New Rural Policy Brief Published on Telepharmacy Rules and Statutes

A new rural policy brief is available from the RUPRI Center for Rural Health Policy Analysis:

Telepharmacy Rules and Statutes: A 3-Year Update for all 50 States

Jason Semprini, MPP; Fred Ullrich, BA; Keith Mueller, PhD

This policy brief analyzed administrative rules and legislative statutes governing each state’s pharmacy practice. Key features of telepharmacy regulations were investigated for comparative analysis. Twenty-one states currently authorize retail telepharmacy, but between these states the regulatory activity varies considerably.

Please click here to read the brief.

Journal of Appalachian Health Is Now On the Directory of Open Access Journals!

The Journal of Appalachian Health has been added to the Directory of Open Access Journals.

DOAJ is a community-curated online directory that indexes and provides access to high quality, open access, peer-reviewed journals. DOAJ is independent; All funding is via donations. All DOAJ services are free of charge including being indexed in DOAJ. All data is freely available.

DOAJ operates an education and outreach program across the globe, focusing on improving the quality of applications submitted (Source: DOAJ, 2020).

New Report Highlights Economic Potential of Region’s Oil & Gas Industries

The Department of Energy (DoE) released a new report titled, The Appalachian Energy and Petrochemical Renaissance: An Examination of Economic Progress and Opportunities. Drawing on ARC data, research, and investment outcomes, the report examines energy resources found in Appalachia, the opportunities/challenges that are associated with these industries, and the steps that can be taken to increase the positive economic impact from these opportunities in parts of Pennsylvania, West Virginia, Ohio, and Kentucky.

The report cites several ARC reports relevant to the Region’s shale and gas industry including the Status of the Appalachian Development Highway System as of September 30, 2018, the Industrial Make-Up of the Appalachian Region and An Economic Analysis of the Appalachian Coal Industry Ecosystem. The report also highlights ARC investments in the Tristate Energy and Advanced Manufacturing (TEAM) Consortium, a network of nearly 50 community colleges and educational institutions, industry representation, local economic development leaders, and investment partners from across Marcellus-Utica region providing credentialed education and training for jobs in Appalachia’s energy and manufacturing sectors as an example of successful workforce development initiatives that could be brought to scale.

“Appalachian energy resources are among the most plentiful in the world, and the region stands poised to continue its growth as an energy producer and an important contributor to the world petrochemical market,” said ARC Federal Co-Chairman Tim Thomas. “The critical policy priorities and strategic investments outlined in this report will be important to the continued energy independence of our nation and the economic development of the Appalachian Region.”

Read the full details here.

National Report: Prevalence of Tooth Loss Among Older Adults

The Centers for Disease Control and Prevention (CDC) released “Prevalence of Tooth Loss Among Older Adults: United States, 2015-2018.” The data was collected using the National Health and Nutrition Examination Survey. The prevalence of complete tooth loss among adults aged 65 and over was 12.9% in 2015-2018. Complete tooth loss can diminish quality of life, limiting food choices and impeding social interaction.

Click here to read the report.

Research Briefs from the Pennsylvania State Data Center

Population Estimates by Age, Sex, Race, and Hispanic Origin

The 2019 vintage of Population Estimates by Age, Sex, Race, and Hispanic Origin are now available from the U.S. Census Bureau. For more information on the Detailed Estimates or to download the data, click here.

Juneteenth National Freedom Day

This month’s brief focuses on trends in the Black or African American population in recognition of Juneteenth. Click here to read the full brief.

New Brief: Provision of Mental Health Services by Critical Access Hospital-Based Rural Health Clinics

Residents of rural communities face longstanding access barriers to mental health (MH) services due to chronic shortages of specialty MH providers, long travel distances to services, increased likelihood of being uninsured or under-insured, limited choice of providers, and high rates of stigma. As a result, rural residents rely more heavily on primary care providers and local acute care hospitals to meet their MH needs than do urban residents. This reality highlights the importance of integrating primary care and MH services to improve access to needed care in rural communities. Critical Access Hospitals (CAHs) are ideally positioned to help meet rural MH needs as 60 percent manage at least one Rural Health Clinic (RHC). RHCs receive Medicare cost-based reimbursement for a defined package of services including those provided by doctoral-level clinical psychologists (CPs) and licensed clinical social workers (LCSWs).

This policy brief explores the extent to which CAH-based RHCs are employing CPs and/or LCSWs to provide MH services, describes models of MH services implemented by CAH-based RHCs, examines their successes and challenges in doing so, and provides a resource to assist CAH and RHC leaders in developing MH services. It also provides a resource for State Flex Programs to work with CAH-based RHCs in the development of MH services.

New Research Brief: Process of Identifying Measures and Data Elements for the HRSA School-Based Telehealth Network Grant Program

A Research & Policy Brief is available from the Rural Telehealth Research Center:

To demonstrate how telehealth can expand access to, and coordinate and improve the quality of health care services offered in schools, the Health Resources and Services Administration (HRSA) Federal Office of Rural Health Policy (FORHP) Office for the Advancement of Telehealth (OAT) awarded grants to 21 organizations across the country for the School-Based Telehealth Network Grant Program (SB TNGP) in September 2016. Grants were targeted to rural, frontier, and underserved communities providing telehealth services for school children, with a particular focus on five clinical areas: asthma, behavioral health, diabetes, healthy weight, and oral health.  As part of this initiative, FORHP funded the Rural Telehealth Research Center (RTRC) to identify a set of measures for the SB TNGP. The principal activities for this project included developing an inventory of potential SB TNGP measures, defining a methodology for evaluating this inventory of measures to determine which were most relevant and applicable for evaluating the SB TNGP initiative, applying the methodology to identify a final list of measures, translating the measures into data elements, and creating a dictionary and tool that could be used to systematically collect and report data by SB TNGP grantees. The goal of the project was to identify a common set of measures that could be collected from each of the grantees on all of their grant-funded telehealth encounters for a cross-grantee assessment of school-based telehealth services, utilization, process, and outcomes.

Please click here to read the brief.

Faculty Research Examined Attitudes of Rural Pennsylvanians on Key Policy Issues

MIDDLETOWN, Pa. — With support from the Center for Survey Research at Penn State Harrisburg, researchers, led by Daniel Mallinson, collaborated to survey the attitudes of rural Pennsylvanians on a variety of topics, and how these attitudes affect their perspectives on issues relevant to state and local government, policymakers, community leaders, and other stakeholders. The research was conducted in 2019, before the coronavirus pandemic began in the U.S.

“Knowledge of the attitudes of rural Pennsylvania residents specifically is needed not only so that policymakers may respond to this quarter of the population, but also because there is evidence that attitudes of rural residents differ from those of urban residents and that attitudes may further vary within rural areas,” said Mallinson, assistant professor of public policy and administration in the college’s School of Public Affairs. “This project provides the data required to inform policymakers of the attitudes of this population concerning several key policy issues.”

Rural areas have been recovering from the recession, managing shifting demands for natural resources, realizing the need for broadband access for daily life, trying to provide access to quality healthcare, and trying to meet the challenge of the opioid crisis, to name only a few trends. According to Mallinson, the attitudes that rural Pennsylvanians hold on these issues, what issues they consider priorities, and what actions they would prefer policymakers take may have shifted over the last 10 years as these developments and others have occurred.

According to the Center for Rural Pennsylvania (CRPA), there are 3.4 million residents across the 48 rural counties in the commonwealth that policymakers serve. The researchers surveyed 2,000 Pennsylvanians (1,200 rural and 800 urban, as defined by the center).

Survey topics included attitudes about respondents’ communities, satisfaction with how things are going in Pennsylvania, trust in government, most-important policy problems, natural resource management, and the opioid crisis. For questions asked in this survey and one conducted in 2008, researchers compared responses to those collected in 2008, which was also funded by CRPA. Researchers also compared rural and urban attitudes to identify commonalities and divergences in opinion on key issues.

“Since the most recent survey had been done in 2008, social, political, economic and demographic changes have occurred which could lead to shifting outlooks or new issues to consider,” Mallinson said. “This project provides up-to-date data on rural views, as well as allows for future opinion polls to continue to assess trends in these views over time.”

Mallinson added that the 2008 report came amid the Great Recession. “At the time of this survey the U.S. economy had recovered, but somewhat unevenly. Urban areas generally recovered better than rural. New issues were at the forefront. For instance, Pennsylvania adopted medical marijuana [a topic of the 2008 study] and the conversation has now moved on to recreational marijuana [a topic of the current study].”

He added that one of the most important differences from 2008 is the decline in engagement in community activities, such as community clubs or organizations and local government commissions, committees, or boards.

Findings include that rural residents agree with their urban counterparts on a number of issues, including general satisfaction with their communities and how things are going in Pennsylvania;    general agreement that most community and state issues should receive the same or higher priority; similar viewpoints on legalizing marijuana, keeping the death penalty, arming school teachers and staff, a graduated instead of flat income tax, the need to regulate fracking, support for a severance tax on natural gas, and support for renewable energy development; and some level of trust in state government institutions and officials.

Urban and rural residents also have some key differences, according to the study, including top priorities — jobs for rural residents, roads and infrastructure for urban residents. Both want action on opioids, but disagree on the forms — urban more supportive of treating this as a health care issue, rural more supportive for greater criminal justice response.

“Even though urban and rural perspectives are often thought to be quite different, we find that there is a lot of agreement,” Mallinson said. “There are some fundamental differences on important policies. There is far more agreement than we expected. We also think the decline in civic engagement is concerning. Lawmakers should think about whether there are policies surrounding things like voting and civic education that can address this problem.”

The project was originally developed as a collaboration between Chelsea Kaufman and the Institute for State and Regional Affairs when Kaufman was a postdoctoral scholar in the Penn State Harrisburg School of Public Affairs. Kaufman continued the collaboration after becoming a faculty member at Wingate University. She serves at a subject matter expert on the project.

“The similarities in rural and urban views on some issues show the importance of surveying citizens on state and local issues to inform policymakers at this level,” Kaufman said. “If we rely on national surveys alone, the views of rural Pennsylvanians on these types of issues may not be clear and policymakers may be forced to extrapolate from rural perspectives on national issues.”

Mallinson added that the final report highlights more nuance in terms of rural and urban differences, as well as how personal and demographic characteristics impact those differences.

The research was funded by a $50,000 grant from CRPA.

The Future of Rural Value-Based Health Care and Surge Capacity

Healthcare service demands consequent to the COVID-19 pandemic have challenged preconceived rural value-based priorities such as inpatient-care reduction and just-in-time inventories. Thus, rural healthcare organizations may struggle with conflicting demands for surge-ready healthcare infrastructure and value-oriented business processes. This Rural Health Value commentary outlines questions for consideration about the future of rural value-based care and payment.

Link:  https://ruralhealthvalue.org/files/Future%20of%20Rural%20VBC%20and%20Surge.pdf

Top resources on the Rural Health Value website:

  • Value-Based Care Assessment – Assess capacity and capabilities to deliver value-based care. Receive an eight-category readiness report.
  • Physician Engagement – Score current engagement and build effective relationships to create a shared vision for a successful future.
  • Board and Community Engagement – Hold value-based care discussions as part of strategic planning and performance measurement.
  • Social Determinants of Health – Learn and encourage rural leaders/care teams to address issues to improve their community’s health.

 Contact information:

Keith J. Mueller, Ph.D., Co-Principal Investigator, keith-mueller@uiowa.edu

 Rural Health Value helps create high performance rural health systems by building and offering an actionable knowledge base through research, practice, and collaboration. Visit www.ruralhealthvalue.org.

Developed with funding from the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $250,000 with 0% financed with non-governmental sources. The contents are those of the authors(s) do not necessarily represent the official views of, nor an endorsement by HRSA, HHS or the U.S. Government.

Varying Trends In The Financial Viability Of US Rural Hospitals, 2011–17

Health Affairs

The financial viability of rural hospitals has been a matter of serious concern, with ongoing closures affecting rural residents’ access to medical services. We examined the financial viability of 1,004 US rural hospitals that had consistent rural status in 2011–17. The median overall profit margin improved for nonprofit critical access hospitals (from 2.5 percent to 3.2 percent) but declined for other hospitals (from 3.0 percent to 2.6 percent for nonprofit non–critical access hospitals, from 3.2 percent to 0.4 percent for for-profit critical access hospitals, and from 5.7 percent to 1.6 percent for for-profit non–critical access hospitals). Occupancy rate and charge markup were positively associated with overall margins: In 2017 hospitals with low versus high occupancy rates had median overall profit margins of 0.1 percent versus 4.7 percent, and hospitals with low versus high charge markups had median overall margins of 1.8 percent versus 3.5 percent. Rural hospital financial viability deteriorated in states that did not expand eligibility for Medicaid and was lower in the South. Rural hospitals that closed during the study period had a median overall profit margin of −3.2 percent in their final year before closure. Policy makers should compare the incremental cost of providing essential services between hospitals and other settings to balance access and efficiency.

Access the full article here.