The Flex Monitoring Team has published a new brief comparing the characteristics of communities served by Critical Access Hospitals (CAHs) predicted to be at high risk of financial distress to communities served by all other CAHs. Using data from 2017, the Financial Distress Index (FDI) model assigns CAHs to high, mid-high, mid-low, or low predicted risk levels for 2019 using Medicare cost reports and Neilsen-Claritas data summed to market areas.

CAHs predicted to be at high risk of financial distress were found to serve communities with significantly higher percentages of non-White individuals (Black individuals in particular), lower high school graduation rates, higher unemployment rates, and worse health status.

People with complex care needs who live in rural communities face many of the same challenges experienced by individuals in urban areas, such as lack of transportation and food insecurity. However, rural communities are not just scaled-down cities. Despite facing similar challenges to patients living in urban areas, individuals with complex needs in rural areas often face additional hurdles caused by lack of infrastructure and geographic distances, making many high-touch complex care interventions difficult — if not impossible — to implement.

This brief, made possible through the Robert Wood Johnson Foundation, explores challenges associated with providing complex care in rural and frontier communities and outlines opportunities to ensure effective programs. Drawing from experts across the country, it summarizes strategies to improve complex care delivery in rural areas and provides examples of rural communities that are enhancing care delivery through workforce adaptations, technology innovations, tailored patient engagement tactics, and new payment models and funding streams.

The brief can be accessed at https://www.chcs.org/resource/opportunities-to-advance-complex-care-in-rural-and-frontier-areas/.

This study from the Maine Rural Health Research Center examined receipt of preventive health services (cholesterol check, fasting blood sugar test, mammogram, pap smear, and vaccination for the human papillomavirus, also known as HPV) by rural and urban women over the age of 18. Findings indicate that rural women were less likely than their urban peers to receive preventive health services.  The report can be accessed at https://www.ruralhealthresearch.org/alerts/279.

This week, the Rural Health Research Gateway released three policy briefs with the most up-to-date data on factors contributing to rural hospital closures.  The producer of these briefs, the North Carolina Rural Health Research Center, keeps track of rural hospital closures and counts 104 since January 2010.  The reports can be accessed at https://www.ruralhealthresearch.org/alerts/281.

Reliable, High-Speed Broadband e-Connectivity is Essential to Enhanced Agricultural Production

WASHINGTON, April 30, 2019 – Agriculture Secretary Sonny Perdue today unveiled a groundbreaking report, A Case for Rural Broadband: Insights on Rural Broadband Infrastructure and Next Generation Precision Agriculture Technologies (PDF, 2.5 MB). The report finds that deployment of both broadband e-Connectivity and Next Generation Precision Agriculture Technology on farms and ranches throughout the U.S. could result in at least $47 billion in national economic benefits every year.

“Broadband and Next Generation Precision Agriculture are critical components for creating vital access to world-class resources, tools and opportunity for America’s farmers, ranchers, foresters and producers,” Secretary Perdue said. “Under the leadership of President Trump, USDA is committed to doing our part to clear the way for nationwide broadband connectivity that will allow the next generation of precision agriculture technologies to thrive and expand.”

Download A Case for Rural Broadband: Insights on Rural Broadband Infrastructure and Next Generation Precision Agriculture Technologies (PDF, 2.5 MB). To see how Next Generation Precision Agriculture Technologies can work on farm and ranching operations, view the Connected Technologies infographic (PDF, 910 KB).

The report also finds that if broadband infrastructure and digital technologies at scale were available at a level that meets estimated producer demand, the U.S. economy could realize benefits equivalent to nearly 18 percent of total agriculture production. Of that 18 percent, more than one-third is dependent on broadband e-Connectivity, equivalent to at least $18 billion in annual economic benefits that only high-speed, reliable internet can provide.

For many years, USDA and the American agriculture industry have been actively researching the feasibility, usage and potential upside of Next Generation Precision Agriculture technologies. Until now though, the interdependency of these technologies and broadband e-Connectivity has not been evaluated. The report released today explores this symbiotic relationship and quantifies the potential economic benefit of broadband buildout and the complementary adoption of connected agriculture technologies. Going forward, the U.S. Department of Agriculture (USDA) will be engaged in multiple facets of infrastructure and technology deployment, including financing rural capital investments and supporting producers who are exploring which Next Generation Precision Agriculture Technologies are best suited to improve their operations and serve their customers.

In April 2017, President Trump established the Interagency Task Force on Agriculture and Rural Prosperity to identify legislative, regulatory and policy changes that could promote agriculture and prosperity in rural communities. In January 2018, Secretary Perdue presented the Task Force’s findings to President Trump. These findings included 31 recommendations to align the federal government with state, local and tribal governments to take advantage of opportunities that exist in rural America. The Report identified Achieving e-Connectivity in Rural America as a cornerstone recommendation. The Administration has been executing this priority call to action through the American Broadband Initiative (ABI) (PDF, 647 KB), which reflects rural broadband build-out as one of President Trump’s directives to the Federal government. A Case for Rural Broadband: Insights on Rural Broadband Infrastructure and Next Generation Precision Agriculture Technologies (PDF, 2.5 MB) opens the next chapter in the USDA’s response to this call to action.

To view the report in its entirety, please view the Report to the President of the United States from the Task Force on Agriculture and Rural Prosperity (PDF, 5.4 MB). In addition, to view the categories of the recommendations, please view the Rural Prosperity infographic (PDF, 190 KB).

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The Pennsylvania Department of Health Oral Health Program is excited to announce the publication of the 2019-2024 Pennsylvania Oral Health Surveillance Plan.  The Oral Health Surveillance Plan provides a consistent source of reliable and valid information for use in the monitoring of oral health status and trends of the state and for developing, implementing, and evaluating programs to improve the oral health of Pennsylvanians.

Click here to view the plan.

Key Design Components and Considerations for Establishing a Single-Payer Health Care System

Congressional interest in substantially increasing the number of people who have health insurance has grown in recent years. Some Members of Congress have proposed establishing a single-payer health care system to achieve universal health insurance coverage. In this report, CBO describes the primary features of single-payer systems, as well as some of the key considerations for designing such a system in the United States.

Establishing a single-payer system would be a major undertaking that would involve substantial changes in the sources and extent of coverage, provider payment rates, and financing methods of health care in the United States. This report does not address all of the issues that the complex task of designing, implementing, and transitioning to a single-payer system would entail, nor does it analyze the budgetary effects of any specific bill or proposal.

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Clinton MacKinney, MD, MS; Fred Ullrich, BA; and Keith J. Mueller, PhD

Approximately 10 percent of primary care clinicians participate in Advanced Alternative Payment Models (A-APMs) and less than 30 percent of primary care clinicians participate in the Merit-Based Incentive Payment System. Metropolitan primary care clinicians are more likely to participate in A-APMs than non-metropolitan primary care clinicians.

Click to download a copy: Primary Care Clinician Participation in the CMS Quality Payment Program

Medicare beneficiaries may be admitted to home health following an inpatient stay (post-acute) or directly from the community (community-entry). An analysis of Medicare data for rural, fee-for-service Medicare beneficiaries who utilized home health from 2011 to 2013 found significant differences in care processes between community-entry and post-acute home health. Compared to post-acute home health episodes, community-entry home health episodes on average were longer; less likely to include physical, occupational, and speech therapy visits; more likely to include medical social work visits; and less likely to be initiated on the physician-ordered start date or within two days of referral. Results suggest community-entry and post-acute home health are serving different needs for rural Medicare beneficiaries, which provides preliminary support for distinguishing between the two types of episodes in payment policy reform.

The Office of the National Coordinator (ONC) reports that nearly all hospitals provided patients with the ability to electronically view and download their personal information in 2017.  However, Critical Access Hospitals (CAHs) and small rural hospitals were less likely than larger and urban hospitals to be able to transmit that data and to have view, download, and transmit (VDT) capabilities.  Under the Promoting Interoperability Program (PI), hospitals are required to use electronic health records technology.  Another aspect of the program is to promote patients’ ability to view and download their personal health information.  The cost of electronic health record systems and limited access to broadband are two of the barriers to electronic capabilities in rural health care settings. See the Policy Updates section below for requests for comment on recent proposals on electronic health information networks.