- Senator Baldwin Introduces HSHS Act to Protect Communities from Hospital Closures
- What to Know about Smoke, Heat and Health
- Tribal Partnership With UW-Madison Combines Ag Research With Indigenous Food Knowledge
- The Rewards of Working as Rural Docs
- Request for Information (RFI): Evolving the Network of the National Library of Medicine
- Dental Therapists, Who Can Fill Cavities and Check Teeth, Get the OK in More States
- Colorectal Cancer Is Rising among Younger Adults. Some States Want to Boost Awareness.
- 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
Oral Health Equity Research Award Funding Opportunity Announced
The American Association for Dental, Oral, and Craniofacial Research and the Delta Dental Institute are now accepting applications for the second annual Oral Health Equity Research Award. This award supports research that advances recommendations for greater oral health equity in populations that lack access to dental care or improves oral health literacy for underserved populations. Submissions must represent original research that addresses social determinants of health and oral health disparities, and promotes oral health equity in the areas of access to care or oral health literacy. Two grants will be awarded at $25,000 each. Applications are due before October 17.
Pennsylvania Broadband Development Authority Approves Comprehensive Five-Year Action Plan To Expand Access Across the Commonwealth
After meeting with hundreds of Pennsylvania residents, businesses and industry partners, PBDA incorporates feedback and finalizes plan to expand broadband infrastructure using $1.16 billion in federal funding
Pennsylvania Broadband Development Authority (PBDA) Executive Director Brandon Carson announced the approval of the five-year action plan to expand internet access across the Commonwealth using $1.16 billion in funding through the federal Broadband Equity, Access, and Deployment (BEAD) Program. Governor Josh Shapiro recently announced the Commonwealth’s BEAD allocation as part of President Biden’s “Internet for All” initiative. Shaped by feedback from Pennsylvanians, the BEAD five-year action plan is now with the National Telecommunications and Information Administration (NTIA) for approval.
The PBDA’s findings encouraged collaboration across the Commonwealth through direct engagement with residents, businesses, and industry partners and the plan was developed with input from 21 community conversations across the state and more than 500 participants. Three roundtable sessions gathered feedback from digital equity stakeholders, workforce development professionals, and internet service providers. The Five-Year Action Plan also includes a survey that collected 5,920 responses in-person and online in several different languages and a public comment period that ran from July 26th through August 8th yielded 526 comments on the draft Action Plan. Together, this public feedback will allow the Commonwealth to drive out resources in an affordable and equitable way for all Pennsylvanians.
“Everyone in the Commonwealth should have access to affordable, high-speed internet,” said Executive Director Carson. “There are more than 276,000 Commonwealth households without internet access and over 52,000 without reliable access. The adoption of this plan puts us another step closer to making sure every Pennsylvanian has access to reliable, high-speed internet. Under the leadership of Governor Shapiro, we look forward to connecting communities across the Commonwealth.”
Since day one, Governor Shapiro has said extending and expanding access to broadband across the Commonwealth and making connections more reliable and affordable for Pennsylvanians is a top priority of his Administration. Just last month, Governor Shapiro announced that the Commonwealth will receive $1.16 billion in federal funding to extend broadband infrastructure to communities that currently lack reliable, affordable, high-speed internet access in order to connect Pennsylvanians and ensure they can go to school, start and grow businesses, and access telemedicine no matter where they live.
Following NTIA approval, the PBDA plans to begin awarding BEAD subgrants to approved, eligible applicants in 2024. The plan is a critical step toward achieving universal, affordable broadband access that meets and exceeds federally defined broadband speeds across the commonwealth.
The Five-Year Action Plan identifies expected obstacles to full deployment and discusses various implementation strategies. Additionally, it details how PBDA will work with a myriad of partners with the shared goals of improving digital access, generating equity, removing obstacles and barriers, acquiring digital skills and devices, fostering resilience, and enriching the benefits of connectivity.
The Broadband Equity, Access, and Deployment Program (BEAD) requires the Five-Year Action Plan be submitted to the National Telecommunications and Information Administration (NTIA) on August 12th for its approval. BEAD also requires a Digital Equity Statewide Plan, which is currently under development as well. As the PBDA awaits NTIA’s approval on the Five-Year Action Plan, the public involvement process continues with additional community conversations, focus groups, and the online survey. These additional public involvement efforts will continue to inform the Digital Equity Statewide Plan. The Five-Year Action Plan aligns its Goals and Objectives with the Digital Equity Plan to produce sustainable outcomes and a long-term solution to lack of high-speed connectivity and access to literacy programs and devices.
The Shapiro Administration is dedicated to expanding broadband access across the state Gov. Shapiro recently travelled to Beaver and Luzerne counties to emphasize the importance of expanding broadband infrastructure across Pennsylvania.
Visit the PBDA’s website to learn more about its work to close the digital divide in the Commonwealth.
For more information about the Department of Community and Economic Development, visit DCED website, and be sure to stay up-to-date with all of our agency news on Facebook, X, and LinkedIn.
New! Rural Innovation Profile of Nebraska ACO
The Rural Health Value team is pleased to release a new Rural Innovation Profile: A Rural Accountable Care Organization’s Journey
For more than a decade, South East Rural Physicians Alliance Accountable Care Organization (SERPA‐ACO), a physician‐led ACO that includes 16 physician-owned clinics in Nebraska has been leveraging health care payment and delivery models to provide high quality, comprehensive, coordinated, and patient‐centered care at a lower cost.
Related resources on the Rural Health Value website:
- Demonstrating Your Value: A Guide to Potential Value-based Care Partnerships for Rural Health Care Organizations. This Rural Health Value resource assists rural health care leaders in demonstrating the value their organizations can bring to networks, affiliations, payers, systems, or accountable care organizations.
- Catalog of Value Based Initiatives for Rural Providers – One-page summaries describe rural-relevant, value-based programs currently or recently implemented by the Department of Health and Human Services (HHS), primarily by the Centers for Medicare & Medicaid Services (CMS) and its Center for Medicare & Medicaid Innovation (CMMI).
- Medicare Shared Savings Program: Rule Changes and Implications for Rural Health Care Organizations – A summary of the changes made to the Medicare Shared Savings Program taking effect January 2023 and 2024. This Rural Health Value analysis outlines how the changes would reduce barriers to participation for potential or reentering ACOs that operate in rural contexts.
For more information, contact Clint MacKinney, MD, MS, Co-Principal Investigator, at clint-mackinney@uiowa.edu
New Report: Addressing the Oral Health Needs of Hispanics in the U.S.
The Hispanic Dental Association and CareQuest Institute for Oral Health released a new report, “Addressing the Oral Health Needs of Hispanics in the U.S.,” which explores the oral health status, dental needs, utilization of dental services, and workforce. The report found that higher percentages of gum disease and tooth loss were reported among Hispanic people compared with other racial groups, and Hispanic children ages 6 to 11 had more decayed and filled teeth than others in that age group. The report also found that Hispanic dentists only represent 6% of the U.S. dentist workforce.
HPV Provider On-Demand Video Series Launched
The American Cancer Society, the National HPV Roundtable, and the Indiana Immunization Coalition launched a new HPV Provider Video Series which features on-demand sessions with expert insight, the latest information and vaccination guidelines for HPV, and strategies to implement in order to increase vaccination rates. Users must register for the series, but will have access to all sessions with registration.
Just Released! Results from 2022 Pennsylvania Dental Assistant Survey
PCOH recently completed the “2022 PA Dental Assistant Survey” and created a resource to share the results. Dental assistants provide a key role in dental offices and health care settings. Like other health care and dental professionals, dental assistants have been affected by the rise in workforce challenges in recent years.
In 2022, PCOH sought to understand the state of dental assistants in Pennsylvania through disseminating a survey to dental assistants across the commonwealth. The survey was shared with dental assistants who had passed the Dental Assisting National Board (DANB) between 1982-2021.
The findings of this survey outline next steps for recruitment and retention of Pennsylvania dental assistants.
Pennsylvania Health Care Providers Tell Lawmakers the State’s Rural Hospitals Are in Crisis
Pennsylvania’s rural hospitals are dealing with a shortage of physicians and mental health providers that has become dire, leaving patients in rural communities with dwindling options for care.
That was the message members of the Center for Rural Pennsylvania heard on Thursday during a hearing with hospital and health care center executives, and public health experts.
The center, a bicameral, bipartisan legislative agency, heard from hospital and health center executives, as well as public health experts about the challenges facing rural health care providers at a public hearing in Bradford.
Dr. Jill Owens, president of Upper Allegheny Health System, put it bluntly: “Rural hospitals are in crisis,” she told the panel.
Owens said that difficulty attracting and retaining health care providers, low Medicaid and Medicare reimbursement and other challenges have led to care deserts and declining health outcomes for rural Pennsylvanians. And without action to reform the struggling health care system and more funding and resources for local providers, the situation is unlikely to improve any time soon.
Attracting Providers
Jeannine McMillan, executive director of the Center for Population Health, a nonprofit focused on population and public health initiatives in rural Cambria and Somerset counties, said that both counties suffer from a lack of primary care physicians and mental health providers.
“Extreme challenges, including lack of adequate public transportation, availability of broadband, food deserts and difficulty recruiting clinicians are magnified in rural communities,” McMillan said.
While her organization has been fortunate to receive funding from philanthropic groups, McMillan said that “significant investments are needed” to improve health outcomes in rural communities.
A study conducted by the Hospital and Healthsystem Association of Pennsylvania (HAP) found that rural hospitals have struggled to fill 39% of vacant registered nurse positions. By comparison, HAP found the average vacancy rates for direct care RNs to be more than 30% statewide.
Kate Slatt, vice president of Innovative Payment and Care Delivery for the Hospital and Healthsystem Association of Pennsylvania, said that HAP supports efforts to strengthen the education and training pipeline for those pursuing health care careers and the creation of an office within Democratic Gov. Josh Shapiro’s administration to focus on “health care workforce innovation and reform,” it does not support legislative attempts to limit the staff-to-patient ratios at Pennsylvania hospitals.
In late June, the House passed HB 106, also known as the “Patient Safety Act.” The bill, co-sponsored by state Reps. Thomas Mehaffie, R-Dauphin, and Kathleen Tomlinson, R-Bucks, would outline the number of patients per-nurse required in different hospital settings.
Supporters of the legislation, including nurses who weathered unmanageable caseloads during the COVID-19 pandemic and the unions representing them, said the legislation protects patients and improves health care outcomes.
In July, the bill was referred to the Senate Health and Human Services Committee.
Maternal Health Deserts
Public health officials also warned lawmakers at the hearing about an “alarming” trend in rural health — a lack of labor and delivery services.
From January 2010 to April 2022, 30 Pennsylvania hospitals closed their doors. Many others were forced to cut specific services — such as OB/GYN — in order to remain financially viable, according to HAP.
Similarly, of Pennsylvania’s 42 rural hospitals, 60% do not have labor and delivery services, an analysis from the Center for Healthcare Quality and Payment Reform found.
“Many pregnant persons in rural areas need to drive almost 40 minutes to reach a hospital that can assist them during birth, which exceeds the recommended 30-minute travel time once a person begins labor,” Lisa Davis, director of the Pennsylvania Office of Rural Health and Outreach explained. “These challenges also contribute to increases in births outside of hospitals versus in hospitals without OB units and in preterm birth, all of which carry greater risks for both mothers and newborns.”
A 2022 report from the March of Dimes found that six of Pennsylvania’s 67 counties — Cameron, Forest, Greene, Juniata, Sullivan, and Wyoming counties — classified as “maternal health deserts” because they lacked hospitals providing obstetric care and birth centers, and had no OB/GYN or certified nurse midwives.
State Sen. Judy Schwank, D-Berks, said she was “very concerned” about the impact maternal health care deserts in rural Pennsylvania could have on the commonwealth’s maternal mortality rate.
“There are hospitals in the state that close maternity care that send persons in labor to another facility by either lifeflight helicopter or ambulance during the times when they can go but those are really expensive, or they may end up just having to deliver in the emergency department if they can’t travel,” Davis explained. “So this is something I think we really need to focus on.”
Davis offered that alternative services, such as birthing centers, may be an effective option for rural communities across the commonwealth.
New Public Health Resource Published: Understanding Air Quality
The ongoing wildfires in Canada (including a blaze that crossed the U.S.-Canada border this past weekend) and an intense nationwide heat wave are having harmful effects on air quality–putting public health at risk. Although a decrease in air quality affects everyone, certain communities and individuals are more vulnerable to its harmful effects.
PHCC’s newest resource, Protect Your Health: Understanding Air Quality, will help you communicate about air quality and protective measures people can take to stay safe. This resource is available in English and Spanish and includes:
- The fundamentals of understanding air quality and the Air Quality Index (AQI)
- A visual guide to the major sources of air pollution
- Recommendations for protecting your health routinely and during air-quality alert days
Download and share the guide with your community to promote the importance of understanding air quality and protecting your health
New CMS Rule Promotes High-Quality Care and Rewards Hospitals that Deliver High-Quality Care to Underserved Populations
The Centers for Medicare & Medicaid Services (CMS) issued a final payment rule for inpatient and long-term care hospitals that builds on the Biden-Harris Administration’s priorities to provide support to historically underserved and under-resourced communities and to promote the highest quality outcomes and safest care for all individuals. The fiscal year (FY) 2024 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) final rule updates Medicare payments and policies for hospitals as required by statute; adopts hospital quality measures to foster safety, equity, and reduce preventable harm in the hospital setting; and recognizes homelessness as an indicator of increased resource utilization in the acute inpatient hospital setting. This is consistent with the Administration’s goal of advancing health equity for all, including members of historically underserved and under-resourced communities, as described in the President’s January 20, 2021, Executive Order 13985 on “Advancing Racial Equity and Support for Underserved Communities Through the Federal Government.”
For acute care hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and are meaningful electronic health record users, the final rule will result in an increase in operating payment rates of 3.1%. This reflects an FY 2024 projected hospital market basket update of 3.3%, reduced by a statutorily required productivity adjustment of a 0.2 percentage point. Under the LTCH PPS, CMS expects payments in FY 2024 to increase by approximately 0.2% or $6 million.
“As part of CMS’ health equity goals, we are rewarding hospitals that deliver high-quality care to underserved populations and, for the first time, also recognizing the higher costs that hospitals incur when treating people experiencing homelessness,” said CMS Administrator Chiquita Brooks-LaSure. “With these changes, CMS is laying the foundation for a health system that delivers higher quality, more equitable, and safer care for everyone.”
Supporting Rural and Other Underserved Communities
In this final rule, CMS is finalizing a health equity adjustment in the scoring methodology for the Hospital Value-Based Purchasing (VBP) Program that rewards hospitals that serve higher proportions of dual-eligible patients for providing excellent care. The newly finalized scoring methodology allows the opportunity for hospitals to earn up to ten bonus points depending on their performance on existing quality measures and the proportion of dually eligible patients they treat. The rule is a first step toward promoting health equity in the Hospital VBP Program and as such, CMS received public comments on additional approaches for equity adjustments in the Hospital VBP Program for future years. These suggestions include using other methods of restructuring the scoring methodology and determining the best metric to identify underserved populations, which CMS will consider for future updates.
CMS is also finalizing a policy to recognize the higher costs that hospitals incur when treating people experiencing homelessness when hospitals report social determinants of health codes on claims, meaning that hospitals will generally receive higher payments when a patient is experiencing homelessness. In addition, CMS is finalizing the policy that allows rural emergency hospitals (REHs) to be designated as graduate medical education training sites. This policy will build upon the Biden-Harris Administration’s commitment to supporting care in rural and other underserved communities by enhancing the health care workforce opportunities in these areas.
Additionally, this final rule will codify the requirements for the additional information that eligible facilities are required to submit when applying for enrollment as an REH, as specified in law. The finalized policy is intended to increase access to essential health care services in rural communities and support the enrollment process for eligible facilities seeking the REH designation.
Promoting Patient Safety
CMS is finalizing proposals for the Hospital IQR and Medicare Promoting Interoperability Programs to adopt three electronic clinical quality measures beginning with the CY 2025 reporting period to foster safety and reduce preventable harm in the hospital setting.
Resources
- For a fact sheet on the final payment rule visit: https://www.cms.gov/newsroom/fact-sheets/fy-2024-hospital-inpatient-prospective-payment-system-ipps-and-long-term-care-hospital-prospective-0
- The FY 2024 IPPS/LTCH PPS final rule can be downloaded from the Federal Register at: https://www.federalregister.gov/public-inspection/2023-16252/medicare-program-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals-and-the
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CMS Releases First Round of Medicaid and CHIP Renewals Data
On July 28, 2023, the Centers for Medicare & Medicaid Services (CMS) released its first monthly data report on Medicaid and Children’s Health Insurance Program (CHIP) eligibility renewals. These data will inform the Biden-Harris Administration’s critical work to help ensure eligible people stay covered, and to help ensure people no longer eligible for Medicaid or CHIP to transition to a range of other coverage options, including affordable health insurance through HealthCare.gov and state Marketplaces.
The data detail updates from the 18 states that had completed at least one cohort of renewals by April 30, 2023, highlighting how many people kept their Medicaid and CHIP coverage, as well as the number of people who were disenrolled from coverage. CMS is also releasing data on state Medicaid call centers, including average wait times and the number of people who disconnected before speaking to a customer service representative. In addition, CMS is releasing HealthCare.gov Marketplace data on consumers who were previously enrolled in Medicaid or CHIP that came to the HealthCare.gov and applied for coverage and State-based Marketplaces (SBM) data on consumers who transitioned to SBM coverage following a Medicaid or CHIP redetermination. See a national summary of the data at a glance, or read more about the data at Medicaid.gov/unwinding-data.
CMS continues to work closely with states as people renew their Medicaid and CHIP coverage or explore other coverage options. In addition to the new data, Health and Human Services (HHS) Secretary Xavier Becerra sent a letter to Governors encouraging states to do more to adopt strategies to automatically renew coverage for people where states already have data showing the person is eligible for Medicaid or CHIP.