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 Fall 2014 Magazine

We are pleased to present our Fall 2014 Magazinefor your review.

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

Swimming Pool Pesticide Applicators Training Program registration now open!

Swimming Pool Pesticide Applicator training

Community Health Worker Summit : The Role of Community Health Workers in Strengthening Health Status registration now open!

May 5, 2015 Penn Stater Conference Center Hotel
Register here

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

CMS initiative helps people make the most of their new health coverage

“From Coverage to Care” outreach to engage doctors and new patients

On June 16, 2014, the Centers for Medicare & Medicaid Services (CMS) launched a national initiative “From Coverage to Care” (C2C), which is designed to help answer questions that people may have about their new health coverage, to help them make the most of their new benefits, including taking full advantage of primary care and preventive services. It also seeks to give health care providers the tools they need to promote patient engagement. For more information, follow this link.

A Guide to Understanding the Variation in Premiums in Rural Health Insurance Marketplaces

Provides a framework for assessing variations in the premiums of plans offered in the Health Insurance Marketplaces (HIMs) across geography. Comparisons of premiums must include adjustments for several factors: plan type (metal level), enrollee age and family status, overall cost of living in the area, and the design of marketplace rating areas (state policy choices). What might appear to be differences showing plans in rural places to be more or less expensive than in urban places could shrink or even reverse after appropriate adjustments.

Contact Information:

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

Profile of Rural Residential Care Facilities: A Chartbook

As federal and state policymakers consider their most cost-effective options for strengthening rural long-term services and supports (LTSS), more information is needed about the current system of care. Using data from the 2010 National Survey of Residential Care Facilities, this chartbook presents information on a slice of the rural LTSS continuum—the rural residential care facility (RCF). Survey results identify important national and regional differences between rural and urban RCFs, focusing on the facility, resident and service characteristics of RCFs and their ability to meet the LTSS needs of residents. Rural RCFs are more likely to have private pay patients compared to urban facilities and their residents have fewer disabilities as measured by their functional assistance needs. Compared to urban facilities, the policies of rural RCFs appear less likely to support aging-in-place.

Contact Information:

Jennifer Lenardson, MHS
Maine Rural Health Research Center
Phone: 207.228.8399
jlenardson@usm.maine.edu

Implications of Rurality and Psychiatric Status for Diabetic Preventive Care Use among Adults with Diabetes

Examines patterns of diabetic preventive care use among adults with diabetes to determine whether these patterns varied according to respondents’ rural/urban residence or psychiatric status (i.e. the presence/absence of a mental health diagnosis).

Key findings include:

  • Rural residents with diabetes are generally less likely than their urban peers to use diabetic preventive services.
  • Rural residents with diabetes and mental health diagnoses used some preventive services at about the same rates as urban people with diabetes, and at higher rates than rural diabetics without mental health diagnoses.
  • Although rural residents with diabetes and mental health diagnoses used preventive care about as often as other groups studied, they had more diabetes complications than their rural peers without mental health diagnoses.

Contact Information:

Jean Talbot, PhD, MPH
Maine Rural Health Research Center
jatalbot@usm.maine.edu

Health Insurance Coverage of Low-Income Rural Children Increases and is More Continuous Following CHIP Implementation

Prior to the passage of the Children’s Health Insurance Program (CHIP), about one in four low-income rural and urban children (family income below 200% of the federal poverty level) were uninsured in a given month. Using data from the Medical Expenditure Panel Survey, this study found that in the years following CHIP’s implementation health insurance coverage and continuity increased among low-income children—particularly for those living in rural areas. By CHIP’s maturity, coverage for rural children improved so much that their uninsured rate dropped below that of urban children (14% compared to 20%, respectively).

Among those with health insurance, rural children were more likely than their urban counterparts to lose coverage pre-CHIP, and were less likely to lose it after CHIP was in place for five or more years. Whether low-income rural adults will see similar gains in coverage continuity under the Affordable Care Act may depend on whether states choose to participate in Medicaid expansions and what outreach strategies they use to enroll rural populations.

Contact Information:


Erika Ziller, PhD
Maine Rural Health Research Center
Phone: 207.780.4615
eziller@usm.maine.edu

High Deductible Health Insurance Plans in Rural Areas

Enrollment in high deductible health plans (HDHPs) has increased amid concerns about growing health care costs to patients, employers, and insurers. Prior research indicates that rural individuals are more likely than their urban counterparts to face high out-of-pocket health care costs relative to income, despite coverage through private health insurance, a difference related both to the lower income of rural residents generally and to the quality of the private plans through which they have coverage. Using the 2007-2010 National Health Interview Survey, this study examines rural residents’ enrollment in HDHPs and the implications for evolving Affordable Care Act Health Insurance Marketplaces.

Rural residents with private insurance are more likely to have an HDHP than are urban, especially when they live in remote, rural areas. Among those covered by an HDHP, rural residents are more likely to have low incomes and more limited educational attainment than urban residents, suggesting that it will be important to monitor HDHP enrollment, plan affordability, and health plan literacy among plans available through the Health Insurance Marketplaces.

Contact Information:

Jennifer Lenardson, MHS
Maine Rural Health Research Center
Phone: 207.228.8399
jlenardson@usm.maine.edu

Nationwide Insurance creates professorship in College of Ag Sciences

UNIVERSITY PARK, Pa. -- Nationwide Insurance has given Penn State a $1 million gift to create and endow the Nationwide Insurance Professorship in the College of Agricultural Sciences. The gift was announced during an April 25 visit by Nationwide representatives to the University Park campus. Read more

Integrated Care Management in Rural Communities

With a focus on community-dwelling older adults in need of integrated physical, behavioral health services, and long term services and supports (LTSS), the authors of this study review the opportunities and challenges reform initiatives under the Affordable Care Act present for rural communities. We assessed four types of organizational models for delivering integrated care management. Each of these models has different strengths and drawbacks, weighing for and against implementation in rural areas.

Key Findings:

  • Introducing an integrated care model in a rural community requires an investment in building relationships with local providers and adapting to local culture and services.
  • Integrated care models that cannot adapt to the local delivery system are more likely to face resistance from local providers and those they serve and potentially duplicate or displace existing rural capacity.
  • Most models of integrated care management have an inherent bias toward larger organizations and infrastructure. Most are built on an investment in health information technology and other systems and capacities.
  • The potential success of any integrated care model is limited by gaps in the continuum of health care services and long term services and supports available in a rural community.
  • “Wraparound” integrated care models can fill gaps in existing care coordination capacity, offering a flexible approach that can adapt to a local rural delivery system.
  • An investment of public resources in shared supports can lower the cost of integrating care in rural delivery systems.


Contact Information:

Eileen Griffin, JD
Maine Rural Health Research Center
elieeng@usm.maine.edu

Pennsylvania Dept of Health Releases Cancer Control Plan

On April 28, the Division of Cancer Prevention and Control in the Pennsylvania Department of Health officially released the new 2013-2018 Pennsylvania Cancer Control Plan (Plan), following a formal presentation to the House of Representatives' Cancer Caucus. The Plan was developed by the Stakeholder Leadership Team cancer coalition and focuses on promoting good health and supporting healthy behavior and choices through broad-reaching PSE approaches to prevent and reduce the burden of cancer. Interested parties can now view the Plan on www.LiveHealthyPA.com and report their implementation strategies. Phase One of the LiveHealthyPA.com site is active for Plan review and reporting purposes only.

Paper Released - Extent of Telehealth Use in Rural and Urban Hospitals

Using the 2013 HIMSS Analytics database, we analyze the extent of use of telehealth (aka telemedicine) and find that 34.0% of rural hospitals and 32.0% of urban hospitals had at least one telehealth application currently in use. Rural and urban hospitals did not differ significantly in overall telehealth implementation rates, however rural and urban hospitals did differ in the department where telehealth was implemented. In particular, rural hospitals were more likely than urban hospitals to have implemented telehealth in radiology departments and in emergency/trauma care. In contrast, urban hospitals were more likely than rural hospitals to have implemented telehealth in cardiology/stroke/heart attack programs, neurology, and obstetrics/gynecology/NICU/pediatrics. Follow-up research will verify the differences in types of telehealth implemented and investigate the low reported utilization rates, which may result from confusion of survey respondents about what constitutes telehealth.