Pennsylvania Office of Rural Health (PORH)
Enhancing the Health Status of Rural Pennsylvanians
The Pennsylvania Office of Rural Health (PORH) works with local state and federal partners to achieve equity in, and access to, quality health care for Pennsylvania's rural residents. We strive to be the premier rural health leadership organization in the state and one of the most effective State Offices of Rural Health in the nation.
Pennsylvania Gov. Tom Corbett proclaims November 17-21 Rural Health Week
FOR IMMEDIATE RELEASE (University Park, Pa.) In an effort to draw attention to the wide-range of issues impacting rural health, Pennsylvania Gov. Tom Corbett has declared Nov. 17-21 Pennsylvania Rural Health week at the request of the Pennsylvania Office of Rural Health (PORH).
Read the press release for important information about Rural Health Week.
PORH Announces Fall 2014 Magazine
We are pleased to present our Fall 2014 Magazine for your review.
For Information Contact:
Lisa Davis Director and Outreach Associate Professor of Health Policy and Administration Pennsylvania Office of Rural Health 202 Beecher-Dock House University Park, PA 16802
Characteristics, Utilization Patterns, and Expenditures of Rural Dual Eligible Medicare Beneficiaries
Dual eligible beneficiaries are known to have a higher disease burden: a higher proportion of dual eligible beneficiaries are disabled, have three or more chronic conditions, report being in fair or poor health or report difficulties with activities of daily living. As a result, Medicare per capita expenditures for dual eligible beneficiaries are nearly double those for other Medicare beneficiaries. The Affordable Care Act (ACA) includes several provisions aimed at improving care and reducing costs of care for dual eligible beneficiaries, including the creation of the Federal Coordinated Health Care Office (FCHCO) and the Center for Medicare and Medicaid Innovation. Located within the Centers for Medicare and Medicaid Services, the FCHCO is tasked with monitoring and improving benefit coordination, expenditures, access, and outcomes of dual eligible beneficiaries. The Center for Medicare and Medicaid Innovation is charged with examining alternative models of care delivery, such as integration of services and joint financing models.
Given the pressing need to improve care while simultaneously reducing costs for dual eligible beneficiaries, it is important to ascertain how rural dual eligible beneficiaries may differ from their urban peers, and to examine potential differences associated with race/ethnicity and region of residence. We used a 5 percent sample of Medicare fee for service beneficiaries for 2009 to examine three related questions about the dual eligible population:
- What was the 2009 distribution of dual eligible beneficiaries by rurality, race/ethnicity, and region?
- What was the aggregate and median per capita Medicare spending for dual eligible beneficiaries, and did either differ by rurality, race/ethnicity, or region?
- What were the characteristics of “high cost” (upper tenth percentile in Medicare expenditures) dual eligible beneficiaries, by rurality, race/ethnicity, or region?
- The 2014 Update of the Rural-Urban Chartbook
- Rural-Urban Disparities in Heart Disease: Policy Brief #1
In 2001, the Centers for Disease Control and Prevention (CDC) published Health, United States, 2001 With Urban and Rural Health Chartbook. The CDC Chartbook was widely used in directing rural health policy and programming and had not been updated since 2001. The Rural Health Reform Policy Research Center updated the 2001 report to examine the current trends and disparities in urban and rural health. The analyses were based on the most recent data available (2006-2011) from the National Vital Statistics System, Area Resource File (Health Resources and Services Administration), U.S. Census Bureau, National Health Interview Survey (National Center for Health Statistics), National Hospital Discharge Survey (National Center for Health Statistics), National Survey on Drug Use and Health (Substance Abuse and Mental Health Services Administration), and the Treatment Episode Data Set (Substance Abuse and Mental Health Services Administration). Output included aggregate data stratified by geographic region and urbanization level.
Findings suggest that rural residents fare worse than their urban counterparts on a number of measures, including rates for smoking, death from chronic obstructive pulmonary disease (COPD), and suicide. Overall, residents of rural areas have less access to physicians and dentists. While the nation’s health has generally improved over the past decade, urban/rural disparities in health status and access to care persist across a variety of measures, and have grown for some measures (e.g., COPD).
Rural Health Network Planning Program Funding Announcement
ORHP is pleased to announce the release of the Rural Health Network Development Planning Program (Network Planning). This is a one year community-driven program targeted to assist in the planning and development of an integrated health care network. Health care networks can be an effective strategy to address a broad range of challenges unique to rural communities by bringing together rural providers and other community organizations. For grantees, this funding provides an opportunity to implement new and innovative approaches to adapting to a changing health care environment that may serve as a model to other rural communities to better align and coordinate local health care services. Network planning activities that model evidence-based frameworks or models that work are encouraged. Previously funded projects include topics such as workforce, behavioral health, telehealth, care coordination, health information technology, and outreach and enrollment.
Historically, grantees have mastered the art of leveraging finances by using ORHP grants to catapult their sustained efforts; they have been able to combine federal funds with local and foundation dollars to support the continuation and development of healthcare services in rural areas. The previous cohort of Network Planning grantees secured over $1.1 M in additional funding to assist in sustaining their programs, demonstrating the importance of collaboration with other organizations in the community. Organizations have creatively sustained and expanded their programs to serve a different population and region, and have worked to ensure that the program is aligned with the current healthcare landscape. As ORHP continues to focus on showcasing outcomes, a priority area that has emerged is the identification of rural evidence-based models, and sharing that information more broadly so that communities have an accessible resource when implementing a similar program. This has led to the development of the Rural Community Health Gateway, located on The Rural Assistance Center (RAC):http://www.raconline.org/communityhealth/ and consists of a number of resources, including success program models and evidence-based toolkits, that may be helpful in the development of an Outreach application.
To learn more about applying for the FY15 Rural Health Network Development Planning Program (HRSA-15-036), please visit http://www.grants.gov/web/grants/search-grants.html?keywords=HRSA-15-036 (click on 'application package’ tab at the top to get the Instructions and Application). The deadline to apply is January 9, 2015, and the program contact is Amber Berrian, email@example.com or 301-443-0845.
Rural Implications of the Blueprints for State-Based Health Insurance Marketplaces
Describes features of states’ blueprints to operate state-based insurance marketplaces that have particular relevance to rural areas. Presents different states’ approaches to service areas and rating areas, network adequacy requirements, rural consumer outreach, rural representation on the marketplace governing board, certification and oversight of Qualified Health Plans, and design of the Small Business Health Options Program.
The Effect of Medicare Payment Policy Changes on Rural Primary Care Practice Revenue
This policy brief describes the impact of recent Medicare payment updates to the Geographic Practice Cost Indices (GPCIs) portion of the Medicare Physician Fee Schedule (MPFS) on rural primary care providers’ practice revenue from Medicare. Using rural primary care provider Medicare claims from 2009 linked to the 2013 MPFS relative value units (RVUs), the 2013 GPCIs for non-metropolitan localities, and the GPCI updates from the Pathway for SGR Reform Act of 2013, we developed a revenue model to derive estimates of Medicare-related average revenue in 2013 and change-in-average-revenue percentage due to the GPCI updates for 50 non-metropolitan localities. Holding the conversion factor (CF) and RVUs fixed, we found that changes to the GPCIs made between January 1, 2013 and March 31, 2014 resulted in an average 0.12% (median 0.18%) increase in Medicare-derived revenue to rural primary care practices. Without the GPCI work floor reinstatement, however, primary care practices in rural areas would have been disproportionately negatively impacted through lower Medicare-related revenues.
RUPRI Center for Rural Health Policy Analysis
University of Iowa
College of Public Health
Department of Health Management and Policy
145 Riverside Drive, N200 - CPHB
Iowa City, IA 52242
Phone: (319) 384-3831
Fax: (319) 384-4371
Web site: www.public-health.uiowa.edu/rupri
The Effect of Medicare Payment Policy Changes on Rural Primary Care Practice Revenue
Describes the impact of recent Medicare payment updates to the Geographic Practice Cost Indices (GPCIs) portion of the Medicare Physician Fee Schedule (MPFS) on rural primary care providers’ practice revenue from Medicare. Using rural primary care provider Medicare claims from 2009 linked to the 2013 MPFS relative value units (RVUs), the 2013 GPCIs for non-metropolitan localities, and the GPCI updates from the Pathway for SGR Reform Act of 2013, we developed a revenue model to derive estimates of Medicare-related average revenue in 2013 and change-in-average-revenue percentage due to the GPCI updates for 50 non-metropolitan localities. Holding the conversion factor (CF) and RVUs fixed, we found that changes to the GPCIs made between January 1, 2013 and March 31, 2014 resulted in an average 0.12% (median 0.18%) increase in Medicare-derived revenue to rural primary care practices. Without the GPCI work floor reinstatement, however, primary care practices in rural areas would have been disproportionately negatively impacted through lower Medicare-related revenues.
Home Health Care Agency Availability in Rural Counties
A range of medical services can be provided in the home setting, allowing patients to be discharged from hospital or inpatient rehabilitation settings more quickly. Medicare reimburses for six types of home health care: skilled nursing, physical therapy, occupational therapy, speech pathology, medical social work, and home health aide services. In November 2011, the Centers for Medicare and Medicaid Services modified Medicare reimbursement for home health care, seeking to control costs by reducing inflation-associated adjustments in charges. In the past, changes in reimbursement may have affected rural home health care agencies more adversely than those in urban areas. The purpose of the current report is to describe the status of home health care service delivery in the rural U.S. in 2008, before passage of the Patient Protection and Affordable Care Act and related efforts.
We used Medicare Compare Home Health Agency files for 2008 to examine two aspects of home health care (HHC) across the United States: HHC agency availability and quality of services provided. Home health agencies are required to report the geographic areas they serve by ZIP Code; they are also required to report quality results across a range of 12 outcomes. This report is based on agency reports; we did not independently verify that services were actually provided within all listed areas.
HHS announces auto-enrollment plans for current Marketplace consumers for 2015
Today, the U.S. Department of Health and Human Services (HHS) expects to announce its plans for helping existing Marketplace consumers get auto-enrolled for next year. These plans would give existing consumers a simple way to remain in the same plan next year unless they want to shop for another plan and choose to make changes. Read the press release for more information.
2013 Pennsylvania State Health Assessment Released
The Bureau of Health Planning is pleased to announce the release of the 2013 Pennsylvania State Health Assessment. This comprehensive assessment provides a “one-stop” summary of information on health status, health risks and healthcare services in Pennsylvania. It will support the department’s and our partners’ work in developing priorities and policies, garnering resources and planning actions to improve the population’s health.
Nominations for the 2014 Rural Health Awards open
The Pennsylvania Office of Rural Health is pleased to announce the invitation of nominations for the 2014 Rural Health Awards!
The 2014 Rural Health Awards will be presented in the honoree's community during the week of National Rural Health Day, November 21, 2014. PORH will begin accepting award nominations on June 16. The deadline for submissions is August 29, 2014.
Nominations for the following categories will be accepted:
*State Rural Health Leader of the Year
*Community Rural Health Leader of the Year
*Rural Health Program of the Year
*Legislator of the Year
*Rural Health Hero of the Year
To nominate, pleasefill out the form
Which Medicare Patients Are Transferred from Rural Emergency Departments?
Note: this policy brief is a revised version of one originally released in March 2014.
Analyzes transfers of Medicare beneficiaries who received emergency care in a CAH or rural hospital and were transferred to another hospital for care. Key findings include the following:
- Among Medicare beneficiaries who received same-day emergency care and inpatient care in 2010, the inpatient stay was in a different hospital for 28.4% of the Critical Access Hospital (CAH) emergency encounters, compared to 9.0% for rural non-CAHs, and 2.0% for urban hospitals.
- The majority of transferred CAH and rural non-CAH emergency patients went to urban hospitals for inpatient care. By diagnosis, most transferred patients with intracranial injuries and cardiac-related diagnoses went to urban hospitals, while 35%-45% of patients with certain mental health diagnoses were transferred to other CAHs or rural non-CAHs.
Update: Independently Owned Pharmacy Closures in Rural America, 2003-2013
Pharmacists provide a range of health services and their loss can have serious implications for the provision of health care, especially in rural areas. Previous policy briefs from the RUPRI Center for Rural Health Policy Analysis have documented the decline in the number of independently owned pharmacies in rural area, especially between 2003 and 2010. This update shows that the number of independently owned rural pharmacies has, with some minor fluctuations, continued to slowly decline. In addition, the number of rural retail pharmacies (including independent, chain, or franchise) that were the only pharmacy in the community has remained relatively stable since 2010.
Support for Rural Recruitment and Practice among U.S. Nurse Practitioner Education Programs
Describes nurse practitioner (NP) education programs across the United States to identify those actively promoting NP practice in rural areas; describes their use of education methods that may promote rural practice; and identifies barriers to recruiting rural students and providing rural NP clinical training. Programs reported that relocating or commuting to campus-based programs, limited rural training opportunities, and affordability were barriers for rural students.
CMS initiative helps people make the most of their new health coverage
“From Coverage to Care” outreach to engage doctors and new patients
On June 16, 2014, the Centers for Medicare & Medicaid Services (CMS) launched a national initiative “From Coverage to Care” (C2C), which is designed to help answer questions that people may have about their new health coverage, to help them make the most of their new benefits, including taking full advantage of primary care and preventive services. It also seeks to give health care providers the tools they need to promote patient engagement. For more information, follow this link.
A Guide to Understanding the Variation in Premiums in Rural Health Insurance Marketplaces
Provides a framework for assessing variations in the premiums of plans offered in the Health Insurance Marketplaces (HIMs) across geography. Comparisons of premiums must include adjustments for several factors: plan type (metal level), enrollee age and family status, overall cost of living in the area, and the design of marketplace rating areas (state policy choices). What might appear to be differences showing plans in rural places to be more or less expensive than in urban places could shrink or even reverse after appropriate adjustments.
As federal and state policymakers consider their most cost-effective options for strengthening rural long-term services and supports (LTSS), more information is needed about the current system of care. Using data from the 2010 National Survey of Residential Care Facilities, this chartbook presents information on a slice of the rural LTSS continuum—the rural residential care facility (RCF). Survey results identify important national and regional differences between rural and urban RCFs, focusing on the facility, resident and service characteristics of RCFs and their ability to meet the LTSS needs of residents. Rural RCFs are more likely to have private pay patients compared to urban facilities and their residents have fewer disabilities as measured by their functional assistance needs. Compared to urban facilities, the policies of rural RCFs appear less likely to support aging-in-place.Contact Information:
Implications of Rurality and Psychiatric Status for Diabetic Preventive Care Use among Adults with Diabetes
Examines patterns of diabetic preventive care use among adults with diabetes to determine whether these patterns varied according to respondents’ rural/urban residence or psychiatric status (i.e. the presence/absence of a mental health diagnosis).
Key findings include:
- Rural residents with diabetes are generally less likely than their urban peers to use diabetic preventive services.
- Rural residents with diabetes and mental health diagnoses used some preventive services at about the same rates as urban people with diabetes, and at higher rates than rural diabetics without mental health diagnoses.
- Although rural residents with diabetes and mental health diagnoses used preventive care about as often as other groups studied, they had more diabetes complications than their rural peers without mental health diagnoses.
Jean Talbot, PhD, MPH
Maine Rural Health Research Center
Health Insurance Coverage of Low-Income Rural Children Increases and is More Continuous Following CHIP Implementation
Prior to the passage of the Children’s Health Insurance Program (CHIP), about one in four low-income rural and urban children (family income below 200% of the federal poverty level) were uninsured in a given month. Using data from the Medical Expenditure Panel Survey, this study found that in the years following CHIP’s implementation health insurance coverage and continuity increased among low-income children—particularly for those living in rural areas. By CHIP’s maturity, coverage for rural children improved so much that their uninsured rate dropped below that of urban children (14% compared to 20%, respectively).
Among those with health insurance, rural children were more likely than their urban counterparts to lose coverage pre-CHIP, and were less likely to lose it after CHIP was in place for five or more years. Whether low-income rural adults will see similar gains in coverage continuity under the Affordable Care Act may depend on whether states choose to participate in Medicaid expansions and what outreach strategies they use to enroll rural populations.
High Deductible Health Insurance Plans in Rural Areas
Enrollment in high deductible health plans (HDHPs) has increased amid concerns about growing health care costs to patients, employers, and insurers. Prior research indicates that rural individuals are more likely than their urban counterparts to face high out-of-pocket health care costs relative to income, despite coverage through private health insurance, a difference related both to the lower income of rural residents generally and to the quality of the private plans through which they have coverage. Using the 2007-2010 National Health Interview Survey, this study examines rural residents’ enrollment in HDHPs and the implications for evolving Affordable Care Act Health Insurance Marketplaces.
Rural residents with private insurance are more likely to have an HDHP than are urban, especially when they live in remote, rural areas. Among those covered by an HDHP, rural residents are more likely to have low incomes and more limited educational attainment than urban residents, suggesting that it will be important to monitor HDHP enrollment, plan affordability, and health plan literacy among plans available through the Health Insurance Marketplaces.
Nationwide Insurance creates professorship in College of Ag Sciences
UNIVERSITY PARK, Pa. -- Nationwide Insurance has given Penn State a $1 million gift to create and endow the Nationwide Insurance Professorship in the College of Agricultural Sciences. The gift was announced during an April 25 visit by Nationwide representatives to the University Park campus. Read more
Integrated Care Management in Rural Communities
With a focus on community-dwelling older adults in need of integrated physical, behavioral health services, and long term services and supports (LTSS), the authors of this study review the opportunities and challenges reform initiatives under the Affordable Care Act present for rural communities. We assessed four types of organizational models for delivering integrated care management. Each of these models has different strengths and drawbacks, weighing for and against implementation in rural areas.
- Introducing an integrated care model in a rural community requires an investment in building relationships with local providers and adapting to local culture and services.
- Integrated care models that cannot adapt to the local delivery system are more likely to face resistance from local providers and those they serve and potentially duplicate or displace existing rural capacity.
- Most models of integrated care management have an inherent bias toward larger organizations and infrastructure. Most are built on an investment in health information technology and other systems and capacities.
- The potential success of any integrated care model is limited by gaps in the continuum of health care services and long term services and supports available in a rural community.
- “Wraparound” integrated care models can fill gaps in existing care coordination capacity, offering a flexible approach that can adapt to a local rural delivery system.
- An investment of public resources in shared supports can lower the cost of integrating care in rural delivery systems.
Eileen Griffin, JD
Maine Rural Health Research Center
Pennsylvania Dept of Health Releases Cancer Control Plan
On April 28, the Division of Cancer Prevention and Control in the Pennsylvania Department of Health officially released the new 2013-2018 Pennsylvania Cancer Control Plan (Plan), following a formal presentation to the House of Representatives' Cancer Caucus. The Plan was developed by the Stakeholder Leadership Team cancer coalition and focuses on promoting good health and supporting healthy behavior and choices through broad-reaching PSE approaches to prevent and reduce the burden of cancer. Interested parties can now view the Plan on www.LiveHealthyPA.com and report their implementation strategies. Phase One of the LiveHealthyPA.com site is active for Plan review and reporting purposes only.
Paper Released - Extent of Telehealth Use in Rural and Urban Hospitals
Using the 2013 HIMSS Analytics database, we analyze the extent of use of telehealth (aka telemedicine) and find that 34.0% of rural hospitals and 32.0% of urban hospitals had at least one telehealth application currently in use. Rural and urban hospitals did not differ significantly in overall telehealth implementation rates, however rural and urban hospitals did differ in the department where telehealth was implemented. In particular, rural hospitals were more likely than urban hospitals to have implemented telehealth in radiology departments and in emergency/trauma care. In contrast, urban hospitals were more likely than rural hospitals to have implemented telehealth in cardiology/stroke/heart attack programs, neurology, and obstetrics/gynecology/NICU/pediatrics. Follow-up research will verify the differences in types of telehealth implemented and investigate the low reported utilization rates, which may result from confusion of survey respondents about what constitutes telehealth.