The Centers for Disease Control and Prevention (CDC) recently issued a new Clinical Practice Guideline for Prescribing Opioids for Pain. This guideline provides recommendations for clinicians providing pain care, including those prescribing opioids, for outpatients over 18 years of age. It updates the previous CDC guideline and includes recommendations for managing acute (duration of less than one month), subacute (duration of 1–3 months) and chronic (duration of more than three months) pain.
Rural Hospital CFOs Don’t See Telehealth As a Solution to Financial Challenges
While rural CFOs acknowledge that telehealth has some financial advantages, they do not believe that it has improved their hospitals’ financial situations, according to a Dec. 5 report published in The American Journal of Managed Care.
The report’s authors interviewed 20 rural hospital CFOs and other hospital administrators from 10 states between October 2021 and January 2022. 17 represented critical access hospitals and 3 represented short-term acute care hospitals, according to the report.
Five findings to know:
- The CFOs interviewed reported that limited reimbursement, low volumes, preference for in-person care, and insufficient broadband were key challenges to telehealth’s financial viability.
- Most CFOs interviewed believed that telehealth was a loss leader or had a neutral impact on their finances.
- Of the hospitals featured in the sample, all but one operated multiple telehealth programs. CFOs shared that their motivation to implement telehealth was driven more by improving quality and, in some cases, keeping up with competition, rather than improving their financial position.
- The CFOs said that telehealth requires substantial initial investment in technology and the downstream financial benefits are hard to quantify and not always realized.
- Some CFOs interviewed said that the requirement that critical access hospitals maintain an average length of stay of less than 96 hours was a barrier to the growth of their impatient and ED-based telehealth programs.
Executives Grapple with Decisions on CMS’ Rural Emergency Hospital Designation
The new Rural Emergency Hospital designation is putting providers between a rock and a hard place, offering an infusion of cash from the federal government that is available only if they eliminate inpatient care, The New York Times reported December 9.
CMS released the final rule for the new designation in November. The rule aims to curb rural hospital closures by offering them a chance to shutter infrequently used inpatient beds and focus on providing outpatient and emergency department services. The new designation is set to go into effect in January.
Hospitals that convert will receive monthly payments of $272,866, with annual increases based on inflation, according to the report. They will also receive higher Medicare reimbursements than larger hospitals.
Some rural healthcare providers and health policy analysts said officials behind the rule are “out of touch with the difficulties of transferring rural patients,” according to the Times. Bigger hospitals are dealing with their own set of challenges and are increasingly unwilling to accept transferred patients, especially from small field hospitals that are unaffiliated with their systems.
Katy Kozhimannil, PhD, director of the University of Minnesota Rural Health Research Center, told the Times she is concerned that gambling with transfers could mean “some of the most extremely remote and marginalized communities could end up with no care at all — and that’s what we were trying to avoid in the first place.”
Some hospitals, such as Sturgis (Mich.) Hospital, have said they are planning to convert to a rural emergency hospital. The hospital was on the verge of closing when the Michigan Hospital Association suggested it convert to a rural emergency facility. Sturgis Hospital CFO Bobby Morin said 80 percent of the facility’s revenue comes from outpatient services, and a sizable portion of its expenses comes from the inpatient side.
Others, such as Bucktail Medical Center in Renovo, Pa., have ruled out the conversion because there would be nowhere to transfer patients in the case of another pandemic surge, according to the report. Bucktail’s financial margin for patient services was minus-43 percent in 2021.
“Am I going to lose some revenue? Possibly,” CEO Time Reeves told the Times. “But is it more important to provide the services needed? That’s the position we’re taking.”
Broadband Listening Sessions to Be Held Across Pennsylvania
Pennsylvanians can learn about the new FCC broadband map, and how to challenge its inaccuracies
Pennsylvania Broadband Development Authority (Authority) Executive Director Brandon Carson today announced listening sessions will be held across the commonwealth beginning December 13 to give Pennsylvanians the opportunity to learn about the Authority, federal funding for broadband, and to hear about the important role they have in reviewing the new Federal Communications Commission (FCC) broadband access map. The map’s accuracy is crucial for the commonwealth to receive sufficient federal funding to ensure high-speed internet access for all Pennsylvanians.
“In today’s world, having access to high-speed internet is a necessity,” said Carson. “Pennsylvanians need broadband access for school, work, and to ensure public safety, and it is critical that we close the digital divide across the commonwealth. The more accurate we can make the FCC map, the more we ensure we get a fair allocation of federal funding to expand broadband.”
The FCC’s broadband access map shows all broadband serviceable locations across the United States where fixed broadband internet access service is or can be installed. The commonwealth’s allocation of funding for broadband deployment under the federal infrastructure law is dependent upon the map being accurate. Pennsylvanians should visit the map to search for their home address to determine whether the information listed by the FCC is accurate.
Listening Sessions
The Authority will host the following broadband listening sessions across the commonwealth:
- Tuesday, December 13 at 10:00 AM – Beaver County
In-person only listening session will be held at Community College of Beaver County, Library Conference Center 9103, 1 Campus Drive, Monaca, PA 16061
- Tuesday, December 13 at 2:00 PM – Somerset County
In-person only listening session will be held at Glencoe United Church of Christ, 128 Critchfield Street, Fairhope, PA 15538
- Wednesday, December 14 at 10:00 AM – Venango County
Hybrid listening session
- In-person will be held at Venango County Training Center, 737 Elk Street (Corner of Elk & 8th), Franklin, PA 16323
- Click here to register and attend virtually
- Wednesday, December 14 at 2:00 PM – Elk County
Hybrid listening session
- In-person will be held at North Central PA Regional Planning and Development Commission, 49 Ridgmont Drive, Ridgway, PA 1585
- Click here to register and attend virtually
- Thursday, December 15 at 10:00 AM – Luzerne County
Hybrid listening session
- In-person will be held at Greater Wyoming Valley Chamber of Commerce, 7 South Main Street, Wilkes-Barre, PA 18701
- Click here to register and attend virtually
- Thursday, December 15 at 2:00 PM – Tioga County
Hybrid listening session
- In-person will be held at Bradford County Public Safety Center, 29 VanKuren Drive, Towanda, PA 18848
- Click here to register and attend virtually
- Friday, December 16 at 10:00 AM – Union County
Hybrid listening session
- In-person will be held at SEDA-Council of Governments, 201 Furnace Road, Lewisburg, PA 17837
- Click here to register and attend virtually
- Monday, December 19 at 11:00 AM – Chester County
In-person only listening session will be held at Borough of Kennett Square, 600 S. Broad Street, 3rd Floor, Kennett Square, PA 19348
Process to Challenge Inaccuracies in the FCC Broadband Map
Challenges to the map can include:
- A location that meets the FCC’s definition of a broadband serviceable location is missing from the map.
- A location’s broadband serviceability is incorrectly identified.
- Information such as the address or unit count for the location is incorrect.
- The location’s placement (its geographic coordinates) is incorrect.
Pennsylvanians should challenge the map to help improve its accuracy by January 13, 2023. There are two ways to submit a challenge: by a single location, or in bulk. The location challenge can be completed by individual consumers utilizing the map itself. Bulk challengers will be required to use the Broadband Data Collection (BDC) platform to submit information to the FCC.
Additional information about the Consumer Challenge Process can be found here, and additional information on the Bulk Challenge Process can be found here. A consumer may also challenge mobile data coverage through the FCC Speed Test App – a free application that can be downloaded from an Apple or Google Play Store.
Governor Tom Wolf announced the creation of the Authority in February 2022 to manage at least $100 million in federal aid to coordinate the rollout of broadband across Pennsylvania. The Authority was charged with creating a statewide broadband plan and distributing federal and state monies for broadband expansion projects in unserved and underserved areas of the commonwealth.
For more information about the Pennsylvania Broadband Development Authority, or the Department of Community and Economic Development, visit the Authority’s website and be sure to stay up-to-date with all of our agency news on Facebook, Twitter, and LinkedIn.
2017-2021 ACS 5-Year Estimates Data Now Available
The U.S. Census Bureau released new statistics from the 2017-2021 American Community Survey (ACS) 5-Year Estimates, now available at https://data.census.gov/. These estimates provide data for all Pennsylvania counties, municipalities, and other geographic areas regardless of population size.
Some highlights from the Pennsylvania State Date Center include:
- Approximately 47.0% of renter households in PA spent more than 30.0% of their income on housing costs, compared to 40.0 percent of renter households nationally.
- The counties with the highest percentage of renters experiencing a housing cost burden were Centre (58.0%), Pike (57.4%), Lawrence (52.5%), Monroe (51.9%), and Philadelphia (51.9%).
- Between 2012-2016 and 2017-2021, 43 counties experienced a statistically significant increase in median household income.
Visit the Data Center’s Research Briefs page to read this brief and past releases.
New Rural Revitalization Podcast from the Brookings Institution Launched
Introducing Reimagine Rural, a podcast featuring rural towns experiencing positive change
While the dominant narrative regarding rural America is one of decline and division, Reimagine Rural is a new podcast that visits rural towns across the United States that are experiencing positive change and explores how public investment in rural people and places can lead to increased and equitable prosperity.
Hosted by Tony Pipa, a scholar in the Center for Sustainable Development at the Brookings Institution and a product of rural America, each episode features local voices telling the story of progress in their community and considering the intersection with policy and public resources.
Join Tony on this journey to visit a diverse set of towns across America to learn more about how rural communities are adapting to the 21st century.
Episode 1 debuted on November 22. Click here to see the list of podcasts and for information on how to subscribe.
New Rural Health Briefs Released
The Rural Health Value team recently released a new policy brief:
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.
Related resources on the Rural Health Value website:
- 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).
- MaineHealth ACO – Integrating and Using Data to Support Care Delivery – A predominantly rural network of hospitals and clinics in Maine integrates clinical and claims data to support improvements in care delivery and target patient needs as part of their Accountable Care Organization.
- Vermont’s All-Payer Accountable Care Organization Model – Mt. Ascutney Hospital and Health Center’s (MAHHC) Experience – Vermont’s dominant payers have partnered to test an alternative payment model statewide that requires health care organizations like MAHHC to innovate health care delivery and achieve shared goals. Participation in the ACO has allowed MAHHC to implement strategies to better meet community needs ranging from prevention to complex care management.
USDA Releases Rural America At A Glance Report
The U.S. Department of Agriculture (USDA) released the Rural America at a Glance report. The report notes a change in the composition of the rural labor force over the past decade due to an overall decline in population growth, aging of the population, and changing industry structure. Rural America has become more economically diverse over time, with increasing employment in health care, hospitality, and other service industries. There is also evidence that the rural workforce is changing in terms of diversity. The report is helpful when considering new ways to strengthen the rural health pipeline.
Improving the Oral Health of Rural Veterans
According to a new report from the American Institute of Dental Public Health (AIDPH) and CareQuest Institute, veterans in rural areas are struggling to receive oral care. Only about 15% of veterans are eligible for dental care through the Veterans Health Administration (VHA), with the percentage being even lower for rural veterans.
Learn more in the full report.
Rural America is Getting Older: A Fifth of the Population Now Over Age of 65
Rural America is continuing to get older, and a new report shows the extent has hit a new high.
The U.S. Department of Agriculture’s annual Rural America at a Glance report shows more than 20% of rural residents are over age 65 compared to 16% in urban areas.
“The aging of the baby-boom generation will continue to contribute to the loss of working-age adults through the end of this decade,” the report from the USDA’s Economic Research Service stated.
The report also said there is a corresponding decrease in the working-age population, with those 18 to 64 making up 58% of non-metro residents, compared with 61% of metro residents.
Fixing the problem will take a lot of work from a lot of different areas, said Mary Hendrickson, a professor of rural sociology at the University of Missouri.
“There’s federal issues, there are state issues, there are community issues, there are regional issues. Can we start thinking about regional networks? There really is not just one thing,” she said.
Hendrickson said rural areas need to make things better for families, and that can include such improvements as better broadband access and reliable day care and preschool options, which are not only lacking but often nonexistent in rural areas.
“If we’re going to talk about wanting to be family friendly, then we’re going to need to have some policies that are helpful,” Hendrickson said.
Some rural communities have tried creative ways to attract younger people to make their home away from urban areas, including offering grants to new homeowners and establishing recruiting committees to entice former residents to move back.
“Those kinds of programs are essential,” Henrickson said. “Folks who live in these rural areas sometimes look around and think more of the challenges rather than thinking about what are the opportunities for helping and making their place attractive for a younger generation.”
Other rural advocates caution those kinds of projects won’t be enough and argue for more systemic change at the federal level.
“We learned during COVID that many people can work from anywhere, and that gave a lot of hope to rural communities looking to increase their population,” said Chris Merritt, executive director of the Illinois Institute of Rural Affairs at Western Illinois University.
“But state and federal governments need to get more involved to make sure these communities have health care, schools, transportation and grocery stores. Those things can’t happen at just the community level.”
While rural communities look to increase their younger population, they will also have to deal with new challenges of having more older residents.
“Declines in the working-age population may make it harder to meet labor demands in some rural industries and local labor markets. At the same time, many rural areas lack sufficient health care capacity, broadband service, community centers and other services to address the challenges associated with an aging population,” the USDA report said.
This story was produced in partnership with Harvest Public Media, a collaboration of public media newsrooms in the Midwest. It reports on food systems, agriculture and rural issues. Follow Harvest on Twitter: @HarvestPM.