A study, published last week in the American Journal of Clinical Nutrition, found that over a two-year period, those 60 and above who took a daily multivitamin were observed to have a “modest benefit” when it came to global cognition. Read more.

The Pennsylvania Health Care Cost Containment Council (PHC4) has produced new reports to shed light on critical health care components and offer data into public health at the county level. PHC4 says the new report “empowers communities” on public health. Read more.

Black patients in Florida are transferred to public hospitals more often than white patients, even when comparing patients from the same hospital with similar health conditions and the same insurance, according to new research led by Charleen Hsuan, assistant professor of health policy and administration at Penn State. Before 1986, hospitals would sometimes transfer patients who could not afford care to public hospitals or other safety net hospitals. These safety net hospitals often had poorer health outcomes for their patients than their private counterparts. In 1986, a new federal law curtailed transfers of patients solely because they could not pay, but concerns remain about the reasons that patients are transferred from one hospital to another, Hsuan said.

Over three million patients are transferred between hospitals in the U.S. each year, according to the Centers for Disease Control and Prevention. While transfers typically occur because the original hospital cannot provide needed treatment, a variety of factors affect where or if a patient is transferred.

Hsuan and an interdisciplinary team of researchers studied more than 1.2 million emergency department transfers in Florida to understand whether individuals from different ethnic and racial groups were treated equitably. Their results, published recently in Health Services Research, revealed that Black patients were more likely to be transferred to public hospitals than white patients.

Read more.

A new report, A Comparison of 2017-19 Uncompensated Care of Rural and Urban Hospitals by Net Patient Revenue, System Affiliation, and Ownership, demonstrates several key factors that contribute to rural hospital uncompensated care.  A summary of the key findings is highlighted below.

Uncompensated care are services provided that are never reimbursed, including charity care and unanticipated bad debt. High uncompensated care burden is a concern because it may contribute to smaller operating margins and rural hospital closures.

The purpose of this study is to better understand patterns of uncompensated care. It extends a 2018 study of geographic variation in uncompensated care between rural and urban hospitals. In the current study, researchers use 2017-2019 Medicare Cost Report data to study the association of uncompensated care with net patient revenue, system affiliation, and ownership among Critical Access Hospitals (CAHs), Rural Prospective Payment System (PPS) hospitals, and Urban PPS hospitals.

Key Findings:

• Rural PPS hospitals had the highest uncompensated care median, and urban PPS hospitals had the lowest.
• Furthermore, rural PPS hospitals with less than $20 million in net patient revenue had the highest median uncompensated care, and urban PPS hospitals with less than $20 million had the lowest.
• Hospitals affiliated with a health system had higher median uncompensated care than hospitals not affiliated with a health system.
• Government-owned hospitals had the highest median uncompensated care for rural PPS and urban PPS, while a small number of for-profit CAHs had the highest median uncompensated care across all groups.

Findings suggest that changes to policies and reimbursement that affect uncompensated care could have a differential effect on hospitals, particularly related to Medicare payment designation, size (as measured by net patient revenue), and ownership.

Contact Information:

George H. Pink, PhD
North Carolina Rural Health Research and Policy Analysis Center
Phone: 919.966.5011
gpink@email.unc.edu

Additional Resources of Interest:

• Geographic Variation in Uncompensated Care Between Rural and Urban Hospitals
• Provision of Uncompensated Care by Rural Hospitals: A Preliminary Look at Medicare Cost Report Worksheet S-10
• Uncompensated Care Burden May Mean Financial Vulnerability for Rural Hospitals in States That Did Not Expand Medicaid
• More information about the North Carolina Rural Health Research and Policy Analysis Center

See this redesigned toolkit from the U.S. Department of Health and Human Services (HHS) Administration for Strategic Preparedness and Response. The Risk Identification and Site Criticality (RISC) Toolkit is an objective, data-driven, all-hazards risk assessment that can inform emergency preparedness planning, risk management activities, and resource investments. It’s designed to aid public and private organizations in the health care and public health sector to identify threats and hazards, assess vulnerabilities, and determine the consequences of disruptions. The toolkit can be used by health centers to support emergency preparedness planning; improve communication and coordination at the community, county, state, and federal levels; and improve preparedness and response efficiencies through a data-sharing model.

Patients who had telehealth visits with someone other than their usual primary care provider were 66% more likely to visit the emergency department (ED) within seven days compared with patients who saw their regular primary care provider via telehealth, according to a study published Dec. 27, 2023, in JAMA Network Open. In the study of more than five million telehealth visits in Ontario, Canada, researchers matched 942,983 patient pairs who saw either their own regular provider or an outside provider. The study’s findings suggest that telehealth services in the context of primary care may be most effective when they occur within an existing clinical relationship.

A new brief, titled Substance Use and Substance Use Disorders by Race and Ethnicity, 2015-2019, describes findings from an analysis of National Survey on Drug Use and Health data to assess whether and how rates of substance use and substance use disorder (SUD) among adults (ages 18 and older) differ by race and ethnicity.

The report from the Centers for Disease Control and Prevention (CDC) shows that, pre-pandemic, death rates were decreasing for both urban and rural U.S. adults aged 65 and older.  Data from the CDC’s National Center for Health Statistics show that, though death rates from 2009 to 2019 were higher in rural areas than urban areas for both men and women and for all race and Hispanic-origin groups, they declined 15 percent in rural areas over that time period.  CDC research from 2019 showed rural Americans are more likely to die from five leading causes than people living in urban areas. The research showed that rural residents are also more likely to die of preventable deaths – with higher rates of cigarette smoking, high blood pressure and obesity, higher rates of poverty, and less access to health care and health insurance.

Read the full article here.

In 2021, the Centers for Medicare & Medicaid Services (CMS) announced a goal to have all Original Medicare (fee-for-service) beneficiaries in care relationships with health care providers that are accountable for the beneficiaries’ total cost of care and quality by 2030. This policy paper from the Rural Health Value team discusses the challenges that are particular to rural areas as well as potential opportunities.

Read the full report here.