The President’s Fiscal Year 2025 Budget proposal for the Health Resources and Services Administration addresses many of the most pressing health care challenges facing American families, including taking action on:

Youth mental health crisis: Recent data highlights the disturbing trends in youth mental health including nearly one-third of youth reporting experiencing poor mental health and 1 in 5 students reporting seriously considering attempting suicide. To respond to this moment, we need to make mental health and substance use disorder treatment readily available. The keys to increasing access to care are growing the behavioral health workforce and better supporting primary care providers in meeting behavioral health needs. We also need to build supports for young people among those they trust, which is often their peers.

The President’s Budget invests in:

• Training 12,000 new behavioral health providers to expand access to behavioral health treatment and services across the country.
• Creating an innovative new youth peer-to-peer mental health support and career pathway program to train youth and young adults to support one another’s mental health needs while building an early behavioral health career pathway program for youth peers.
• Supporting mental health training and support for pediatricians where pediatricians can directly access tele-consultation with psychiatrists and other mental health clinicians to support the mental health needs of their young patients and training.
• Making mental health and substance use disorder a required service in community health centers that are the primary source of health care services, regardless of ability to pay, to more than 30 million people—including more than 8.5 million children—in some of the highest need urban and rural communities across the country.

Maternity Care Deserts: More than eight million women of childbearing age live in counties that lack a hospital with labor and delivery services. The March of Dimes estimates that nearly 150,000 babies a year are born in “maternity care deserts” that lack a hospital or birth center providing obstetric care and lack obstetricians or midwives. Well-trained health care providers are essential to improving health outcomes, identifying and addressing pregnancy-related complications, protecting women’s health, and ensuring every birth provides the best opportunity for a strong start.

The President’s Budget invests in:

• Building obstetric capacity in maternity care deserts to respond to obstetric-related emergencies in rural, urban, and suburban areas without ready access to labor and delivery services.
• Training more Labor and Delivery Nurses and Certified Nurse Midwives to increase access to maternal and perinatal health care, particularly in rural and underserved communities.
• Building a community-based doula workforce to support pregnant individuals and ensure their voices are heard and needs are met.
• Expanding access to maternal mental health support to respond to maternal depression and increase access through the National Maternal Mental Health Hotline at 1-833-TLC-MAMA.

Closing gaps in access to primary care: Delayed care is often the result of barriers such as lack of primary care and behavioral health providers located in many rural or underserved communities, workforce challenges across the health care system, and lack of access to transportation, limited appointment availability, and limited operating hours for patients who require care outside of standard working hours. In 2020, 46 percent of households surveyed nationwide reported negative health consequences as a result of not being able to get an appointment when they needed it.

The President’s Budget invests in:

• A plan to create a pathway to double the federal investment in the community health center program to ensure that it can reach over 37 million people in need of and struggling to access primary care.
• Expanding health center street medicine services to ensure people experiencing homelessness have access to primary care.
• Expanding health center hours of operation to make it easier for people who work later shifts or face childcare or transportation issues to access primary care.

Meeting the opioid treatment and recovery needs of rural communities: Opioid use disorder is particularly concerning in rural communities and accessing treatment can be challenging due to geographic isolation, transportation barriers, and limited substance use disorder providers. In support of President Biden’s Unity Agenda, HRSA launched a Rural Opioid Treatment and Recovery Initiative to support establishing and expanding comprehensive substance use disorder treatment and recovery services in rural areas, including by increasing access to medications for opioid use disorder, such as buprenorphine.

The President’s Budget invests in:

• Creating more access to treatment in rural communities for people to receive medications such as buprenorphine to treat opioid use disorder and get recovery supports.
• Supporting rural community activities such as mobile units providing medication for opioid use disorder and integration of this treatment into rural primary care settings.
• Integrating supportive services—such as food access, housing support and employment training and opportunities, transportation to treatment, and other social determinants of health.
• Expanding the rural substance use disorder workforce, including clinical providers and peer support professionals who help individuals find and sustain a path to recovery.

Growing the health care workforce: The National Center for Health Workforce Analysis has identified current projected shortages through 2035 in a wide range of health care occupations. At the same time, many training curricula and models for training health professionals, particularly in medicine, remain unchanged from decades ago; they do not fully leverage the technology available today. HRSA is committed to growing the health care workforce by funding new, leading-edge health profession education and training models and expanding the supply of health care professionals in underserved and rural areas.

The President’s Budget invests in:

• Providing scholarships and loan repayment to over 24,000 clinicians, nurses, and health professionals to provide health care in underserved and rural areas.
• Making it possible for more than 1,800 medical and dental residents to work and train in underserved and rural communities.
• Seeding new approaches to recruit and grow the health care workforce and deliver a more modern, robust, and diverse workforce pipeline.

Transforming the Organ Matching System to Better Serve Patients and Families: HRSA oversees the Organ Procurement and Transplantation Network (OPTN), which was established by Congress nearly four decades ago and consists of a comprehensive network of transplant professionals and community members charged with increasing organ donation and operating and overseeing a fair and accountable system for allocating and transplanting organs in the United States. Across the nearly 40-year history of the OPTN, all functions of the OPTN have been managed by a single vendor and not competed separately based on technical expertise in areas like IT or operations. In 2023, Congress adopted the Administration’s proposal to update the decades-old statute, including allowing HRSA to make multiple different contract awards to benefit from best-in-class vendors in different areas to improve performance and innovation. Congress also adopted HRSA’s proposal to require the OPTN Board of Directors support contract be distinct from OPTN operations support contractors to strengthen OPTN accountability and oversight. The new law also eliminated the arbitrary appropriation cap to support this work.

The President’s Budget invests in:

• Doubling funding for the organ transplant system to increase competition and better serve the more than 100,000 people on the organ donor waitlist.

Read HRSA’s FY 2025 Congressional Budget Justification.

For more than a dozen years, leaders in the rural health care field have issued strong warnings: Rural hospitals are struggling financially.

Despite public attention and some changes in federal policies, difficulties continue. A new report from a private healthcare consulting company has found that nearly 20% of all rural hospitals are at risk of closing.

The report, issued annually by the Chartis Center for Rural Health, said the percentage of rural hospitals operating in the red jumped to 50%, up from 43% last year. Of the independent rural hospitals across the country, 55% were operating in the red. More than 60% of rural hospitals are affiliated with larger health-systems. Of those, 42% were operating in the red.

All told, Chartis identified 418 of the 2,115 of the rural hospitals as “vulnerable to closure.” Since 2020, 35 rural hospitals have closed, including nine last year. Nearly 200 rural hospitals have closed since 2005.

“I think we’re in a much, much worse situation,” Michael Topchik, national leader for the Chartis Center for Rural Health said in an interview with the Daily Yonder. “I mean, more than 15 years ago, I remember sharing some of these statistics… and there was a little bit of ‘Chicken Little’ in the air with a third of rural hospitals operating in the red… Now, to see half of rural hospitals operating in the red… in the absence of something being done, things have just gotten more challenging.”

Those increased challenges include changes to Medicare and Medicaid reimbursement rates, changes to how hospitals are categorized, and what services hospitals are able to provide, among other things.

Read more.

In a little more than two years as CEO of a small hospital in Wyoming, Dave Ryerse has witnessed firsthand the worsening financial problems eroding rural hospitals nationwide.

In 2022, Ryerse’s South Lincoln Medical Center was forced to shutter its operating room because it didn’t have the staff to run it 24 hours a day. Soon after, the obstetrics unit closed.

Ryerse said the publicly owned facility’s revenue from providing care has fallen short of operating expenses for at least the past eight years, driving tough decisions to cut services in hopes of keeping the facility open in Kemmerer, a town of about 2,400 in southwestern Wyoming.

South Lincoln’s financial woes aren’t unique, and the risk of hospital closures is an immediate threat to many small communities. “Those cities dry out,” Ryerse said. “There’s a huge sense of urgency to make sure that we can maintain and really eventually thrive in this area.”

A recently released report from the health analytics and consulting firm Chartis paints a clear picture of the grim reality Ryerse and other small-hospital managers face. In its financial analysis, the firm concluded that half of rural hospitals lost money in the past year, up from 43% the previous year. It also identified 418 rural hospitals across the U.S. that are “vulnerable to closure.”

Mark Holmes, director of the Cecil G. Sheps Center for Health Services Research at the University of North Carolina, said the report’s findings weren’t a surprise, since the financial nosedive it depicted has been a concern of researchers and rural health advocates for decades.

The report noted that small-town hospitals in states that expanded Medicaid eligibility have fared better financially than those in states that didn’t.

Leaders in Montana, whose population is nearly half rural, credit Medicaid expansion as the reason their hospitals have largely avoided the financial crisis depicted by the report despite escalating costs, workforce shortages, and growing administrative burden.

“Montana’s expansion of Medicaid coverage to low-income adults nearly 10 years ago has cut in half the percentage of Montanans without insurance, increased access to care and preserved services in rural communities, and reduced the burden of uncompensated care shouldered by hospitals by nearly 50%,” said Katy Mack, vice president of communications for the Montana Hospital Association.

Not one hospital has closed in the state since 2015, she added.

Hospitals elsewhere haven’t fared so well.

Read more.

From Becker’s Healthcare

Danville, Pa.-based Geisinger appointed Terry Gilliland, MD, as the next president and CEO of Geisinger Health.

Dr. Gilliland will succeed Jaewon Ryu, MD, JD, after he transitions to CEO of Risant Health, a nonprofit organization created by Kaiser Foundation Hospitals. Oakland, Calf.-based Kaiser Permanente agreed to acquire Geisinger last year as the first health system to join Risant, and the deal is waiting on regulatory approval.

Geisinger’s board conducted an extensive search for Dr. Ryu’s successor.

“The role of leading Geisinger is unique,” said Heather Acker, chair of the Geisinger board of directors, in a news release. “It requires passion for our mission–to make better health easier for our patients and members across Pennsylvania; a drive to innovate care delivery; and a commitment to educating future caregivers. We are confident that Dr. Gilliland is the right person to lead Geisinger on our path forward.”

In his new role as the eighth leader of Geisinger, Dr. Gilliland will oversee the system’s 25,000 employees, who serve more than 1 million people annually. The 10-hospital system also includes a health plan with more than 500,000 members, a research institute and Geisinger College of Health Sciences. Geisinger has more than 1,700 employed physicians.

Dr. Gilliland has previous experience as chief medical officer and chief science officer of Cogitativo, an artificial intelligence and machine learning company focused on healthcare. He was also executive vice president of healthcare quality and affordability for Blue Shield of California and senior vice president and chief medical officer of Norfolk, VA.-based Sentara Healthcare.

Dr. Gilliland also spent time in leadership roles at Mid-Atlantic Permanente Medical Group and Colorado Permanente Medical Group early in his career.

The Rural Health Value team is pleased to announce the release of an updated version of the Catalog of Value-Based Initiatives for Rural Providers. The catalog summarizes 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). Its purpose is to help rural leaders and communities identify HHS value-based programs appropriate for rural participation.

Related resources on the Rural Health Value website:

• RHV’s “Get Ahead of AHEAD in rural!” webinar recording & handout. This webinar discussed the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) model. The webinar was designed to help rural health leaders (including state agencies such as Medicaid and public health) interested in the AHEAD model identify opportunities and next steps. Find the CMS website for AHEAD here States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model | CMS
• 2023 Uniform Data Set (UDS) Measure Crosswalk to Other Quality Reporting Programs This crosswalk highlights alignment between Uniform Data Set (UDS) measures and other quality reporting programs. Intended to help health centers identify which UDS measures are being utilized by other programs such as CMS Accountable Care Organizations (ACOs), and the CMS Quality Payment Program (QPP).

Medicare Shared Savings Program: Rule Changes and Implications for Rural Health Care Organizations
This summary is of changes made to the Medicare Shared Savings Program taking effect in 2023 and 2024. This Rural Health Value analysis outlines how the changes may reduce barriers to participation for potential or reentering ACOs that operate in rural contexts.

Did you know… rural Americans are at greater risk for premature death from five leading causes, including heart disease?

Call for Applications: Million Hearts^® 2024 Hypertension Control Challenge

 Million Hearts® is a national initiative to prevent 1 million heart attacks and strokes within 5 years. It focuses on implementing a small set of evidence-based priorities and targets that can improve cardiovascular health for all.

If you’re a rural healthcare professional, or represent a rural practice or health system with hypertension control rates of 80% or better, please consider applying for the “Challenge.” Moreover, colleagues with the Million Hearts program would welcome an opportunity to spotlight the success of a 2024 Hypertension Control Champion serving a rural community, as would we!

The Million Hearts^® 2024 Hypertension Control Challenge recognizes and celebrates health care professionals, practices, and health systems that have achieved exceptional hypertension control rates of at least 80%. Practices and clinicians in the U.S. and its territories are eligible for possible recognition as a Champion. The submission deadline is April 5, 2024.

 Learn more about the Challenge rules and eligibility

Application form