Rural Health Information Hub Latest News

HHS Coronavirus Data Hub

Last week, the U.S. Department of Health & Human Services (HHS) launched a website with data on the COVID-19 response at federal, state, and local levels.  The hub includes estimated and reported hospital capacity by state, with numbers updated daily.

Appeals Court Upholds Nearly 30% Payment Cut to 340B Hospitals

Fierce Healthcare

A federal appeals court has ruled the Trump administration can install nearly 30% cuts to the 340B drug discount program.

The ruling Friday is the latest legal setback for hospitals that have been vociferously fighting cuts the Department of Health and Human Services (HHS) announced back in 2017.

340B requires pharmaceutical manufacturers to deliver discounts to safety net hospitals in exchange for participation in Medicaid. A hospital will pay typically between 20% and 50% below the average sales price for the covered drugs.

HHS sought to address a payment gap between 340B and Medicare Part B, which reimburses providers for drugs administered in a physician’s office such as chemotherapy. There was a 25% and 55% gap between the price for a 340B drug and on Medicare Part B.

So HHS administered a 28.5% cut in the 2018 hospital payment rule. The agency also included the cuts in the 2019 payment rule.

Three hospital groups sued to stop the cut, arguing that HHS exceeded its federal authority to adjust the rates to the program.

A lower court agreed with the hospitals and called for the agency to come up with a remedy for the cuts that already went into effect.

But HHS argued that when it sets 340B payment amounts, it has the authority to adjust the amounts to ensure they don’t reimburse hospitals at higher levels than the actual costs to acquire the drugs.

If the hospital acquisition cost data are not available, HHS could determine the amount of payment equal to the average drug price. HHS argued that hospital cost acquisition data was not available and so HHS needed to determine the payment rates based on the average drug price.

The court agreed with the agency’s interpretation.

“At a minimum, the statute does not clearly preclude HHS from adjusting the [340B] rate in a focused manner to address problems with reimbursement rates applicable only to certain types of hospitals,” the ruling said.

The court added that the $1.6 billion gleaned from the cuts would go to all providers as additional reimbursements for other services.

340B groups were disappointed with the decision.

“These cuts of nearly 30% have caused real and lasting pain to safety-net hospitals and the patients they serve,” said Maureen Testoni, president and CEO of advocacy group 340B Health, which represents more than 1,400 hospitals that participate in the program. “Keeping these cuts in place will only deepen the damage of forced cutbacks in patient services and cancellations of planned care expansions.”

This is the latest legal defeat for the hospital industry. A few weeks ago, the same appeals court ruled that HHS had the legal authority to institute cuts to off-campus clinics to bring Medicare payments in line with physician offices, reversing a lower court’s ruling.

The groups behind the lawsuit — American Hospital Association, American Association of Medical Colleges and America’s Essential Hospitals — slammed the decision as hurtful to hospitals fighting the COVID-19 pandemic. But the groups didn’t say if it would appeal the decision.

“Hospitals that rely on the savings from the 340B drug pricing program are also on the front-lines of the COVID-19 pandemic, and today’s decision will result in the continued loss of resources at the worst possible time,” the groups said in a statement Friday.

Pennsylvania Dashboard Data Shows Weekly COVID Case Increases Statewide, Multiple Counties with High Percent-Positives

Pennsylvania Governor Tom Wolf released a weekly status update detailing the state’s mitigation efforts based on the COVID-19 Early Warning Monitoring System Dashboard comparing the seven-day period of July 24 – July 30 to the previous seven days, July 17 – July 23.

The dashboard is designed to provide early warning signs of factors that affect the state’s mitigation efforts. The data available on the dashboard includes week-over-week case differences, incidence rates, test percent-positivity, and rates of hospitalizations, ventilations and emergency room visits tied to COVID-19.

“The mitigation efforts we took on July 15 were a proactive step to get in front of the rise of cases that we continue to see,” Gov. Wolf said. “Our percent positivity decreased this week, which is a positive sign, but in order to continue to see numbers decrease, we must continue to wear masks and practice social distancing.

“Going out without a mask and congregating at a bar or in a crowded backyard party where social distancing isn’t being practiced continues to lead to spikes in cases. We need to recommit to these simple measures to stop the spread and go back to more freedoms.”

As of Thursday, July 30, the state has seen a seven-day case increase of 6,228, the previous seven-day increase was 6,010, alerting that cases are continuing to rise throughout the state.

The statewide percent-positivity went down to 4.6% from 4.7% last week. Counties with concerning percent-positivity include Lawrence (7.4%), Franklin (7.2%), Indiana (7.2%), Fayette (7.1%), Armstrong (7.0%), Beaver (6.5%), Delaware (6.5%), Allegheny (6.4%), Lancaster (5.8%), Berks (5.6%), Philadelphia (5.4%) and Chester (5.3%). Each of these counties bear watching as the state continues to monitor all available data.

The Department of Health updated its travel recommendations, originally announced on July 2, to remove Wyoming to the list of states recommended for domestic travelers returning from to quarantine for 14 days upon return to Pennsylvania.

It is important that people understand that this recommendation is in place to prevent the spread of COVID-19 in Pennsylvania. A significant number of recent cases have been linked to travel, and if people are going to travel, we need them to take steps to protect themselves, their loved ones and their community, and that involves quarantining.

Gov. Wolf continues to prioritize the health and safety of Pennsylvanians through the COVID-19 pandemic. Pennsylvanians should continue to take actions to prevent the spread of COVID-19, regardless of the status of their county. This includes wearing a mask or face covering anytime they are in public. COVID-19 has been shown to spread easily in the air and contagious carriers can be asymptomatic.

Pennsylvania Department of Health Continues to Increase Testing in Several Regions

The Pennsylvania Department of Health announced that beginning Wednesday, August 5, various Walmart locations across the state will begin providing drive-thru testing for residents living in areas where there is a need for testing sites.

“We appreciate the hard work done by health systems, pharmacies, Federally Qualified Health Centers (FQHCs), medical clinics and other entities that are providing testing for COVID-19 across Pennsylvania,” Secretary of Health Dr. Rachel Levine said. “When we established our testing strategy, we wanted testing to be accessible, available and adaptable and we are working to meet that challenge. Anyone who believes they are in need of a COVID-19 test and meet testing criteria can get tested today in Pennsylvania.”

Nine new drive-thru testing sites will launch on August 5. There is no testing in stores. These sites will be open weekly to test up to 50 registered patients. Registration is required one day in advance. The following drive-thru testing sites will be open Monday-Friday from 9:00 AM to 4:00 PM starting Wednesday, August 5th:

  • Walmart Supercenter pharmacy drive-thru, 355 Walmart Drive, Uniontown, PA
  • Walmart Supercenter pharmacy drive-thru, 2601 Macarthur Rd Relocation, Whitehall, PA
  • Walmart Supercenter pharmacy drive-thru, 2010 Village Center Dr, Tarentum, PA
  • Walmart Supercenter pharmacy drive-thru, 134 Daniel Kendall, West Brownsville, PA

The following drive-thru testing sites will be open Monday, Wednesday, Friday from 7:00 AM to 9:00 AM starting Wednesday, August 5th:

  • Walmart Supercenter parking lot, 20245 Route 19, Cranberry Township, PA
  • Walmart Supercenter parking lot, 200 Kocher Lane, Elizabethville, PA
  • Walmart Supercenter parking lot, 50 Newberry Parkway, Etters, PA
  • Walmart Supercenter parking lot, 1355 East Lehman St, Lebanon, PA
  • Walmart Supercenter parking lot, 100 Chippewa Town Center, Beaver Falls, PA

These nine new sites are in addition to existing Walmart drive-thru sites in Clarion, State College, New Castle and Edinboro. The most updated testing sites and information is available on the Department of Health’s website.

Pennsylvania Governors’s Administration, Local Law Enforcement Stress Important Roles Education and Understanding Play in Enforcement of COVID-19 Orders

Pennsylvania Governor Tom Wolf visited the Susquehanna Township Police headquarters to discuss the important roles education and understanding play in the enforcement of the various COVID-19 mitigation orders in place across the state.

“We have to do everything we can to keep our communities safe and healthy, including wearing a mask and following mitigation orders so our business operate safely,” Gov. Wolf said. “We have the ability to enforce these rules, and we are going to continue to work closely with commonwealth agencies and local officials to enforce public safety orders.”

The governor was joined by representatives of commonwealth agencies and local law enforcement involved in mitigation order enforcement, including Secretary of Heath Dr. Rachel Levine, Secretary of Agriculture Russell Redding, Pennsylvania State Police Lt. Col. Scott Price, and Susquehanna Township Chief of Police Rob Martin.

Each representative focused on the role their agency plays in education and enforcement of the various orders in place to keep Pennsylvanians safe and stop the spread of COVID-19.

“Wearing a mask is so important to protecting each other. I implore all Pennsylvanians to do right thing,” Dr. Levine said. “When you wear a mask you are not only telling that person you pass on the street that you care about their safety, you are telling police and other first responders that you care about their safety, too.”

“Pennsylvania’s restaurant owners and staff and have delivered for us, putting safe, healthy food on our tables,” Redding said. “We can all deliver for them by wearing a mask and following the COVID-19 measures to keep them safe and healthy.”

“As some of the most visible public servants in the commonwealth, the state police will continue working collaboratively with the Department of Health and local police departments to remain at the forefront of law enforcement pandemic response efforts,” said Lieutenant Colonel Price.  “We are grateful to the majority of Pennsylvanians who have stepped up to follow mitigation requirements and for all the support our troopers and liquor control enforcement officers have received during the past several months.”

Local law enforcement’s role is a collaborative one with state agencies and local officials, and Chief Martin stressed his department’s work to educate businesses and residents, and to refer any suspected violations of the governor and Dr. Levine’s orders to the proper state agency if necessary.

“Our citizens in Susquehanna Township have been inspiring. On many occasions they have contacted our police department and our government center for advice, guidance, and our assistance. We wish to meet our citizens where they are and be an educational voice of gentle persuasion,” Martin said. “Of the times that we have had to make referrals to our commonwealth partners, we have been met with cooperation and understanding. I want to thank the commonwealth for being a valued partner, and thank Governor Wolf for his always civil mannered discourse, as what our country needs right now is civility.”

The governor also asked local elected officials and business owners to work with local law enforcement to protect their communities and constituents.

“I’m calling upon every Pennsylvanian to do their part to help us get as close as we can to 100 percent compliance on masking,” Gov. Wolf said. “We need the help of our business owners to get workers masking. We need the help of our local elected officials to emphasize the importance of masking on keeping the community safe.”

According to a recent poll by Franklin & Marshall College, two-thirds of registered voters in Pennsylvania believe it is “extremely important” to wear a mask whenever they leave home.

“We need to come together, unified, against COVID-19,” Gov. Wolf said. “I’m calling upon every Pennsylvanian to do their part to help us get as close as we can to 100 percent compliance on masking.”

New! NOSORH Issue Brief Defining Rural Population Health and Health Equity

New NOSORH issue brief examines the definitions of population health and health equity for rural stakeholders, and offers examples of successful rural strategies.

In recent years, the terms “population health” and “health equity” have often been used interchangeably by some rural stakeholders. This issue brief aims to examine the differences between the two terms, and offers successful examples of rural population health and health equity activities by State Offices of Rural Health (SORH) and their partners. The brief also offers suggestions on how rural health stakeholders can get started in population health and health equity efforts at the state and local levels.

With support from the Federal Office of Rural Health Policy, NOSORH developed this issue brief for SORH and other rural health stakeholders as a means of ensuring unified definitions and approaches to population health and health equity by rural stakeholders.

Looking for more?

Check out the Resources by Topic and Position Statements sections of the NOSORH website.

High-Quality Pre-K Across Pennsylvania

Access to high-quality pre-k is a fundamental building block of our state’s education system. In PPC’s role as a principal partner of the Pre-K for PA campaign, they annually update this mapping feature to help all Pennsylvanians learn more about this vital early learning experience in their local area.

View the map

Use it to search by House or Senate district, by school district or county, and this year a school district map showing the percentage of capacity that is high-quality is now available. After completing your search, you can also print a fact sheet that includes the number of children served, unmet need, the number of high-quality providers and current capacity.

ARC Annual Summit Goes Virtual With Summer Showcase

This year, ARC’s annual summit is going virtual with a four week seminar series discussing major themes and best practices guiding the Region’s economic future. Register now for Economic Innovation + Ingenuity During COVID: An Appalachian Perspective, a free seminar produced in partnership with the state of Ohio. Join a session every Wednesday, 11 am (ET) August 19- September 9:

  • August 19: Lessons Learned in Leadership During the COVID-19 Crisis with Ohio Governor Mike DeWine; ARC Federal Co-Chairman Tim Thomas; and Coshocton Port Authority Executive Director Tiffany Swigert; moderated by Ohio Development Services Agency Director Lydia Mihalik.
  • August 26: Appalachia’s dual pandemics: Substance Abuse and COVID 19 with Deputy Secretary of Health Preparedness and Community Protection in Pennsylvania Ray Barishansky; Executive Director of Ross County Community Action Commission in Ohio Julie Bolen; and Executive Director of Southern Tier East Regional Planning Development Board in New York Jennifer Gregory; moderated by RecoveryOhio Director Alisha Nelson.
  • September 2: Highways to Cyberways: Innovations in Infrastructure with Natural Resources Business Specialist in Garrett County, Maryland Cheryl DeBerry; Executive Director of LENOWISCO Planning District Commission in Virginia Duane Miller; and Executive Director of DriveOhio Patrick Smith; moderated by Chief of the Office of BroadbandOhio Peter Voderberg.
  • September 9: Attracting the Socially Distant Tourist with Executive Director of the Hatfield McCoy Regional Recreation Jeff Lusk; Director of TourismOhio Matthew MacLaren; and Producing Artistic Director of Barter Theatre in Virginia Katy Brown; moderated by Ohio Development Services Agency Director Lydia Mihalik.

More information about the series is available at www.arc.gov/summit.

All Appalachian Counties Report Confirmed Cases of COVID-19

Appalachia’s first COVID-19 cases were confirmed in early March. 143 days later, on July 26, Doddridge County, West Virginia became the final of Appalachia’s 420 counties to report a confirmed COVID-19 case. Drawing on data from the Johns Hopkins University, COVID-19 Cases in Appalachia maps COVID-19’s spread in the region in relation to the rests of the country.  

More county-level information regarding COVID-19 cases can be found using the searchable database offering demographic data snapshots of confirmed cases and deaths in relation to hospital bed counts, population and businesses, and categories of people at risk for COVID-19. By hovering over each statistical icon, users can learn more about the supporting data. COVID-19 related data is updated daily.

Trump to Sign Order Aimed at Boosting Rural Health Care, Telehealth

Trump’s announcement comes as his administration has rolled out multiple health care announcements in recent weeks.

President Donald Trump is expected to sign an executive order on August 3, 2020 aimed at boosting health care in rural areas, where struggling hospitals have faced worsening economic conditions during the pandemic, according to five individuals familiar with the planned announcement.

The order will focus on an administration effort to create new ways of financing rural health care, as well as propose a permanent extension for some telehealth policies that helped fuel virtual care’s explosive growth amid stay-at-home orders.

Trump’s announcement comes as his administration has rolled out multiple health care announcements in recent weeks, in a pre-election effort to bolster the president’s record on an important issue to voters. These actions have included executive orders aimed at slashing drug prices, though the ambitious plans have limitations and are not expected to take effect before Election Day. Last week, the administration also released a report on surprise medical bills, as it urged Congress to revive bipartisan efforts to pass consumer protections.

Pressed about his lack of a replacement for Obamacare, Trump also has spent days promising to unveil a health plan of his own, though he declined to detail exactly what that plan would do.

“We’re signing a health-care plan within two weeks, a full and complete health-care plan,” Trump said on “Fox News Sunday” on July 19 — just over two weeks ago.

One federal health official said the rural health changes are limited and should not be viewed as a replacement for the health care law. Three officials also said the administration does not have plans to imminently produce an Obamacare alternative.

Some elements of the rural health plan have been under consideration for more than two years, but the White House budget office balked at proposals to reform hospital payments, fearing that they would be unworkable in practice. Federal health officials retooled the proposals to demonstrate they would save the federal government money.

Under the new plan, the federal Medicare agency will leverage its authority to test new pilot projects that offer financial incentives for providers who deliver higher-quality care to patients. Administration officials believe its new financial model will help keep rural hospitals open, after about 130 have closed in the past decade. The program will be optional, according to three sources.

However, officials have debated the risks of overhauling rural hospital payments, given that the industry is already are under considerable financial pressure and the administration could face political backlash if more hospitals shutter after the White House’s plan takes effect. It’s unclear if any of the changes could be finalized before the election.

On telehealth, the administration will issue a proposed rule to make permanent Medicare payment of the technology for certain health care providers, in an effort to ensure the expansion of virtual care outlasts the pandemic, said two officials. However, a more sweeping extension of pandemic telehealth policies would likely have to come from Congress, which is just beginning to review the issue.

During the height of nationwide shutdowns, Medicare telehealth visits grew from just a few thousand per week to more than 1 million. Trump himself has often remarked about the technology’s rapid rise during the pandemic.

The White House and HHS declined to comment. A CMS spokesperson did not immediately respond to a request for comment. A White House announcement is expected at 5 p.m., two sources said.