Rural Health Research – A Comparison of 2017 – 2019 Uncompensated Care of Rural and Urban Hospitals by Net Patient Revenue, System Affiliation and Ownership

February 2, 2024

Rural Health Research – A Comparison of 2017 – 2019 Uncompensated Care of Rural and Urban  Hospitals by Net Patient Revenue, System Affiliation and Ownership

Researchers at the North Carolina Rural Health Research and Policy Analysis Center use 2017 – 2019 Medicare Cost Report data to study the association of uncompensated care with:

  • Net patient revenue
  • System affiliation
  • Ownership among Critical Access Hospitals
  • Rural Prospective Payment System (PPS) hospitals
  • Urban PPS hospitals

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Research Study at Washington University Seeks Participants for an Interview!

June 21, 2023

Research Study at Washington University Seeks Participants for an Interview!

A research study at Washington University seeks participants for an interview. The purpose of the study is to learn what pharmacy customers think about distributing kits at their pharmacy that can find colon cancer.

Participants will take part in a 1-hour interview over Zoom.

Do I Qualify:

A person might qualify if they:

  • Are 44 to 85 years old
  • Haven’t had colon cancer (& no family history)
  • Live in a rural Missouri county
  • Have been a customer at their local pharmacy

Participants will be offered a gift card for their time.

Sign up at: https://redcap.link/fit4pharmacy

Email: Sienna.ruiz@wustl.edu

Call: (314) 286-2837

CMS Announces Plan to Ensure Availability of New Alzheimer’s Drugs

June 2, 2023

CMS Announces Plan to Ensure Availability of New Alzheimer’s Drugs

Yesterday, the Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure announced how people can get drugs that may slow the progression of Alzheimer’s disease covered by Medicare. If the Food and Drug Administration (FDA) grants traditional approval, then Medicare will cover it in appropriate settings that also support the collection of real-world information to study the usefulness of these drugs for people with Medicare.

“Alzheimer’s disease takes a toll on not just the people suffering from the disease but also on their loved ones and caregivers in a way that almost no other illness does. CMS has always been committed to helping people obtain timely access to innovative treatments that meaningfully improve care and outcomes for this disease,” Brooks-LaSure said. “If the FDA grants traditional approval CMS is prepared to ensure anyone with Medicare Part B who meets the criteria is covered. I’m pleased to make this announcement today as part of CMS’ mission to help improve the lives of Americans we serve. I hope we see more private sector partners in this work making their own announcements soon.”

The FDA’s Peripheral and Central Nervous System Drugs Advisory Committee will discuss the results of a confirmatory trial of the Eisai product Leqembi on June 9, with a potential decision on traditional approval possible within weeks. Broader Medicare coverage would begin on the same day the FDA grants traditional approval. Under CMS’ current coverage policy, if FDA grants traditional approval to other drugs in this class they would also be eligible for broader coverage. Currently two drugs in this class have received accelerated approval from the FDA, but no product has received traditional approval.

Medicare will cover drugs with traditional FDA approval when a physician and clinical team participates in the collection of evidence about how these drugs work in the real world, also known as a registry. Clinicians will be able to submit this evidence through a nationwide, CMS facilitated portal that will be available when any product gains traditional approval and will collect information via an easy-to-use format. This method, and any others that may follow, will adhere to robust privacy protections in accordance with applicable federal laws and regulations, including HIPAA. Researchers will have access to the information to conduct studies, furthering knowledge of how these drugs can potentially help people. CMS is working with multiple organizations that are getting ready to open their own registries. More information will be released as they come on line.

The approach is consistent with CMS’ National Coverage Determination. To get Medicare coverage people will need to:

  • be enrolled in Medicare Part B
  • be diagnosed with mild cognitive impairment or early dementia caused by Alzheimer’s disease
  • have a qualified physician participating in a registry, including the options above, with an appropriate clinical team and follow up care. These criteria are in addition to any label requirements the FDA specifies.

Registries are common tools in clinical settings that have successfully gathered information on patient outcomes for decades. There is strong precedent for using registries to gather more information on a newly-approved treatment. For example, when the FDA granted traditional approval to the transcatheter aortic valve replacement (TAVR), CMS required the clinicians and hospitals to participate in a registry to track outcomes. Information gathered from that registry has since been used to further inform Medicare coverage determinations, and to help people and their clinicians make better decisions about whether TAVR is the best treatment for them.

Other registries for drugs that may slow the progression of Alzheimer’s disease may become available in the coming weeks and months.

Information will be available at https://www.cms.gov/Medicare/Coverage/Coverage-with-Evidence-Development as studies come on line.

Social Determinants of Health Screening Moves Beyond Pilot Program for VCU Health System

June 1, 2023

Social Determinants of Health Screening Moves Beyond Pilot Program for VCU Health System

VCU Health System (VCUHS) systematically screened patients for health-related social needs to identify and address factors outside of the clinical setting that impact patients’ health. Screening for social determinants of health (SDOH) is still relatively new for many health care providers but VCUHS committed to this practice at the beginning of a pilot model and continued the work beyond the trial end date.

VCUHS used the Accountable Health Communities Health-Related Social Needs Screening Tool as part of its program that focused on Richmond-area (Virginia) Medicaid and Medicare beneficiaries for five core needs: food, housing, utilities, transportation and safety. It became one part of several programs VCUHS is currently implementing to address their patients’ needs to address inequities in health outcomes.

Click HERE to read more.

Chartis Study Shows More Rural Hospitals Slash Services

February 17, 2023

Chartis Study Shows More Rural Hospitals Slash Services

The Chartis Group released a study at NRHA’s Rural Health Policy Institute last week that found nearly 51 percent of rural hospitals have a negative operating margin and indicates the number of facilities eliminating services like obstetrics increased in 2022.

Experts say the REH designation could offer a lifeline, especially as pandemic relief dollars are tapped out and patient volumes fail to return to pre-pandemic levels, according to NRHA COO Brock Slabach. Around 500 rural health stakeholders traveled to Washington, D.C., for NRHA’s Rural Health Policy Institute to advocate in person for solutions to these and other pressing challenges. Check out all videos, data, advocacy materials, and other documents under the Agenda tab of the event page, as well as NRHA’s fighting for rural page and the conference app.

View Brief

Call for Applications: National Research Study on Incorporating Play in Pediatric Care

February 14, 2023

Call for Applications: National Research Study on Incorporating Play in Pediatric Care

The Weitzman Institute is excited to announce an opportunity to engage in a national research study focused on embedding a learning through play intervention into pediatric care.

Prescription for Play is a program delivered by medical providers during routine well-child visits for patients 18-36 months.  The program promotes learning through play by supplying free LEGO®️ DUPLO® brick kits and educational materials to pediatric providers to use as prompts to engage caregivers around the benefits of play in early child development.  We are recruiting organizations now to participate in a 6-month feasibility study!

Benefits of Participation in the Study:

  • Enhance the quality of your 18-36 month well-child visits by educating caregivers on the value of play in early childhood
  • Receive LEGO®️ DUPLO®️ bricks for your patients
  • Opportunities to collaborate on publications or presentations on the findings of the study
  • Receive a financial stipend of up to $50,000 for your organization

Interested in applying? Complete the short application below by February 24, 2023.

Apply Now

The above program information is being forwarded by the Office of Rural Health and Primary Care (ORHPC) as a service of this office. ORHPC does not endorse or recommend any vendor or service. Please review for the appropriate use within your organization.

Data on aging, maternal health, mental health, travel burden

November 4, 2022

Data on aging, maternal health, mental health, travel burden

Rural Health Research Gateway recently compiled research coauthored by multiple NRHA members related to aging in place, race and rurality regarding maternal health disparities, rural mental health, and the travel burden to receive care. Additionally, a recording is available of a recent EMSC Innovation and Improvement Center webinar on optimizing clinical care processes for children and adolescents presenting to the ED with acute suicidality through quality improvement collaboratives. Teams can enroll through Jan. 13. Advocate for the mental health needs of your rural community by joining NRHA and hundreds of rural health stakeholders Feb. 7-9 at NRHA’s 34th Rural Health Policy Institute.

Update on Rural Independently Owned Pharmacy Closures in the United States, 2003-2021

Date: September 1, 2022

Update on Rural Independently Owned Pharmacy Closures in the United States, 2003-2021

Nearly half of rural pharmacies are independently owned retail stores and are susceptible to closing due to financial hardship. This policy brief builds on the history of Rural Policy Research Institute projects examining the provision of pharmacy services and updates pharmacy closure in rural areas of the United States. Monthly data on all institutions providing pharmacy services in the 50 states and District of Columbia were obtained from the National Council for Prescription Drug Programs.

Key Findings:

  • Between 2003 and 2021, the number of retail pharmacies declined in noncore rural areas by 9.8 percent, and in rural micropolitan areas by 4.4 percent, while the number in metropolitan areas increased by 15.1 percent during the same period.
  • Between 2003 and 2021, the number of independently owned retail pharmacies declined in noncore areas by 16.1 percent, and in micropolitan areas by 9.1 percent, while the number in metropolitan areas increased by 28.2 percent during the same period.
  • Between 2003 and 2021, the number of chain pharmacies grew in all three geographies, with the largest growth occurring in metropolitan areas (noncore: 4.6 percent, micropolitan: 3.7 percent, metropolitan: 10.5 percent).
  • Franchise pharmacies have never represented a large segment of the market (1.1 percent of all retail pharmacies in 2021), but their number declined dramatically in all three geographies from 2003 to 2021.

Contact Information:

Keith J. Mueller, PhD
RUPRI Center for Rural Health Policy Analysis
Phone: 319.384.3832
keith-mueller@uiowa.edu

Additional Resources of Interest:

Availability of Home Health, Hospice, and Pharmacy Services in Minoritized Racial/Ethnic Group Areas

Date: August 25, 2022

Availability of Home Health, Hospice, and Pharmacy Services in Minoritized Racial/Ethnic Group Areas

This series of briefs documents disparities in geographic access to health services for ZIP code tabulation areas (ZCTAs) containing a high proportion of minoritized racial/ethnic group (MRG) residents.

Availability of Home Health Services in Minoritized Racial/Ethnic Group Areas

  • In the U.S., home health agency reporting services are not available in 5.9% of all ZCTAs and an additional 10.3% of ZCTAs receive services from a single agency.
  • In 2020, 10.3% of all rural ZCTAs and 2.2% of all urban ZCTAs lacked home health service access. As a ZCTA becomes more rural and remote, these communities are more likely to lack any home health care or have limited service.
  • Within rural ZCTAs in the top 5th percent for minoritized population group representation, non-Hispanic Black representation was less likely to lack all home health services and non-Hispanic American Indian/Alaska Native representation was more likely to lack all home health services when compared to “all other” rural ZCTAs.

Availability of Medicare-Certified Hospice Services in Minoritized Racial/Ethnic Group Areas

  • Centers for Medicare & Medicaid Services-certified hospice providing services are not available in 5.6% of ZCTAs and 14.2% are served by a single hospice.
  • In 2020, 2.4% of all urban ZCTAs had no service while 9.4% of all rural ZCTAs had no service.
  • Within rural ZCTAs in the top 5th percent for minoritized population group representation, American Indian/Alaska Native (32.6%), Asian American/Pacific Islander (12.9%), non-Hispanic white (24.7%), and multiple MRG groups (23.1%) were each more likely than “all other” rural ZCTAs to lack any hospice service (4.5%).

Availability of Pharmacies in Minoritized Racial/Ethnic Areas

  • The mean density of pharmacies across rural ZCTAs was 1.2 pharmacies per 10,000 persons. The mean density of pharmacies across urban ZCTAs was 1.7 pharmacies per 10,000 persons.
  • The lowest density of pharmacies across rural-urban MRG designation was found in rural Hispanic ZCTAs.

Contact Information:

Janice C. Probst, PhD
Rural and Minority Health Research Center
Phone: 803.251.6317
jprobst@mailbox.sc.edu

Additional Resources of Interest:

More information from the Rural Health Information Hub’s topic guides: Healthcare Access in Rural Communities, Rural Home Health Services, Rural Hospice and Palliative Care, Rural Pharmacy and Prescription Drugs

Rural and Urban Pharmacy Presence – Pharmacy Deserts

Date: August 22, 2022

Rural and Urban Pharmacy Presence – Pharmacy Deserts

The purpose of this brief is to examine the availability of community pharmacies and their provided services in rural areas of the U.S. The brief also provides a deeper analysis of counties with no retail pharmacies (i.e., pharmacy deserts) based on metropolitan/nonmetropolitan locations.

In 2021, there were 138 counties with no retail pharmacy, including 101 noncore, 15 micropolitan, and 22 metropolitan counties. By most measures, the proportion of the population considered vulnerable, including nonwhite, uninsured, unemployed, and income below the federal poverty level, is higher in noncore counties with no retail pharmacies than in other counties with no retail pharmacies. Further, the percent of population aged 65 and older and the percent aged 85 and older are higher in noncore and micropolitan counties with no pharmacy than in metropolitan counties.

Despite the possibility of using telepharmacy to improve access to health services in medically underserved regions, only around half of U.S. states have passed legislation authorizing telepharmacy.

Contact Information:

Keith J. Mueller, PhD
RUPRI Center for Rural Health Policy Analysis
Phone: 319.384.3832
keith-mueller@uiowa.edu

Additional Resources of Interest: