Ambulatory care refers to medical services performed same day on an outpatient basis, without admission to a hospital or other facility, and includes services ranging from wellness and disease management to surgical treatment and rehabilitation. Not much is known, however, about the ambulatory care that rural Medicare patients typically receive. This chartbook from the North Carolina Rural Health Research and Policy Analysis Center uses available Medicare claims data to describe costs and common diagnoses for Medicare beneficiaries at rural ambulatory care facilities (excluding private practitioners).
April is Sexual Assault Awareness Month
The Office on Women’s Health at the U.S. Department of Health & Human Services recognizes April as the month to raise awareness of sexual assault, and increase understanding of its effects that go well beyond targeted victims. While prevalence of the consequences of violence is higher among women than among men, decades-old research on children who are exposed to domestic violence shows life-long impact on chronic conditions for physical and mental health. The New England Journal of Medicine (NEMJ) notes that intimate partner violence is “more prevalent during a woman’s lifetime than conditions such as diabetes, depression, or breast cancer, yet it often remains unrecognized by health professionals.” In the same editorial, NEMJ refers to a strategic framework to improve the response of health care systems implemented here at the Health Resources and Services Administration (HRSA). The HRSA Strategy to Address Intimate Partner Violence includes a partnership with the Administration for Children and Families to increase coordination between clinical and social response systems.
The Latest from ERS on Rural Poverty and Well-Being
The Economic Research Service (ERS) at the U.S. Department of Agriculture released data from its research on the economic, social, and demographic factors affecting rural poverty. The ERS reports that there are 353 persistently poor counties in the United States, meaning that 20 percent or more of their populations were living in poverty over the course of several decades. Eighty-five percent of these counties are rural. In 2017, more than one-third of non-metro families headed by a female with no spouse present were poor (33.8 percent), and nearly half of those with related children were poor (44.4 percent).
Who Isn’t Using Patient Portals and Why
Experts in health management, sociology, and psychology analyzed responses to the 2017 Health Information National Trends Survey to examine characteristics of patients who do not access electronic medical records and communications from their provider through online portals. The researchers found that of the sixty-three percent of patients who reported not using a portal during the prior year, the nonusers were more likely to be male, be on Medicaid, lack a regular provider, and have less than a college education compared to those who did access portals. Though we don’t typically include articles requiring paid access in this space, the findings may have implications on the advancement of telehealth for rural areas
CDC: Drug Poisoning Mortality in the United States
The Centers for Disease Control and Prevention (CDC) recently released the latest figures on drug poisoning deaths at the national, state, and county levels from the years 1999 through 2017. Updated data collection and methodology over that time period allows researchers to capture death rates in counties with small population sizes or small numbers of deaths, permitting reports on urban/rural trends by state (see pull-down menu under the heading “Options”).
Rural Health Leadership Radio: A Conversation with Lisa Davis
The global budget is underway in Pennsylvania, but there is a lot more than that taking place. In this episode of Rural Health Leadership Radio™ we are talking about Medicaid expansion, rural hospital budget transformation, medical student community orientation and other topics of interest to rural health leaders. We are having that conversation with Lisa Davis, Director of the Pennsylvania Office of Rural Health and Outreach Associate Professor of Health Policy and Administration at Penn State.
“Pennsylvania is considered to be one of the most rural states in the nation.”
In her role, Lisa is responsible for the overall direction and leadership of the state office of rural health, including ensuring that the office meets its mission of being a source of networking, coordination, and technical assistance to organizations focused on rural health care delivery; developing and sustaining linkages with state and national partners; and seeking ways to expand the office’s role in enhancing the health status of rural Pennsylvanians.
“Medicaid expansion has been very important here in the state for a number of reasons.”
On the national, state, and university levels, Davis serves on a wide range of boards of directors, advisory committees, and task forces focused on rural health policy, rural health research, economic development, outreach and education, and vulnerable populations and specific health issues such as oral health and cancer. She has extensive experience in the field of rural health research.
“They learned about what it means to be those individuals, what it means to live there, what the social structure is, what the economy is like in those communities.”
Davis is the recipient of the Distinguished Service Award from the National Organization of State Offices of Rural Health, an Outstanding Leadership Award from the Pennsylvania Rural Health Association, and an Award for Individual Contributions to Public Health from the Pennsylvania Public Health Association. The Pennsylvania Office of Rural Health received the Award of Merit from the National Organization of State Offices of Rural Health.
She holds a graduate degree in Health Administration from Penn State.
CMS Issues New Frequently Asked Questions (FAQs) Regarding Medicaid Home and Community-Based Services (HCBS)
March 2019
The Centers for Medicare & Medicaid Services (CMS) has issued Frequently Asked Questions (FAQs) that provide more information to State Medicaid programs on what settings have the qualities of an institution and are ineligible for Home and Community Based Services (HCBS), which settings qualify for HCBS, and under what circumstances CMS needs to conduct a review with heightened scrutiny to determine if the setting qualifies for HCBS. The guidance clarifies that while rural settings may appear to meet the criteria to conduct a heightened scrutiny review, States should only request such a review if a setting has the qualities of an institution and if individuals qualifying for HCBS in a rural area do not have the same access to engage in the community as enrollees not receiving Medicaid HCBS in the same area.
CMS Issues Report on Quality Payment Program Clinician Experience
March 2019
The Centers for Medicare & Medicaid Services (CMS) has published information on clinician participation, reporting, and performance in year one (2017) of the Quality Payment Program (QPP). Among the findings, CMS noted that rural clinicians eligible for the Merit-Based Incentive Payment System (MIPS) had a participation rate (94 percent) virtually equal to the overall average, and 93 percent of rural clinicians participating in MIPS received a positive payment adjustment. CMS also reiterated their commitment to alleviating barriers and creating pathways for improvement and success for rural clinicians through the Small, Underserved, and Rural Support initiative.
Wolf Administration Awards $15 Million in Housing Grants to Help Individuals Battling Opioid Use Disorder
March 27, 2019
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Harrisburg, PA – Governor Tom Wolf announced today that the departments of Drug and Alcohol Programs (DDAP) and Human Services (DHS) have awarded $15 million in federal Substance Abuse and Mental Health Services Administration (SAMHSA) grants for a new program to provide case management and housing support services for Pennsylvanians with an opioid use disorder (OUD). The pilot programs will support innovative practices that increase access to support services for individuals with OUD, keep people engaged in treatment and recovery, and help prevent overdose-related deaths.
“With these grant announcements we are taking an important step in removing a barrier to recovery and independence for those suffering from opioid use disorder,” Gov. Wolf said. “As we continue to battle this health crisis, being able to address housing as a means to get people into treatment and on the road to recovery is a key component.”
First announced in October, the program will direct the $15 million through 16 grant agreements that will assist urban and rural counties throughout the commonwealth. The pilot programs will assist individuals as they become and remain engaged in evidence-based treatment programs and will provide individuals with support services such as pre-tenancy and tenancy education services to maintain stable housing.
The counties selected for pilot programs under the request for applications were identified via a formula that equally considered the rate of individuals diagnosed with a substance use disorder (SUD) and rate of overdose-related deaths in a county. The selected grant recipient are:
| Awardee | Counties Served |
| Allegheny Department of Human Services | Allegheny |
| Armstrong County Community Action Agency | Armstrong |
| Blair County Community Action Program | Blair |
| Center for Community Resources | Butler |
| Commission on Economic Opportunity | Luzerne |
| Community Counseling Center for Mercer County | Mercer |
| Connect, Inc. | Greene, Washington |
| Delaware County Office of Behavioral Health | Delaware |
| Family Health Council of Central PA | Dauphin |
| Fayette County Community Action Agency | Fayette |
| Juniata Valley Tri-County Drug & Alcohol Abuse Commission | Mifflin |
| Lawrence County Drug & Alcohol Commission | Lawrence |
| Lehigh Conference on Churches | Lehigh |
| Northern Tier Community Action Corporation | Cameron |
| Philadelphia Single County Authority | Philadelphia |
| The Wright Center for Community Health | Lackawanna, Luzerne |
“We know that each individual seeking treatment is just that – an individual,” said DDAP Secretary Jennifer Smith. “They each have different situations and circumstances hindering their recovery. In order to truly combat this crisis, we must build capacity to support individuals by providing necessary, supportive wrap around services like stable housing and case management.”
“The conditions in which a person lives play a substantial role in a person’s health. When a person experiences homelessness in addition to a substance use disorder, the lack of a secure home is often a barrier to staying engaged with treatment and recovery, if they are able to access treatment at all,” said DHS Secretary Teresa Miller. “These programs will soon assist people with housing access and stability and will help more people stay engaged in treatment and reach recovery.”
SAMHSA has distinguished four major dimensions that support a life in recovery: Health, Home, Purpose, and Community. This project aims to support two components of the dimensions – Home and Purpose. By giving an individual a stable, safe place to focus on their recovery, paired with the independence and self-worth that housing provides, an individual’s overall health and wellbeing is greatly improved.
Housing instability, combined with unmet basic needs, makes the road to recovery and independence extremely challenging. According to national data, about one in five people experiencing homelessness has a chronic substance use disorder. This aligns with information gathered from Pennsylvania’s 45 state-sponsored OUD Centers of Excellence, a majority of which identify housing as a major barrier for their clients.
The grants are made possible by the $55.9 million SAMHSA grant secured to bolster the state’s response to the prescription opioid and heroin epidemic. Additional initiatives included in the grant are focused on expanding services to pregnant women and veterans affected by OUD, developing the treatment and recovery workforce, and strengthening criminal justice and law enforcement initiatives with a focus on reentrant supports.
Find more information on the state’s efforts to battle the opioid crisis here.
MEDIA CONTACT: J.J. Abbott, 717-783-1116
Pennsylvania Department of Health Earns National Public Health Accreditation
March 26, 2019
Harrisburg, PA – The Pennsylvania Department of Health achieved national public health accreditation on Monday, demonstrating the department’s continued commitment to protecting and improving the health and safety of Pennsylvanians.
“This is a very important milestone in our continued efforts to promote healthy lifestyles, prevent injury and disease and to assure the safe delivery of quality health care to Pennsylvanians,” Secretary of Health Dr. Rachel Levine said. “Each day, we are working to address health issues in a wide range of areas, including ensuring Pennsylvania has healthy moms and healthy kids, protecting seniors in nursing homes and addressing the opioid crisis. We are committed to working toward a healthy Pennsylvania.”
There are 34 states that have achieved their accreditation through the Public Health Accreditation Board since the national accreditation program launched in 2011 with funding from the Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation. More than 240 health departments nationwide have achieved the prestigious designation, including Allegheny County, Erie County, the Bethlehem Health Bureau and the Philadelphia Department of Public Health in Pennsylvania.
Accreditation also satisfies a goal of the Centers for Disease Control and Prevention (CDC), which identified accreditation as a key strategy for strengthening our nation’s public health infrastructure. A strong public health infrastructure is more important than ever in the constantly changing local, national and global health environment.
The department began preparing for this step several years ago. Before submitting its application, the department completed several crucial steps, including finalizing the state’s health improvement plan and its organizational strategic plan, addressing challenges identified in a self-assessment and strategy maps for health reform and health equity.
“Public health is an ever-changing landscape, with potential threats including Ebola, pandemic influenza and the misinformation regarding vaccinations,” Secretary Levine said. “We are committed to preparing for each of these concerns and also being aware of new potential issues that could affect the health of Pennsylvanians each day.”
For more information on the Department and the work being done to ensure the health of Pennsylvanians, visit www.health.pa.gov or follow us on FacebookOpens In A New Window and TwitterOpens In A New Window.
MEDIA CONTACT: Nate Wardle, 717-787-1783 or ra-dhpressoffice@pa.gov