- 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
- Rural RPM Program Is a Lifeline for Pregnant Women
- Safe and Stable Housing Is a Foundation of Successful Recovery
- 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
- Limited Continuing-Care Options in Rural Virginia Create Challenges for an Aging Population
Impacts of Rural Economy on Farmer Mental Health
In a poll sponsored by the American Farm Bureau Federation, nearly half of farmers and farmworkers surveyed said they are experiencing more mental health challenges than they were a year ago. Financial issues were the most common stressor cited; other factors included the weather, the economy, isolation and stigma. Most of the rural Americans polled said that cost and stigma would make it harder for them to seek help or treatment. Research has shown that eighty-five percent of federally designated mental health professional shortage areas are in rural locations.
CDC: Pregnancy-Related Deaths Happen Before, During, and Up to a Year After Delivery
In a new release during the week of May 6, 2019, the Centers for Disease Control and Prevention (CDC) reports that about 700 women die from pregnancy-related complications each year in the U.S. and that 60 percent of these deaths could be prevented. According to the Vital Signs report, Black women and American Indian/Alaska Native women were about three times as likely to die from a pregnancy-related cause as White women. In 2018, several studies reported that this national trend is exacerbated by rural hospital closures. The Office of Research on Women’s Health at the National Institutes of Health recently updated an online portal for data, resources and learning events on maternal morbidity and mortality.
New One-Stop Resource for FORHP’s Rural Communities Opioid Response Program (RCORP)
The Health Resources and Services Administration’s (HRSA) Federal Office of Rural Health Policy (FORHP) created this new web page with information on upcoming RCORP funding opportunities, current grant recipients, and the program’s impact to date. RCORP currently includes grants for planning, implementation, and medication-assisted treatment expansion for rural communities and consortia, as well as cooperative agreements for technical assistance, evaluation, and three Rural Centers of Excellence on Substance Use Disorders. As a reminder, RCORP-MAT Expansion and RCORP-Rural Centers of Excellence on Substance Use Disorders are currently accepting applications through June 10.
USDA Economic Research Service Releases Atlas of Rural and Small Town America
The rural atlas, maintained and updated each year by the Economic Research Service (ERS) at the U.S. Department of Agriculture, features an interactive map with county-level data. The report provides statistics on three broad categories of socioeconomic factors: demographics, including migration and immigration, education, and characteristics of veteran population; jobs, with employment trends, industrial composition, and household income; and county classifications that include the rural-urban continuum, economic dependence, persistent poverty, and other characteristics.
HHS Secretary Azar Releases Statement on Measles Outbreaks
Secretary of the U.S. Department of Health & Human Services Alex Azar issued a statement this week about the outbreak of measles, now diagnosed in more than 700 cases across the country. The Centers for Disease Control and Prevention (CDC) has confirmed outbreaks in 22 states. Symptoms of measles generally appear about seven to 14 days after a person is infected and typically include high fever, cough, runny nose, and a rash of flat, red spots. Available data do not indicate that rural areas are more or less affected, but the CDC’s national surveys that monitor vaccination coverage have identified that unvaccinated children are more likely to be uninsured, live below the poverty level, and live in rural areas. Many may not know about the CDC’s Vaccines for Children Program that serves children up to age 18 who are uninsured or underinsured, or who receive care through Federally Qualified Health Centers or Rural Health Clinics. Adults who are unsure of their measles vaccination status should consider getting the updated Measles Mumps Rubella (MMR) vaccine.
Pennsylvania Substance Use Disorder Loan Repayment Program Practitioner Application Announced
May 1, 2019
Applications are invited to the Pennsylvania Department of Health’s Pennsylvania Substance Use Disorder Loan Repayment Practitioner Program, in accordance with RFA # 67-86.
All questions regarding this RFA must be directed in writing by e-mail to RA-DHSUDLRP@pa.gov, no later than May 12, 2019. All questions must include the specific section of the RFA about which the potential applicant is questioning. Answers to all questions will be posted at https://www.health.pa.gov/topics/Health-Planning/Pages/SUD-LRP.aspx on or before May 17, 2019.
Please submit an application via the on-line Pennsylvania Substance Use Disorder Loan Repayment Program Practitioner Application found at the following website: https://www.health.pa.gov/topics/HealthPlanning/Pages/SUD-LRP.aspx, beginning Wednesday, May 1, 2019. Completed applications must be submitted before 11:59 p.m. on Monday, June 3, 2019.
LATE APPLICATIONS WILL NOT BE ACCEPTED REGARDLESS OF THE REASON.
It is expected that the evaluation of applications and the selection of grantees will be completed within six weeks of the submission due date.
Information Released on the 2020 U.S. Census Impact on Services
The 2020 Census is closer than you think. The United States Census Bureau has released a public facing flyer detailing what the census is and why it is essential that everyone is counted, especially for services. Many large federal programs distribute funds based on population. Consider sharing the flyer in public places to encourage census participation.
Open Comment Period for Pennsylvania WIC
The Pennsylvania Women, Infants, and Children (WIC) program is accepting public comments on its program. Please consider mentioning the importance of oral health in WIC programming. Comments can be provided at upcoming WIC Public Meetings. Written comments can be sent via email to bmellott@pa.gov or mailed to The Department of Health, Bureau of Women, Children, Infants and Children (WIC), 625 Forster St., 7 West, Health and Welfare Building, Harrisburg, PA 17120. Written comments should be received by May 31.
Can we heal rural health? All eyes are on Pennsylvania’s bold experiment | Opinion
By Rachel Levine and Andy Carter, For the Philadelphia Inquirer, April 26, 2019
Rural communities and their hospitals are struggling.
In terms of health and well-being, rural Pennsylvania and urban Philadelphia have all too much in common, including high rates of child poverty and mortality, food insecurity, and chronic disease.
In terms of the health care needed to address these issues, rural hospitals face some unique challenges. These include sustaining a wide array of services for smaller numbers of patients due to sparsely populated geographies. About half of Pennsylvania’s rural hospitals operate at a loss and are at risk for closure.
Respected research organizations have reported on this problem nationwide. Since 2010, 104 U.S. rural hospitals have closed, two of them in Pennsylvania.
Pennsylvania’s bold experiment
In partnership with the Center for Medicare & Medicaid Innovation, the Pennsylvania Department of Health’s new Rural Health Model flips the script on hospital care. In place of hospitals’ traditional focus — treating patients when they are sick or injured — the new model also aims to reward hospitals for keeping patients healthy and out of the hospital altogether.
To accomplish these goals, the model changes the way hospitals are paid.
Typically, hospitals receive payment for each health care service they provide. With the Rural Health Model, hospitals get paid based on annual budgets, which provides more consistent cash flow. These budgets define the financial resources hospitals will have during the year — independent of how many patients are hospitalized or come to emergency rooms. Insurers (commercial and Medicare) and hospitals work together to establish budgets based on the payments hospitals typically received in the past.
With their financial footings a bit more predictable, hospitals can redirect resources and invest in services and partnerships to improve community health. Hospitals are encouraged to focus on keeping people healthy.
This new payment approach not only provides a measure of stability for hospitals, but also for rural communities and jobs.
In metropolitan areas, with a pick of health care systems and services, it may be hard to imagine how important a hospital is to its rural community. In emergencies, that hospital may be the only source of care for 20 miles or more.
Hospitalizations in rural Pennsylvania, across the state, and nationwide are going down.
Hospitals and health systems are shifting care to outpatient and home settings whenever safe and appropriate. Doctors, nurses, and health educators are working with patients, encouraging them to seek preventive care and improve health habits. The goal is to foster better quality of life and avoid intensive and costly inpatient care.
The Rural Health Model gives hospitals predictable finances — those annual budgets — and, potentially, additional flexibility with which to foster this move to better health and lower health care spending.
Now, instead of focusing on expanding services just for the sake of growing market share under the traditional fee-for-service model, hospitals can focus on providing the services most needed by the community. This right-sizing frees up resources to focus on the services needed to address the community’s biggest health challenges (diabetes, for example) and to kick start the virtuous cycle of better health and less need for hospital care.
Five Pennsylvania hospitals have signed up to test out this new payment strategy. (Five insurers have also joined the pilot.) The hospitals have defined strategies for how they will move from just providing sick care to also helping improve the overall health of their communities. Common strategies include better care coordination for patients with chronic disease and better geriatric care for older adults, with the goal of reducing expensive emergency room visits.
The pressing need to help rural communities become healthier, and the potential for this model, has attracted interest from scores of state and federal government agencies and health policy organizations. They really want to make this model work, and effective collaboration is key.
Creating the Rural Health Redesign Center would establish the hub to bring these resources together, to help with the planning and analysis needed to identify successful strategies and replicate them. Five hospitals are using the model now, and we have high interest from up to 25 additional hospitals in joining them over the next two years. Learning from one another about what works and what doesn’t will speed progress.
State legislation is needed to set up the Rural Health Redesign Center. Senate Bill 314, sponsored by Senator Lisa Baker, and House Bill 248, sponsored by Representative Tina Pickett, both have bipartisan support.
Governments, health departments, and hospitals across the nation are watching Pennsylvania’s experiment carefully. Since starting work on this model several years ago, we’ve heard from over a dozen different states, all asking: “Is it working?”
We invite you to pay close attention as well, and to learn more about how five hospitals and insurers are working together, exploring a new and better way to care for their communities. Pennsylvania’s Rural Health Model could help to usher in a new era of health care.
Rachel Levine, MD is Pennsylvania Secretary of Health. Andy Carter is president and CEO of the Hospital and Healthsystem Association of Pennsylvania.
Final Rule Announced Health Insurance Benefit and Payment Parameters
Last week, the Centers for Medicare & Medicaid Services (CMS) released the final Notice of Benefit and Payment Parameters for the 2020 benefit year, a document that sets forth instructions to insurers participating in the Health Insurance Exchanges or “Marketplaces”. Among the changes for 2020 are flexibilities related to the duties and training requirements for the Navigator program and opportunities for innovations in the direct enrollment process. In 2018 and 2019, the percentage of enrollments in the federal exchange (healthcare.gov) by rural residents remained unchanged at 18 percent.