The School-Based Health Alliance is the national school-based health care advocacy, technical assistance, and training organization based in Washington DC. The Alliance works to improve the health of children and youth by advancing and advocating for school-based health care. As youth-friendly and accessible settings, school-based health centers (SBHCs) are uniquely positioned to deliver high quality, confidential services that equip children and adolescents with the information, tools, and support they need to be healthy and safe where they are, when they need it… in school.  Visit the website to access resources and learn more. Also stay tuned as PACHC is working with the School-Based Health Alliance to offer a webinar on Adolescent Motivational Interviewing sometime in July.

Online Training and Resources for Rural First Responders.  The Rural Domestic Preparedness Consortium provides free online training and resources to help rural communities plan for and respond to mass injuries and fatalities.  Supported by The Center for Rural Development, the site provides self-paced online training and scheduled, in-person training that has been certified by the U.S. Department of Homeland Security.

Comments Requested:  CMS Issues Draft Guidance on Hospital Co-location – July 2. The Centers for Medicare & Medicaid Services (CMS) seeks public input on draft guidance regarding how CMS and State Agency surveyors will evaluate a hospital’s co-location of space and staff when assessing the hospital’s compliance with the Medicare Conditions of Participation (CoPs).  It clarifies that sharing of staff may be done through a contractual arrangement where there are clear lines of authority and accountability and that sharing public areas, such as entrances and waiting rooms, would be permissible. RHIhub highlights several programs in rural communities that have used co-location of services and staff to improve efficiencies, including lessons learned about this approach.  See Events section below for an upcoming session on this topic.

(June 19, 2019)  Laurel Fork, VA—FCC Commissioner Brendan Carr visited a community health care clinic in rural Laurel Fork, Virginia which sits in the southwest corner of the state.  Carr announced that the FCC will be voting at its July 10th meeting to advance a $100 million Connected Care Pilot Program to support telehealth for low-income Americans across the country, including those living in rural areas and veterans.  At the clinic, two patients with diabetes demonstrated how they are using remote monitoring technologies to improve their health.

“With advances in telemedicine, health care is no longer limited to the confines of traditional brick and mortar health care facilities,” said Commissioner Carr.  “With an Internet connection, patients can now access high-quality care right on their smartphones, tablets, or other devices regardless of where they are located.  I think the FCC should support this new trend towards connected care, which is the healthcare equivalent of moving from Blockbuster to Netflix.  That’s why the FCC will vote to advance my $100 million pilot program at our July 10 meeting.  It will focus on ensuring that low-income Americans and veterans can access this technology.  Particularly in rural communities like Laurel Fork, where the nearest hospital is in a different state, access to telehealth can make a life-saving difference.”

“In Laurel Fork, telehealth is already delivering results,” continued Carr.  “Diabetes patients here that participated in a remote telehealth program saw their A1C levels decline by 2.2 points on average, which significantly reduced their risk of renal disease, heart disease, and death caused by those conditions.  Through the Connected Care Pilot Program, the FCC can build on the success of projects like these, which are helping create a model for the adoption of connected care technologies and bridging the doctor divide in rural America.”

The FCC will vote on a Notice of Proposed Rulemaking at its July Open Meeting that seeks comment on:

• Budgeting for $100 million in USF support for health care providers to defray the qualifying costs of connected care services for low-income patients, including people in medically underserved areas and veterans.
• Targeting support for innovative pilot projects to respond to a variety of health challenges, including diabetes management, opioid dependency, high-risk pregnancies, pediatric heart disease, and cancer.
• Providing an 85% discount on qualifying services for a three-year period with controls in place to measure and verify the benefits, costs, and savings associated with connected care technologies.
• Collecting relevant data to enable stakeholders to better understand the impact of telehealth and consider broader reforms that can support the trend toward connected care.

Connected care has resulted in substantial savings, particularly in the management of chronic diseases, which account for over 85% of direct health care spending in the U.S.:

• A remote patient monitoring trial in the Mississippi Delta resulted in nearly $700,000 in annual savings due to reductions in hospital readmissions alone.  Assuming just 20% of Mississippi’s diabetic population enrolled in this program, annual Medicaid savings in the state would be $189.
• The Veterans Health Administration’s (VHA) remote patient monitoring program cost $1,600 per patient compared to more than $13,000 per patient for VHA’s home-based primary services.
• A telehealth project in the Northeastern U.S. found that every $1 spent on remote monitoring resulted in a $3.30 return in savings.
• Analysts estimate that the widespread use of remote patient technology and virtual doctor visits could save the American health care system $305 billion annually.

Connected care technologies are also improving health outcomes for patients:

• A study of 20 remote patient monitoring trials found a 20% reduction in all-cause mortality and a 15% reduction in heart failure-related hospitalizations.
• The VHA’s remote patient monitoring program resulted in a 25% reduction in days of inpatient care and a 19% reduction in hospital admission for more than 43,000 veterans with conditions like hypertension, congestive heart failure, chronic obstructive pulmonary disease, depression, and PTSD.
• One remote patient monitoring initiative showed a 46% reduction in ER visits, a 53% reduction in hospital admissions, and a 25% shorter length of stay.

###

For press inquiries, contact Evan Swarztrauber at evan.swarztrauber@fcc.gov or (202) 418-2261.

Office of Commissioner Brendan Carr: (202) 418-2200

Twitter: @BrendanCarrFCC

www.fcc.gov/about/leadership/brendan-carr

The Hill, By Former Sens. Tom Daschle (D-S.D.) and Olympia Snowe (R-Maine), opinion contributors — 06/12/19.  The views expressed by contributors are their own and not the view of The Hill

As former senators from rural states, we’ve seen firsthand the importance of providing affordable, quality care to those living in rural areas. The isolation that exists in some parts of South Dakota and Maine means residents have limited access to care.

Many patients must travel great distances to even reach a hospital. Yet more and more rural hospitals are closing around the country. In fact, 106 of them have shut down since 2010. It is staggering to think of these challenges when, compared to people living in urban and suburban areas, rural Americans are generally older and poorer, more uninsured or underinsured, and therefore less healthy.

Rural health is a bipartisan issue that greatly concerns all Americans. While it has never been a top tier issue on the campaign trail, we believe it could be a powerful topic in the 2020 election and demands attention by policymakers and candidates.

Our survey with the American Heart Association conducted by Morning Consult, shows that 92 percent of Democrats and 93 percent of Republicans consider access to rural health an important issue. Perhaps even more encouraging, three in five voters say they are more likely to endorse a candidate who makes access to rural health care a priority.

At a time when Democrats and Republicans agree on little, it is clear rural health transcends political parties. However, efforts by lawmakers to revive rural America have been largely unsuccessful in recent years. People living in remote areas continue to face greater disparities and barriers to high-quality health care than those in non-rural communities.

More than half of the rural voters polled say access to medical specialists, such as cardiologists, oncologists and gynecologists, is a problem in their local community, compared to 33 percent of non-rural voters, and more than one-quarter (27 percent) say it is difficult to access behavioral health professionals, compared to 16 percent of non-rural voters. Forty-seven percent of rural voters also agree access to quality health care is a challenge, compared to 34 percent of non-rural voters.

In addition to our national poll, we surveyed adults living in three rural states that will be important in the 2020 election: Iowa, North Carolina, and Texas. When it comes to accessing medical services or treatment, rural voters are more likely than urban and suburban voters to agree that appointment availability (56 vs. 50 percent) and the distance to receive care (50 vs. 37 percent) are obstacles.

Today, nearly 60 million Americans live in rural communities. Data from the Centers for Disease Control and Prevention show these residents have a greater risk of dying from heart disease, cancer, stroke, and chronic lower respiratory disease, and that should prompt candidates and policymakers alike, to take action.

Four policy options could help rural communities receive the quality care they deserve:

First, allow rural communities to adjust their health care services to better suit the needs of their local area. Critical Access Hospitals and other rural inpatient facilities need pathways to transform, in order to focus on emergency and outpatient services, and primary and prevention-focused care.

In Texas alone, 17 hospitals have closed in the past nine years. One in five Texas voters say it is difficult to access hospitals, urgent care facilities, primary care physicians, and medical specialists in their community.

Second, create new payment mechanisms for rural providers that account for low patient volumes, growing health care needs, and demographic trends in rural communities. Facilitate alternative payment and care delivery models that could help hospitals transition to value-based care.

Third, build and support a sustainable and diverse workforce. The patient-to-primary care physician ratio in urban areas is 53 physicians per 100,000 people, while rural areas have only 40 physicians for the same number of residents.  

Indeed, our survey shows that one in three rural adults in North Carolina — and 46 percent in Iowa — believe that access to medical specialists and quality health care are problems in their communities. New workforce models should be designed with universities and community health centers to expose providers to rural environments and telemedicine. Nurse practitioners, physician assistants, and pharmacists could also help fill vital primary care roles.

Fourth, expand telemedicine services to virtually connect patients with medical professionals. To be an effective tool, rural areas need adequate broadband and reimbursement for services.

Geography should never be an impediment to quality care. Tackling the barriers to delivering high-quality and efficient health care to rural America is long overdue. With the 2020 election campaign underway, candidates and policymakers have an opportunity to create a health care system that better serves all Americans.

Tom Daschle is a former Senate majority leader from South Dakota and a co-founder of the Bipartisan Policy Center.  Olympia Snowe is a former Senator from Maine and a BPC board member and senior fellow. They co-chair BPC’s Rural Health Task Force.   

CDC Information on Syringe Services Programs.  The Centers for Disease Control and Prevention (CDC) recently updated information they provide on community-based prevention programs that can provide a range of services, including linkage to substance use disorder treatment; access to and disposal of sterile syringes and injection equipment; and vaccination, testing, and linkage to care and treatment for infectious diseases.

VA Announces Final Community Care Regulations under MISSION Act. On June 5, the U.S. Department of Veterans Affairs (VA) announced the publication of two final regulations as part of its new Veterans Community Care Program under the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018. One of the rules focuses on a new urgent care benefit. VA also published the final regulation for the Veterans Community Care Program governing how eligible Veterans receive necessary hospital care, medical services, and extended care services from non-VA entities or providers in the community. The new Veterans Community Care Program replaces the Veterans Choice Program, which expired June 6, 2019. Of note, the final rule addresses payment of higher rates to health care providers in highly rural areas. The term “highly rural area” means an area located in a county that has fewer than seven individuals residing in that county per square mile.

 CMS Requests Feedback Reducing Regulatory Burden – August 12.  On June 6, the Centers for Medicare & Medicaid Services (CMS) issued a Request for Information (RFI) seeking new ideas from the public on how to reduce administrative and regulatory burden as part of the agency’s Patients over Paperwork initiative. CMS is especially seeking innovative ideas that broaden perspectives on potential solutions to relieve burden and ways to improve: reporting and documentation requirements; coding and documentation requirements for Medicare or Medicaid payment; prior authorization procedures; policies and requirements for rural providers, clinicians, and beneficiaries; policies and requirements for dually enrolled (i.e., Medicare and Medicaid) beneficiaries; beneficiary enrollment and eligibility determination; and CMS processes for issuing regulations and policies.

 HRSA Requests Public Feedback on Health Center Service Areas – July 8.  The Health Resources and Services Administration (HRSA) is seeking input from the public on service area considerations that may inform decisions to expand the program through the addition of new service delivery sites onto existing health centers.  The considerations include factors such as proximity to existing health centers, parameters for unmet need, and consultation with other local providers.   

HRSA Releases Allied Health Workforce Projections for 2016–2030. The Health Resources and Services Administration (HRSA) recently released Allied Health Workforce Projections providing national-level health workforce estimates for the following occupations: chiropractors and podiatrists, emergency medical technicians and paramedics, medical and clinical laboratory technologists, occupational and physical therapists, optometrists and opticians, pharmacists, registered dieticians, and respiratory therapists.  While shortages of health care providers in rural areas is well-known, consistent data on rural allied health professionals has been difficult to collect and analyze.  Visit HRSA’s Bureau of Health Workforce website to see more data, projections, and federal programs.