alternative models of care delivery, such as integration of services and joint financing models.

Given the pressing need to improve care while simultaneously reducing costs for dual eligible beneficiaries, it is important to ascertain how rural dual eligible beneficiaries may differ from their urban peers, and to examine potential differences associated with race/ethnicity and region of residence. We used a 5 percent sample of Medicare fee for service beneficiaries for 2009 to examine three related questions about the dual eligible population:

  • What was the 2009 distribution of dual eligible beneficiaries by rurality, race/ethnicity, and region?
  • What was the aggregate and median per capita Medicare spending for dual eligible beneficiaries, and did either differ by rurality, race/ethnicity, or region?
  • What were the characteristics of “high cost” (upper tenth percentile in Medicare expenditures) dual eligible beneficiaries, by rurality, race/ethnicity, or region?

Contact Information:

Kevin Bennett, PhD
South Carolina Rural Health Research Center
Phone: 803.251.6317
kevin.bennett@sc.edu

Rural-Urban Chartbook

In 2001, the Centers for Disease Control and Prevention (CDC) published Health, United States, 2001 With Urban and Rural Health Chartbook. The CDC Chartbook was widely used in directing rural health policy and programming and had not been updated since 2001. The Rural Health Reform Policy Research Center updated the 2001 report to examine the current trends and disparities in urban and rural health. The analyses were based on the most recent data available (2006-2011) from the National Vital Statistics System, Area Resource File (Health Resources and Services Administration), U.S. Census Bureau, National Health Interview Survey (National Center for Health Statistics), National Hospital Discharge Survey (National Center for Health Statistics), National Survey on Drug Use and Health (Substance Abuse and Mental Health Services Administration), and the Treatment Episode Data Set (Substance Abuse and Mental Health Services Administration). Output included aggregate data stratified by geographic region and urbanization level.

Findings suggest that rural residents fare worse than their urban counterparts on a number of measures, including rates for smoking, death from chronic obstructive pulmonary disease (COPD), and suicide. Overall, residents of rural areas have less access to physicians and dentists. While the nation’s health has generally improved over the past decade, urban/rural disparities in health status and access to care persist across a variety of measures, and have grown for some measures (e.g., COPD).

Contact Information:

Alana Knudson, PhD
North Dakota and NORC Rural Health Reform Policy Research Center
Phone: 301.634.9326
knudson-alana@norc.org

Rural Health Network Planning Program Funding Announcement

ORHP is pleased to announce the release of the Rural Health Network Development Planning Program (Network Planning). This is a one year community-driven program targeted to assist in the planning and development of an integrated health care network. Health care networks can be an effective strategy to address a broad range of challenges unique to rural communities by bringing together rural providers and other community organizations. For grantees, this funding provides an opportunity to implement new and innovative approaches to adapting to a changing health care environment that may serve as a model to other rural communities to better align and coordinate local health care services. Network planning activities that model evidence-based frameworks or models that work are encouraged. Previously funded projects include topics such as workforce, behavioral health, telehealth, care coordination, health information technology, and outreach and enrollment.

Historically, grantees have mastered the art of leveraging finances by using ORHP grants to catapult their sustained efforts; they have been able to combine federal funds with local and foundation dollars to support the continuation and development of healthcare services in rural areas. The previous cohort of Network Planning grantees secured over $1.1 M in additional funding to assist in sustaining their programs, demonstrating the importance of collaboration with other organizations in the community. Organizations have creatively sustained and expanded their programs to serve a different population and region, and have worked to ensure that the program is aligned with the current healthcare landscape. As ORHP continues to focus on showcasing outcomes, a priority area that has emerged is the identification of rural evidence-based models, and sharing that information more broadly so that communities have an accessible resource when implementing a similar program. This has led to the development of the Rural Community Health Gateway, located on The Rural Assistance Center (RAC):http://www.raconline.org/communityhealth/ and consists of a number of resources, including success program models and evidence-based toolkits, that may be helpful in the development of an Outreach application.

To learn more about applying for the FY15 Rural Health Network Development Planning Program (HRSA-15-036), please visit http://www.grants.gov/web/grants/search-grants.html?keywords=HRSA-15-036 (click on 'application package’ tab at the top to get the Instructions and Application). The deadline to apply is January 9, 2015, and the program contact is Amber Berrian, aberrian@hrsa.gov or 301-443-0845.

Rural Implications of the Blueprints for State-Based Health Insurance Marketplaces

Describes features of states’ blueprints to operate state-based insurance marketplaces that have particular relevance to rural areas. Presents different states’ approaches to service areas and rating areas, network adequacy requirements, rural consumer outreach, rural representation on the marketplace governing board, certification and oversight of Qualified Health Plans, and design of the Small Business Health Options Program.

Contact Information:

Keith J. Mueller, PhD
RUPRI Center for Rural Health Policy Analysis
Phone: 319.384.3832
keith-mueller@uiowa.edu

The Effect of Medicare Payment Policy Changes on Rural Primary Care Practice Revenue

This policy brief describes the impact of recent Medicare payment updates to the Geographic Practice Cost Indices (GPCIs) portion of the Medicare Physician Fee Schedule (MPFS) on rural primary care providers’ practice revenue from Medicare. Using rural primary care provider Medicare claims from 2009 linked to the 2013 MPFS relative value units (RVUs), the 2013 GPCIs for non-metropolitan localities, and the GPCI updates from the Pathway for SGR Reform Act of 2013, we developed a revenue model to derive estimates of Medicare-related average revenue in 2013 and change-in-average-revenue percentage due to the GPCI updates for 50 non-metropolitan localities. Holding the conversion factor (CF) and RVUs fixed, we found that changes to the GPCIs made between January 1, 2013 and March 31, 2014 resulted in an average 0.12% (median 0.18%) increase in Medicare-derived revenue to rural primary care practices. Without the GPCI work floor reinstatement, however, primary care practices in rural areas would have been disproportionately negatively impacted through lower Medicare-related revenues.

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RUPRI Center for Rural Health Policy Analysis
University of Iowa
College of Public Health
Department of Health Management and Policy
145 Riverside Drive, N200 - CPHB
Iowa City, IA 52242
Phone: (319) 384-3831
Fax: (319) 384-4371
Web site: www.public-health.uiowa.edu/rupri

The Effect of Medicare Payment Policy Changes on Rural Primary Care Practice Revenue

Describes the impact of recent Medicare payment updates to the Geographic Practice Cost Indices (GPCIs) portion of the Medicare Physician Fee Schedule (MPFS) on rural primary care providers’ practice revenue from Medicare. Using rural primary care provider Medicare claims from 2009 linked to the 2013 MPFS relative value units (RVUs), the 2013 GPCIs for non-metropolitan localities, and the GPCI updates from the Pathway for SGR Reform Act of 2013, we developed a revenue model to derive estimates of Medicare-related average revenue in 2013 and change-in-average-revenue percentage due to the GPCI updates for 50 non-metropolitan localities. Holding the conversion factor (CF) and RVUs fixed, we found that changes to the GPCIs made between January 1, 2013 and March 31, 2014 resulted in an average 0.12% (median 0.18%) increase in Medicare-derived revenue to rural primary care practices. Without the GPCI work floor reinstatement, however, primary care practices in rural areas would have been disproportionately negatively impacted through lower Medicare-related revenues.

Contact Information:

Keith J. Mueller, PhD
RUPRI Center for Rural Health Policy Analysis
Phone: 319.384.3832
keith-mueller@uiowa.edu

Home Health Care Agency Availability in Rural Counties

A range of medical services can be provided in the home setting, allowing patients to be discharged from hospital or inpatient rehabilitation settings more quickly. Medicare reimburses for six types of home health care: skilled nursing, physical therapy, occupational therapy, speech pathology, medical social work, and home health aide services. In November 2011, the Centers for Medicare and Medicaid Services modified Medicare reimbursement for home health care, seeking to control costs by reducing inflation-associated adjustments in charges. In the past, changes in reimbursement may have affected rural home health care agencies more adversely than those in urban areas. The purpose of the current report is to describe the status of home health care service delivery in the rural U.S. in 2008, before passage of the Patient Protection and Affordable Care Act and related efforts.

We used Medicare Compare Home Health Agency files for 2008 to examine two aspects of home health care (HHC) across the United States: HHC agency availability and quality of services provided. Home health agencies are required to report the geographic areas they serve by ZIP Code; they are also required to report quality results across a range of 12 outcomes. This report is based on agency reports; we did not independently verify that services were actually provided within all listed areas.

Contact Information:

Janice C. Probst, PhD
South Carolina Rural Health Research Center
Phone: 803.251.6317
jprobst@mailbox.sc.edu

HHS announces auto-enrollment plans for current Marketplace consumers for 2015

Today, the U.S. Department of Health and Human Services (HHS) expects to announce its plans for helping existing Marketplace consumers get auto-enrolled for next year. These plans would give existing consumers a simple way to remain in the same plan next year unless they want to shop for another plan and choose to make changes. Read the press release for more information.

2013 Pennsylvania State Health Assessment Released

The Bureau of Health Planning is pleased to announce the release of the 2013 Pennsylvania State Health Assessment. This comprehensive assessment provides a “one-stop” summary of information on health status, health risks and healthcare services in Pennsylvania. It will support the department’s and our partners’ work in developing priorities and policies, garnering resources and planning actions to improve the population’s health.

Nominations for the 2014 Rural Health Awards open

The Pennsylvania Office of Rural Health is pleased to announce the invitation of nominations for the 2014 Rural Health Awards!

The 2014 Rural Health Awards will be presented in the honoree's community during the week of National Rural Health Day, November 21, 2014. PORH will begin accepting award nominations on June 16. The deadline for submissions is August 29, 2014.

Nominations for the following categories will be accepted:

*State Rural Health Leader of the Year
*Community Rural Health Leader of the Year
*Rural Health Program of the Year
*Legislator of the Year
*Rural Health Hero of the Year

To nominate, pleasefill out the form


Which Medicare Patients Are Transferred from Rural Emergency Departments?

Note: this policy brief is a revised version of one originally released in March 2014.

Analyzes transfers of Medicare beneficiaries who received emergency care in a CAH or rural hospital and were transferred to another hospital for care. Key findings include the following:

  • Among Medicare beneficiaries who received same-day emergency care and inpatient care in 2010, the inpatient stay was in a different hospital for 28.4% of the Critical Access Hospital (CAH) emergency encounters, compared to 9.0% for rural non-CAHs, and 2.0% for urban hospitals.
  • The majority of transferred CAH and rural non-CAH emergency patients went to urban hospitals for inpatient care. By diagnosis, most transferred patients with intracranial injuries and cardiac-related diagnoses went to urban hospitals, while 35%-45% of patients with certain mental health diagnoses were transferred to other CAHs or rural non-CAHs.

Contact Information:


Michelle Casey, MS
University of Minnesota Rural Health Research Center
Phone: 612.623.8316
mcasey@umn.edu

Update: Independently Owned Pharmacy Closures in Rural America, 2003-2013

Pharmacists provide a range of health services and their loss can have serious implications for the provision of health care, especially in rural areas. Previous policy briefs from the RUPRI Center for Rural Health Policy Analysis have documented the decline in the number of independently owned pharmacies in rural area, especially between 2003 and 2010. This update shows that the number of independently owned rural pharmacies has, with some minor fluctuations, continued to slowly decline. In addition, the number of rural retail pharmacies (including independent, chain, or franchise) that were the only pharmacy in the community has remained relatively stable since 2010.

Contact Information:

Keith J. Mueller, PhD
RUPRI Center for Rural Health Policy Analysis
Phone: 319.384.3832
keith-mueller@uiowa.edu

Support for Rural Recruitment and Practice among U.S. Nurse Practitioner Education Programs

Describes nurse practitioner (NP) education programs across the United States to identify those actively promoting NP practice in rural areas; describes their use of education methods that may promote rural practice; and identifies barriers to recruiting rural students and providing rural NP clinical training. Programs reported that relocating or commuting to campus-based programs, limited rural training opportunities, and affordability were barriers for rural students.

Contact Information:

Susan M. Skillman, MS
WWAMI Rural Health Research Center
Phone: 206.543.3557
skillman@uw.edu