Bipartisan Policy Center: Rural Health Report Update

The Bipartisan Policy Center (BPC) held a two-hour webcast on April 21, 20202, to mark the release of a new rural health policy report. This latest report is an update of its previous report. It has some new perspectives reflecting experiences of rural communities during the COVID-19 pandemic. The new report can be read here: BPC_Rural-Health-Care-Report – 2020.

There are multiple payment-related recommendations in the new report which would affect CAHs, RHCs and FQHCs. Many of these recommendations could become the basis of future COVID-19 relief legislation.

During the webcast Rural Health Task Force members provided their individual perspectives on the challenges facing rural health care. Many of the policy positions were shared by Task Force members:

  • The need for payment reforms is emphasized by the BPC Task Force. Many of these are incremental changes, though there is great interest in the global payment approach being explored in PA.
  • There is a strong shared sentiment that many hospitals need to transition to a smaller, reduced service operation. This sentiment is embodied in the Task Force recommendation for the establishment of a new CMS hospital designation – the Rural Emergency and Outpatient Hospital (REO). Transition of hospitals to the new model would be accomplished through a community-wide transformation planning process to be supported with Federal funds.
  • The Task Force also sees a potential role for FQHCs and RHCs that might wish to expand services into the inpatient arena. This would be permitted under a new Extended Rural Services (ERS) Program.
  • The Task Force looks for payment reforms and expanded workforce training programs to address the need to improve access to maternal care in rural areas.
  • Multiple rural health workforce program expansions are recommended. These include expansions of the J-1 Visa Waiver program and rural training track program, New support programs – including rural provider tax credit programs modeled after successful OR and NM programs – are also recommended.
  • A variety of recommendations related to rural broadband and telehealth expansions are presented.
  • The need for rural relevant quality measurement and performance monitoring is recognized in the report.

BPC recommendations, if implemented, may lead to an expansion of SORH activities. The REO and ERS programs would require planning efforts which could easily be coordinated with SORH participation.

For those interested in hearing the full webcast, check the following link:

https://bipartisanpolicy.org/event/covid19-exposes-threat-to-americas-broken-rural-health-care-system-bpc-task-force-policy-recommendations-webinar/

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.

USDA State Fact Sheets on Economy and Population

The Economic Research Service at the U.S. Department of Agriculture (USDA) frequently provides information on population, income, poverty and food security, among other economic indicators. Data are available for all states, and for metro/non-metro breakouts within states. Links to county-level data are provided where available. The State Fact Sheets were updated May 13, 2020. Statistics on population and employment/unemployment have been updated with the latest available data (2019).

House Committee Assesses COVID-19 Impact on Minority Communities

On May 27, the House Committee on Ways and Means (W&M) held its first virtual hearing. The hearing, titled “The Disproportionate Impact of COVID-19 on Communities of Color,” is available for viewing on W&M’s website here, along with a witness list and submitted witness testimony. The hearing featured health experts with knowledge of existing health disparities in the African American, Latino, Native American, and Pacific Islander communities, as well as a health expert on the economic impact of the virus. Members agreed that the disparities among communities of color were the result of preexisting cracks in the health system, now being widened by the coronavirus pandemic.

Access to Medicare Part D Plans: A Comparison of Metropolitan and Nonmetropolitan Areas

The Medicare Part D program allows Medicare beneficiaries to add prescription drugs to their Medicare coverage.  Within Medicare, two plans – Part D prescription plans and Medicare Advantage prescription plans– offer an array of payment options and benefits.  Researchers at the RUPRI Center for Rural Health Policy Analysis found that Medicare Advantage prescription drug coverage plans were offered in lower numbers of noncore counties, had higher monthly premiums, and were less likely to offer enhanced benefits.  Read more here.

Learning About Local Health Workforce Through Commute Patterns

To learn more about the available supply of nurses and allied health workers at local levels, researchers at the University of Washington Center for Health Workforce Studies looked at commute patterns found in the American Community Survey.  The report says a key takeaway for researchers and workforce planners is a need to measure local supply based not only on where people report working, but also where they live.  Read the report here.