A study of almost 3,000 children found silver diamine fluoride may be as effective as dental sealants for caries prevention. The study was reported in JAMA Network Open. The objective was to determine the noninferiority of silver diamine fluoride with fluoride varnish versus traditional glass ionomer sealants with fluoride varnish after two years when provided to children via a school-based health care program.
Rural Hospitals Face Renewed Financial Challenges, Especially in States That Have Not Expanded Medicaid
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.
New Report: Bank Branch Closures and Banking Deserts in PA, NJ, and DE
A new Philadelphia Fed report finds that the loss rate of bank branches in the Third District states of Pennsylvania, New Jersey, and Delaware more than doubled during the pandemic. Here are some of the highlights from the study.
- The three states combined experienced a net loss of 627 branches and a significant increase in the number of banking deserts, census tracts without nearby bank branches, during the pandemic.
- The number of lower-income, non-White, or rural banking deserts increased from six to 11 from 2019 to 2022.
- The share of low- and moderate-income (LMI) individuals living in banking deserts increased by 30 percent.
Increasing bank branch closures are a cause for concern, as banking deserts can limit opportunities for lower-income residents to improve their financial health and accrue wealth.
Read the report.
New Report: The Role of Telehealth in Achieving a High Performing Rural Health System: Priorities in a Post-Pandemic System
Telehealth usage increased during the Public Health Emergency (PHE), and this has fueled discussions on the optimum use of telehealth in healthcare delivery. Based on experiences during the PHE, and new applications of telecommunications technologies, this report assesses potential improvements in rural health service delivery, as well as potential unintended consequences that could undermine goals to improve services for currently underserved populations. The assessment is guided by the over-arching framework of the high-performing rural health system (HPRHS), to understand the benefits of telehealth in improving health equity as affecting four pillars of the HPRHS – access, affordability, community health, and quality.
Click here to open the full document.
Principal Authors: Joel M. James, MPH and Keith J. Mueller, PhD (Panel Chair)
Prepared by the RUPRI Health Panel: Alva O. Ferdinand, DrPh, JD; Alana D. Knudson, PhD; Jennifer P. Lundblad, PhD, MBA; A. Clinton MacKinney, MD, MS; Timothy D. McBride, PhD; Nancy E. Schoenberg, PhD
New Policy Brief: Patient Transfers to and from CAHs During the COVID-19 Pandemic
A new policy brief is available on the Flex Monitoring Team website: Patient Transfers to and from Critical Access Hospitals During the COVID-19 Pandemic. In this brief, the Flex Monitoring Team describes the volume, barriers, and facilitators of inbound and outbound patient transfers as found in a survey of Critical Access Hospital CEOs.
Updated! Catalog of Value Based Initiatives for Rural Providers Released
The Rural Health Value team has released the annual update of the Catalog of Value Based Initiatives for Rural Providers. This is your “go to” resource for staying current on CMMI payment demos that are germane for rural health care organizations and clinicians. Please share this resource as appropriate with your networks and stakeholders:
Catalog of Value Based Initiatives for Rural Providers
One-page summaries describe 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). (2023)
Related resources on the Rural Health Value website:
- Medicare Shared Savings Program: Rule Changes and Implications for Rural Health Care Organizations – A summary of the changes made to the Medicare Shared Savings Program taking effect January 2023 and 2024. This Rural Health Value analysis outlines how the changes would reduce barriers to participation for potential or reentering ACOs that operate in rural contexts.
- How to Design Value‐Based Care Models for Rural Participant Success: A Summit Findings Report – Based on the input from a two-day virtual summit of rural participants in value-based care models and programs, summarizes themes and actionable recommendations that can be used by those designing and supporting value-based care models to improve the viability, relevance, and likelihood of rural health care organization participation and success.
- Experience in the Pennsylvania Rural Health Model: Barnes-Kasson County Hospital – A critical access hospital in Susquehanna, PA provides insight into their experience participating in the Pennsylvania Rural Health Model, which includes a global budget and transforming care to address community health needs.
Contact information:
Clint MacKinney, MD, MS, Co-Principal Investigator, clint-mackinney@uiowa.edu
Report Shows Major Increase in Public Health Majors
According to a new study, the number of undergraduate public health majors has increased significantly over the past two decades. The study analyzed the popularity of undergraduate public health majors, the demographics of those programs, and the careers their graduates pursue. The increased interest can partially be attributed to the COVID-19 pandemic.
Pennsylvania Report Addresses Rural Oral Health Access Issues
The Pennsylvania Legislative Budget and Finance Committee (LBFC) released a report that analyzed the state of dentistry in rural Pennsylvania and found that the state has a growing problem with access to dental care. To combat those trends and problems, the report suggests some financial changes, as well as expanding technological use.
PCOH was excited to assist the LBFC on this report as the lead stakeholder.
New CAH Coordination of Care Brief Released
The Flex Monitoring Team released a new policy brief, Care Coordination and Community Partnerships for Cancer Care in Critical Access Hospitals. This brief presents data from a survey of 135 CAHs across the U.S. and provides specific data on care coordination services provided in CAHs and staff providing these services, as well as information related to CAH partnerships with community organizations in community cancer initiatives.
Data Updates Announced by the Pennsylvania Data Center
New Brief Highlights Changes to Urban Areas in Pennsylvania
The U.S. Census Bureau released an updated list of urban areas, boundary maps and other related material this month. Read more on our Research Briefs page or click here to go straight to the brief.
Census Bureau Updates
- American Community Survey 2017-2021 5-Year Public Use Microdata Sample (PUMS) Released
The 2017-2021 ACS 5-year PUMS were released this month. PUMS files allow data users to create custom estimates and tables that are not available through ACS pretabulated data products. Click here to explore options for accessing the latest data.
- New ACS Data Products Available for the 118th Congress
The Census Bureau released new social, economic, housing, and demographic statistics for the 118th Congress. The four Data Profiles are available for all 435 congressional districts and are available in the Census Bureau’s FTP site and through a web-based lookup tool on the ACS website.
- American Community Survey Migration Flows
The U.S. Census Bureau released new data tables from the 2016-2020 American Community Survey (ACS) highlighting the geographic mobility of people. Click here to learn more.
- Census Bureau and AmeriCorps Released the Civic Engagement and Volunteering Supplement
Click here to access the 2021 Current Population Survey (CPS), Civic Engagement and Volunteering (CVC) Supplement Microdata File. This is the most robust longitudinal survey about volunteerism and other forms of civic engagement in the United States.