- Rural Hospitals Built During Baby Boom Now Face Baby Bust
- Food Stamps Go Further in Rural Areas — Until You Add Transportation Costs
- CMS Announces Resources and Flexibilities to Assist with the Public Health Emergency in the State of Texas
- CMS Proposes New Payments for Digital Health Under CY2025 PFS Draft Rule
- Improving Public Health by Strengthening Community Infrastructure
- Biden Harris Administration Proposes Policies to Reduce Maternal Mortality, Advance Health Equity, and Support Underserved Communities
- Nearly Half of U.S. Counties Don't Have a Single Cardiologist
- Randolph County, Ill. Turns Unused Part of Nursing Home Into State-Of-The-Art Behavioral Health Center
- Rural RPM Program Is a Lifeline for Pregnant Women
- Safe and Stable Housing Is a Foundation of Successful Recovery
- Expert: Rural Hospitals Are Particularly Vulnerable to Increasing Cyberattacks Targeting Healthcare Facilities
- Biden-Harris Administration Invests Over $200 Million to Help Primary Care Doctors, Nurses, and Other Health Care Providers Improve Care for Older Adults
- AJPH Call for Papers Special Section on Intersections of Public Health And Primary Care
- NIH HEAL Initiative Turns Attention to Pragmatic Trials in Rural Communities
- Limited Continuing-Care Options in Rural Virginia Create Challenges for an Aging Population
Rural Hospitals Built During Baby Boom Now Face Baby Bust
OSKALOOSA, Iowa — Rural regions like the one surrounding this southern Iowa town used to have a lot more babies, and many more places to give birth to them.
At least 41 Iowa hospitals have shuttered their labor and delivery units since 2000. Those facilities, representing about a third of all Iowa hospitals, are located mostly in rural areas where birth numbers have plummeted. In some Iowa counties, annual numbers of births have fallen by three-quarters since the height of the baby boom in the 1950s and ’60s, when many rural hospitals were built or expanded, state and federal records show.
Similar trends are playing out nationwide, as hospitals struggle to maintain staff and facilities to safely handle dwindling numbers of births. More than half of rural U.S. hospitals now lack the service.
“People just aren’t having as many kids,” said Addie Comegys, who lives in southern Iowa and has regularly traveled 45 minutes each way for prenatal checkups at Oskaloosa’s hospital this summer. Her mother had six children, starting in the 1980s, when big families didn’t seem so rare.
“Now, if you have three kids, people are like, ‘Oh my gosh, are you ever going to stop?’” said Comegys, 29, who is expecting her second child in late August.
These days, many Americans choose to have small families or no children at all. Modern birth control methods help make such decisions stick. The trend is amplified in small towns when young adults move away, taking any childbearing potential with them.
Hospital leaders who close obstetrics units often cite declining birth numbers, along with staffing challenges and financial losses. The closures can be a particular challenge for pregnant women who lack the reliable transportation and flexible schedules needed to travel long distances for prenatal care and birthing services.
Maternal Mortality Rates Released, State by State
KFF has released a new analysis outlining maternal mortality rates for every state and Washington, D.C.
KFF used 2018-22 data from the CDC’s National Center for Health Statistics to compile maternal deaths and mortality rates. Maternal deaths are defined as deaths of women while pregnant or within 42 days of pregnancy termination. Only causes of death from or aggravated by pregnancy are included.
Nationwide, 4,295 maternal deaths were reported between 2018 and 2022, resulting in a maternal mortality rate of 23.2 deaths per 100,000 live births. The U.S. has the highest maternal mortality rate of any developed nation, according to The Commonwealth Fund.
To address this issue, CMS has proposed adding obstetrical standards for hospitals as part of its conditions of participation requirements. Hospitals and physicians have pushed back on the suggestion, arguing the approach is too punitive and could inadvertently hinder access to obstetrical care.
Below is a breakdown of maternal mortality rates by state.
Note: KFF expressed caution at making comparisons between states, as data for many states are based on small numbers and could be statistically unreliable. The organization suppressed data for several states, if mortality rates were based on fewer than 20 deaths. Variation in state rates is likely due to differences in the quality of maternal mortality data, KFF said.
Tennessee
Maternal mortality rate: 41.1
Number of deaths: 166
Mississippi
Maternal mortality rate: 39.1
Number of deaths: 70
Alabama
Maternal mortality rate: 38.6
Number of deaths: 112
Arkansas
Maternal mortality rate: 38.3
Number of deaths: 69
Louisiana
Maternal mortality rate: 37.3
Number of deaths: 108
Kentucky
Maternal mortality rate: 34.6
Number of deaths: 91
Virginia
Maternal mortality rate: 32.7
Number of deaths: 158
South Carolina
Maternal mortality rate: 32.3
Number of deaths: 92
Georgia
Maternal mortality rate: 32.1
Number of deaths: 201
Indiana
Maternal mortality rate: 30.9
Number of deaths: 124
Arizona
Maternal mortality rate: 30
Number of deaths: 118
Oklahoma
Maternal mortality rate: 29.6
Number of deaths: 72
Texas
Maternal mortality rate: 28.2
Number of deaths: 532
New Mexico
Maternal mortality rate: 28
Number of deaths: 31
North Carolina
Maternal mortality rate: 26.7
Number of deaths: 159
New Jersey
Maternal mortality rate: 26
Number of deaths: 131
Nebraska
Maternal mortality rate: 25.1
Number of deaths: 31
Ohio
Maternal mortality rate: 24.5
Number of deaths: 161
Florida
Maternal mortality rate: 24.1
Number of deaths: 263
West Virginia
Maternal mortality rate: 23.9
Number of deaths: 21
Missouri
Maternal mortality rate: 23.8
Number of deaths: 84
Kansas
Maternal mortality rate: 22.8
Number of deaths: 40
New York
Maternal mortality rate: 22.4
Number of deaths: 241
Maryland
Maternal mortality rate: 21.3
Number of deaths: 74
Nevada
Maternal mortality rate: 20.4
Number of deaths: 35
Idaho
Maternal mortality rate: 20
Number of deaths: 22
Iowa
Maternal mortality rate: 19.5
Number of deaths: 36
Michigan
Maternal mortality rate: 19.1
Number of deaths: 101
Illinois
Maternal mortality rate: 18.1
Number of deaths: 123
Washington
Maternal mortality rate: 18
Number of deaths: 76
Pennsylvania
Maternal mortality rate: 17.5
Number of deaths: 116
Oregon
Maternal mortality rate: 16.6
Number of deaths: 34
Massachusetts
Maternal mortality rate: 16.4
Number of deaths: 56
Colorado
Maternal mortality rate: 16
Number of deaths: 50
Connecticut
Maternal mortality rate: 15.6
Number of deaths: 27
Utah
Maternal mortality rate: 15.5
Number of deaths: 36
Wisconsin
Maternal mortality rate: 13.2
Number of deaths: 41
Minnesota
Maternal mortality rate: 12.3
Number of deaths: 40
California
Maternal mortality rate: 10.5
Number of deaths: 228
Alaska
Maternal mortality rate: Data suppressed
Number of deaths: 12
Delaware
Maternal mortality rate: Data suppressed
Number of deaths: 9
District of Columbia
Maternal mortality rate: Data suppressed
Number of deaths: 12
Hawaii
Maternal mortality rate: Data suppressed
Number of deaths: 13
Maine
Maternal mortality rate: Data suppressed
Number of deaths: 7
Montana
Maternal mortality rate: Data suppressed
Number of deaths: 17
New Hampshire
Maternal mortality rate: Data suppressed
Number of deaths: 11
North Dakota
Maternal mortality rate: Data suppressed
Number of deaths: 11
Rhode Island
Maternal mortality rate: Data suppressed
Number of deaths: 9
South Dakota
Maternal mortality rate: Data suppressed
Number of deaths: 16
Vermont
Maternal mortality rate: Data suppressed
Number of deaths: 1
Wyoming
Maternal mortality rate: Data suppressed
Number of deaths: 7
Pennsylvania Fluoride Study Featured in Journal of the American Dental Association
A Pennsylvania-based study will be featured in the upcoming August issue of the Journal of the American Dental Association (JADA). “Cross-sectional study of association between caries and fluoridated water among third-grade students in Pennsylvania,” authored by Pennsylvania Department of Health Oral Health Program epidemiologist Dr. Jun Yang, also features PCOH Executive Director Helen Hawkey as a co-author. The study found that community water fluoridation was significantly associated with a reduced risk of developing caries among Pennsylvania children.
Oral Health and Nicotine/Tobacco Updates Available
The Association of State and Territorial Dental Directors (ASTDD) Dental Public Health Policy Committee announced a new policy statement on preventing tobacco/oral nicotine use to promote oral health. The statement provides information on the impacts to oral and overall health as well as guidance identifying effective strategies in prevention.
Click here to read the statement.
The World Health Organization (WHO) released the first-ever “Clinical Treatment Guidelines for Tobacco Cessation in Adults.” The guidelines include a set of cessation interventions for adults seeking to quit all kinds of tobacco products. These guidelines are designed to help communities and governments provide the best possible support for adults trying to quit tobacco products.
Free Clinic Association Rebrands as Pennsylvania Charitable Healthcare Coalition; Launches GiveCare Now
GiveCare Now, a statewide call for volunteer talent, including medical & dental professionals
Launching a statewide call for volunteer talent and medical professionals, the Free Clinic Association of Pennsylvania today announced a rebrand, as the organization is relaunched as the Pennsylvania Charitable Healthcare Coalition.
The organization represents charitable healthcare providers across Pennsylvania that fill a critical role, providing high-quality, free care for people who are under-insured or uninsured and lack access to care.
“Today, we’ve announced a rebrand that captures the essence of our life-changing work and launched a statewide call for volunteers to help us meet the growing needs of our communities,” said executive director Kristen Houser Rapp. “With more than 50 providers operating in the Commonwealth, free and charitable clinics deliver hope to people across Pennsylvania who lack access to healthcare. Without them, thousands of people would not have access to any type of care at all.”
Charitable healthcare providers are integral to keeping Pennsylvanians who do not qualify for Medicaid healthy, and help avoid medical debt from urgent care, emergency visits, and medications, as families move between health plans or lack other options. While some clinics employ limited staff, the majority of clinical care is provided by volunteer talent.
“Right now, and in the weeks and months to come, opportunities are available for volunteers to help provide care and give back to others,” said Rapp. Anyone interested in volunteering should visit pacharitablehealth.org/volunteer, where PCHC can then connect them with a local clinic. PCHC is currently seeking volunteers that include:
- Doctors
- Nurses
- Pharmacists
- Dentists, dental assistants, & dental hygienists
- Mental health professionals
- Volunteers with administrative skills
Volunteer opportunities vary from clinic to clinic and by position. All volunteers meet strict credentialing and background checks and receive training and support.
“I find that the best part of my day is always that I served in the clinic,” said Ridge Salter, M.D., a volunteer at Katallasso Family Health Center in York. “Volunteering my expertise has added so much professional fulfillment, and I know it has been an antidote — and a bit of an immunization — to burnout.”
In 2023 alone, PCHC member clinics provided at least 114,000 appointments for patients, averaging more than 3,000 per clinic.
“In the last year, hundreds of thousands of people in our state have lost their Medicaid coverage,” said Mary Herbert, MPH, MS, Clinical Director at The Program for Health Care to Underserved Populations/Birmingham Free Clinic in Pittsburgh. “Despite their lack of state funding, free providers face the need to accommodate a major shift in the number of patients we serve, doing more than ever with limited resources.”
“PCHC’s member clinics and charitable providers fill a growing gap that many of our most vulnerable neighbors rely on for basic care, and volunteers are critical to this work,” said Highmark Foundation President Yvonne Cook. “The Highmark Foundation recognizes the vital work of charitable clinics and is proud to continue our partnership with PCHC through a $172,700 grant to further its mission to provide equitable, quality health care for all Pennsylvanians.”
ABOUT THE PENNSYLVANIA CHARITABLE HEALTHCARE COALITION (PCHC)
PCHC is the support and advocacy organization for free and charitable healthcare providers who make up the healthcare safety net for uninsured and underinsured Pennsylvanians. Free and charitable clinics provide primary and preventative care such as medical screenings, chronic disease management, medication assistance, dental care and connections to other social services. Clinics do not receive state or federal funding and rely on community support. For information, testimonials from volunteers, and a searchable database of clinic locations, go to www.pacharitablehealth.org.
Courts Become the New Health Policy Arena
From Axios
If courts weren’t already exerting outsized influence over health policy, they’re much closer to being final arbiters now that the Supreme Court has scrapped the decades-old doctrine that gave the Food and Drug Administration, Centers for Medicare and Medicaid Services and other health agencies the power to interpret vague or ill-defined laws.
Why it matters: Judges could get the final say on Medicare payment rates, drug and device regulation and even what constitutes a public health emergency.
The big picture: We’ve already seen courts shape the rules of the road on matters like access to abortion pills, surprise billing disputes and how certain hospitals access discounted drugs.
National Telecommunications and Information Administration Digital Equity Competitive Grant Program Announced
The PA Broadband Development Authority (PBDA) would like to remind you the National Telecommunications and Information Administration (NTIA) will be releasing the Notice of Funding Opportunity (NOFO) for the Digital Equity Competitive Grant Program. This program will be facilitated through the NTIA, the PBDA will not be responsible for receiving, reviewing, nor determining allocations for this program.
The Digital Equity Competitive Grant Program’s goal is to fund initiatives that will ensure communities across the Nation have the access and skills to fully participate in the digital world. This program is intended to compliment those digital equity activities that will be funded by the Digital Equity Capacity Grant Program, which the PBDA has applied and is awaiting approval for. The Digital Equity Competitive Grant Program provides $1.25 billion Nationwide and NTIA anticipates releasing the NOFO by end of July.
The NTIA has a number of resources available on their website to include a “Get Ready” one-pager as well as an opportunity to sign-up for updates from the NTIA regarding this program. PBDA encourages you to visit the NTIA website and review these resources.
Three Perspectives on Leveraging State Level Measures of Anchor Institution Impacts
Can the economic impact of anchor institutions across the state help in attracting global companies? Assist in developing plans for growing small businesses and creating jobs in underserved communities? Or uncover new ideas for potential partnerships with local hospitals and universities?
Higher education institutions and hospitals, so-called “eds and meds,” are two types of anchor institutions that researchers at the Philadelphia Fed are studying to learn more about how these public-serving institutions impact their local and state economies. This includes developing an interactive dashboard that allows users to explore the economic impacts of anchor institutions across 524 U.S. regions and state profiles that detail the economic impacts of anchor institutions state-level measures of anchor institution economic impacts.
Deborah Diamond, director of the Philadelphia Fed’s Anchor Economy Initiative, shares insights from three experts who are using data on the economic impact of anchor institutions to start conversations, support greater collaboration, and drive economic growth in their regions and states.
New Hospital Price Transparency Rule Goes Into Effect
From Becker’s Legal & Regulatory Issues
The new CMS price transparency rule went into effect July 1, requiring hospitals to report price information in a standard machine-readable format, according to the American Hospital Association.
The agency finalized changes to the hospital price transparency requirements as part of the 2024 Hospital Outpatient Prospective Payment System and ASC rule. CMS hopes the new file format requirements will make it easier for the public to learn about hospital charges.
Hospitals must include the price transparency information as a single file intended to be read by machines to process standard charge information. Hospitals are required to conform to a standard CMS template layout with data specifications and data dictionary.
The final rule also mandates hospitals put a “footer” at the bottom of their homepage linking to the webpage with the machine readable file, and ensure a .txt file is included in the root folder of the website, according to a CMS information page.
“The .txt file must identify the URL for both the MRF and the webpage that contains the link to the MRF. CMS believes these requirements will improve the automated accessibility of hospital standard charges information and streamline CMS enforcement of the requirements,” CMS wrote.
CMS will warn hospitals not in compliance and require them to submit an acknowledgement of receipt for any warning notices. The agency is also able to communicate directly with health system leadership about an issue and will publish enforcement activities in addition to civil monetary penalties as part of the final rule.
Read more from the fact sheet here.
ACA Rule Strengthens Nondiscrimination Protections for Consumers
The U.S. Department of Health and Human Services (HHS) Office for Civil Rights and the Centers for Medicare & Medicaid Services (CMS) recently issued a final rule under Section 1557 of the Affordable Care Act to strengthen nondiscrimination protections and advance civil rights in health care. This rule offers protections against discrimination based on race, color, national origin, sex, age, and disability. This rule also reduces language access barriers, expands physical and digital accessibility, tackles bias in health technology, and much more.
Among other provisions, the 1557 final rule:
- Holds HHS health programs and activities to the same nondiscrimination standards as recipients of Federal financial assistance.
- Requires covered health care providers, insurers, grantees, and others to let people know that language assistance and accessibility services are available to patients at no cost.
- Clarifies that covered health programs and activities offered via telehealth must also be accessible to individuals with limited English proficiency and individuals with disabilities.
- Protects patients from discriminatory health insurance benefit designs made by insurers.
- Clarifies that nondiscrimination in health programs and activities continues to apply to the use of AI, clinical algorithms, predictive analytics, and other tools.
For more information about this new rule and how it may affect consumers, visit the resources below:
- Fact sheet and FAQ
- Press release
- Final rule in the Federal Register