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CMS initiative helps people make the most of their new health coverage

“From Coverage to Care” outreach to engage doctors and new patients

On June 16, 2014, the Centers for Medicare & Medicaid Services (CMS) launched a national initiative “From Coverage to Care” (C2C), which is designed to help answer questions that people may have about their new health coverage, to help them make the most of their new benefits, including taking full advantage of primary care and preventive services. It also seeks to give health care providers the tools they need to promote patient engagement. For more information, follow this link.

A Guide to Understanding the Variation in Premiums in Rural Health Insurance Marketplaces

Provides a framework for assessing variations in the premiums of plans offered in the Health Insurance Marketplaces (HIMs) across geography. Comparisons of premiums must include adjustments for several factors: plan type (metal level), enrollee age and family status, overall cost of living in the area, and the design of marketplace rating areas (state policy choices). What might appear to be differences showing plans in rural places to be more or less expensive than in urban places could shrink or even reverse after appropriate adjustments.

Contact Information:

Keith J. Mueller, PhD
RUPRI Center for Rural Health Policy Analysis
Phone: 319.384.3832
keith-mueller@uiowa.edu

Profile of Rural Residential Care Facilities: A Chartbook

As federal and state policymakers consider their most cost-effective options for strengthening rural long-term services and supports (LTSS), more information is needed about the current system of care. Using data from the 2010 National Survey of Residential Care Facilities, this chartbook presents information on a slice of the rural LTSS continuum—the rural residential care facility (RCF). Survey results identify important national and regional differences between rural and urban RCFs, focusing on the facility, resident and service characteristics of RCFs and their ability to meet the LTSS needs of residents. Rural RCFs are more likely to have private pay patients compared to urban facilities and their residents have fewer disabilities as measured by their functional assistance needs. Compared to urban facilities, the policies of rural RCFs appear less likely to support aging-in-place.

Contact Information:

Jennifer Lenardson, MHS
Maine Rural Health Research Center
Phone: 207.228.8399
jlenardson@usm.maine.edu

Implications of Rurality and Psychiatric Status for Diabetic Preventive Care Use among Adults with Diabetes

Examines patterns of diabetic preventive care use among adults with diabetes to determine whether these patterns varied according to respondents’ rural/urban residence or psychiatric status (i.e. the presence/absence of a mental health diagnosis).

Key findings include:

  • Rural residents with diabetes are generally less likely than their urban peers to use diabetic preventive services.
  • Rural residents with diabetes and mental health diagnoses used some preventive services at about the same rates as urban people with diabetes, and at higher rates than rural diabetics without mental health diagnoses.
  • Although rural residents with diabetes and mental health diagnoses used preventive care about as often as other groups studied, they had more diabetes complications than their rural peers without mental health diagnoses.

Contact Information:

Jean Talbot, PhD, MPH
Maine Rural Health Research Center
jatalbot@usm.maine.edu

Health Insurance Coverage of Low-Income Rural Children Increases and is More Continuous Following CHIP Implementation

Prior to the passage of the Children’s Health Insurance Program (CHIP), about one in four low-income rural and urban children (family income below 200% of the federal poverty level) were uninsured in a given month. Using data from the Medical Expenditure Panel Survey, this study found that in the years following CHIP’s implementation health insurance coverage and continuity increased among low-income children—particularly for those living in rural areas. By CHIP’s maturity, coverage for rural children improved so much that their uninsured rate dropped below that of urban children (14% compared to 20%, respectively).

Among those with health insurance, rural children were more likely than their urban counterparts to lose coverage pre-CHIP, and were less likely to lose it after CHIP was in place for five or more years. Whether low-income rural adults will see similar gains in coverage continuity under the Affordable Care Act may depend on whether states choose to participate in Medicaid expansions and what outreach strategies they use to enroll rural populations.

Contact Information:

Erika Ziller, PhD
Maine Rural Health Research Center
Phone: 207.780.4615
eziller@usm.maine.edu

High Deductible Health Insurance Plans in Rural Areas

Enrollment in high deductible health plans (HDHPs) has increased amid concerns about growing health care costs to patients, employers, and insurers. Prior research indicates that rural individuals are more likely than their urban counterparts to face high out-of-pocket health care costs relative to income, despite coverage through private health insurance, a difference related both to the lower income of rural residents generally and to the quality of the private plans through which they have coverage. Using the 2007-2010 National Health Interview Survey, this study examines rural residents’ enrollment in HDHPs and the implications for evolving Affordable Care Act Health Insurance Marketplaces.

Rural residents with private insurance are more likely to have an HDHP than are urban, especially when they live in remote, rural areas. Among those covered by an HDHP, rural residents are more likely to have low incomes and more limited educational attainment than urban residents, suggesting that it will be important to monitor HDHP enrollment, plan affordability, and health plan literacy among plans available through the Health Insurance Marketplaces.

Contact Information:

Jennifer Lenardson, MHS
Maine Rural Health Research Center
Phone: 207.228.8399
jlenardson@usm.maine.edu

Nationwide Insurance creates professorship in College of Ag Sciences

UNIVERSITY PARK, Pa. — Nationwide Insurance has given Penn State a $1 million gift to create and endow the Nationwide Insurance Professorship in the College of Agricultural Sciences. The gift was announced during an April 25 visit by Nationwide representatives to the University Park campus. Read more

Integrated Care Management in Rural Communities

With a focus on community-dwelling older adults in need of integrated physical, behavioral health services, and long term services and supports (LTSS), the authors of this study review the opportunities and challenges reform initiatives under the Affordable Care Act present for rural communities. We assessed four types of organizational models for delivering integrated care management. Each of these models has different strengths and drawbacks, weighing for and against implementation in rural areas.

Key Findings:

  • Introducing an integrated care model in a rural community requires an investment in building relationships with local providers and adapting to local culture and services.
  • Integrated care models that cannot adapt to the local delivery system are more likely to face resistance from local providers and those they serve and potentially duplicate or displace existing rural capacity.
  • Most models of integrated care management have an inherent bias toward larger organizations and infrastructure. Most are built on an investment in health information technology and other systems and capacities.
  • The potential success of any integrated care model is limited by gaps in the continuum of health care services and long term services and supports available in a rural community.
  • “Wraparound” integrated care models can fill gaps in existing care coordination capacity, offering a flexible approach that can adapt to a local rural delivery system.
  • An investment of public resources in shared supports can lower the cost of integrating care in rural delivery systems.

Contact Information:

Eileen Griffin, JD
Maine Rural Health Research Center
elieeng@usm.maine.edu

Pennsylvania Dept of Health Releases Cancer Control Plan

On April 28, the Division of Cancer Prevention and Control in the Pennsylvania Department of Health officially released the new 2013-2018 Pennsylvania Cancer Control Plan (Plan), following a formal presentation to the House of Representatives’ Cancer Caucus. The Plan was developed by the Stakeholder Leadership Team cancer coalition and focuses on promoting good health and supporting healthy behavior and choices through broad-reaching PSE approaches to prevent and reduce the burden of cancer. Interested parties can now view the Plan on www.LiveHealthyPA.com and report their implementation strategies. Phase One of the LiveHealthyPA.com site is active for Plan review and reporting purposes only.

Paper Released – Extent of Telehealth Use in Rural and Urban Hospitals

Using the 2013 HIMSS Analytics database, we analyze the extent of use of telehealth (aka telemedicine) and find that 34.0% of rural hospitals and 32.0% of urban hospitals had at least one telehealth application currently in use. Rural and urban hospitals did not differ significantly in overall telehealth implementation rates, however rural and urban hospitals did differ in the department where telehealth was implemented. In particular, rural hospitals were more likely than urban hospitals to have implemented telehealth in radiology departments and in emergency/trauma care. In contrast, urban hospitals were more likely than rural hospitals to have implemented telehealth in cardiology/stroke/heart attack programs, neurology, and obstetrics/gynecology/NICU/pediatrics. Follow-up research will verify the differences in types of telehealth implemented and investigate the low reported utilization rates, which may result from confusion of survey respondents about what constitutes telehealth.

Obstetric Services and Quality among Critical Access, Rural, and Urban Hospitals in Nine States

Although approximately 25% of U.S. births occur in rural hospitals, many questions about the types and quality of obstetric care in different types of hospital settings have remained unexamined. This study takes a step toward filling this gap, assessing and comparing obstetric care among rural and urban hospitals in nine states.

Key Findings:

  • Women who gave birth in CAHs and other rural hospitals in 2010 were younger on average and had lower rates of clinical complications than those who gave birth in urban hospitals.
  • CAHs compared favorably with other rural and urban hospitals on a number of obstetric care quality measures.
  • Medicaid covered 49 percent of births in CAHs and 56 percent of births in other rural hospitals, compared to 41 percent of births in urban hospitals.
  • The percentage of CAHs, other rural hospitals, and urban hospitals providing obstetric services in 2010 varied significantly across states, with the greatest variation among CAHs.
  • Half of the CAHs in this study’s sample provided obstetric services in 2010, likely a higher rate than all CAHs nationwide due to the selection criteria for the sample.

Contact Information:
Katy Kozhimannil, PhD
University of Minnesota Rural Health Research Center
Phone: 612.626.3812
kbk@umn.edu

Rural Implications of the Primary Care Incentive Payment Program

This brief reports on eligibility among rural primary care providers for the Primary Care Incentive Payments established in the Patient Protection and Affordable Care Act. Using the National Provider Identifier files and the lists of providers eligible to receive the payments, we found that the number and proportion of providers eligible increased during 2011–2013 and that for most practice types, rural providers were more likely to be eligible than urban counterparts. However, rural family practice physicians were less likely to be eligible for Primary Care Incentive Payments than their urban counterparts.

Contact Information:
Keith J. Mueller, PhD
RUPRI Center for Rural Health Policy Analysis
Phone: 319.384.3831
keith-mueller@uiowa.edu

Assessing the Impact of Rural Provider Service Mix on the Primary Care Incentive Payment Program

The Patient Protection and Affordable Care Act of 2010 created the Primary Care Incentive Payment Program. For the years 2011 through 2015, if certain evaluation and management services represent 60% or more of Medicare allowable charges, then the provider qualifies for a 10% bonus calculated on the primary care portion of allowable charges. Based on analysis of 2009 Medicare claims data, more than 70% of rural primary care physicians (PCP) and non-physician practitioners (NPP) qualify for payments. The average incentive payment for qualifying rural PCPs would result in an additional $8,000 in Medicare patient revenue per year. For qualifying NPPs, the result is an additional $3,000 in Medicare patient revenue per year.

Contact Information:
Keith J. Mueller, PhD
RUPRI Center for Rural Health Policy Analysis
Phone: 319.384.3831
keith-mueller@uiowa.edu

Promotion and Protection of Rural Miner Health: Are the Resources in Place?

Policy Brief

Full Report

Mining communities’ access to appropriate health care has not been well studied. Appropriate care includes competencies to adequately diagnose and treat mining related disease or illness. The current study has two primary objectives. First, we seek to understand whether mining communities face shortages in numbers of safety net providers compared to non-mining communities. To accomplish this, the study locates and maps mine locations in the U.S. and rural safety net providers (Rural Health Clinics, Federally Qualified Health Centers, Critical Access Hospitals and Black Lung Clinics). Second, we assess the capacity of rural safety net providers in mining areas to prevent, diagnose and treat mining related injury and illness. This was done through a survey of rural primary care providers practicing in safety net facilities co-located with mining communities.

Contact information:
Cynthia Armstrong Persily PhD, RN, FAAN
West Virginia Rural Health Research Center
Phone: 304-347-1253
cpersily@hsc.wvu.edu

The Uninsured: An Analysis by Income and Geography

This policy brief analyzes data from the 2010 Small Area Health Insurance Estimates in order to report on uninsurance rates in rural and urban places according to individuals’ income levels. We find lower uninsurance rates at income levels below 400% of the Federal Poverty Line (FPL) in rural places. However, we also show that, due to a concentration of incomes below 138% FPL, rural uninsured populations stand to benefit more from possible Medicaid expansions than their urban counterparts. As a percentage of the overall adult population, rural places have more potential enrollees in both expanded Medicaid programs and Health Insurance Marketplaces. We also report on the considerable regional variation in these results.

Contact Information:
Keith J. Mueller, PhD
RUPRI Center for Rural Health Policy Analysis
Phone: 319.384.3831
keith-mueller@uiowa.edu

The Frontier Extended Stay Clinic Model: A Potential Health Care Delivery Alternative for Small Rural Communities

The Frontier Extended Stay Clinic (FESC) model may be a viable means of maintaining essential services in remote rural areas. Based on published evaluations of the demonstration project in Alaska and Washington, FESC operations in isolated remote areas can yield cost savings and improve quality of care. This Policy Brief presents data showing potential use of the FESC model in five rural states with substantial frontier area, using distance criteria from the demonstration project.

Contact Information:
Keith J. Mueller, PhD
RUPRI Center for Rural Health Policy Analysis
Phone: 319.384.3831
keith-mueller@uiowa.edu

Causes and Consequences of Rural Pharmacy Closures: A Multi-Case Study

The RUPRI Center for Rural Health Policy Analysis completed case studies in six rural communities that lost their only remaining retail pharmacy since 2007. In five of the six communities, residents now either drive to the nearest pharmacy or use mail- order to receive their prescriptions and, in some instances, receive their prescriptions through a courier service from a pharmacy in a nearby town. Access to pharmacy services in these communities is of most concern for individuals with limited mobility and those who lack a support system that can pick up and deliver their prescriptions (e.g., the elderly and people with acute conditions). Rural communities will need to continue exploring options for delivering pharmacy services given the financial difficulties inherent in the traditional model of the local independent pharmacy.

Please click on the following link to download a copy of the policy brief: http://cph.uiowa.edu/rupri/publications/policybriefs/2013/Pharmacy_Loss_Case_Study.pdf

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RUPRI Center for Rural Health Policy Analysis
University of Iowa
College of Public Health
Department of Health Management and Policy
105 River Street, N200 – CPHB
Iowa City, IA 52242
Phone: (319) 384-3831
Fax: (319) 384-4371
Web site: www.public-health.uiowa.edu/rupri

Medicare Accountable Care Organizations: Program Eligibility, Beneficiary Assignment, and Quality Measures

The Patient Protection and Affordable Care Act established a Medicare Shared Savings Program (MSSP) and accompanying Medicare ACOs to facilitate coordination and cooperation among providers to improve the quality of care for Medicare fee-for-service (FFS) beneficiaries and reduce unnecessary costs. To assist rural providers considering ACO formation, this policy brief describes MSSP eligibility and participation requirements, beneficiary assignment processes, and quality measures.

Organizations considering participating in the MSSP (Medicare ACO program) should carefully review program eligibility requirements and the beneficiary assignment process. Due to beneficiary assignment based on the greater of allowed Medicare charges, new Medicare ACOs may discover fewer assigned beneficiaries than anticipated. Potential shared savings will be reduced by suboptimal quality. Therefore, new Medicare ACOs must provide excellent care in 33 outpatient clinical quality and patient satisfaction measures to avoid shared savings reduction.

Contact Information:

Keith J. Mueller, PhD
RUPRI Center for Rural Health Policy Analysis
Phone: 319.384.3832
keith-mueller@uiowa.edu

Medicare Accountable Care Organizations: Program Eligibility, Beneficiary Assignment, and Quality Measures

The Patient Protection and Affordable Care Act 2010 (ACA) established a Medicare Shared Savings Program (MSSP) and accompanying Medicare ACOs to “facilitate coordination and cooperation among providers to improve the quality of care for Medicare fee-for-service (FFS) beneficiaries and reduce unnecessary costs”. To assist rural providers considering ACO formation, this policy brief describes MSSP eligibility and participation requirements, beneficiary assignment processes, and quality measures.

Organizations considering participating in the MSSP (Medicare ACO program) should carefully review program eligibility requirements and the beneficiary assignment process. Due to beneficiary assignment based on the greater of allowed Medicare charges, new Medicare ACOs may discover fewer assigned beneficiaries than anticipated. Potential shared savings will be reduced by suboptimal quality Therefore, new Medicare ACOs must provide excellent care in 33 outpatient clinical quality and patient satisfaction measures to a void shared savings reduction. Please click on the following link to download a copy of the policy brief: ACO Eligibility Assignment

RUPRI Center for Rural Health Policy Analysis University of Iowa College of Public Health Department of Health Management and Policy 145 Riverside Drive, N200 – CPHB Iowa City, IA 52242 Phone: (319) 384-3831 Fax: (319) 384-4371 Web site: www.public-health.uiowa.edu/rupri

  • Perinatal Health in the Rural United States, 2005

    Policy Brief #138

    Policy Brief #139

    Policy Brief #140

    Policy Brief #141

    This series of briefs examine perinatal outcomes in rural areas across the United States in 2005. Low birth weight, a key indicator of the health of the U.S. population, and adequacy of prenatal care, a critical indicator of access and quality of health care, are explored to discover how they are related to rural or urban location, race, and ethnicity.

    Contact information:
    Laura-Mae Baldwin, MD, MPH
    WWAMI Rural Health Research Center
    Phone: 206-685-4799
    lmb@fammed.washington.edu

  • A new rural policy brief is available from the RUPRI Center for Rural Health Policy Analysis:

    Demographic and Economic Characteristics Associated with Sole County Pharmacy Closures, 2006 – 2010

    This brief describes seven demographic and economic characteristics of counties that lost their only independent pharmacy between May 1, 2006, and December 1, 2010, and discussesimplications of these findings for health care access and delivery in these types of areas. In general the counties are sparsely populated, have declining and aging populations, higher percentages of households in poverty and uninsured than the nation, and less presence of primary care and other doctors. The majority of these counties already experience primarymedical care access problems, as the whole-county HPSA designations and average number of physicians per capita in these counties show. Consequently, rural counties, especially thosethat have shortages of primary care providers, rely heavily on the array of health services that sole pharmacies provide, and pharmacy closure removes a critical source of health care.

    Please click on the following link to download a copy of the policy brief: http://www.public-health.uiowa.edu/rupri/publications/policybriefs/2013/Sole%20County%20Pharm%20Closures.pdf

    RUPRI Center for Rural Health Policy Analysis
    University of Iowa
    College of Public Health
    Department of Health Management and Policy
    105 River Street, N200 – CPHB
    Iowa City, IA 52242
    Phone: (319) 384-3831
    Fax: (319) 384-4371
    Web site: www.public-health.uiowa.edu/rupri

  • Demographic and Economic Characteristics Associated with Sole County Pharmacy Closures, 2006-2010

    This brief describes seven demographic and economic characteristics of counties that lost their only independent pharmacy between May 1, 2006, and December 1, 2010, and discusses implications of these findings for health care access and delivery in these types of areas. In general the counties are sparsely populated, have declining and aging populations, higher percentages of households in poverty and uninsured than the nation, and less presence of primary care and other doctors. The majority of these counties already experience primary medical care access problems, as the whole-county HPSA designations and average number of physicians per capita in these counties show. Consequently, rural counties, especially those that have shortages of primary care providers, rely heavily on the array of health services that sole pharmacies provide, and pharmacy closure removes a critical source of health care.

    Contact Information:
    Keith J. Mueller, PhD
    RUPRI Center for Rural Health Policy Analysis
    Phone: 319.384.3831
    keith-mueller@uiowa.edu

  • Critical Access Hospitals

    Implications for Beneficiary Travel Time If Financially-Vulnerable Critical Access Hospitals Close
    Change in Profitability and Financial Distress of Critical Access Hospitals from Loss of Cost-Based Reimbursement
    Rural/Urban Differences in Inpatient Related Costs and Use among Medicare Beneficiaries
    This is a series of three briefs that provides information for policy makers and stakeholders as policy changes for Critical Access Hospitals (CAHs) are considered. The briefs focus on potential increases in beneficiary travel distance if financially-vulnerable CAHs close; the projected financial impact that a reduction in Medicare payments might have on CAHs; and on the rural-urban differences in inpatient costs and use among Medicare beneficiaries.

    Contact information:
    George Pink, PhD
    North Carolina Rural Health Research Program
    Phone: 919-966-1457
    gpink@email.unc.edu

  • Two Case Studies of Regional Extension Centers Serving Rural Practices

    These two case studies focus on the experiences of HIT Regional Extension Centers working with rural physicians in their respective service areas. They are intended to serve as companions to our recent article in The Journal of Rural Health, which examined the national impact of the REC program and the role of the RECs in helping rural physician practices achieve “meaningful use” of Electronic Health Records. The two RECs were selected for these case studies based on their high rankings among the 62 RECs nationwide on the number of rural providers that had signed up for REC services, implemented EHRs, and attained meaningful use as of May 2012.

    The case studies feature commentary and advice from key staff at the RECs as well as selected physician practices serving rural areas.

    Contact information:
    Michelle Casey, MS
    University of Minnesota Rural Health Research Center
    Phone: 612.624.6151
    mcasey@umn.edu

  • Telemental Health in Today’s Rural Health System

    Telemental health is widely promoted as a way to address access barriers to mental health care in rural areas. However, we lack a clear picture of how telemental health is being used across the country. This brief describes the organizational setting, services provided, and staff used in 53 telemental health programs. The report concludes by outlining the opportunities and challenges for telemental health in today’s rural health system.

    Contact Information:
    David Lambert, PhD
    Maine Rural Health Research Center
    Phone: 207-780-4502
    davidl@usm.maine.edu

  • Assessing the Impact of Rural Provider Service Mix on the Primary Care Incentive Payment Program

    The Patient Protection and Affordable Care Act of 2010 created the Primary Care Incentive Payment Program. For the years 2011 through 2015, if certain evaluation and management services represent 60% or more of Medicare allowable charges, then the provider qualifies for a 10% bonus calculated on the primary care portion of allowable charges. Based on analysis of 2009 Medicare claims data, more than 70% of rural primary care physicians (PCP) and non-physician practitioners (NPP) qualify for payments. The average incentive payment for qualifying rural PCPs would result in an additional $8,000 in Medicare patient revenue per year. For qualifying NPPs, the result is an additional $3,000 in Medicare patient revenue per year.

    Contact Information:
    Keith J. Mueller, PhD
    RUPRI Center for Rural Health Policy Analysis
    Phone: 319.384.3831
    keith-mueller@uiowa.edu

  • CMS FINALIZES SMALL BUSINESS HEALTH OPTIONS PROGRAM (SHOP) RULE & APPLICATION

    The Centers for Medicare & Medicaid Services (CMS) released a Small Business Health Options Program (SHOP) final rule and the application that provides small employers with easy-to-understand access to health insurance options for their employees.

    Beginning on October 1, 2013, small employers will be able to choose from a range of coverage options through the SHOP for their employees for coverage, beginning on January 1, 2014. The SHOP will offer a single point of entry for employers and their employees to apply for coverage, and if eligible, the employer may qualify for a tax credit worth up to 50 percent of the employer’s premium contribution.

    For the SHOP Rule (CMS-9964-F2), PLEASE CLICK HERE.

    For the SHOP Application: PLEASE CLICK HERE.

  • VIDEO: HEALTH INFORMATION TECHNOLOGY (Health IT) — WHAT IT MEANS FOR YOU

    Watch this 3 minute video to find out how Health IT—including Electronic Health Records (EHRs) — can help provide a complete and secure picture of your medical records. Learn about the future of Health IT and how you may be able to securely access your family’s medical records online, schedule doctor appointments online, review health test results online, and track chronic conditions with your doctor without having to make the trip to the doctor’s office.

  • VIDEO: UNDERSTANDING HEALTH INFORMATION EXCHANGE IN PENNSYLVANIA

    This 5 minute video shows how the Pennsylvania eHealth Partnership Authority was formed and how it is establishing statewide exchange of electronic medical records.