Nonmetro Counties Gain Population for Second Straight Year

From the Daily Yonder…

By Tim Marema

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Rural America’s population grew by 0.1 percent from 20017 to 2018. The growth was small and clustered near metropolitan areas. But it reverses the trend of population loss that occurred from 2011 to 2016.

The size of the non-metropolitan population crept up for the second year in a row in 2018, adding about 37,000 residents to reach 46.1 million.

That’s a gain of about 0.1 percent, according to a report from demographer Kenneth M. Johnson at the University of New Hampshire’s Carsey School of Public Policy.  The rate of growth is roughly the same as the growth rate from 2016 to 2017, when non-metropolitan counties added 33,000 residents.

The overall U.S. population grew by about 0.6 percent over the last year.

While the gains for non-metropolitan America were scant, they continue to reverse the historic drop in non-metropolitan population that occurred from 2011-16.

The map shows which counties gained or lost population from 2017 to 2018. County-level data is available  a map. Or see the map in a new, full-sized window.

About half of America’s 2,000 or so non-metropolitan counties gained population, while about three quarters of metropolitan counties did.

Rural America’s net growth came from rural counties that are adjacent to metropolitan areas, Johnson said in his report. Those counties gained 46,000 residents, while non-metro counties that don’t touch a metro area lost 9,000 residents.

Johnson said non-metro counties grew from a combination of migration (more people moving into a county than leaving it) and natural increase (more births than deaths). The rate of natural increase is dwindling, Johnson said.

Growth rates in non-metropolitan American varied by region. “The fastest growing counties have recreational and scenic amenities that attract migrants including retirees from elsewhere in the United States,” according to the report. In contrast, farm counties had more people leave than move into the counties.

The Census Bureau, which released the 2018 population estimates Wednesday (April 18, 2019), noted that the South and West tended to have the fastest numerical growth in counties.

How this story defines rural: This story uses the Office of Management and Budget metropolitan statistical area system to define rural. Rural counties are defined as those that are not in a metropolitan statistical area or MSA. In this story, rural is synonymous with non-metropolitan. There are numerous ways to define rural. You can learn more (much more!) from the USDA Economic Research Research and the U.S. Census

CMS Advances Agenda to Re-think Rural Health and Unleash Medical Innovation

 

On April 24, 2019, the Trump Administration proposed changes that build on the progress made over the last two years and further the agency’s priority to transform the healthcare delivery system through competition and innovation while providing patients with better value and results. The proposed rule would update Medicare payment policies for hospitals under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) for fiscal year 2020 and advances two key CMS priorities, “Rethinking Rural Health” and “Unleashing Innovation,” by proposing historic changes to the way Medicare pays hospitals.

“One in five Americans are living in rural areas and the hospitals that serve them are the backbone of our nation’s healthcare system,” said CMS Administrator Seema Verma. “Rural Americans face many obstacles as the result of our fragmented healthcare system, including living in communities with disproportionally higher poverty rates, more chronic conditions, and more uninsured or underinsured individuals. The Trump Administration is committed to addressing inequities in health care, which is why we are proposing historic Medicare payment changes that will help bring stability to rural hospitals and improve patients’ access to quality healthcare.”

The inpatient hospital wage index specifies how inpatient payment rates are adjusted to account for local differences in wages that hospitals face in their respective labor markets. It is intended to measure differences in hospital wage rates across geographic regions and is updated annually based on wage data reported by hospitals. Hospitals located in areas with wages less than the national average receive a lower Medicare payment rate than hospitals located in areas with wages higher than the national average. For example, a hospital in a rural community could receive a Medicare payment of about $4000 for treating a beneficiary admitted for pneumonia while a hospital in a high wage area (like many urban communities) could receive a Medicare payment of nearly $6000 for the same case, due to differences in their wage index.

In last year’s proposed rule, CMS invited comments on changes to the Medicare inpatient hospital wage index. Many responses reflected a common concern that the current wage index system makes the disparities between high and low wage index hospitals worse. High wage index hospitals, by virtue of higher Medicare payments, can afford to pay their staff more, allowing the hospitals to continue operating as high wage index hospitals. Conversely, low wage index hospitals often cannot afford to pay wages that would allow them to climb to a higher wage index. Over time, this creates a downward spiral that increases the disparity in payments between high wage index hospitals and low wage index hospitals, and payment for rural hospitals and other low wage index hospitals declines.

To address these disparities, CMS is proposing to increase the wage index of low wage index hospitals. This change would ensure that people living in rural areas have access to high quality, affordable healthcare. CMS is considering several ways to implement this change, and the agency looks forward to comments on the different approaches.

The Trump Administration is also announcing proposals that would ensure Medicare beneficiaries have access to a world-class healthcare system by unleashing innovation in medical technology and removing potential barriers to innovation and competition in order to expedite access to novel medical technology.

“Transformative technologies are coming to the private market, but Medicare’s antiquated payment systems have not contemplated these technologies,” said CMS Administrator Seema Verma. “I am particularly concerned about cases that have been reported to the agency in which Medicare’s inadequate payment has led hospitals to curtail access to needed therapies. We must continually update our policies in response to the rapid pace of advancement in medical science.”

To ensure that Medicare payment supports broad access to transformative technologies, CMS is proposing several payment policy changes. These include proposing to increase the new technology add-on payment, which provides hospitals with additional payments for cases with high costs involving new technologies, including potentially new antimicrobial therapies. The increase would apply to all technologies receiving add-on payments starting on October 1, 2019, so that when a physician determines that a patient needs a qualifying new therapy, the hospital at which the therapy is administered would be able to more completely cover its costs. This change would promote patient access and reduce the uncertainty that innovators face regarding payment for new medical technologies for Medicare beneficiaries.

CMS is also proposing to modernize payment policies for medical devices that meet FDA’s Breakthrough Devices designation. For devices granted this expedited FDA approval, real-world data regarding outcomes for the devices in different patient populations is often limited. At the time of approval, it can be challenging for innovators to meet the requirement for evidence demonstrating “substantial clinical improvement” in order to qualify for new technology add-on payments.

Therefore, CMS is proposing to waive for two years the requirement for evidence that these devices represent a “substantial clinical improvement.” Waiving this requirement would provide additional Medicare payment for the technologies for a period of time while real-world evidence is emerging, so Medicare beneficiaries do not have to wait for access to the latest innovations.

In the proposed rule, CMS highlights the unique challenges associated with paying for CAR-T technology in particular. CAR-T is the first-ever gene therapy and is used to treat certain forms of cancer for which no other treatment options exist. The agency is considering several changes to payment policies for CAR-T for 2020, including additional changes to new technology add-on payments for CAR-T and changes to the formula that is used to calculate payments to hospitals for CAR-T. These changes may help ensure adequate payments to hospitals administering this groundbreaking therapy while CMS continues our work to ensure that we pay for innovative therapies appropriately.

The IPPS and LTCH PPS proposed rule is one of five Medicare payment rules released on a fiscal year cycle, to define payment and policy for inpatient hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, skilled nursing facilities, and hospice. Modernizing and strengthening Medicare through rulemaking is critical to achieving CMS’s objectives, and the IPPS and LTCH PPS proposed rule is an opportunity to further advance its goals.

For a fact sheet on the proposed rule (CMS-1716-P), please visit: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2020-medicare-hospital-inpatient-prospective-payment-system-ipps-and-long-term-acute

To view the proposed rule (CMS-1716-P), please visit: https://www.federalregister.gov/documents/2019/05/03/2019-08330/medicare-program-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals-and-the

New Guide Brings Clarity to the Complexities of Funding Assistive Technology

As Vernon saw it, a Pennsylvania Assistive Technology Foundation (PATF) loan was the clear choice to pay for his new hearing aids, with a low interest rate, no fees, and affordable monthly payments. But sometimes finding the right funding isn’t so straightforward.

In 2018, when Vernon’s hearing had declined enough that he was missing large chunks of conversation due to background noise at work and at home, he knew he needed new hearing aids. Vernon has worked in upper management for York Water Company for 21 years. After speaking with the Office of Vocational Rehabilitation (OVR), Vernon was referred to PATF. He found the PATF interest rate was significantly lower than that of a traditional consumer loan and it was cheaper than charging the hearing aids on his credit card. He also described the monthly payments as very manageable. In Vernon’s case, with few other funding options for hearing aids, a low-interest loan made the most sense. Now, Vernon is grateful to have his hearing aids, and says that they have significantly improved his quality of life and made a drastic difference for him both at work and in his personal relationships.

But finding funding is not always so simple. In fact, one of the leading obstacles for many people in obtaining assistive technology (AT) is finding the money to pay for it. And, there are many factors to take into account when developing a funding solution. A person’s diagnosis, age, whether or not they are a student, where they live, whether or not they work, their financial situation, and their wants and needs all come into play when determining what funding options are available.

While PATF provides loans for the purchase of AT to Pennsylvanians of all ages, all income levels, and all disabilities and health conditions, we also provide free information and assistance services with the goal of helping people navigate the complex process of finding funding. Our recent publication, Funding Your Assistive Technology: A Guide to Funding Resources in Pennsylvania, includes the information we cover most frequently with callers. Chapters include topics such as what is assistive technology, tips and considerations when choosing your AT, how to develop a funding strategy, a list of funding resources, specifics on how to access AT through waivers including Community HealthChoices, and how to save safely for assistive technology using an ABLE account and a Special Needs Trust.

“This comprehensive guide is an easy-to-use resource for Pennsylvanians with disabilities, seniors, their families, service providers, and legislators. It empowers Pennsylvanians with the knowledge to gain access to devices and services that make independence and autonomy possible,” says Nancy Murray, President of The Arc of Greater Pittsburgh at ACHIEVA and incoming Board President at PATF.

Read more about Funding Your Assistive Technology.

Increasing Number of Grandparents Raising Grandchildren

Increasing Number of Grandparents Raising Grandchildren.  An analysis from the U.S. Census Bureau shows that, in 2016, there were over 7.2 million grandparents nationwide living with grandchildren under the age of 18.  Reports from media outlets and nonprofit organizations suggested that a recent rise in these arrangements is due in part to the opioid crisis.  To get an accurate and better understanding of what is happening, the Census Bureau examined data from its American Community Survey and data on opioid prescribing from the Centers for Disease Control and Prevention (CDC).  Previous research focused on the national or state level, but levels of opioid prescriptions vary widely within states, and county level data allow for a more localized analysis.  Data analysis showed a rural-urban divide in grandparents caring for grandchildren that is similar to the higher rates of overdose deaths in rural areas.  In 2016, 32 percent of grandparents were responsible for grandchildren in urban areas, compared to 46 percent of grandparents in rural areas.  The Census Bureau created an overview of their analysis, with methods, maps and data.  See frequently asked questions answered by the Administration for Children and Families on this topic and the Funding Opportunities section below for related resources.

Podcasts: Rural Chronic Obstructive Pulmonary Disease (COPD) and its Prevalence in Rural America

The National Rural Health Resource Center (The Center) has partnered with Dr. Bill Auxier of Rural Health Leadership Radio to produce a six-part podcast series about Rural Chronic Obstructive Pulmonary Disease (COPD) and its prevalence in rural America. This series from The Center provides information about COPD, how rural providers are meeting the needs of their communities, and the importance of billing and coding appropriately while ensuring quality of care is being addressed. Each podcast features a guest with expert knowledge in COPD and rural health.

Available Now: Episode 5 featuring Lindsay Corcoran and Laurie Daigle, Stroudwater

Listen here: http://ruralcenter.libsyn.com/the-rural-copd-podcast-episode-5

  • In this episode, Lindsay and Laurie discuss the billing and coding considerations for hospitals and pulmonary rehab programs, the financial challenges hospitals with these programs face, opportunities for hospitals within their existing pulmonary rehab programs, where to find up-to-date financial resources on COPD programs, and the future of COPD care.
  • Lindsay Corcoran is an accomplished senior consultant and practice management professional with over ten years of healthcare and medical office experience. At Stroudwater Associates, Lindsay focuses on supporting and sustaining healthcare access for rural communities through hospital operational improvement and affiliation strategies, and has assisted rural and community hospitals and clinics across the country to improve operational and financial performance. Results-oriented and highly organized, Lindsay is a skilled and effective communicator with medical providers, patients, and administration.
  • Laurie Daigle, a senior consultant at Stroudwater Revenue Cycle Solution, is a certified professional coder with over 18 years of experience in medical insurance claim processing, medical billing software training, auditing, and healthcare financial management. She has years of experience as a manager for a national commercial payor, and extensive experience in Healthcare Management, from physician group practices to large academic institutions. She has been instrumental in the creation of Revenue Integrity resources to unify coding, billing, and compliance concerns for total and inclusive revenue cycle oversight. She has led successful initiatives to increase physician and departmental productivity, to improve business office efficiency and accuracy, and to develop policies and procedures for all areas within the Revenue Cycle.

Available Now: Episode 4 featuring Michelle Collins

Listen here:  https://ruralcenter.libsyn.com/-the-rural-copd-podcast-episode-4

  • Michelle Collins is a registered respiratory therapist at Lincoln Health, Franklin Memorial Hospital, and Central Maine Medical Center in Maine. Working in a rural, critical access, and tertiary hospital, Michelle has wide range of hospital experiences, a passion for cardio pulmonary medicine, and a strong concern for her patients and making sure they have access to the care that they need and the knowledge to utilize the tools at their disposal.
  • Michelle discusses her definition of leadership, the history of respiratory therapy, the gaps in COPD healthcare, reimbursement issues related to COPD treatment and pulmonary rehab program closures, COPD Patient obstacles, respiratory treatment and medication, respiratory and medical training, and the hope going forward with COPD care.

Available Now: Episode 3 featuring Dan Doyle, MD
Listen here: http://ruralcenter.libsyn.com/the-rural-copd-podcast-episode-3

  • Dan Doyle is a physician at New River Health Association, a Federally Qualified Community Health Center (FQHC) in West Virginia. He is a physician and consultant at Cabin Creek Health Center, another FQHC in West Virginia, Medical Director of New River Breathing Center, a Black Lung Clinic which is part of the West Virginia and Federal Black Lung Clinics Program. As of 2013, Dr. Doyle has been the Medical Director of the Grace Anne Dorney Pulmonary Rehabilitation project of West Virginia, which is a collaborative effort of Cabin Creek Health System FQHC, New River Health Association FQHC, Southern West Virginia Health System FQHC, West Caldwell County FQHC in North Carolina, Boone Memorial Hospital, and Jackson General Hospital providing community-based pulmonary rehabilitation services.
  • Doyle discusses his medical background and how he initially got involved at the New River Health Association, the impact of COPD on rural communities, the lack of access to COPD care, diagnosing COPD and pulmonary function testing, the Dorney Koppel Foundation, the COPD National Action Plan, and the future of COPD care.

Available Now:  Episode 2 featuring Paul Moore, DPh
Listen here: http://ruralcenter.libsyn.com/the-rural-copd-podcast-episode-2

  • Paul Moore is a Senior Health Policy Advisor for the Federal Office of Rural Health Policy (FORHP) and Executive Secretary for the National Advisory Committee for Rural Health and Human Services.
  • Paul discusses his background in rural health care and pharmacy, hospital administration turnover and rural recruiting challenges, the essential aspects of leadership, his professional and personal experiences with COPD, COPD’s lack of national attention and funding, COPD patient and financial statistics, the impact of COPD on rural communities, rural workforce issues with COPD, and the future of COPD care.

Available Now:  Episode 1 featuring Grace Anne Dorney Koppel
Listen here: http://ruralcenter.libsyn.com/the-rural-copd-podcast

  • Grace Anne Dorney Koppel is President of the Dorney Koppel Foundation, the immediate former President and a current board member of the COPD Foundation, and chair of the Advocacy and Public Policy Committee for the COPD Foundation. Grace Anne is also a patient of COPD, diagnosed in 2001.
  • Grace Anne explains COPD’s prevalence, its symptoms, the stigma surrounding the disease, her personal experiences with COPD, the challenges of COPD treatment in rural communities, her work with the Dorney Koppel Foundation, and the path to success with COPD.

This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UB1RH24206, Information Services to Rural Hospital Flexibility Program Grantees, $1,100,000 (0% financed with nongovernmental sources). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

2018 County Population Estimates Released

The U.S. Census Bureau has released estimates of the total population of counties in the nation and Pennsylvania as of July 1, 2018. The estimates show that the Southeast and South Central regions of Pennsylvania continue their growth since 2010 with Cumberland County in the lead as the fastest growing county. Click here to read the Penn State Data Center brief.

Enhancements to the CMS Mapping Medicare Disparities (MMD) Tool

The Mapping Medicare Disparities (MMD) tool provides interactive maps to illustrate disparities between subgroups of beneficiaries on key measures of health outcomes, use, and spending.  CMS recently added rural and urban data to the population view, so users can view and compare across rural and urban counties. They also added four opioid use disorder indicators, including hospital and ER visits and medication-assisted therapy utilization.

Additional Telehealth Benefits for Medicare Advantage Finalized

To implement provisions of the Bipartisan Budget Act of 2018, CMS has finalized provisions allowing Medicare Advantage (MA) plans to offer additional telehealth benefits as part of the basic benefits.  While Medicare Advantage plans have always been able to offer more telehealth benefits than traditional Medicare, this rule gives MA plans even more flexibility with paying for these services, which could expand telehealth further.  For example, enrollees in urban and rural areas may be able to receive telehealth from their homes. In 2017, about one in four rural Medicare beneficiaries were enrolled in an MA plan.

Latest CMS Podcast Episode Features Rural Providers

During the week of April 1, 2019, CMS released the latest episode of their podcast, CMS: Beyond the Policy. This episode brings highlights from the 2019 CMS Quality Conference, including perspectives from rural providers at the conference. The theme of this year’s conference was “Innovating for Value and Results.”