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Health care representatives and policymakers in Pennsylvania are warning of declining maternity services in rural parts of the commonwealth, a shift that’s making it harder for pregnant women in these communities to access vital care.
But as hospitals continue to close down labor units and obstetricians exit some small towns, an array of organizations are working to help fill the health care gaps left behind.
Here are a few of the resources available to rural residents who are or are planning to become pregnant:
Rural Health Clinics
The federal government established a rural health clinic program in the 1970s in response to the lack of physicians in these areas who would treating Medicare patients. By receiving a designation through this program, clinics can benefit from enhanced Medicare and Medicaid reimbursement rates.
Today, there are about 70 of these health clinics scattered across rural parts of the commonwealth, according to the Pennsylvania Office of Rural Health.
While not all of the health system’s clinics have an OB/GYN, Pierce said the primary care providers at these facilities do offer prenatal services and help connect a patient with more specialized care elsewhere.
“They will get the patient started with the prenatal vitamins, get them tested to make sure they’re pregnant, get them started on the right path,” she said.
A list of Pennsylvania’s rural health clinics is accessible at bit.ly/3t67h8V.
Federally Qualified Health Centers
One of the missions of federally qualified health centers is to provide care in underserved communities, including rural areas. They are also obligated to care for any patient, regardless of the person’s insurance status or ability to pay.
Pennsylvania has about 99 FQHC sites in rural areas, according to the Center for Rural Pennsylvania.
George Garrow, CEO of Primary Health Network, an FQHC that has sites in 16 counties, said that while his health system doesn’t operate any hospitals where someone could give birth, the organization does offer a wide range of primary care services.
Many of its locations deliver behavioral or mental health services, and the network also makes use of case navigators to help patients with their individual needs and to avert any obstacles to care, Garrow said.
Navigators, for instance, might make sure a woman gets started on her prenatal vitamins early in her pregnancy or connect her with obstetricians and other specialists.
Community health workers in the network also assist people who have trouble getting to appointments, using partnerships with transportation programs or by contracting with ridesharing services, Garrow said. And the network also operates a charitable foundation that can aid people who can’t afford the cost of their prescription medicines.
You can search for FQHCs by county and specialty at my.pachc.org/Find-a-Health-Center
Jasmin Martinez Castellanos, M.D.: Pregnancy brings higher risk of cardiovascular disease
Through this program, women who are lower income can receive regular home visits from a nurse during their pregnancies and for the first two years of their child’s life.
Elizabeth Cassidy, a nurse who works in the partnership, said she aims to check in on women anywhere from once every several weeks to every week. During these visits, she’ll monitor her clients’ blood pressure, encourage them to establish healthy habits and form a trust-relationship that will continue after their child is born.
“We work with moms to achieve their own goals,” said Cassidy, whose employer, Maternal and Family Health Services, administers the nurse-family partnership program in northeastern Pennsylvania. “It’s not just baby-focused, but also to work on themselves and be the best parent that they can be.”
The nurse-partnership program traditionally is only open to first-time mothers, but Maternal and Family Health Services recently received permission also to serve pregnant women who already have children.
Information on nurse-family partnerships in Pennsylvania is available at nursefamilypartnership.org/locations/pennsylvania/
Paul Speer, M.D.: High blood pressure during pregnancy can lead to later health issues
The USA TODAY Network is covering healthcare access issues in rural parts of the commonwealth. As part of this reporting, we’re interested in hearing from Pennsylvanians in these communities who have struggled to access medical, dental and mental health care.
Fill out the form at bit.ly/pa-maternity and your response will go directly to a USA TODAY Network reporter. You may be contacted for further details about your story.
The National Maternal and Child Oral Health Resource Center (OHRC) recently published “Promoting Oral Health in Schools: A Resource Guide.” This guide provides information about materials for promoting oral health in schools and features materials on data and surveillance, policy, professional education, program development, and public education.
The Centers for Medicare & Medicaid Services (CMS) continues to recognize the challenges faced by members of the Sickle Cell Disease (SCD) community and is releasing a new Sickle Cell Disease Action Plan to address and eliminate barriers within CMS programs. The actions in this plan are designed to improve health outcomes and reduce health disparities for individuals living with SCD.
The burden of this disease, particularly for people enrolled in CMS programs, underscores the importance for CMS to use existing levers to take action on opportunities and solutions. The Action Plan builds on the Health Equity pillar of the CMS Strategic Plan and the goals under the CMS Framework for Health Equity. It also aligns with the mission and vision of the CMS National Quality Strategy and the CMS Behavioral Health Strategy’s goal to ensure effective pain treatment and management.
For more information about Sickle Cell Disease and related work that is happening across the agency, check out the resources below and review this recent blog from CMS Administrator Chiquita Brooks-LaSure and Acting CMS OMH Director Dr. Aditi Mallick.
- NEW! Read CMS’ Sickle Cell Disease Action Plan.
- Infographic on the Action Plan
- Check out these SCD resources from the CMS Office of Minority Health:
- Watch our Sickle Cell Disease video to learn more about common health complications faced by individuals with SCD, in addition to disparities, symptoms, and treatment options.
- Download The Invisible Crisis: Understanding Pain Management in Medicare Beneficiaries with Sickle Cell Disease, which highlights treatment options for pain management in SCD patients.
- Read the Prevalence of Sickle Cell Disease among Medicare Fee-for-Service Beneficiaries Age 18-75 Years, in 2016 data highlight to learn about other common chronic conditions among SCD patients and more.
- Explore our Coverage to Care initiative, which helps patients understand their health coverage and connect to primary care and preventive services, including chronic care management resources for providers and patients.
Learn more about other activities surrounding SCD from agencies across the Department of Health and Human Services (HHS):
- From the National Institutes of Health’s National Heart Lung Blood Institute (NIH/NHLBI) check out “Today’s Faces of SCD“, where NHLBI highlights people living with SCD, their loved ones, researchers, and others, every Friday during the month of September. Also, check out the Sickle Cell Awareness Month tab on their Blood Diseases and Disorders Education Program (BDDEP) webpage. Also view their SCD fact sheets, available in English and in Spanish. Finally, take a look at their Blood Health Network webpage for more information.
- Look at the Cure Sickle Cell Initiative’s webpage to learn more about their patient-focused research eﬀort designed to accelerate promising genetic therapies to cure sickle cell disease. Also review their Sickle Cell Awareness month page for more information about SCD.
- Review the Centers for Disease Control & Prevention’s Sickle Cell Disease Fact Sheet for a collection of resources to increase understanding of the disease.
The U.S. Department of Agriculture (USDA) Rural Development today announced that USDA, on October 1, 2023, will begin using the most recently released data from the U.S. Census Bureau to determine program eligibility for Rural Development programs.
Beginning in Fiscal Year 2024, the agency will use 2020 Decennial Census population data and 2017-2021 American Community Survey (ACS) income data to determine eligibility. The agency previously used 2010 Decennial Census population data and 2006-2010 ACS data.
Rural Development will also unveil updated online program eligibility maps. The maps will help individuals and organizations applying for Fiscal Year 2024 funding to quickly determine if an area is considered rural and/or eligible for Rural Development programs. The updated maps will be posted to the RD Eligibility Site.
The agency will continue to use 2010 census population data and 2006-2010 ACS income data to process complete applications submitted prior to Sept. 30, 2023, if the:
- Funds are obligated by June 30, 2024; or
- Funds are obligated after June 30, 2024, and the agency administrator has provided concurrence that the
application remains eligible under these metrics; or
- Funds are obligated by Sept. 30, 2024, for programs that accept applications on a rolling basis. These programs are the Intermediary Relending Program, Rural Energy for America Program, Rural Economic Development Loan and Grant Program and the Rural Microentrepreneur Assistance Program.
For more information about the transition to the 2020 Decennial Census data and 2017-2021 ACS data, please contact your RD State Office representative at https://www.rd.usda.gov/about-rd/state-offices.
If you’d like to subscribe to USDA Rural Development updates, visit our GovDelivery subscriber page.
The U.S. Department of Health and Human Services’ (HHS), Health Resources and Services Administration (HRSA) announced nearly $90 million in awards to support the White House Blueprint for Addressing the Maternal Health Crisis (PDF – 912 KB), a whole-of-government strategy to combat maternal mortality and improve maternal and infant health, particularly in underserved communities.
In recent decades, the United States’ maternal mortality rate has been among the highest of any developed nation. Disparities in mortality are stark — Black women are more than three times as likely as White women to die from pregnancy-related causes. The Biden-Harris Administration is committed to reversing these trends and making the U.S. the best country in the world to have a baby.
“At the Health Resources and Services Administration, we are laser-focused on reversing this crisis by expanding access to maternal care, growing the maternal care workforce, supporting moms experiencing maternal depression, and addressing the important social supports that are vital to safe pregnancies” said HRSA Administrator Carole Johnson. “We know it will take a sustained approach to reduce and eliminate maternal health disparities and we are committed to this work.”
The Administration’s White House Blueprint for Addressing the Maternal Health Crisis identifies five key goals to realize the vision of the U.S. being the best country in the world to have a baby. Today’s HRSA announcement takes action on each of those goals.
Click here to read more.
On September 1, 2023, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that would create new requirements for nurse staffing levels in nursing facilities, settings that provide medical and personal care services for nearly 1.2 million Americans. The adequacy of staffing in nursing homes has been a longstanding issue. A recent report issued by the National Academy of Sciences, Engineering, and Medicine (NASEM) raised concerns about low nursing staff levels in nursing facilities across the country and the impact on the quality of care for nursing home residents. The high mortality rate in nursing facilities during the COVID-19 pandemic highlighted and intensified the consequences of inadequate staffing levels.
The new proposed rule includes several provisions to bolster staffing in nursing homes. It proposes a minimum of 0.55 registered nurse (RN) and 2.45 nurse aide hours per resident day; requires facilities to have an RN on staff 24 hours per day, 7 days per week; strengthens staffing assessment and enforcement strategies; creates new reporting requirements regarding Medicaid payments for institutional long-term services and supports (LTSS); and provides $75 million for training for nurse aides. As noted in the proposed rule, CMS aims to balance the goal of establishing stronger staffing requirements against the practicalities of implementation and costs. Comments on the proposed rule are due by November 6, 2023.
This issue brief analyzes the percentage and characteristics of facilities that would meet the rule’s proposed requirements for the minimum number of RN and nurse aide hours to better understand the implications of the rule. The analysis does not evaluate facilities’ ability to comply with other requirements, including the requirement to always have a registered nurse on duty 24/7 or the ability to meet the new reporting and assessment requirements due to data limitations (see methods). The analysis uses Nursing Home Compare data, which include 14,591 nursing facilities (97% of all facilities, serving 1.17 million or 98% of all residents) that reported staffing levels in August 2023.
Click here to read more and to access the brief.
The U.S. Preventive Services Task Force released a final recommendation statement on screening for hypertensive disorders of pregnancy. The Task Force recommends that all pregnant people have their blood pressure measured throughout pregnancy. To view the recommendation, the evidence on which it is based, and a summary for clinicians, please go here.
Individuals with opioid use disorder (OUD) who were prescribed a lower buprenorphine dose were 20% more likely to discontinue treatment than those on a higher dose, according to a study of patients prescribed buprenorphine in Rhode Island from 2016 to 2020, as fentanyl became widely available. “The current recommended target dose of buprenorphine was derived from studies conducted prior to the widespread availability of fentanyl. Now, we’re seeing people with higher levels of tolerance to and dependence on opioids, and our findings suggest that a higher buprenorphine dose – up to 24 mg – may help improve treatment retention for these individuals,” said Rachel Wightman, M.D., Associate Professor of Emergency Medicine and Epidemiology at Alpert Medical School of Brown University and one of the principal investigators of the study.
Representatives Glenn “GT” Thompson (PA-15) and Ann Kuster (NH-02) introduced the bipartisan Helping Ensure Access to Local TeleHealth, or the HEALTH Act, as part of National Telehealth Awareness Week. This legislation secures Medicare reimbursement for telehealth services provided by community health centers and rural health clinics. It will continue to allow providers to utilize audio-only telehealth visits for patients who do not have access to broadband services. PACHC worked with Rep. Thompson’s office on the legislation. “As the nation’s largest network of primary care providers, Federally Qualified Health Centers (FQHC) provide a wide array of services in underserved areas of the country, both rural and urban,” said Cheri Rinehart, President and CEO of Pennsylvania Association of Community Health Centers (PACHC). “The ability to use telehealth throughout and after the pandemic has clearly demonstrated how vital telehealth is in improving health equity by increasing access to care for the vulnerable populations FQHCs serve and contributing to positive outcomes. Telehealth must remain an available service to ensure continued access to critical primary and behavioral health care services.” Click here to learn more.
The Penn State Alumni Association honored 13 Penn Staters with the 2023 Alumni Fellow Award; the most prestigious award given by the Alumni Association. A ceremony to honor their achievements was held on September 20 at the State Theatre in downtown State College. Among this year’s honorees is George Garrow’s 85g Med (Shenango*), President and CEO of Primary Health Network. Congratulations Dr. Garrow. Visit the Alumni Association’s website for more information on this year’s honorees and the award.