Researchers at Indiana University conducted one-on-one interviews with clinical providers and other stakeholders in the recovery arena to better understand the slow uptake of the drug most used to treat opioid use disorder.  Biases against buprenorphine were the most consistent theme, though the reason for bias differed amongst stakeholders. Clinical providers and behavioral health care providers preferred the abstinence approach rather than the use of medications. Hospital administrators, peer recovery coaches, and criminal justice representatives tended to hold a bias against substance use in general and/or had a lack of knowledge of how buprenorphine was administered and how it works.  Similar responses were reported in a 2020 study of attitudes in rural Ohio.

An analysis by the Center for Rural Pennsylvania has shown that the number of deaths from drug overdoses may be declining in rural areas. But optimism remains cautious, as many rural areas still have overdose rates above the state average and less access to lifesaving interventions. At a recent hearing, addiction treatment providers in the state stressed the need for regulatory changes to meet rural needs. Providers testified that finding transportation to get to treatment services is a challenge and the majority of people housed at the county’s jail have substance use disorders.

New report from USDA’s Economic Research Service

Although healthcare is one of the largest and fastest-growing sectors in the rural U.S., many rural communities suffer from poor access to healthcare, in part due to difficulties recruiting and retaining healthcare professionals.

A report issued today by USDA’s Economic Research Service, Linkages Between Rural Community Capitals and Healthcare Provision: A Survey of Small Rural Towns in Three U.S. Regions, focuses on how rural communities can attract and retain healthcare professionals. The study is based on key informant interviews and a survey of healthcare professionals in 150 rural small towns in 9 U.S. states.

Here are a few key findings from the report:

• Social capital (the value of personal and professional relationships) was widely perceived by both key informants and healthcare professionals as important for the recruitment and retention of the professionals. Many key informants and most healthcare professionals highlighted the importance of relationships with family, friends, colleagues, and patients in recruitment and length-of-stay decisions.
• Physical capital such as the availability and quality of housing, medical facilities, and equipment was widely cited as a factor, though less often than social capital.
• Human capital, reflected in the quality of both schools and healthcare professionals, is also widely perceived as important for recruitment and retention, though cited less often than social capital. Key informants more often cited the importance of school quality for recruitment—while healthcare professionals often cited the quality of the medical community, colleagues, and staff as important to accepting and retaining employment.

For more information, please refer to the full report.

  A new analysis from the national nonprofit Kaiser Family Foundation reports slimmer operating margins for rural hospitals (2.2 percent versus 3.9 percent in states with Medicaid expansion) for the period from July 2021 through June 2022.  Moreover, the report says these margins would have dropped to 1.2 percent in expansion states and -0.7 percent in non-expansion states if not for federal COVID-19 relief funds.

 RAND Corporation, an independent research organization, examined state-level mortality data to compare state-by-state and national-level rates of death.  An interactive map that sorts by gender, race (Black, White, and Hispanic), urban/non-urban, and age shows that 29 of 50 states have an annual rate of death higher than the national average.  The data originated with the Centers for Disease Control and Prevention, which last year announced historically high rates of firearm homicide nationwide and the highest rates of firearm suicide in rural areas.  RAND reports that suicide deaths drive the overall death rate higher in nonurban areas.  A second interactive map shows how adding or removing firearm laws could affect death rates in each state.

See below for new briefs from the Pennsylvania State Data Center.  For more information, contact the Data Center at pasdc@psu.edu.

New Brief Highlights Median Household Income in Pennsylvania

Our latest brief details median household income in Pennsylvania. The brief explores differences by race and ethnicity at the state level and compares Black or African American households and White households at the county level. Read more on our Research Briefs page.

Census Bureau Updates

• 2021 County business Patterns

The U.S. Census Bureau released the 2021 County Business Patterns (CBP) First Look data table. This preliminary tabulation includes the number of establishments; employment for the week of March 12, 2021; first quarter payroll; and annual payroll at the North American Industry Classification System (NAICS) sector level for the nation. Final CBP tables for 2021 are scheduled for release in April 2023. Click here to learn more.

• New National Experimental Data Product about Wellbeing

The U.S. Census Bureau released the first set of estimates from the National Experimental Wellbeing Statistics (NEWS) project, an experimental data product that uses a new methodology to calculate income and poverty estimates. Click here to learn more.

• New data from phase 3.7 of the experimental Household Pulse Survey (HPS)

The HPS is an effort by the Census Bureau and other federal statistical agencies to provide near real-time data on how the COVID-19 pandemic, and changes in social and economic conditions are affecting people’s lives to inform federal and state response and recovery planning. Click here to explore the data.

The Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2024 Advance Notice for Medicare Advantage (also known as Medicare Part C) and Medicare Prescription Drug Programs (also known as Medicare Part D). The notice includes payment updates and star rating updates for both parts of Medicare, a one-time growth rate adjustment for Medicare Advantage, and technical updates to the Medicare Advantage risk adjustment model. Also included are significant Medicare Part D changes required by the Inflation Reduction Act of 2022 and which will go into effect next January including reduced cost-sharing for insulin, eliminated cost-sharing for preventive vaccines, eliminated cost-sharing for Part D prescription drugs in the catastrophic phase, and expanded eligibility for full cost-sharing and premium subsidies under the Low-Income Subsidy program. The comments are due by March 3, 2023.

Zachary Levinson Follow @zlevs100 on Twitter , Jamie Godwin , and Scott Hulver
Published: Feb 23, 2023

Policymakers have had ongoing concerns about the financial health of rural hospitals and the implications  for access to care and the local economy. Rural hospital finances improved during the COVID-19 pandemic as a result of government relief funds. However, industry reports suggest that the outlook for the hospital sector as a whole deteriorated in 2022 as these funds have gone away and due to ongoing effects of the pandemic (such as labor shortages), rising prices, and investment losses. Concerns about the viability of rural hospitals have been cited as one factor that could potentially motivate lawmakers to expand Medicaid in the eleven states that have not already done so. These non-expansion states collectively account for about one-third (34%) of rural hospitals, based on our analysis of 2021 hospital cost report data.

In this data note, we provide a background on rural hospital finances and use hospital cost report data to describe operating margins among rural hospitals before and during the COVID-19 pandemic (see Methods for details). We find that median operating margins among the rural hospitals in our analysis increased earlier in the COVID-19 pandemic, likely as a result of government relief funds, but that these facilities face renewed financial challenges, especially in states that have not expanded Medicaid (Figure 1). Among rural hospitals in non-expansion states, median operating margins were 2.1 percent during the July 2021-June 2022 period and were -0.7 percent when excluding documented relief funds. In Medicaid expansion states, median operating margins dropped, but remained positive even after excluding documented relief funds.

Read more.