Ambulatory care refers to medical services performed same day on an outpatient basis, without admission to a hospital or other facility, and includes services ranging from wellness and disease management to surgical treatment and rehabilitation.  Not much is known, however, about the ambulatory care that rural Medicare patients typically receive.  This chartbook from the North Carolina Rural Health Research and Policy Analysis Center uses available Medicare claims data to describe costs and common diagnoses for Medicare beneficiaries at rural ambulatory care facilities (excluding private practitioners).

The Centers for Disease Control and Prevention (CDC) recently released the latest figures on drug poisoning deaths at the national, state, and county levels from the years 1999 through 2017.  Updated data collection and methodology over that time period allows researchers to capture death rates in counties with small population sizes or small numbers of deaths, permitting reports on urban/rural trends by state (see pull-down menu under the heading “Options”).

Abigail Barker, PhD; Lindsey Nienstedt, BA; Leah Kemper, MPH; Timothy McBride, PhD; and Keith Mueller, PhD

This brief uses data from the 2012–13 Medicare Current Beneficiary Survey (MCBS) to describe rural and urban differences in the populations that enroll in the Medicare Advantage (MA) program. Combined with county-level data on MA issuer participation, this dataset also allows us to assess the degree to which issuers may engage in selective MA market entry on the basis of observed demographic characteristics. Rural and urban MA and fee-for-service populations did not differ much by any characteristics reported in the data, including age, self-reported health status, cancer diagnosis, smoking status, Medicaid status, or by other variables assessing frailty and presence of chronic conditions. Most measures of access were similar across rural and urban respondents. While rurality on its own was often a significant predictor of lower issuer participation in a county’s MA market, the addition of other demographic characteristics did not influence the prediction. In other words, we found no evidence, based upon MCBS data, that issuers exclude rural counties due to other demographics. These findings suggest that poor health – as approximated by the demographic characteristics captured in MCBS data – is also captured similarly in risk adjustment formulas, meaning that MA issuers are compensated for this observed risk.

Click to download a copy: Comparing Rural and Urban Medicare Advantage Beneficiary Characteristics

The Flex Monitoring Team’s latest briefing paper is a report on our evaluation of projects implemented under Flex Program Area 5: Integration of Innovative Health Care, which is a new program area in the current funding cycle.

We describe the initiatives of seven states in the areas of telehealth, care coordination, and quality improvement, and discuss their implementation and their early results. We also examine the role and impact of Program Area 5 in the Flex Program, and highlight key lessons learned from this first round of implementation.

Click through to access the paper.

Please click here to view full PDF.

Tackling HPV Cancers.  The Human Papillomavirus (HPV) vaccine can prevent 30,000 Americans from getting cancer each year, but data from 2017 show that fewer than half of adolescents completed the HPV vaccination series.  In rural communities, adolescents are less likely than their urban peers to be aware of the HPV vaccine and its importance in cancer prevention.  Monday, March 4^th is International HPV Awareness Day and the U.S. Department of Health & Human Services (HHS) asks you to join the #EndHPVCancers Twitter Chat on that day at 3:00 pm ET.  And to help others understand the risks and ways to prevent HPV, share resources from the HHS HPV Promotional Toolkit, the National HPV Roundtable, and Centers for Disease Control and Prevention.

New Data Show Growth in Rural Population.  The Economic Research Service (ERS) at the U.S. Department of Agriculture reports an uptick in population for the first time in nearly a decade.  In 2016-17, the rural population increased by 0.1 percent, adding 33,000 people. This annual report from the ERS also includes geographic variations in population trends and a breakdown by race and ethnicity.

Approximately 1.73 million Pennsylvanians (13.7%) have at least one disability. This month we highlight trends in the population with disabilities in PA according to the 2013-2017 American Community Estimates. Key trends include:

• A higher percentage of females and older persons had disabilities
• Ambulatory, or movement-based, disabilities were the most common type
• Those with disabilities had lower educational attainment and earnings

Read more: https://pasdc.hbg.psu.edu/sdc/pasdc_files/researchbriefs/Feb_2019.pdf

AHA Report on Challenges to Rural Access to Care.  The American Hospital Association (AHA) report takes a comprehensive look at persistent challenges to health care in rural communities, an examination that includes hospital closures, the opioid crisis, social determinants of health, lack of behavioral health and workforce shortages.  While it acknowledges a role and responsibility for better policy at every level, the report focuses on federal policies and investments in light of their nationwide impact and reach.

Advancing Tobacco Prevention and Control in Rural America. The National Network of Public Health Institutes (NNPHI), in conjunction with the Maine Public Health Institute and the National Association of Chronic Disease Directors (NACDD), announced the release of a new report highlighting the significant toll tobacco has on rural communities.  The report – which includes 15 recommendations for advancing rural tobacco control initiatives and suggestions for future research – explores rates and patterns of commercial tobacco use across rural, aspects of the rural context that may affect tobacco control efforts, and current rural tobacco control activities. According to the Centers for Disease Control and Prevention, cigarette smoking disproportionately affects the health of people with lower socioeconomic status, withpeople living in deprived, rural areas experiencing rates of lung cancer that are 18-20 percent higher than people living in urban areas.