- Native Americans Have Shorter Life Spans, and It's Not Just Due to Lack of Health Care
- Promotoras Play Essential Role in Connecting Farmworkers with Health Care in Rural NorCal
- Using Medicaid to Address Young People's Mental Health Needs in School Settings
- Across the Country, Amish Populations Are on the Rise
- Sunsets, Wildlife and Limited Care: Challenges of Aging in Place in Rural America
- City-Country Mortality Gap Widens amid Persistent Holes in Rural Health Care Access
- Tribal Environmental Impact Network
- Minnesota's Rural Ambulance Providers Look to State Capitol for Their Own Lifeline
- Biden-Harris Administration Takes Action to Support the Primary Care Workforce
- Over 3,000 Homes on the Navajo Nation Receive Accurate Addresses for the First Time
- Rural Population Grows for Second Consecutive Year
- Rapides Library Offers Telehealth to a Town Without Doctors
- Rural Infection Preventionists Need Community Support
- New Federal Health IT Strategy Sets Sights on a Heathier, More Innovative, and More Equitable Health Care Experience
- Upcoming Virtual Workshop: Partnering for Success: Building Partnerships for Health Workforce Training and Education
Rural Response to Coronavirus Disease 2019
The Rural Health Information Hub posted a guide to help you learn about activities underway to address COVID-19. New: Rural Healthcare Surge Readiness a tool developed by the COVID-19 Healthcare Resilience Working Group that helps rural healthcare facilities prepare for and respond to a COVID-19 surge. The tool provides the most up-to-date resources for rural healthcare systems preparing for and responding to a COVID-19 surge in a range of healthcare settings (EMS, inpatient and hospital care, ambulatory care, and long-term care) and covers a range of topics including behavioral health, healthcare operations to telehealth, and more.
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.”
Federal Ways and Means Committee Report Lays Out Rural Health Issues, Says Scalable Fixes Scarce
By Michelle M. Stein / July 15, 2020
A House Ways & Means Democratic report on rural and medically underserved areas says stakeholders painted a bleak picture of the myriad problems facing those areas but they didn’t provide many overarching solutions — and that may mean that narrow, community-specific interventions are what’s needed, even if those models aren’t necessarily scalable.
The report, which analyzes feedback from stakeholders to the committee’s bipartisan rural health task force, says no federal policy alone will solve the issues. Instead, a sustained commitment from Congress, state, local and private-sector interests is necessary to develop sustainable, creative solutions to decades-long problems facing rural and underserved communities.
The committee in 2019 set up a rural health task force, chaired by Reps. Terri Sewell (D-AL), Danny Davis (D-IL), Jodey Arrington (R-TX) and Brad Wenstrup (R-OH), in a bid to better understand the challenges impeding health equity and to come up with best practices to tackle those issues. The committee received input from almost 200 stakeholders that highlighted challenges including: variable life expectancy across geographic areas; infrastructure issues like clean water and lack of broadband; lower rates of commercial insurance coverage in rural areas than urban areas; and health workforce and mental health shortages.
“Overall, RFI respondents presented a bleak picture of underserved communities that grapple with similar challenges ranging from population health and coverage barriers, to massive health system deficiencies, to structural environmental factors that adversely impact health. Respondents also emphasized the challenges in collecting data that appropriately quantify and highlight these differences in a meaningful way for researchers and policymakers to better understand — and ultimately propose interventions to address — these inequities,” the report says.
The task force and committee leadership have asked the Medicare Payment Advisory Commission to update its 2012 report on Medicare in rural areas, and to also look closer at dual eligibles and those with multiple chronic conditions in upcoming analyses.
Disparities and inequalities have only been exacerbated by the COVID-19 pandemic, the report says. For example, telehealth and other technology has been helpful during the pandemic for some, but it won’t help if individuals don’t have access to smartphones or broadband, the report says.
“Such experiences are a clarion sign of the differences that exist between and among us, illustrating how even exciting innovations always have the potential to leave communities behind,” according to the report.
The root causes of these problems also need to be addressed, the lawmakers say. For example, the report says hospital closures are not the result of Medicare pay rates alone, but also population size in a rural area, a lack of population health coverage, absence of public transportation, decisions not to expand Medicaid, and other factors. Telehealth doesn’t deal with the problems of bringing providers into an underserved community, even if it could help with some access, the report says.
“Without considering these other drivers, such a policy is merely a band aid on a gaping wound,” the report says.
The committee received “few concrete, data-driven fixes” from stakeholders, and “even those appeared limited by questions of their scalability,” the report says.
“Perhaps this gap in data across submissions is a reflection of the truth that ‘silver bullet’ policies do not exist when attempting to address phenomena that are varied, intertwined, and have historic roots dating back hundreds of years. The plight of rural and urban underserved communities is complex and implicates many principles seen to reflect the nation’s conscience. In these circumstances, where structural changes inform social advancements, it is extremely difficult to develop one-size-fits-all solutions to satisfy every stakeholder,” according to the report.
The report adds that community-tailored solutions have been, and may continue to be, the most promising to tackle these issues.
However, the lawmakers say Ways & Means is still committed to working on the larger, overarching issues contributing to the health disparities in rural and underserved areas.
“Renewed leadership from the federal government is critically needed to efficiently and effectively address the role that racism and other social and structural determinants have in perpetuating health inequity as seen through disparities,” the report says. “The complexities involved demand accountability, transparency, and solutions that transcend ‘health’ and ‘health care’ as America’s programs have traditionally defined it. The Ways and Means Committee, guided by the Task Force’s findings, is working to answer that call.”
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.
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.