This week, the National Rural Health Resource Center released findings from their May 2020 Virtual Summit, which focused on the issues, challenges, and strategies related to the integration of acute and post-acute care in rural areas.  The report covers the current state of rural post-acute care, including the impact of COVID-19, and explores strategies and tactics to address key issues, such as payment, workforce, and community care coordination. Read more here.

The report from the U.S. Census Bureau presents data based on information collected every month in the Current Population Survey (CPS).  Findings show a median household income of $68,703 in 2019, with a 1.3 percent decline in the official poverty rate.  Read more here.

In its annual report, the Substance Abuse and Mental Health Services Administration (SAMHSA) presents data on the use of illicit drugs, alcohol, and tobacco, as well as trends in mental health and access to treatment. Statistics cover a range of demographic and geographic characteristics, including comparison of urban and rural. Read more here.

The Centers for Disease Control and Prevention (CDC) used data from the National Vital Statistics System to find that suicide rates increased overall for urban and rural areas for the years studied, with the pace of increase greater for rural suicide rates.  On Wednesday, the CDC’s National Center for Health Statistics released their findings from a survey on Mental Health Treatment Among Adults in 2019. Results show that overall, as the level of urbanization decreased, the percentage of adults who had taken medication for their mental health increased, and the percentage who had received counseling or therapy decreased.  Read more here.

The National Rural Health Resource Center (The Center), supported by the Federal Office of Rural Health Policy (FORHP), convened a virtual summit of key stakeholders to examine the current state of post-acute care (PAC) in rural America. The COVID-19 pandemic has brought PAC/long-term care (LTC) into the national spotlight, as a significant percentage of pandemic deaths in the U.S. are occurring in LTC and skilled nursing facilities (SNFs). Summit attendees explored issues, challenges, and strategies related to the integration of rural acute and PAC and considered how rural PAC can be successfully included in a population health and value-based payment future.

Focused Topics

Participants engaged in a wide-ranging discussion about current and often longstanding PAC-focused issues and challenges confronting health care organizations and communities across the rural U.S. In particular, the breakout sessions focused on four major topics, identifying both issues and potential strategies and tactical solutions to address those issues.

Identified Common PAC Challenges 

• Impact of the shifting payment environment from traditional volume-driven fee-for-service and cost-based reimbursement methods to value-based payment arrangements
• Need to improve access to rural PAC and services
• Evolving role of technology, particularly the rapid expansion of telehealth in response to the COVID-19 pandemic
• PAC workforce challenges and opportunities
• Importance of addressing social determinants of health

Check out the Full Report

This report provides a background on PAC, the Summit participants, process used at the Summit, comprehensive lists of identified strategies and tactics to address high priority rural PAC issues, a discussion on how state Flex Programs can help rural providers address PAC, and a collection of PAC best practices from the field.

The Pennsylvania Data Center released a new brief on access to broadband internet in the state.  The report showed that subscriptions increased for the general population in Pennsylvania from 2015 (81.2%) to 2019 (89.0%). By 2019, access to broadband was comparable for those under 18 years of age and those 18 to 64 years of age (93.2% and 92.1%, respectively). Pennsylvania’s seniors, or those age 65 years and over, still had lower access to broadband in comparison (74.3%).

Click here to read to read the brief. Be sure to click the link within the brief to explore the interactive chart showing broadband internet access by age and race.

This week, the CMS Innovation Center released the final evaluation results of the Accountable Care Organization (ACO) Investment Model (AIM), which operated under the Shared Savings Program (SSP) from 2015 to 2018. AIM provided up-front payments to select ACOs to invest in infrastructure and staffing and targeted small ACOs, many of which were in rural areas.  Overall, participating ACOs reduced total Medicare spending and utilization without decreasing quality of care.  Read more here.

This week, the Centers for Medicare & Medicaid Services (CMS) released guidance to states on pathways they can use to advance value-based care, which seeks to reward providers based on quality of care instead of volume of services.   This letter describes several models that can be used across many types of payers, key features of these models, and relevant Medicaid authorities needed for adoption.  It includes several models identified in 2019 by Rural Health Value as appropriate for rural clinicians or health care delivery organizations.  Read more here.

This week, the Centers for Medicare & Medicaid Services (CMS) released earlier than usual their proposal for contract year 2022 to calculate risk scores for Medicare Advantage (MA) payments using only encounter data submitted by MA organizations and the 2020 CMS Hierarchical Conditions Categories (HCC) model.  The intent of risk adjustment is to ensure that payments to MA plans reflect the relative risk, or characteristics and health conditions, of the enrollees.  Research has found lower average risk scores for beneficiaries served by rural providers than urban, which is contrary to extensive research showing rural populations are less healthy than urban.  Read more here.

This policy brief from the University of Minnesota Rural Health Research Center describes the challenges rural hospitals face in providing emergency obstetric care and highlights resources that could help rural hospitals more safely respond to obstetric emergencies.  Read more here.