The Patient-Centered Outcomes Research Institute conducted a rapid review of telehealth use for prenatal and postpartum health care visits during the COVID-19 pandemic. Their report indicates telehealth is a promising alternative to in-person care and also finds gaps that point to future research priorities.
The CDC Begins The Vaccines for Children Program
The Centers for Disease Control and Prevention oversee the purchase and distribution for all children under age 19 who are Medicaid eligible, uninsured, underinsured or are American Indian or Alaska Natives. This guide from the National Academy for State Health Policy explains current gaps in vaccine access for children and how states are addressing barriers to enrollment and cost burdens for providers.
COPD Data and Statistics Has Been Released
The new page from the Centers for Disease Control and Prevention provides data for chronic obstructive pulmonary disease (COPD) at the national, state, and county levels. Data show how COPD prevalence and death rates have changed over time and across different U.S. geographic locations. The percentage of adults in rural areas diagnosed with COPD is nearly double the percentage in large metropolitan areas.
Medicare Finalizes Inpatient Hospital Payment Rules
CMS released the (FY) 2023 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) final rule on August 1, 2022. The rule establishes fee-for-service payment rates and policies for inpatient hospitals and LTCHs. For FY 2023, the hospital payment rate will increase by 4.3% resulting in a $2.6 billion hospital payment increase for FY 2023. CMS finalized graduate medical education policies to increase flexibilities for rural hospitals participating in residency training through rural track programs. Finally, the rule also builds on key CMS priorities to advance health equity. Policy efforts include three new health equity-focused measures in the Inpatient Quality Reporting program and a focus on improving maternal health outcomes with the establishment of a “Birthing-Friendly” hospital designation. The final rule will be effective on January 1, 2023.
Medicare Finalizes SNF, IRF, IPF, and Hospice Payment Rules
CMS released final rules for Skilled Nursing Facilities (SNF), Inpatient Rehabilitation Facilities (IRF), Inpatient Psychiatric Facilities (IPF), and Hospices. Each rule updates Medicare payment and quality measurement policies for Fiscal Year (FY) 2023, which begins October 1. Average payments for rural SNFs, IRFs, IPFs, and hospices in FY 2023 are projected to increase by 2.5%, 3.1%, 2.9 %, and 3.8%, respectively, compared to FY 2022.
Comments Requested on the Proposed Rule on Nondiscrimination in Health Programs and Activities
Last week, the U.S. Department of Health & Human Services released a proposed rule implementing Section 1557 of the Affordable Care Act, which prohibits discrimination on the basis of race, color, national origin, sex, age, and disability in certain health programs and activities. Proposals include clarification of nondiscrimination requirements that apply to activities offered via telehealth, and requiring staff to have training on effective communication for people with limited English proficiency and people with disabilities.
Comments are due by September 26.
Information Requested on How to Improve Medicare Advantage
The Centers for Medicare & Medicaid Services (CMS) seeks responses to a series of questions on how to improve Medicare Advantage in regards to improving health equity and serving rural populations, expanding access to care, promoting person-centered care, and engaging partners. In 2021, over a third of rural Medicare beneficiaries were enrolled in a Medicare Advantage plan.
Requests are due by August 31!
Creating Awareness for Disparities in Organ Donation
August is the month for bringing attention to the gap between the number of organ donors and the number of people who are African American, Hispanic, Native American, or Asian/Pacific Islander who need life-saving organs or tissues. Of more than 100,000 people waiting for organ transplants, nearly 60 percent are from multicultural communities. Researchers have cited low socio-economic status as a primary driver of racial disparities.The Rural location also presents barriers to patients needing transplants; those who are older, lack advanced education, are underemployed, or are Medicaid beneficiaries are less likely to get on waitlists.
HRSA Releases Nearly $60 Million to Improve Access to Care in Rural Communities
On August 8, the Federal Office of Rural Health Policy announced investments of nearly $60 million to grow the health workforce and increase access to quality health care in rural communities, including nearly $46 million in funding from President Biden’s American Rescue Plan. The Biden-Harris Administration is committed to improving health outcomes and promoting health equity in rural America. In 2021, thanks to President Biden’s American Rescue Plan, the Department of Health and Human Services invested over $16 billion to strengthen rural health.
Nearly $46 million in American Rescue Plan funding will support 31 awardees to expand health care capacity in rural and tribal communities through health care job development, training, and placement. This funding includes support for critical health workforce needs in rural areas such as dental hygienists, medical or dental assistants, community-based doulas, and other frontline health care workers.
Nearly $10 million will support 13 organizations through the Rural Residency Planning and Development Program to establish new medical residency programs in rural communities to increase the number of physicians training in rural settings. In addition, nearly $4 million will support 18 awards to improve patient health outcomes and quality and delivery of care throughout rural counties and improve access to care for rural veterans.
“Among the most important steps we can take to improve access to health care in rural communities, including access to behavioral health care, is to invest in growing the rural health care workforce,” said HRSA Administrator Carole Johnson. “Today’s announcements are another important part of the Health Resources and Services Administration’s strategy to advance health equity for the nearly 65 million people who call rural areas home.”
Approximately one in five Americans lives in a rural area, and rural communities are becoming even more diverse. However, health disparities between rural and urban areas tripled between 1999 and 2019, with rural residents experiencing higher rates of heart disease, respiratory disease, cancer, stroke, unintentional injury, and suicide; and higher risk of maternal morbidity and mortality. Access to quality health care is at the heart of these issues.
Today’s announcement reflects HRSA’s investments through the following programs:
- The Rural Public Health Workforce Training Network Programis awarding nearly $46 million to 31 community-based organizations to expand public health clinical and operational capacity through workforce development. Additionally, a technical assistance provider was awarded $500,000 to strengthen the ability for these networks to develop formal training and certification programs.
- The Rural Residency Planning and Development Programis awarding $9.7 million to 13 organizations to establish new rural residency programs in rural communities to train resident physicians in rural clinical settings.
- The Small Health Care Provider Quality Improvement Programis awarding $2.9 million to 15 community-based organizations improve patient health outcomes and quality and delivery of care throughout rural counties.
- The Rural Veterans Health Access Programis awarding nearly $1 million to 3 organizations to improve access to health care services for veterans living in rural areas. This program is a collaboration between FORHP and the Veterans Health Administration to strengthen partnerships between rural health providers and the VA system.
For a complete list of recipients, see https://www.hrsa.gov/rural-health/grants/rural-community/fy2022-awards.
Defining Rural America: The Consequences of How We Count
From the The Center on Rural Innovation (CORI)
There is a phrase often used in the world of rural development: “If you’ve seen one rural community, you’ve seen one rural community.”
It reflects the fact that the parts of our country referred to as rural America are a vast geography — stretching from coast to coast — made up of varied places with unique histories, landscapes, and peoples. This reality makes it extremely difficult to settle on a single set of characteristics that encapsulate rural America. Even the people who live in areas referred to as rural often disagree on what makes a place rural.
As we set off on this Rural Aperture Project, in which we will use data to help people see the opportunities, challenges, and inequities of rural places in a new light, we face the difficult task of defining rural America.
The challenges of definitions are felt by journalists, researchers, philanthropists, nonprofits, and governments who all rely on data to understand, make sense of, and make critical decisions about rural America and how resources are distributed. It can be tempting to shrug off the issue as too complicated to deal with, but doing so neglects the fact that the definitions we choose have real-world consequences — the ways that federal statistical agencies define rural have significant political and economic implications. Rural definitions affect the distribution of billions of dollars in federal funding each year, and shape the way that companies, banks, and philanthropies view communities and make investment decisions. We cannot separate the question of how rural America is defined from conversations around critical issues like education, health, racial equity, and economic opportunity in the U.S.
The goal of this story is not to argue that any one definition is best, but to show how these definitions impact narratives about rural America, as well as outcomes on the ground. We approach the issue from two perspectives:
- Demonstrating that using data based on different rural definitions can lead us to tell different stories about the state of rural America.
- Exploring how differences in definitions can create confusion about who is and isn’t eligible for federal funding that targets rural areas.
We hope that those who use data on rural America to tell stories, conduct research, distribute resources, make investments, or develop policy do so with greater awareness about how their choices define who is and is not counted, and with greater awareness of the impact of those choices.