How Could Nurse Practitioners and Physician Assistants Be Deployed to Provide Rural Primary Care?

New (2014) rural enrollees in the insurance plans available on federal and state exchanges—platinum, gold, silver, bronze and catastrophic plans—are expected to generate about 1.39 million primary care visits per year. At a national level, it would require 345 full-time equivalent (FTE) physicians to provide those visits to new rural enrollees. This study uses data on rural insurance uptake, expected utilization and productivity of physicians, physician assistants (PAs), and nurse practitioners (NPs) to examine how different mixes of physicians, PAs and NPs might be able meet expanding population requirements for care. There is substantial regional variation in the need for providers to meet the needs of new enrollees, with high levels of need found in East North Central, West North Central and South Atlantic Census divisions.

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Quality Measures and Sociodemographic Risk Factors: The Rural Context

Researchers and policymakers have publicly discussed and debated whether or not to adjust provider quality measures for differences in patient characteristics. Lacking in this discussion, however, is a nuanced understanding of how adjustment should be conducted within a rural context and what impact it might have on patients and providers when quality measures are used for benchmarking and payment.

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Graduates of Rural-Centric Family Medicine Residencies: Determinants of Rural and Urban Practice

The researchers surveyed graduates of family medicine residencies with a mission to produce rural physicians to understand physician characteristics, experiences, and attitudes that affected their practice location choices. Influential factors included partner or spouse characteristics, residency experiences, and practice community amenities. Some physicians are clearly self-selected into rural practice, but much needs to be done, particularly during and after residency training, to sustain their interests and to encourage other physicians to embark on rural careers.

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Aligning Forces for Quality Initiative: Summative Findings and Lessons Learned from Efforts to Improve Healthcare Quality at the Community Level

The volume features three guest commentaries and eight original research reports by the Aligning Forces for Quality (AF4Q) evaluation team. Collectively, the evaluation reports present the summative findings and lessons learned from the 10-year evaluation AF4Q. Specifically, the articles provide in-depth information on AF4Q’s research design; background and evolution; interventions in the main programmatic areas of the initiative; AF4Q’s longitudinal impact on measures of population health, quality and experience of care, and cost of care; and the AF4Q alliances’ challenges to sustainability.

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Supply and Distribution of the Behavioral Health Workforce in Rural America

There are large differences in the supply of behavioral health providers available to treat rural residents when compared to their urban counterparts. Nationally, the provider to population ratio of psychiatrists and psychologists in Non-Metro counties is less than half the ratio than in Metropolitan counties. Additionally the supply of social workers, psychiatric nurse practitioners and counselors in rural counties is much lower than urban counties. Non-Core counties have the lowest provider to population ratios for all of the five provider types studied. Seventeen percent of all non-core counties lack any of the behavioral health providers studied.

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Trends in Risk of Financial Distress among Rural Hospitals

From January 2005 to July 2016, 118 rural hospitals have closed permanently, not including seven others that closed and subsequently reopened. The number of closures has increased each year since 2010, and in the first half of 2016, the closure rate surpassed two closures per month. Hospital closures impact millions of rural residents in communities that are typically older, more dependent on public insurance programs, and in worse health than residents in urban communities. Identifying hospitals at high risk of closure and assessing the trends over time may inform strategies to prevent or mitigate the effects of closures.

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Data about Appalachia at Your Fingertips

Every year, the Appalachian Regional Commission (ARC) uses an index-based county economic classification system to identify and monitor each county in our Region to illustrate which counties are considered economically distressed, at-risk, transitional, competitive, or have reached “attainment.” This involves creating a national index of county economic status by comparing each county’s averages for unemployment, per capita market income, and poverty rate with national averages. With this data, they create a map illustrating the economic status of each of the 420 counties that helps their state partners develop effective grant proposals. Now, they have made the data behind the map even more accessible with their redesigned Data Reports page. With this resource, researchers and other data lovers can easily search each Appalachian county’s economic status dating back 15 years or look at the poverty, education, income, population density, and other statistics at the county level in comparison to the rest of the state and the rest of the country. And they have also made a simple way to see how some of these key economic indicators have historically played out across the Region. This statistical treasure trove is the most comprehensive collection of data about Appalachia available.

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The Impact of the Low Volume Hospital (LVH) Program on the Viability of Small, Rural Hospitals

Intro: The purpose of this research was to investigate the financial experience of LVHs in comparison to other rural hospitals.

Methods: Descriptive and bivariate statistics (non-parametric equality of medians, Wilcoxon rank-sum, t-test and chi-square) were used to identify rural LVHs, compare rural LVH characteristics to those of rural non-LVHs, and to simulate the potential profitability consequences of changes to the LVH program.

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The Financial Importance of the Sole Community Hospital Payment Designation

The purpose of this study was to assess the financial importance of the Sole Community Hospital (SCH) program by investigating: 1) the proportion of SCHs that was reimbursed at the hospital specific rate between 2006 and 2015; 2) the profitability of providing services to Medicare patients in SCHs between 2006 and 2015, and; 3) the financial consequences if the SCH program had not existed in 2015.

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Comparing the Community Benefit Spending of Critical Access, Other Rural, and Urban Hospitals

The ACA increased focus on the safety net role of tax-exempt hospitals, specifically on their charity care and other community benefit policies and activities, by amending portions of the IRS tax code which clarified and expanded hospital charity care obligations and community benefit reporting requirements. This policy brief examines variations in the types and levels of hospital charity care, other community benefit spending, and community-building activities across Critical Access (CAH), other rural, and urban hospitals.

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