Rural America is Losing its Pharmacies

Batson’s Drug Store seems like a throwback to a simpler time. The independently owned pharmacy in Howard, Kan., still runs an old-fashioned soda counter and hand-dips ice cream. But the drugstore, the only one in the entire county, teeters on the edge between nostalgia and extinction.

Julie Perkins, pharmacist and owner of Batson’s, graduated from the local high school and returned after pharmacy school to buy the drugstore more than two decades ago. She and her husband bought the grocery store next door in 2006 to help diversify revenue and put the pharmacy on firmer footing.

But with the pandemic exacerbating the competitive pressures from large retail chains, which can operate at lower prices, and from pharmaceutical middle men, which can impose high fees retroactively, Perkins wonders how long her business can remain viable.

She worries about what will happen to her customers if she can’t keep the pharmacy running. Elk County, with a population of 2,500, has no hospital and only a couple of doctors, so residents must travel more than an hour to Wichita for anything beyond primary care.

“That’s why I hang on,” Perkins said. “These people have relied on the store from way before I was even here.”

Corner pharmacies, once widespread in large cities and rural hamlets alike, are disappearing from many areas of the country, leaving an estimated 41 million Americans in what are known as drugstore deserts, without easy access to pharmacies. An analysis by GoodRx, an online drug price comparison tool, found that 12% of Americans have to drive more than 15 minutes to reach the closest pharmacy or don’t have enough pharmacies nearby to meet demand. That includes majorities of people in more than 40% of counties.

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Senators Introduced the Rural Health Equity Act to Establish an Office of Rural Health within the CDC.

Senator Merkley (D-OR) and Representative McEachin (D-VA) led the bicameral introduction of the Rural Health Equity Act (H.R. 5848/S. 3149) to establish an Office of Rural Health within the Centers for Disease Control and Prevention (CDC) and help address the unique health care challenges and inequities faced by rural communities across America. Alan Morgan, National Rural Health Association chief executive officer, notes that, “Throughout the COVID-19 pandemic, the structural barriers facing rural Americans have become increasingly evident, and has exacerbated the need for rural representation within the CDC.”

New Policy Brief: CAH Use of Federal Funding and Regulatory Flexibilities

The Flex Monitoring Team (FMT) has released a new policy brief: Critical Access Hospitals’ Initial Response to the COVID-19 Pandemic: Use of Federal Funding and Regulatory Flexibilities. This brief uses survey data collected by the FMT about Critical Access Hospitals’ response during the first seven months of the COVID-19 pandemic and describes key findings from the survey including:

  • How many participating CAHs received federal funding and from which sources
  • Which regulatory waivers and flexibilities were most commonly used by participating CAHs

On our website, you can read more about other FMT work assessing the impact of the COVID-19 pandemic on Critical Access Hospitals.

Governor Proclaims November 15-19, 2021 Rural Health Week in Pennsylvania

In an effort to draw attention to the wide range of issues that impact rural health, Pennsylvania Governor Tom Wolf has declared November 15-19, 2021, as Rural Health in Pennsylvania week at the request of the Pennsylvania Rural Health Association (PRHA) and the Pennsylvania Office of Rural Health (PORH).

Governor Wolf made the proclamation to promote awareness of the full range of issues that impact rural health care throughout the Commonwealth and the health status of rural Pennsylvanians. Nationally, Pennsylvania ranks as one of the states with the highest number of rural residents, with 26 percent of Pennsylvanians residing in rural areas. In recognition of Pennsylvania’s diverse rural needs, the Commonwealth has supported the development of the Center for Rural Pennsylvania, the Pennsylvania Office of Rural Health, and other agencies and initiatives to address the needs of rural Pennsylvanians.

The week encompasses November 18, which is National Rural Health Day, established in 2011 by the National Organization of State Offices of Rural Health (NOSORH) to showcase rural America; increase awareness of rural health issues; and promote the efforts of NOSORH, State Offices of Rural Health (SORHs) and others in addressing those issues.

“Nearly 59.5 million Americans, including 3.4 million Pennsylvanians, live in rural communities,” said Lisa Davis, PORH director and outreach associate professor of health policy and administration at Penn State. “These small towns and communities continue to be fueled by the creative energy of citizens who step forward to provide a wealth of products, resources, and services.

Rural communities also face unique health care concerns: a lack of providers; accessibility issues, particularly in terms of transportation and technology; and affordability issues as the result of larger percentages of uninsured and underinsured citizens and greater out-of-pocket health costs. Rural hospitals and health care providers, which frequently are the economic backbone of the communities they serve, deserve special consideration so that they can continue to provide high-quality services and meet the needs of rural residents.”

To celebrate the work being done to achieve health care access and equity in Pennsylvania, PORH will present Pennsylvania Rural Health Awards during virtual ceremonies across rural Pennsylvania.

PORH was established in 1991 to enhance the health status of rural Pennsylvanians and strengthen the delivery and quality of care in the communities in which they live. Each year, the organization presents awards to recognize rural health programs and individuals who have made substantial contributions to rural health in Pennsylvania. To learn more about the Pennsylvania Office of Rural Health, visit porh.psu.edu.

PRHA is dedicated to enhancing the health and well-being of Pennsylvania’s rural citizens and communities. Through the combined efforts of individuals, organizations, professionals, and community leaders, the Association is a collective voice for rural health issues and a conduit for information and resources. More information can be found at paruralhealth.org.

Primary Care Access Helped Reduce Risk of COVID-19 Infection, Death

Counties with greater primary care access, more robust public health and fewer social vulnerabilities had fewer COVID-19 infections and deaths, according to a report from the Primary Care Collaborative (PCC) and Robert Graham Center. “As we emerge from the current pandemic and re-imagine and rebuild primary care, we also need to look at other factors, such as investment in public health and community-based services,” PCC President and CEO Ann Greiner said in a statement. “It is beyond time for us all to reach beyond our silos and join forces to address the widening health inequities that the pandemic laid bare.”

CMS Issues Behavioral Health Telehealth Rule

The Centers for Medicare and Medicaid Services (CMS) issued a final rule that it says promotes wider use of telehealth in behavioral health. The CMS final rule on the Physician Fee Schedule for Medicare payments for calendar year 2022 eliminates restrictions on where patients can be when they seek mental health care via telehealth. Under the new final rule:

  • Medicare would allow for mental health telehealth visits to originate from within a patient’s home.
  • Geographic restrictions for mental health services offered via telehealth are eliminated.
  • Providers can do audio-only communications to diagnose and treat mental health disorders with established patients in their homes under certain circumstances—i.e., circumstances where a mental health provider could do a two-way video chat but the patient cannot use or refuses to consent to use the video chat system.
  • Providers are required to note that they were able to do an audio-only call but the patient wasn’t able to or didn’t want to use a video call.
  • The fact that mental health services include treatment for substance use disorder is clarified.
  • Medicare is permitted to pay rural health clinics (RHCs) and federally qualified health centers (FQHCs) for mental health services furnished via telehealth regardless of the public health emergency.
  • Similar rules about having patients come to an in-person appointment at least every 12 months apply to RHCs and FQHCs as well.

Pennsylvania Governor’s Administration Highlights Need to Expand Harm Reduction Services

Members of Pennsylvania Governor Wolf’s Administration joined the Pennsylvania Harm Reduction Network (PAHRN), members of the General Assembly and other advocates and stakeholders in support of expanding access to life-saving harm reduction services for individuals struggling with a substance use disorder (SUD). Two bills that focus on harm reduction were discussed: Senate Bill 926, sponsored by Senators Pat Browne and Anthony Williams, and a forthcoming House Bill from Representatives Jim Struzzi and Ed Gainey that would legalize syringe services programs in Pennsylvania. “Syringe Services programs are a valuable tool in assisting people to enter treatment as well as helping to reduce HIV and HCV,” said Sen. Browne. “In addition, expanding these programs in Pennsylvania will save the commonwealth millions of dollars annually and reduce the burden on our health care system.” House Bill 1393, sponsored by Rep. Struzzi, and Senate Bill 845, sponsored by Sen. Tim Kearney, would legalize fentanyl test strips for personal use. “The rapid proliferation of fentanyl has been killing thousands of Pennsylvanians and destroying our families for years, and legalizing fentanyl test strips is a common sense change we can make to save lives,” said Sen. Kearney. “People cannot recover from addiction if they are dead – it’s time to get with the evidence and fight smart against addiction.”

To read the full article click here.

Pennsylvania Partnerships for Children Releases 2021 State of Children’s Health Care Report

More than 2 in 5 children in PA now rely on publicly funded or supported health insurance

Pennsylvania Partnerships for Children (PPC), the only statewide advocacy organization with a public policy agenda that spans a child’s life prenatally through adulthood, released its 2021 State of Children’s Health Care in Pennsylvania: Health Insurance During the COVID-19 Pandemic. Due to the unique circumstances of the COVID-19 pandemic and the limited data available as a result, this year’s report takes a different approach by using alternate data sources.

The report highlights steps to connect Pennsylvania children to health insurance better and reduce known racial disparities that will continue to deepen if not directly addressed.

“We found that families have weathered the pandemic storm under the umbrella of public health coverage because enrollment increased in the last year,” said Kari King, President and CEO of Pennsylvania Partnerships for Children.

Together, Medicaid, the Children’s Health Insurance Program, and Pennie™, the state-based marketplace, account for 45.9% of children covered in Pennsylvania. Statewide, Medicaid and CHIP have enrolled 10% more children since the beginning of the pandemic, and every county has seen an increase.

King said a key factor affecting the increase is the disenrollment freeze implemented in the Families First Coronavirus Response Act in March of 2020, which will be in place for as long as the federal public health emergency (PHE) is in effect.

However, an estimated 500,000 individuals stand to lose coverage once the PHE expires and routine Medicaid operations resume if Pennsylvania does not carefully plan.

“Threats to safety net programs existed before the pandemic,” said King. “We cannot understate the importance of ensuring that every eligible child and pregnant or postpartum individual does not unnecessarily lose coverage.

“Keeping eligible people connected to Medicaid once the public health emergency ends is avoidable,” she continued. “In partnership with other Pennsylvania health advocates, we offer best practices to assist DHS, the state’s Medicaid agency, in its planning efforts for the enormous task ahead, some of which can start now, before the PHE ends.”

Those recommendations include ensuring those with existing coverage stay connected without unnecessary gaps in coverage through auto-renewal strategies, updating current mailing addresses and more extended time frames for continuous coverage.

In addition, data shows disproportional impacts of the pandemic by race and ethnicity on Pennsylvania households with children, causing economic hardship, food insufficiency and delayed medical care. Larger percentages of children of color enrolled in Medicaid during the pandemic than their White counterparts, which would appear consistent with existing health disparities that have become exacerbated over the past nearly two years.

“We acknowledge that we do not have all of the pieces of the puzzle. What we do know is that these disparities will continue to deepen if not directly addressed. Using data disaggregated by race and ethnicity coupled with feedback from impacted communities can help achieve equitable outcomes,” said King.

The report also covers the impact of the pandemic on routine immunizations that protect from 17 childhood diseases. Overall, Pennsylvania had a 5% decline in vaccination coverage. The early part of 2021 shows vaccination gaps continued among children, particularly preschool and young school-age children ages 4-10. Ensuring kids are up to date on routine immunizations is necessary for community health and helps keep them healthy enough to stay in school.

Health Care in Rural America: A Focus on Dental Care

The report, Health Care in Rural America: A Focus on Dental Care, presents findings from a survey of rural adults age 40 and over, conducted from November 20 to December 18, 2020.  The report addresses challenges rural populations face in maintaining oral health and consistently accessing oral health providers, difficulties paying dental bills, and delays in seeking care. Data on dental visits by health status, income, insurance coverage, and reasons for delaying or forgoing care are presented.

Additional links: Annotated Questionnaire

Sponsoring organization: AARP

COVID-19 Health Care Staff Vaccination IFC-6: Presentation Slides and Video

Thank you for your interest in in the COVID-19 Omnibus Vaccine Rule (IFC-6). The recent stakeholder call had a limit of 10,000 participants and we exceeded that number. Please accept our apologies.

CMS has posted the presentation slides and a recording of the stakeholder call for your convenience.

To view the slides, visit: https://www.cms.gov/files/document/covid-19-health-care-staff-vaccination-ifc-6-national-stakeholder-call-slides.pdf

To view the video, visit: https://www.youtube.com/watch?v=xHA0zY1aC-Y

In addition to the resources above, CMS has prepared a frequently asked questions document, available here: https://www.cms.gov/files/document/cms-omnibus-staff-vax-requirements-2021.pdf