Rural Health Information Hub Latest News

Data on Nearest Source of Care Affecting HPSA Scores

The Health Resources and Services Administration (HRSA) has released the seventh preliminary report on automatic Health Professional Shortage Area scores (auto-HPSAs). Uses may have noticed in their scores that the Nearest Source of Care (NSC) for primary care, dental or behavioral health was inaccurate. According to the Pennsylvania Department of Health (DOH), which serves as the commonwealth’s Primary Care Office, HRSA knows that most of the NSCs for the auto-HPSAs are not correct. DOH is unable to change those providers, however, until after the national update when the HRSA auto-HPSA portal will be available to change the NSC and submit supplemental documentation. The national update will take place when the preliminary scores become official and take the place of the current scores. Information provided about NSCs cannot be entered since the portal is not yet available, so DOH is asking Community Health Centers to wait until after the national update to request a change. This will help DOH track, comply and best change requests. To request a change, please send an email to Belinda Williams, Public Health Program Administrator, at belwilliam@pa.gov.

Comment Deadline July 8 on HRSA’s Service Area Considerations

The Health Resources and Services Administration (HRSA) is still accepting feedback for the Health Center Program Service Area Considerations Request for Information (RFI) that may inform HRSA decisions regarding Health Center Program expansion through an existing health center’s addition of new service delivery sites. The deadline is Monday, July 8. HRSA welcomes feedback on the following areas of consideration: unmet need; proximity; reasonable boundaries for service area; consultation with other local providers; demonstrated capacity and performance in existing service area; and insuring patient input/representation. Share your thoughts and thank you to those who have already submitted input.

Primary Care a 2019 Priority for Hospital Executives

At the start of every year, the Health Care Advisory Board conducts the Advisory Board Research Annual Health Care CEO Survey to identify the top strategic priorities for hospital and health system leaders. The survey found that 57% ranked improving ambulatory access a high priority, while strengthening primary care alignment and redesigning systems for population health were also ranked as high priorities by more than half. Read more.

Feds Release Shortage Area Score Requirements for NHSC Scholars

Health Professional Shortage Area (HPSA) scores for National Health Service Corps scholars in Class Year 2020 have once again gone up, making the list of eligible sites even smaller. Priority for assignment of NHSC scholars at NHSC-approved sites is as follows:

  • Primary medical care HPSAs with scores of 19 and above are authorized for the assignment of NHSC scholars who are primary care physicians, primary care nurse practitioners, or primary care physician assistants; primary medical care HPSAs with scores of 16 and above are authorized for the assignment of NHSC scholars who are certified nurse midwives.
  • Mental health HPSAs with scores of 21 and above are authorized for the assignment of NHSC scholars who are psychiatrists; mental health HPSAs with scores of 19 and above are authorized for the assignment of NHSC scholars who are mental health nurse practitioners or mental health physician assistants; and
  • Dental HPSAs with scores of 19 and above are authorized for the assignment of NHSC scholars who are dentists.

The NHSC has determined that the minimum HPSA scores listed above for all service-ready NHSC scholars will enable it to meet its statutory obligation to identify a number of entities eligible for NHSC scholar assignment that is at least equal to, but not greater than, twice the number of NHSC scholars available to serve in the 2020 class year. Read more on the HRSA website.

School-Based Health Centers – There’s a National Resource

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.

Insurer Participation in Rural Health Insurance Marketplaces: Are Some Markets Intrinsically More Competitive Than Others?

A new rural policy brief is available from the RUPRI Center for Rural Health Policy Analysis authored by Abigail R. Barker, PhD; Timothy D. McBride, PhD; Keith J. Mueller, PhD

The Patient Protection and Affordable Care Act of 2010 established Health Insurance Marketplaces (HIMs) as a mechanism to improve the functioning of existing individual insurance markets. However, to be successful, this model requires the presence of at least a handful of insurers from which beneficiaries in each local market can choose. Over the first five years of HIMs, rural counties have often struggled to attract sufficient numbers of HIM insurers. In this project, county-level data were combined from HIM plan availability files, Medicare Advantage (MA) availability and enrollment files, and Federal Employees Health Benefits Program (FEHBP) availability and enrollment files. We calculated the Herfindahl Index, which is a measure of competition in a given market, for MA and FEHBP markets for each county in 2013-16.

We found that, within a given population density category, the number of HIM insurers was positively correlated with the prior level of FEHBP market competition in a county. Note, also, that market competition was generally higher as population density increased. In 2017, the pattern continued to hold, with those counties that still attracted several insurers (rather than just one or two) averaging the lowest prior-year FEHBP Herfindahl index. We found that many of the population measures were in fact significant in their own right, including population density, total population, primary care providers per capita, and rural status of the county. Furthermore, even when controlling for these measures, prior FEHBP market concentration (low competition) was a significant predictor of low insurer participation in HIMs. In addition, from 2014 to 2017, the magnitude of the effect increased.

Click to download a copy: Insurer Participation in Rural Health Insurance Marketplaces: Are Some Markets Intrinsically More Competitive Than Others?

Online Training and Resources for Rural First Responders

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

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.

Cost-Sharing as a Barrier to Accessing Care at FQHCs and RHCs for Rural Medicare Beneficiaries

Cost-Sharing as a Barrier to Accessing Care at FQHCs and RHCs for Rural Medicare Beneficiaries.  Cost is often a significant barrier to accessing care for the rural Medicare population, so having a better understanding of the variations in cost-sharing per claim (deductibles and coinsurance amounts) at various types of safety-net facilities is important. The purpose of this study from the North Carolina Rural Health Research and Policy Analysis Center is to investigate cost as a barrier to accessing care at Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) for the rural Medicare population.

Measuring Access to Care in National Surveys: Implications for Rural Health

Measuring Access to Care in National Surveys: Implications for Rural Health.  In order to assess the efficacy of healthcare in meeting the needs of the population and to ensure access to timely, appropriate care, it is important to have nationally representative measures of access and barriers to healthcare. Given the unique healthcare context in rural settings, it is also important to understand whether, and how, access is measured in ways that are salient for rural populations. This brief from the University of Minnesota Rural Health Research Center reviews access measures included in major national surveys and presents implications for rural research on access to care.