- 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
- Safe and Stable Housing Is a Foundation of Successful Recovery
- Rural RPM Program Is a Lifeline for Pregnant Women
- 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
CDC: Naloxone Prescriptions Up but Still Fall Short in Rural Areas
The Centers for Disease Control and Prevention (CDC) examined trends and characteristics of prescriptions for naloxone, a drug that can help prevent overdose deaths by reversing the effects of opioids. By analyzing data from retail pharmacies across the U.S., the CDC found that the number of naloxone prescriptions increased substantially from 2012 to 2018 with an increase of 106 percent from 2017 to 2018 alone. The CDC Guideline for Prescribing Opioids for Chronic Pain recommends prescribing naloxone for patients who are at high risk for overdose, but the new research found that only one naloxone prescription was dispensed for every 69 high-dose opioid prescriptions – with the lowest rate in rural counties. Last week, the CDC’s National Center for Health Statistics released a brief, Urban-Rural Differences in Drug Overdose Death Rates, showing rates were higher in urban areas for overdose deaths involving heroin, synthetic opioids, and cocaine, but higher in rural for natural and semisynthetic opioids, and psychostimulants with abuse potential. Click here to access the full report.
HRSA Awards Over $111 Million to 96 Organizations to Combat Opioid Epidemic in Rural Communities
On August 8, 2019, the Health Resources and Services Administration’s (HRSA) Federal Office of Rural Health Policy announced awards of over $111 million to 96 rural organizations across 37 states as part of its multi-year Rural Communities Opioid Response Program (RCORP) initiative. These funds, which also include support for an evaluation of the initiative, will strengthen rural communities’ capacity to provide needed substance use disorder prevention, treatment, and recovery services and build the evidence base for interventions that are effective in rural settings.
- Eighty rural consortia received RCORP-Implementation awards of $1 million each to implement a set of prevention, treatment, and recovery activities that align with the U.S. Department of Health and Human Services’ Five-Point Strategy to Combat the Opioid Crisis.
- Twelve recipients received RCORP-Medication-Assisted Treatment (MAT) Expansion awards of up to $725,000 each to establish and/or expand MAT in rural health clinic, hospital, Health Center Look-Alike, and tribal settings.
- Three recipients received $6.6 million each to establish Centers of Excellence on Substance Use Disorders (CoEs) that will identify, translate, disseminate, and implement evidence-based and promising practices related to the treatment for and prevention of substance use disorder (SUD).
The full announcement can be accessed here.
Bringing Together Young And Old To Ease The Isolation Of Rural Life
Now, Bogema is in her 60s, frail and mostly confined to her house. Her arthritis and other health problems have limited her mobility. She struggles with the upkeep of her home and yard. She drives into town once a week for groceries and a movie with other seniors. But she doesn’t have close friends she sees regularly and her children and grandchildren only visit once every few months.
The solitude she once sought is no longer as comforting. “It can get lonely, very lonely,” she says.
According to a recent poll by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health, Bogema is one of about 2.5 million rural residents (about 7% of the total rural population) who say they have no friends or family nearby to rely on. An additional 14 million (about 39%) say they only have a few people. Like Bogema, many feel isolated.
Meredith Rizzo/NPR
People in rural areas report “feeling lonely or left out,” says Carrie Henning-Smith, the deputy director of the University of Minnesota Rural Health Research Center and one of the authors of a recent study on rural isolation, despite the fact that rural communities often have stronger social networks than urban ones. She notes that many communities have become more socially isolated in recent years as rural economies have declined and young people moved away.
Social isolation is increasingly recognized as a public health issue. Studies show that isolation and loneliness puts people at a higher risk of long term physical and mental health problems, including premature mortality. And Henning-Smith’s preliminary research suggests that in rural areas, isolation can reduce people’s ability to meet daily needs, like access to health care and food.
A group in northeastern Minnesota is tackling this problem in a novel way: They’re trying to reconnect a fragmented social fabric by bringing together generations to support each other — kids and the elderly.
McGregor is one of 18 rural communities running the program, called AGE to age. It connects more than 4,000 youth with almost 2,500 older adults annually.
The initiative is not just geared to help the elderly — the support runs both ways. It also helps children and young people in these communities feel more supported, giving them work experience and mentors. Children and seniors work on projects together — the kind of activity varies from community to community, and can range anywhere from participating in a reading club, to building and maintaining a community garden, to helping local food pantries, to working on art projects. Along the way, they develop meaningful relationships that can last beyond the program.
The full article can be accessed here.
“At the Core of Care” Podcast Preview Available Now
The Pennsylvania Action Coalition published a seven minute preview for the “At the Core of Care” podcast series, which features stories of innovative nurses and the people and communities they serve. Season One launches this September. Subscribe now on Apple, Google, Stitcher, or wherever you get your podcasts. Subscribe now
Pennsylvania Governor’s New Executive Order Focuses on the Most Vulnerable
During the week of July 29, 2019, Pennsylvania Gov. Tom Wolf by executive order announced that an overhaul of the state services and systems to protect the most vulnerable Pennsylvanians will begin. Governor Wolf’s “Protection of Vulnerable Populations” Executive Order establishes an Office of Advocacy and Reform, maintained by the governor’s office with an executive director, creates a new Child Advocate position and integrates the Long-term Care Ombudsman. It also establishes a Council on Reform, with 25 voting members appointed by Gov. Wolf to support this effort by looking at protecting vulnerable populations from three perspectives: prevention and diversion, protection and intervention, and justice and support. Both the Council on Reform and the Office of Advocacy and Reform will identify reforms needed for Pennsylvania to better protect and support individuals relying upon services and assistance from the commonwealth. The governor also shared his intent to pursue extensive regulatory and legislative actions.
CMS Releases More Payment Increases
During the week of July 29, 2019, the Centers for Medicare and Medicaid Services (CMS) released rules finalizing Medicare payment adjustments for skilled nursing facilities (SNFs), hospices, and inpatient rehabilitation (IRFs) and psychiatric (IPFs) facilities for FY 2020. Under the final rules, Medicare payments to SNFs will increase by 2.4% in FY 2020 relative to FY 2019; payments to IPFs by 1.5%, or $65 million; payments to IRFs will increase by 2.5%, or $210 million; and payments for hospice facilities will increase by 2.6%, or $520 million.
Medicare Part D Premiums Decline
During the week of July 29, 2019, the Centers for Medicare and Medicaid Services (CMS) announced the average basic premium for Medicare Part D plans is projected to decline in 2020 for the third year in a row, falling from $32.50 this year to $30 next year. CMS Administrator Seema Verma said the downward trend in Part D premiums stems from “actions that CMS has taken to strengthen the Medicare prescription drug program.”
CMS Finalizes Inpatient Payment Bump
During the week of July 29, 2019, the Centers for Medicare and Medicaid Services (CMS) issued its Inpatient Prospective Payment System final rule for fiscal year (FY) 2020, which aims to address payment disparities for rural and urban health facilities and increase add-on payments for emerging technology and therapies. The 2,273-page final rule will affect about 3,300 acute care facilities and is expected to increase total Medicare spending on inpatient hospital services, including capital, by about $3.8 billion in FY 2020 when compared with FY 2019.
Researchers Estimate Societal Costs of the Opioid Epidemic
New supplement to The American Journal of Managed Care explores how the opioid epidemic affects society.
UNIVERSITY PARK, Pa. — The devastating consequences of the opioid crisis are far-reaching in the United States, impacting public health as well as social and economic welfare. Penn State researchers recently collaborated to address the issue in a supplement of The American Journal of Managed Care, titled “Deaths, Dollars, and Diverted Resources: Examining the Heavy Price of the Opioid Epidemic.”
According to Dennis Scanlon, distinguished professor of health policy and administration and director of the Center for Health Care and Policy Research at Penn State, the articles and commentaries in the special issue focus on the costs to governments, notably state governments.
“State and local governments have long shouldered the burden of the opioid epidemic and its costs to individuals and families,” said Scanlon. “They are at ground zero for the epidemic, where services for those being harmed by opioids are significant and costly, spanning well beyond healthcare for treatment and prevention.”
Scanlon, along with Christopher Hollenbeak, professor of health policy and administration at Penn State, authored the introduction to the special issue, noting, “We take an opportunity to raise several important broader questions we believe have not received enough attention but are critically important for learning from the current opioid epidemic and preventing the potential burdens that could be associated with the next epidemic.”
Topics in this special issue are diverse and include the costs of the opioid crisis on employment and labor market productivity, burdens on the child welfare system and special education, the increased costs to the criminal justice system, and the economic burden on state Medicaid programs.
“The supplement fulfills our initial goal of exploring the effects of the opioid crisis on societal costs,” Scanlon explained. “Each article in this special issue presents complex cost analyses of the implications of opioid misuse, shedding new light on the opioid epidemic at the state level, and adds to a growing body of literature about the opioid epidemic.”
For example, researchers found that in the United States between 2000 and 2016, opioid misuse reduced state tax revenue by more than $11 billion, including approximately $10 billion in lost income tax revenue and almost $2 billion in lost sales tax revenue. In another paper, researchers found that between 2007 and 2016, total costs to Pennsylvania’s criminal justice system from the opioid crisis was over $526 million.
“Each article in this special issue presents complex cost analyses of the implications of opioid misuse, shedding new light on the opioid epidemic at the state level, and adds to a growing body of literature about the opioid epidemic.” — Dennis Scanlon, distinguished professor of health policy and administration and director of the Center for Health Care and Policy Research at Penn State
Meanwhile, total Medicaid costs associated with opioid-use disorder more than tripled between 1999 and 2013, reaching more than $3 billion. Additionally, total annual education costs for children born in Pennsylvania with neonatal abstinence syndrome associated with maternal use of prescription opioids was estimated at over $1 million. Finally, researchers also found increased costs of almost $3 billion to the child welfare system from 2011 to 2016.
“Due to these costs, every American will continue to experience loss from resources diverted to the epidemic that could have been made available for other uses had the epidemic been prevented,” said Scanlon.
Another unique aspect of the issue is the strong Penn State presence, as all authors are either faculty, staff, or current or former graduate students. Additionally, one of the commentaries is co-authored by Pennsylvania Secretary of Health Rachel Levine, who provides further perspective into the opioid crisis at the state level.
Other lead Penn State authors include Max Crowley, assistant professor of human development and family studies; Doug Leslie, professor of public health sciences and psychiatry; Paul Morgan, professor of education; Joel Segel, assistant professor of health policy and administration, and Gary Zajac, associate research professor.
Research contributions in the supplement were supported by the Commonwealth of Pennsylvania under the project “Estimation of Societal Costs to States Due to the Opioid Epidemic,” and as part of larger work supported under a Strategic Planning Implementation award from the Penn State Office of the Provost, “Integrated Data Systems Solutions for Health Equity.”
Funding for the production of this supplement was provided by Penn State’s Social Science Research Institute and by the Penn State Clinical and Translational Science Institute through the National Center for Advancing Translational Sciences, National Institutes of Health.
Comments Requested: Medicare Physician Fee Schedule Proposed Policy, Payment, and Quality Provisions for CY 2020
On July 29, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2020. Proposals that may be of interest to rural stakeholders include adding telehealth codes for bundled episodes of care in the treatment of opioid use disorders (OUDs); modifying the regulation on physician supervision of physician assistants (PAs) to give PAs greater flexibility; updating payment and/or codes for certain care management services; and implementing a new Medicare Part B benefit for OUD treatment services, including medication-assisted treatment (MAT), furnished by opioid treatment programs (OTPs). Comments are due on September 27, 2019. The full announcement can be accessed here.