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.

Headlines

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.

Grant Writing Workshop

Registration is now open for the "Positioning Your Grant Seeking Process for Success: Effective Grant Writing Tools and Resources" workshop.

June 25, 2014 10:00 AM – 3:00 PM Pennsylvania Rural Electric Association 212 Locust Street, Harrisburg, PA

To register: http://www.cvent.com/d/94q2sk

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.

PORH Announces Annual Report & Spring 2014 Magazine

We are pleased to present our annual report and Spring 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

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.

Rural Health Value website launched

The Rural Health Systems Analysis and Technical Assistance (RHSATA) project – funded by the Office of Rural Health Policy – just launched its new website RuralHealthValue.org. The RHSATA vision is to help create high performance rural health systems by spreading innovation and providing specific tools and resources that help translate knowledge into local action. The website’s information, tools, and resources will address these questions (among others):

· As a local provider, how can I learn from, and adapt innovations succeeding elsewhere to my particular circumstances?

· What tools are available to help me educate others (including my board of trustees and potential partnering providers) about changes in payment and other policies that will require us to change how we approach organizing and delivering health care?

· How can I, as a nonprofit or government entity charged to help local communities and providers transition from a world based on volume to a world where value is the basis for payment and policy, facilitate and support winning strategies?

Widening Rural–Urban Disparities in Life Expectancy, U.S., 1969–2009

This study by HRSA’s Maternal and Child Health Bureau examines the trends in life expectancy disparities between rural and urban areas in the United States between 1969 and 2009. The article finds that the disparity has increased since 1990, because life expectancy has grown more rapidly in urban than in rural areas. The disparity in life expectancy of urban over rural areas stood at 2.4 years during 2005-2009. Furthermore, the study’s findings indicate that mortality from cardiovascular diseases, injuries, lung cancer, and COPD is much higher in rural than in urban areas.

\Where You Live Matters to Your Health

The County Health Rankings provide a health snapshot for nearly every county in all 50 states. See how well your county is doing on 29 factors that influence health, including smoking, high school graduation, employment, physical inactivity, access to healthy foods, and more.

Discharge to Swing Bed or Skilled Nursing Facility: Who Goes Where?

This Findings Brief examines health conditions of patients discharged from rural Prospective Payment System (PPS) hospitals and Critical Access Hospitals (CAHs) to swing beds and skilled nursing facilities (SNFs). Patients discharged to facility-based, post-acute care from CAHs are sent to SNFs and swing beds almost equally. Those discharged from rural PPS hospitals predominantly are sent to SNFs. This is the fourth and final brief in a series of studies to better understand swing bed utilization and cost.

Contact Information:
Victoria A. Freeman, RN, DrP
North Carolina Rural Health Research and Policy Analysis Center
Phone: 919-966-6168
victoria_freeman@unc.edu

2012 Rural Medicare Advantage Quality Ratings and Bonus Payments

The Patient Protection and Affordable Care Act of 2010 established bonus payments to reward Medicare Advantage (MA) plans with high quality ratings (4 stars or higher) beginning in 2012. In addition, the Centers for Medicare and Medicaid Services created a demonstration project that expanded the quality-based bonus payments to plans with lower quality ratings (3 stars or higher) from 2012 through 2014. This brief analyzes differences in quality and payment and suggests reasons why quality ratings vary by geography. Overall, the quality rating of MA plans in rural areas is lower than in urban areas, a result of the availability of, and enrollment in, different types of MA plans. This suggests that the focus on quality improvement for MA plans should be on the type of plan, not its location.

Contact Information:
Keith J. Mueller, PhD
RUPRI Center for Rural Health Policy Analysis
Phone: 319.384.3831
keith-mueller@uiowa.edu

Meaningful Use of Electronic Health Records by Rural Health Clinics

Little information is available on the rate of Electronic Health Record (EHR) adoption by Rural Health Clinics (RHCs). This study was conducted to identify the rates of EHR adoption among a national random sample of RHCs and the extent to which RHCs that have adopted an EHR are likely to achieve Stage 1 meaningful use. To achieve Stage 1 meaningful use and qualify for meaningful use incentive payments, eligible health professionals must, at a minimum, meet CMS defined criteria for the required 14 core measures. Fifty-nine percent of RHCs report having an EHR, and independent RHCs were more likely than hospital-based RHCs to have an EHR. Common barriers to EHR adoption by RCHs include acquisition and maintenance costs, lack of capital, and potential productivity or income loss during transition.

Contact information:
John A. Gale, MS
Maine Rural Health Research Center
Phone: 207-228-8246
jgale@usm.maine.edu

Second Biennial Pennsylvania Health Equity Conference SAVE THE DATE Aug. 21 & 22, 2014

“Engaging and Empowering YOU to Enhance Health Equity”

Aug. 21 and 22, 2014 - Capitol Region

Second biennial conference aimed towards increasing knowledge about health equity and sharing best practices to reduce health disparities that affect underserved and vulnerable populations in Pennsylvania. The focus at this year’s conference will be the impact of chronic diseases and its associated risk factors for diverse populations, particularly for immigrants/refugees, as well as the role that socioeconomic differences, race and ethnicity, sexual orientation, age, disabilities, etc., play in creating health disparities. It includes, but it is not limited to, cultural competence, language issues, health literacy, as well as the impact of the social determinants of health in achieving health equity.

WHEN: Aug. 21 and 22, 2014

WHERE: Radisson Convention Center, 1150 Camp Hill Bypass, Camp Hill, PA 17011

For more information please contact:
Dr. Hector R. Ortiz | Director Department of Health | Office of Health Equity Health and Welfare Building | Room 905 625 Forster Street | Harrisburg, PA 17120 Phone: 717.547.3315 Fax: 717.780.4827 hectoortiz@pa.gov | www.health.state.pa.us