For the third year in a row, more than half of small businesses in Pennsylvania, New Jersey, and Delaware said their financial conditions were poor or fair. Their top operational challenges? Hiring or keeping qualified staff. Reaching customers or growing sales. Supply chain issues.

Distilling data from the Fed’s national 2024 Report on Employer Firms: Findings from the 2023 Small Business Credit Survey, these briefs offer a view into business conditions in Pennsylvania, New Jersey, the Philadelphia metro, and the Third District states overall (Delaware, New Jersey, and Pennsylvania).

Additional findings from the survey for Delaware, New Jersey, and Pennsylvania:

• More firms said they experienced no change in their revenues between 2022 and 2023 than did between 2021 and 2022.
• Fewer firms carried debt, although about the same number of firms applied for loans, lines of credit, or merchant cash advances compared with the previous year.

Read the briefs.

In March 2021, Jellico, TN, a town of about 2,000 residents in the hills of east Tennessee, lost its hospital, a 54-bed acute care facility. Campbell County, where Jellico is located, ranks 90th of Tennessee’s 95 counties in health outcomes and has a poverty rate almost double the national average, so losing its health care cornerstone sent ripple effects through the region.

“Oh, my word,” said Tawnya Brock, a health care quality manager and a Jellico resident. “That hospital was not only the health care lifeline to this community. Economically and socially, it was the center of the community.”

Since 2010, 149 rural hospitals in the United States have either closed or stopped providing in-patient care, according to the Cecil G. Sheps Center for Health Services Research at the University of North Carolina. Tennessee has recorded the second-most closures of any state, with 15, and the most closures per capita. Texas has the highest number of rural hospital closures, with 25.

Each time a hospital closes there are health care and economic ripples across a community. When Jellico Medical Center closed, some 300 jobs went with it. Restaurants and other small businesses in Jellico also have gone under, said Brock, who is a member of the Rural Health Association of Tennessee’s legislative committee. And the town must contend with the empty husk of a hospital.

Dozens of small communities are grappling with what to do with hospitals that have closed. Sheps Center researchers have found that while a closure negatively affects the local economy, those effects can be softened if the building is converted to another type of health care facility.

Read more.

Among the key findings in this brief from the University of Minnesota Rural Health Research Center:

• Rural hospitals experienced an increasing number of ransomware attacks from 2016 to 2021.
• From 2016 to 2021, 43 rural hospitals across 22 states experienced a ransomware attack.
• Ransomware attacks afflicted all types of rural hospitals, including Critical Access Hospitals (N=9), Sole Community Hospitals (N=13), Rural Referral Centers (N=3), and hospitals paid under Medicare’s Inpatient Prospective Payment System (N=18).
• Eighty-four percent of ransomware attacks on rural hospitals resulted in operational disruptions. Common disruptions included electronic system downtime (81%), delays or cancellations in scheduled care (42%), and ambulance diversion (33%). Operational disruptions were similar in rural and urban hospital settings.

A recent study from the Pennsylvania Department of Health (DOH) has found that Black people who died from opioid overdoses were half as likely as white people to receive the life-saving drug naloxone, otherwise known as Narcan. The study also found that Black overdose deaths in Pennsylvania increased by more than 50% between 2019 and 2021, compared with no change in white overdose deaths. A DOH representative said that similar rises in overdose deaths are being seen across the country, especially among Black, American Indian and Alaska Native populations, but researchers are still investigating what’s behind the spike. Read more.

This study assesses how, among behavioral health clinicians working in rural safety net practices, the amount of exposure to care in rural underserved communities received during training relates to confidence in skills important in their work settings, successes in jobs and communities, and anticipated retention.

This study summary provides a quick overview of the study published by the Journal of Rural Health.

View the Study Summary here.

From AXIOS

The level of care patients receive in a medical emergency varies widely based on where 911 is being dialed.

Why it matters: A first-of-its-kind study of emergency medical service systems’ performance across the country points to opportunities to improve patient care when the pressure is on.

What they did: Researchers at the Icahn School of Medicine at Mount Sinai reviewed more than 26 million responses from nearly 9,700 EMS agencies in 2019.

• They assessed how those agencies performed on safety and clinical quality measures that had been outlined by a nonprofit industry organization that year.
• The researchers said it’s a shift from looking primarily at response times to determine EMS performance, which they say is an imprecise metric for most calls.

What they found: Agencies largely responding in rural areas were less likely to treat low blood sugar or improve trauma patients’ pain, researchers found.

• They were also more likely to use lights and sirens unnecessarily, which other studies have found raises the risk of crashes.
• Delivery of time-sensitive treatment also varied during EMS calls. For instance, 4 in 10 kids with wheezing or asthma attacks didn’t get breathing treatment, and about 1 in 3 suspected stroke patients didn’t have a stroke assessment documented.

What they’re saying: “We have to move away from solely looking at response times and start looking at performance that directly impacts the people we are meant to treat,” said lead author Michael Redlener, an associate professor of emergency medicine.

The Rural Health Value team is pleased to announce the release of an updated version of the 2024 Uniform Data Set (UDS) Measure Crosswalk to Other Quality Reporting Programs .

The Crosswalk highlights alignment between Uniform Data Set (UDS) measures and other quality reporting programs. It is intended to help health centers identify which UDS measures are being utilized by other programs such as CMS Accountable Care Organizations (ACOs), and the CMS Quality Payment Program (QPP).

Related resources on the Rural Health Value website:

• The Catalog of Value-Based Initiatives for Rural Providers. The catalog summarizes rural-relevant, value-based programs currently or recently implemented by the Department of Health and Human Services (HHS), primarily by the Centers for Medicare & Medicaid Services (CMS) and its Center for Medicare & Medicaid Innovation (CMMI). Its purpose is to help rural leaders and communities identify HHS value-based programs appropriate for rural participation.
• Rural Innovation Profile: Iowa Community Health Centers and Value-Based. The Iowa Primary Care Association (Iowa PCA), IowaHealth+, and INConcertCare collaborate as a network to leverage resources in support of community health centers (CHCs) across Iowa. The three organizations have established a common strategic plan that supports a clinically integrated network for Medicaid and Medicare value-based care (VBC) contracting. This profile provides an overview and background information on how the partnership supports value-based care and planned next steps.

The Pennsylvania Office of Children, Youth, and Families released a child welfare workforce recruitment and retention study, analyzing the trends, challenges, and needs to stabilize the system. Several partners were engaged in developing the report, including 10 county child welfare agencies, the Child Welfare Resource Center, Pennsylvania Children and Youth Administrators, Pennsylvania Council for Children, Youth, and Families, the Civil Service Commission, and OCYF. Some leading factors contributing to the significant turnover in the field include compensation, organizational culture, working conditions, and partner/stakeholder relationships. The report concludes by outlining 43 recommendations across six themes: cross-cutting, compensation, recruiting, caseworker workloads, training, and safe, supportive workplaces. It is further recommended that a recruitment and retention investment fund and a working group be created to strategize on each recommendation. With the staffing crisis impacting many child welfare agencies across the commonwealth, it will be important for the administration, policymakers, and stakeholders to partner and make these recommendations achievable.

Damaged or destroyed homes, displaced families, and personal harm. Millions of Americans face the impacts of flooding each year. Two new reports examine flood hazards and risk in Pennsylvania, New Jersey, and Delaware.

One study finds that in noncoastal areas in the three states, properties in low- and moderate-income neighborhoods face greater risks when compared with their higher-income counterparts. When it comes to coastal areas, the opposite is true. Yet, increased flood hazards touch all residents in shore communities.

A companion report compares the Federal Emergency Management Agency’s well-established Special Flood Hazard Areas with a new, alternative measure from the First Street Foundation. The study seeks to understand the implications for residents in less advantaged communities.

For more on climate risks and adaptation in our region, the Federal Reserve Banks of Philadelphia and New York invite you to a one-day event on workforce solutions for community climate resilience. Learn more and register.