- Ways and Means Members Put Forth Solutions to Strengthen Telehealth Access and Improve Health Care for Rural Communities
- In Rural Texas, ERs Are Facing a Growing Mental Health Crisis
- Sage Memorial Hospital in Navajo Nation Constructs New Facility to Improve Health Care
- How the State, Tribes and Federal Government Are Working to Curb SD's Syphilis Epidemic
- Rural Children Struggle to Access Hospital Services, Say Researchers
- RPHARM Program Fulfills Need for Rural Pharmacists
- A Pilot Program in Rural Vermont Hopes to Build a Blueprint for Substance Abuse Recovery
- Farmers Don't Do Mental Health
- Biden-Harris Administration Announces Critical More Than $1.5 Billion State and Tribal Opioid Response Funding Opportunities
- Outlining the Intersection between Health Care and Missing and Murdered Indigenous People
- USDA Rural Development Seeks Input to Improve Access to Grants and Help More Communities Thrive
- Rural Telehealth Extension Reintroduced in Congress
- The South Was the Center of Rural Population Growth Last Year
- Students From Across the State Emphasized the Need for Mental Health Resources in Rural Alaska During a Conference
- How HHS SUD Confidentiality Regulations Will Impact Rural Providers
FTC/HHS Seek Feedback on Drug Wholesaler and GPO Contributions to Drug Pricing and Shortages
Federal regulators are seeking more information about drug wholesalers and group purchasing organizations (GPOs) as they investigate pharmaceutical pricing and generic drug shortages. The Federal Trade Commission (FTC) and Department of Health and Human Services (HHS) last week issued a request for information, seeking input from the public on whether GPOs and wholesalers are complying with antitrust laws, if GPOs’ exemption from a federal law that bans kickbacks affects market concentration and drug shortages, and if the dominant market share of several GPOs and wholesalers has limited competition, among other topics. The move comes as regulators and Congress continue to probe pharmaceutical intermediaries, which have been blamed for drug shortages and exorbitant drug prices. The 60-day deadline to submit public comments at Regulations.gov is April 15. All comments submitted will be posted to Regulations.gov. Learn more by reviewing the FTC press release on the RFI.
Notes Published on the Pennsylvania Human Services Executive Budget
The Pennsylvania Department of Human Services (DHS) budget is a mixture of state and federal funding. Each year, DHS is involved in the state budget process where annual funding for the department’s programs and services are expected to be determined by June 30. To learn more about the budget process in Pennsylvania, visit the Office of the Budget. Each year, DHS publishes the “Blue Book,” which provides additional details on the Governor’s budget proposal as it relates to programs managed by DHS. The “Blue Book” is available on the DHS website, prior to the DHS budget hearings in front of the Senate and House Appropriations Committees on March 5 and March 6 respectively. Click here for the slides from DHS’ presentation. A recording is available on DHS’ YouTube page.
The Doctor Is Out: 6-County Swath of Northern Pennsylvania will Soon Have No Maternity Care
From the Pittsburgh Post-Gazette
Pinned to the door of Stephanie Zuroski’s refrigerator is a curling black and white ultrasound image of her baby at 11 weeks, 1 day old.
The baby’s delivery is still months off, but her worry these days is whether she will get to a maternity hospital from her rural Elk County home in time for the birth. Penn Highlands Healthcare Elk Hospital, 20 miles away, is closing its obstetrics unit May 1, leaving a six-county area of north-central Pennsylvania — twice the size of Delaware — without hospital maternity care. “I like being in the woods, surrounded by the Allegheny National Forest,” Ms. Zuroski, 32, said about the home she shares with husband, Nathan, 30, but “this is the downfall of living in rural Pennsylvania.”
Rural hospitals are in crisis, experts say, and shuttering maternity units is the just latest cost-cutting move to stem the flow of red ink. In addition to Elk County, maternity units in Clarion and McKean counties have closed in recent years at a time when infant mortality rates exceeded the statewide average.
McKean County, population 39,866, had an average infant mortality rate of 7 deaths per 1,000 births for the years 2016 through 2020, the most recent numbers available and well above the statewide average of 5.9 infant deaths before the age of 1, according to the state Department of Health. Infant mortality rates for the other five counties were not available from the health department. Cameron, Clinton, and Forest counties are the other areas without hospitals to care for new moms.
At a meeting Friday at the St. Marys hospital, which was closed to the public, health system executives said the hospital only had 147 births last year, far short of the 1,000 births needed for such a program to break even, according to Ridgway Borough Council member Zack Pontious, who was in attendance. Mr. Pontious didn’t think there was any chance the decision would be reversed. “I don’t think anything’s going to change,” he said.
Meanwhile, the population of the new maternity care desert will grow to 156,664 — four times bigger than Cranberry Township in Butler County, north of Pittsburgh, which is served by four hospitals, including one offering maternity care that opened in 2021. Cranberry’s population is about 33,000.
Is the Nation’s Primary Care Shortage as Bad as Federal Data Suggest?
Federal policymakers have been trying for a long time to lure more primary care providers to understaffed areas. The Biden administration boosted funding in 2022 to address shortages and Sen. Bernie Sanders (I-Vt.) pushed sweeping primary care legislation in 2023.
But when KFF Health News set out last year to map where the primary care workforce shortages really are — and where they aren’t — we encountered spotty data and a whole lot of people telling us the absence of better information makes it hard to know which policies are working. Turns out, consistent national data is a pipe dream.
We analyzed the public data that does exist: the federal government’s official list of primary care health professional “shortage areas,” created to help funnel providers where they’re most needed. We found that more than 180 areas have been stuck on the primary care shortage list for at least 40 years.
CMS Finalizes DSH Payment Cuts for Some Safety-Net Hospitals: 8 Things to Know
From Becker’s Healthcare
CMS will cut Medicaid disproportionate share hospital payments for some safety-net hospitals in fiscal year 2024, which began Oct. 1, 2023, according to a final rule published Feb. 20.
The rule will result in an $8 billion reduction in DSH payments annually from fiscal year 2024 to 2027, culminating in a $32 billion overall cut over the four-year period, according to CMS.
Eight things to know:
- Following a congressional directive from the Consolidated Appropriations Act of 2021, the final rule outlines how hospital-specific payment limits will be calculated and clears up ambiguities within the DSH program to improve administrative efficiency, according to Bloomberg.
- Hospitals previously calculated Medicaid shortfalls (the difference between costs and payments for Medicaid-eligible patients) by projecting yearly treatment costs for Medicaid patients alone as well as those with other types of coverage, including Medicare or commercial coverage.
- Under the new rule, hospitals can only include costs and payments for services provided to beneficiaries for whom Medicaid is the primary payer for such services. The limit excludes costs and payments for services provided to Medicaid beneficiaries with other sources of coverage.
- The final rule does not apply to safety-net hospitals serving the highest percentage of low-income patients. Hospitals in and above the 97th percentile of inpatient days comprising patients who are entitled to Medicare Part A benefits and Supplemental Security Income benefits are exempt.
- The exception provides qualifying hospitals with a hospital-specific limit that is the higher of that calculated under the methodology in which costs and payments for Medicaid patients are counted only for beneficiaries for whom Medicaid is the primary payer, or the methodology in effect on Jan. 1, 2020.
- New York ($3.9 billion) spends the most on Medicaid DSH payments annually, followed by Texas, Pennsylvania and Louisiana, which pay $1.2 billion, according to data published in November by KFF.
- Hospital groups have pushed back against DSH cuts set out in the Affordable Care Act, arguing that the need for DSH funding is even greater now as hospital expenses per patient have increased significantly since the pandemic.
- The American Hospital Association said it is concerned about the effect that DSH cuts will have on hospital finances. “This policy was based in-part on the flawed notion that hospitals receive the entirety of a Medicare or Medicaid payment rate when in reality most state Medicaid programs pay less than that,” Ben Finder, AHA’s vice president of coverage policy, said in a statement provided to Becker’s. “That means that many hospitals are not compensated fully for care provided to patients dually eligible for Medicare and Medicaid and this policy would reduce their ability to offset those cuts and potentially create additional financial strain at a time when many hospitals are already struggling.”
These changes will take effect April 27, 60 days after the final rule’s publication in the federal register.
Click here for more details on the final rule.
Improving Access to Pulmonary Rehab Programs
Two new educational videos from the National Rural Health Resource Center highlight the prevalence of chronic obstructive pulmonary disease (COPD) in the country’s rural communities and the steps that Critical Access Hospitals and other small rural hospitals can take to improve access to much-needed pulmonary rehabilitation services. The first video, Understanding COPD and Pulmonary Rehabilitation, provides an overview of COPD — its symptoms and causes — and explains how rural-based pulmonary rehabilitation services help to restore independence and quality of life in COPD patients. The second video, How to Launch a Pulmonary Rehab Program, highlights the benefits — to hospitals and their communities — of operating pulmonary rehab programs, and shares practical advice and tips.
CMS Changing Policy for Research Data Access – Comment by March 29
The Centers for Medicare & Medicaid Services (CMS) plans to change the way that data is made available to researchers and seeks feedback from stakeholders who may be affected. Currently, CMS offers researchers two options for accessing CMS data: 1) have physical Research Identifiable File (RIF) data shipped to their institution, and 2) a secure online resource called the Chronic Conditions Warehouse Virtual Research Data Center (CCW VRDC). Because of growing concerns about data security, CMS will no longer ship physical data for new research. Beginning on August 19 of this year, researchers will be required to use the CCW VRDC. CMS will accept feedback on these plans via email at VRDCRFI@cms.hhs.gov until March 29.
Article Released Discussing Support for Vulnerable Rural Hospitals: Lessons Learned
An overview of state and federal programs and models designed to support Critical Access Hospitals (CAHs) and other rural hospitals describes challenges – including chronic workforce shortages, high operating and staffing costs, inadequate reimbursement, operational and regulatory issues, and the diverse demographics of rural communities. The information comes from the FORHP-supported Flex Monitoring Team, a consortium of researchers evaluating the effectiveness of the Medicare Rural Hospital Flexibility Program.
CareQuest Releases New Teledentistry Toolkit
The CareQuest Institute for Oral Health has released Teledentistry Regulation and Policy Guidance: A Toolkit to Promote Access and Quality Care Through Teledentistry. This document identifies primary considerations for regulators and policymakers regarding teledentistry and includes key recommendations. Model teledentistry rules within the toolkit can form a basis for discussions on how to improve the regulatory climate for teledentistry moving forward.
In Pennsylvania, there is legislation pending in the Senate Banking and Insurance Committee (HB1585) that would direct our State Board of Dentistry to develop guidelines for Pennsylvania.
Policy Statement Released on Integrating Oral Health into Primary Care
The ASTDD Dental Public Health policy committee is pleased to announce the availability of a new ASTDD policy statement, Integrating Oral Health into Primary Care. They extend their appreciation to Katrina Holt, MPH, MS, RD, FAND; Katy Battani, RDH, MS; and Ruth Barzel, MA, of the National Maternal and Child Oral Health Resource Center for their support and collaboration in the development of this document.